Inspection on 16/11/06 for Elm Cottage

This inspection was carried out on 16th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elm Cottage 19/02/08

Elm Cottage 08/02/06

Elm Cottage 02/08/05

Elm Cottage 01/12/04

Elm Cottage 05/05/04

Elm Cottage 08/03/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Elm Cottage 108 Harepath Road Seaton Devon EX12 2AX Lead Inspector Belinda Heginworth Key Unannounced Inspection 16th November 2006 09:00 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 Elm Cottage DS0000021931.V309738.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. Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elm Cottage Address 108 Harepath Road Seaton Devon EX12 2AX 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) 01297 23658 Mrs Shirley Ann Copp Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3) of places Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th February 2006 Brief Description of the Service: Elm Cottage is a small family run residential home situated on the outskirts of Seaton providing personal care for up to three older people. It has a large lounge, kitchen / dining room. There is a small and level private garden with a paved area. There is outdoor seating and a large summerhouse, which is accessible to residents. Each resident has their own room, one of which is on the ground floor and has en suite facilities. The other two rooms are on the first floor and have wash hand basins. There is a stair lift. Care is provided by the providers and their son, with one additional part time care assistant and a part time domestic worker. Information provided prior to the inspection indicates that fees range from £306 to £410 per week with no additional charges. Inspection reports are made available on request. Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over three hours during a weekday starting at 9am. The provider completed a pre-inspection questionnaire and forwarded it to the Commission several weeks before the inspection visit took place. From this information, questionnaires were sent to residents, staff, relatives and professionals involved in the home. Responses were received from 3 staff, 3 residents and 2 GP’s. The results from these helped to inform the judgements and findings of this inspection. During the inspection, time was spent talking with all residents and staff. All residents were ‘case tracked’ by reading the records gathered before their admission and the care plans drawn up as a result of this information. Daily care records, medication administration, accident reports, and risk assessments were checked in relation to these three residents. The inspector looked around the building and other records were inspected. These included, fire safety logbook, staff training records and quality assurance records. What the service does well: The atmosphere at Elm Cottage is relaxed, caring, fun and homely. New residents are given good information and opportunities to get to know the home before any decision to move in is made. The provider will normally visit the person in order to get to know them and to carry out an assessment of their needs. Visits to the home and if possible short stays are encouraged. Information is also gathered from relatives and health or social care professionals. Good information is provided to staff in the form of a care plan using the assessment details that were gathered prior to admission. These care plans are regularly reviewed to ensure they are up-to-date and give accurate information to care staff about how each resident wants to be assisted. The care plans show how the residents are able to make choices in many aspects of their daily lives. The residents living at Elm Cottage showed no interest in their care plans but said they were consulted on all aspects of their lives. Care has been taken to ensure that medicines are stored and administered safely. Staff have received training in the safe administration of medicines, therefore protecting residents’ safety and welfare. Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 6 There are good procedures in place to ensure that concerns and complaints are taken seriously and acted upon promptly. No complaints have been received by the Commission since the last inspection. Residents are protected from potential abuse through good training and good recruitment procedures. Elm Cottage appears comfortable, attractive and homely throughout. All areas have been maintained to a good standard. Residents have single bedrooms and one has en-suite facilities. All areas of the home are kept clean and free from any odours. Equipment has been regularly serviced and maintained. Risk assessments have been carried out on all areas of the home and the tasks carried out. Staff have received training and updates on all health and safety topics. The provider has good systems to monitor the quality of the care and services provided to ensure continuous improvements and to ensure the home is run in the best interests of residents. 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 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. Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 7 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 Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 8 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): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to make an informed choice about where they want to live through good admission and assessment procedures. EVIDENCE: Only one recently admitted resident could remember the assessment process and said they felt confidant the home could meet their needs. The provider visited the prospective resident to get to know them, to provide information about the home, to answer questions, and to carry out an assessment of health and social care needs. Details of initial assessments, care plans and other related information were read. These files showed that a wide range of relevant information was gathered before the resident decided to move in, including assessments carried out by health and social care professionals. The provider and staff talked about the process they follow when assessing prospective new residents, and how they take care to ensure that the home is able to meet their needs before agreeing to admit them. New residents are welcome to visit the home for cups of tea and overnight stays wherever Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 9 possible. Residents are admitted initially on a three-month trail period before deciding whether to make elm Cottage their home. These visits prior to moving in and the trial periods ensure residents and the home get to know each other. Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 10 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 excellent. This judgement has been made using available evidence including a visit to this service. Residents’ personal, social and health care needs are understood and well met. Residents are safeguarded by good methods of administration and recording of medicines. Residents are treated with dignity and their privacy is respected. EVIDENCE: Residents said they were not interested in their care plans but knew that information was written about them. One resident said, “I trust the staff fully and I don’t want to be bothered with paperwork”. Another resident said “the staff treat me so well and consult me about everything, I don’t need to see it written down”. Three care plans were read and contained comprehensive information covering all aspects of the residents’ needs. The plans showed how the home considered the goals they hoped to achieve when assisting residents to maintain or regain independence. Records showed that the plans have been Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 11 reviewed at least once a month. This ensures the care residents receive remains appropriate and safe. The documents are stored in files that also contain daily diaries completed by the care staff. This ensures that staff have daily access to the care plans and can refer to them when writing the daily reports to check that all required care has been carried out effectively. The care plans included information about health care needs, including diabetes and catheter care. Two GP’s responded to this inspection by completing questionnaires, and their responses showed that they are satisfied with the care provided by the home. Nutritional screening is carried out where necessary, weight is monitored regularly, and assessments are carried out to ensure pressure sores are prevented. Staff have received