Inspection on 20/11/06 for East Cosham House

This inspection was carried out on 20th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

East Cosham House 11/11/08

East Cosham House 13/06/06

East Cosham House 17/10/05

East Cosham House 25/04/05

East Cosham House 11/10/04

East Cosham House 11/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE East Cosham House 91 Havant Road East Cosham Portsmouth Hampshire PO6 2JD Lead Inspector Clare Hall Unannounced Inspection 20th November 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service East Cosham House Address 91 Havant Road East Cosham Portsmouth Hampshire PO6 2JD 023 9232 1805 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs P Drabble Mr G Drabble Mrs Kim Ina Shelton Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (24), Old age, not falling within any other category (24) East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th June 2006 Brief Description of the Service: East Cosham House is registered with the Commission for Social Care (CSCI) to accommodate up to 24 residents who are over 65 and have an age related mental health need. The home is a large detached property and is situated up a short drive; it is just off the main road through East Cosham and provides easy access to the town centre. The home has two gardens, one that is enclosed to the rear of the premises, with seating areas for residents. There are 18 single and 3 double bedrooms. The home has three communal lounges and a dining room, which are all pleasantly furnished and decorated providing a valuing environment for the people living there. There is parking for up to 6 vehicles. The fees range between £363 and £485 weekly. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook a visit to the premises and spoke with service users, the provider, deputy manager, care and ancillary staff. A brief tour of the premises was under taken as a full tour had been undertaken some six months previously. One service user consented to show the inspector through the home and accompany her to view the access to bathrooms, bedrooms and talked at length about the home. The inspector has in this preceding twelve months managed to speak with five relatives. Comment cards provided to service users, relatives, visiting health and social care professionals have all provided feedback regarding the services provided. This information has also been used to inform the report and the judgements made. Staff were also observed throughout the day assisting and supporting clients and their practices observed for good practice. Service users were observed making use of shared facilities, taking breakfast and lunch. Case tracking was undertaken as part of the evidence gathering process, with the involvement of service users. All contact with the home, events, Regulation 37 Notifications and Regulation 26 reports has been considered with the evidence collated throughout this visit to inform this report. What the service does well: This is the second visit to the premises in a six-month period due to concerns raised. Great efforts have been made to address the concerns and the over all rating of this home has improved. There are no concerns in respect of promoting core values and there are also some good practices in relation to supporting individuals with their social preferences. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 6 The provider and deputy manager has ensured the service users live in a wellmaintained environment. The Provider in the absence of the registered manager has been supporting and supervising staff appropriately. What has improved since the last inspection? Since the last visit the provider and the deputy manager have taken considerable steps to address shortfalls. There has been investment in new equipment and furnishings. A review of infection control practices has been undertaken in consultation with the public health nurse and in line with the new infection control guidance by the Department of Health. A review of poor practice regarding infection control has been addressed. Service users’ records have been audited. Terms and conditions regarding their stay reviewed and agreements such as the room to be occupied clearly indicated. The management processes have been audited and improved. Some management procedures have been improved through incorporating audit tools. Care records have been reviewed. These are now addressing behaviours which challenge, manual handling and nutrition. They have started to address issues relating to the promotion of continence but this requires some further work. New procedures are now in place to ensure information in daily records inform the care plans. Significant improvements have been noted for the review of the home’s administration of medicines policy. This has been done with appropriate reference to best practice initiatives from the Royal Pharmaceutical Society and incorporating the Misuse of Drugs Act guidance. The provider and manager have undertaken a full review of the recruitment practices and developed a robust procedure, and an audit tool to monitor compliance. The provider and manager are in discussion on how to develop a comprehensive audit tool which will incorporate the social care outcomes and which will also ensure positive outcomes for service users by ensuring minimum standards are met. The provider has resourced relevant publications to support service users with special therapeutic needs. Reference materials are now available to staff which address best practice initiatives when supporting individuals with dementia. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make an informed choice about where to live. The current written contract/statement of terms and conditions does provide all the relevant information. The pre-admission information indicates how needs can be met and informs the care plan. EVIDENCE: The inspector read the homes service user guide and statement of purpose. It has been identified that this document holds all the necessary information regarding the home, its staff and facilities. