CARE HOMES FOR OLDER PEOPLE
East Cosham House 91 Havant Road East Cosham Portsmouth PO6 2JD
Lead Inspector Richard Slimm Unannounced 25 April 2005 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 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service East Cosham House Address 91 Havant Road East Cosham Portsmouth PO6 2JD 023 9232 1805 Telephone number Fax number Email 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 Mrs Kim Ina Shelton Care Home 24 Category(ies) of OP - 24 registration, with number DE(E) - 24 of places MD(E) - 24 East Cosham House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 11th / 12th October 2004 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 dinning 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. East Cosham House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place between the hours of 10 am and 4 pm on the 25/4/05. The day was spent visiting service users in their own rooms, and communal areas of the home and interviewing them in order to establish their views of the quality of service provided by the home, the inspector also discreetly observed the lunch period including the administration of medication. The inspector checked records and other relevant documentation, interviewing care, management staff and one of the owners. Both residents and staff spoken to, made positive comments about the home. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
East Cosham House Version 1.10 Page 6 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 Standards Statutory Requirements Identified During the Inspection East Cosham House Version 1.10 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Residents have their needs assessed prior to admission. Residents and/or their representatives could be more involved in the completion and development of their care records. EVIDENCE: A sample of care assessments, planning and review systems were inspected. The introduction of personal profiles as part of assessment has improved the quality of information about residents’ lives prior to entering the home. Care assessments continue to develop, and it was agreed that action would be taken to involve residents as much as possible in their assessments in the future, and where necessary seek additional input from residents advocates. Residents were found to be contented, but given the degree of confusion were not fully aware of care records held about them. Staff members were able to demonstrate an awareness of the importance of care planning systems in regard to promoting consistency and accountability. Staff would benefit from some training in the ongoing development and completion of care records at the home. East Cosham House Version 1.10 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 - 8 - 9 Residents had individual plans of care. Care plans were not fully specific. Care plans, and management systems, did ensure residents health care needs were identified and met. Arrangements for the administration of medications were found to be appropriate to the needs of the resident group. EVIDENCE: Each Resident has a plan of care. Care plans included terms like “regular” which need to be made more specific, especially in such areas as maintaining continence. New care plan systems had been developed and these plans continue to improve in line with the particular needs of the resident group. Residents were found to be contented, but given the degree of confusion were not fully aware of care records held about them. Staff members were able to demonstrate an awareness of the importance of care planning systems in regard to promoting consistency and accountability, but some staff training needs were identified in this area. East Cosham House Version 1.10 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 - 14 - 15 Residents are provided with support to lead their own lives as far as possible. Contact from outside of the home is encouraged and supported. Residents are encouraged and supported to exercise choice and control, and the home provides a balanced diet with options to main menus based on the wishes/needs of residents. EVIDENCE: Given the degree of vulnerability of the resident group, supervision is needed in all aspects of daily living. Residents need support outside of the home, and the home strives to provide opportunities for residents to get out when possible. Many residents have family support in this area. Visitors to the home are welcomed and encouraged. Residents confirmed that they had visitors. Activities are arranged in the home relevant to the needs and abilities of the residents. There are few restrictions in the home, with residents having full freedom of movement and choice in such areas as where they eat, this was observed during the visit. Support is provided wherever needed by a patient and dedicated and well supported staff team. Residents spoke highly of the staff and good relations were evident. Routines appeared to be kept to a minimum, with the residents placed firmly at the centre of the running of the home. Residents and/or their representatives could be more involved in the completion of their care records. Residents choose where they eat their meals, and support is provided to maintain dignity and independence. Residents
East Cosham House Version 1.10 Page 10 spoken to were found to be happy with the quality and choice of food provided. Special diets are catered for where necessary. East Cosham House Version 1.10 Page 11 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16-18 Systems are in place to ensure any concerns or complaints are listened to, taken seriously and acted on. This includes systems to protect residents from potential abuse. EVIDENCE: The home has a clear and comprehensive complaints procedure. This is made available to residents and/or their representatives. The manager has the role of investigating any concerns and full records are maintained. There had been no complaints since the last inspection visit. There is an adult protection policy and procedure in place and this is available to all staff members. Staff training in adult protection has been provided. The home reports all incidents effecting the wellbeing of residents to the CSCI as required. Residents confirmed that they felt safe living at East Cosham House. East Cosham House Version 1.10 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 - 26 The home was safe clean and well maintained, providing a valuing environment to residents. EVIDENCE: On entering the home there was a minor issue of the odour of incontinence, however, any soiled carpets were being washed throughout the visit. The home works hard to overcome odours, given the high dependency of the resident group. The home is well presented and maintained, with both a maintenance staff member and a gardener on the team. The home was found to be cleaned to a good standard at the time of the visit. Residents stated that they were happy living at the home. East Cosham House Version 1.10 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 - 29 - 30 Staffing arrangements exceeded the recommended levels. Best practice is followed in the area of staff recruitment, selection, supervision and retention. Staff training in care record development and maintenance is needed. EVIDENCE: The home has clear staff rosters. Staffing levels were in excess of the recommended levels. The home has not had to employ agency staff since January this year. Residents spoke highly of the staff team. Staff members were observed interacting well with residents, and providing sensitive support. Staff may benefit from increased training in the development and maintenance of the homes’ new care record systems. There are two waking staff members. In addition to care staff the home employs ancillary staff including cooks, domestics, house-keeper, maintenance and gardener. The home uses a thorough recruitment and selection system that meets the legal requirements and provides safeguards for residents, by ensuring all staff receive appropriate checks. There is a clear commitment to the ongoing training and development of the staff team. East Cosham House Version 1.10 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 - 35 - 38 The home is run in the best interests of residents. Residents financial interests are protected wherever the home have any involvement. The Health and safety of residents and staff is promoted. EVIDENCE: A sample of policies and procedures were inspected. Systems of quality assurance continue to develop at the home. The homes’ owners and manager are keen to work with the CSCI in the ongoing development of the service. The home ensures that wherever residents’ valuables or monies are handled full systems of accountability are in place. A sample of residents personal allowance records were checked and balanced. Residents spoken to confirmed that they could have access to money if they needed it. The home does not act as appointee for residents. Staff members had received training in all core topics, including manual handling, fire safety, first aid, food-hygiene and infection control. The manager makes arrangements for the maintenance of health and safety at the home. Service contracts are in place for the maintenance of the central heating, chair lifts, electrical items/systems and
East Cosham House Version 1.10 Page 15 bath hoists/chair. Fire precaution maintenance is fully recorded, including staff fire training and fire drills. Residents confirmed that they felt safe living at the home. East Cosham House Version 1.10 Page 16 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 4 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 x x 3 East Cosham House Version 1.10 Page 17 NO Are there any outstanding requirements from the last inspection? 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 Regulation Requirement Timescale for action 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 3/7 Good Practice Recommendations It is recommended that the registered persons ensure that care assessments/plans are completed with as much input as possible from residents and/or their representatives. Care plans should be specific and avoid terms like regular, in order to ensure care staff are working to clear instructions/guidance. In light of the introduction of new proformas the registered persons should put in place staff training in the area of care record development and maintenance. 2. 30 East Cosham House Version 1.10 Page 18 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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