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 10 It was discussed with the provider that any changes to the current management structure within the home will need to be reflected in the document, in view of the long term absence of the registered manager. The information was found in the drawer in the kitchen. It was stated that residents remove the documents left in the hallway. The staff could look at ways of improving how this information is provided and in what format so that it is easily accessible /available. All new resident files had the necessary information regarding the terms and conditions of stay and pre admission papers with assessments. All service users appeared to be supported in an environment suited to their needs and aspirations. All service users met felt their needs were being met, and were very happy to be in the home. Contracts indicate the agreement regarding what room the service user has agreed to occupy. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Great efforts have been taken to improve the service users’ plans of care. Assessments for mobility and nutrition have now been developed and incorporated in care records. The home’s written policy and procedures regarding the safe administration of medicines have been completely rewritten and developed in line with best practice. The staff now need to review all aspects of storage, and safe administration. EVIDENCE: The staffs have made significant efforts to ensure the current service users’ plans are informed and generated from comprehensive assessments. The improvements noted identify that they now reflect the basis for the care to be delivered. There is some room for further improvement for the daily records to reflect whether or how the outcomes for care have been met. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 12 The deputy manager has been working hard to ensure that care assessments address the mental health needs of service users, especially those identified with challenging behaviours. The provider demonstrated numerous resources she has obtained regarding nutritional support for this client group and specific to the needs of persons with dementia. Nutritional assessments and food plans are now developed and one in particular was really well developed. It had a list of all the available finger foods suitable for the needs of one client while ensuring the right nutritional balance was being delivered. The provider and deputy manager have undertaken a lot of work in developing areas for mobility, manual handling and nutrition. They confirmed they would now develop the homes policy and procedures for the promotion of continence. The inspector observed medication being given and reported the procedure needed significant improvement. The provider has taken great steps to update the homes policies and is addressing the home policy for administration of medicines. It was identified that the senior staffs need to audit and completely revamp the process for the storage and administration of medicines now the procedure has been developed. On the day the inspector discussed with the staff her concerns regarding: • • • • • The current storage of medicines. The management for disposal and returns. The record keeping and completion of administration records. The procedure for identification and administration and safety. Cleanliness and hygiene of medication areas, equipment, storage areas and liquids. In view of the recent steps the provider and deputy manager have taken to improve this area they agreed to address the above as a matter of priority. The home now has a Controlled Drugs register and the necessary reference materials and are just waiting for an up to date drug reference (BNF). East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are no concerns in respect of promoting core values and there are also some good practices in relation to supporting individuals with their social preferences. Significant efforts have been made to improve outcomes in relation to the provision for food and drink. EVIDENCE: It was observed throughout the visit that staff were dealing with clients in a dignified manner and dealing with their needs in a sensitive manner. A previous visit to the home some six months ago identified that the outcomes for service users in relation to social and leisure were good and discussions with service users during this visit indicates this remains unchanged. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 14 Staff are now monitoring the outcomes for service users in relation to their needs for good nutrition and hydration. The management team has developed assessment tools in line with good practice guidance and have significantly improved outcomes. Service user were being provided with regular fluids and the homes menu was in the process of being revised in line with service users choices/preferences. The home’s policy regarding access to the food area has been revised in line with guidance from the environmental health department. New equipments for the safe storage of food have been purchased and the staffs have received relevant training for food handling and preparation. The cook is now incorporating the safer food, better business guidance by the Food Standards agency in every day practice. Service users and relatives have been complimentary regarding the food provided. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are recorded and dealt with in line with the services complaints procedures. EVIDENCE: The service has the relevant Adult Protection Procedures available to staff and these are incorporated in their induction and training processes. The home’s complaints procedure was seen and read by the inspector at the previous visit and remains unchanged. There has been one complaint made regarding the home since the last inspection and it was dealt with in line with the homes procedure and there was a clear audit trail. It was established when auditing the staff recruitment files that robust recruitment practices are now being undertaken, thus protecting vulnerable persons. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a well-maintained environment and areas of concern raised at the last have been addressed. EVIDENCE: One service user gave the inspector a tour of part of the premises. Discussions indicate that service users feel the establishment is well maintained and clean. Relatives have previously been very complimentary regarding the homes décor during previous visits and stated that it is clean comfortable and homely. Records indicate there is a program of routine maintenance and renewal of the fabric and decoration of the premises undertaken and implemented with records kept. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 17 One concern was there has been a leak into one service users room from the roof. It was stated by the provider that the roofer needed a dry spell to be able to address it. The grounds remain tidy, safe, and attractive despite the time of year. A further concern was that one upstairs toilet did not have a wash hand basin. This has now been addressed by the home in consultation with public health team. Service users reported to the inspector that the home had been without hot water for four days. The staff were managing as best as possible by transporting hot water. This was causing some distress to service users but every effort was being undertaken by the management /maintenance to install a new boiler. The provider has now undertaken steps to ensure that water is stored at a temperature of at least 60oC and distributed at 50oC minimum, to prevent risk from Legionella. Temperature records are now being kept. All rooms now have mixer valves installed. The provider has been in consultation with the public health team regarding infection control procedures. Staff are now wearing appropriate aprons when providing care or food handling. In view of the concerns previously raised regarding the poor standard of the laundry and wall coverings, the provider stated there are now plans to completely refurbish this area. The staff have now received guidance on the prevention of infection. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are being supported and protected by the home’s recruitment policy and practices. Staff are provided with a good standard of training. EVIDENCE: Staffing numbers observed throughout the visit appear appropriate to the needs of the residents at that time. The home has separate cleaning maintenance and kitchen staff. It was confirmed during the previous visit that there is a minimum ratio of 50 trained members of care staff (NVQ level 2 or equivalent). The two newly appointed staff files were audited. The provider and deputy manager have taken significant steps to ensure all necessary information is received prior to employing new staff. Files had audit tools indicating whether the candidate has provided all the necessary information. The home’s interview records indicate reasons for leaving previous positions and notes on all gaps identified with suitability to post employed. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 19 The provider discussed the future developments for the provision for training within the home. Previously, care worker surveys and training records identified that staff undertake training in challenging behaviour, basic food & hygiene, infection control health and safety and dementia awareness. The home has further improved the provision by expanding it to meet the skills for care guidance. This has been incorporated in providing the relevant knowledge sets and induction standards. A lot of work was evidenced during the visit in this area. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite the absence of a registered manager the provider and deputy manager have taken significant steps to ensure areas of concern are addressed. Outside specialists and relevant best practice publications and guidance have been used to improve and inform practice. Further development is required for the home’s quality audit processes undertaken and for the supervision of staff. Care practice and their outcomes must be monitored. Service users are now supported and protected by the home’s recruitment, training and induction policy and practices. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home’s registered manager has been on extended sick leave. In the interim period the provider now wishes to register as manager. Since the last visit the staff confirmed the provider has been in attendance at the home on a regular basis. The provider and the deputy manager have worked hard to address the areas of serious concern identified at the last visit. The provider has addressed her own development needs by undertaking a number of training courses and by inviting experts/specialists to give advice and guidance. This has reflected in the resources available to staff, and the standard of policies procedures and practices now being undertaken which are more in line with recent guidance and best practice. Staff stated they felt supported, consulted and kept informed. The provider stated that in view of the changes in social care, the home’s quality assurance processes would be adapted to incorporate the new outcomes. This work still needs to be undertaken and the provider was informed of the need to continuously monitor the quality of service provision. A point of discussion was that the home’s current processes for auditing the standards of practice and support within the home is not adequate. It was clear that the staff lack supervision and that some care workers practices are poor leading to significant poor outcomes for service users. The majority of service users looked well cared for but there was a significant few whose care posed a concern and this was identified during the visit. Adequate monitoring and supervision of care practice by senior care staff is needed. The Provider has started using a new regulation 26 visit template, but it was identified that the everyday standards of care practice must be monitored and outcomes audited. Service users spoke of staff as kind, patient and caring. The provider explained that she has arranged for a health and safety advisor to come and review the home’s policies and practices in health and safety. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 x x x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 2 3 3 East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 Requirement Timescale for action 20/12/06 2. OP33 24 The procedure for the storage, returns, cleanliness of equipment, storage, records and administration of medicines must be improved and in line with best and safe practice guidance. The registered person must 28/02/07 ensure that the quality of the care and service provided is monitored through continuous audit processes. This has been partially met but requires a longer deadline. 3 OP36 18 Care staff practice and outcomes for service users must be monitored and staff supervised when delivering care. 30/11/06 East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The information regarding the home could be made more accessible and could be provided in a user-friendlier format. East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI East Cosham House DS0000012360.V321074.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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