a range of training on health topics including diabetes, catheter and skin care. Moving and handling risk assessments have been completed with clear instructions on how staff should move residents safely. Staff have received appropriate training to ensure they understand such needs. They demonstrated an excellent knowledge of residents’ needs, risks, likes and dislikes. Because the home is small with a small staff team, communication between staff is very good. Residents liked the small family atmosphere and said “nothing was too much trouble”, “they are always in and out of my room, talking and making sure I’m ok”. The home uses a monitored dosage system (Nomad) for medication. This is supplied by the local pharmacy. At the last inspection it was recommended that staff sign to say medication has been given rather than tick boxes. Staff now sign administration charts to confirm that medicines have been given. The medication administration sheets are handwritten by the provider, discussions took place about ensuring two people check and sign these handwritten entries to reduce the risk of errors. The provider agreed to implement this straight away. All staff have received in depth training on the safe handling and administration of medicines, therefore protecting residents health and welfare. Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 12 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 excellent. This judgement has been made using available evidence including a visit to this service. Residents are enabled to have choice over all aspects of their daily lives, including activities suitable for their interests and abilities. Residents’ families and friends are encouraged to visit whenever they want and to be fully involved in the care of their loved-ones. Residents receive well-balanced and nutritious meals to suit individual tastes and dietary needs. EVIDENCE: The provider makes it clear in her statement of purpose and during the assessment process, prior to admission, that organised activities are not provided in the home. However, individual interests are catered for and outings are arranged if requested. The three residents living at the home prefer to spend time in their rooms listening to music, reading and watching TV. Some residents enjoy using the garden in the summer and occasionally use the lounge. Residents said staff spend time with them playing cards, reading to them or just chatting and sharing music and TV. Residents were very happy with this, one resident said they preferred to be on their own and did not want Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 13 company. Another resident said, “they are constantly in my room checking to see if I’m ok and spending time with me”. A third resident said, “I chose this home because I’m not forced to do anything I don’t want to” and then went on to say “I don’t want to sit and do organised games”. Residents’ care plans reflected their individual wishes, likes and dislikes in terms of their social needs. Residents said they are fully consulted on all aspects of their lives; staff are very supportive to help them maintain their independence and said that staff always respect their wishes. Relatives who have contact with the home are kept informed and updated on their loved ones health and progress. Thank you letters to the home from relatives were read by the inspector during this visit. The home does not have menus; each day the provider discusses meals with residents. They can then choose alternatives if they do not want what is on offer. Daily diaries showed a wide range of varied and healthy meals being provided. Residents said the food was “wonderful”, one resident said “the staff know my likes and dislikes so I never have to choose something else”. Special dietary needs, such as diabetic needs are fully catered for. Staff have received training on how to care for someone with diabetes and demonstrated an excellent understanding of the foods needed. All food cooked in the home is organic and homemade; some of the vegetables and salads are grown by staff at the home. Care plans showed significant improvement is some residents’ health and dietary needs since living at Elm Cottage. For example a service user came in using a lot of medication for health related illness. The home has managed to stop the resident using such medication through good nutrition instead. Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 14 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 excellent. This judgement has been made using available evidence including a visit to this service. Residents are assured they will be listened to and their concerns and complaints acted upon. Good measures have been put in place to protect residents from abuse. EVIDENCE: No complaints have been received by the Commission or the home since the last inspection. The residents who responded to this inspection by completing a questionnaire said they always know who to talk to if they aren’t happy, or if they want to make a complaint. The home has a complaints procedure, which has been updated since the last inspection. Residents said if they were unhappy they would talk to any staff or the provider, another resident said “I can’t imagine ever having a complaint, but if I did, they would listen and sort my grumbles out”. The home has a range of policies and procedures in place relating to the prevention of abuse. All staff have had training on the protection of vulnerable adults. All staff demonstrated an excellent understanding of different types of abuse and understood what to do if they suspected any. The home is very aware that because it a family run business extra care is taken to ensure residents, relatives and healthcare professional are consulted and asked their views on the home. Staff felt very passionate about delivering excellent care and protecting their residents from abuse. One staff said, “this is a family and we treat everyone as members of the family”. Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 15 Elm Cottage DS0000021931.V309738.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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable, safe, clean and attractive environment. EVIDENCE: The home has been well maintained both internally and externally. All areas of the home have been decorated and furnished to a high standard and appeared comfortable and homely. The domestic and care staff take pride in the home, ensuring that all areas are kept clean and fresh at all times. This was confirmed when speaking to the residents. All bedrooms are of a good size and have been individually furnished and decorated to a good standard. Finishing touches include attractive bedspreads, curtains and good quality carpets. Residents are encouraged, if they wish, to bring furniture and personal effects in order to make there rooms feel homely. Residents said, although they prefer to stay in their rooms they are free to use all areas of the house and gardens. Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 17 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 excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from sufficient well trained staff to meet their needs safely and consistently. Residents are protected from potential abuse through good recruitment practices. EVIDENCE: The provider, her husband and son work fulltime at the home. An additional staff is employed at weekends and domestic staff are employed part time. Most days the provider, her husband and son work in the home. At night the provider lives on the premises and provides night care as necessary. Residents felt there were plenty of staff to care for all of their needs. They said, “you only have to ring the bell or call out and someone is there within seconds”. Another resident said, “they are always checking I’m ok and spending time with me”. Recruitment files include all of the necessary checks, including police checks (CRBs) to ensure residents are protected from potential abuse. All staff have received a good level of training and over 50 of the team have completed NVQ level 2 or above. Training included diabetes, catheter care, health & safety, fire safety, medication and manual handling. The provider also Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 18 arranges training according to the needs of the residents as and when necessary. Staff demonstrated an excellent awareness of residents needs and risks throughout the inspection. Because the home is small has a small staff team, communication between the provider and staff is excellent which ensures residents’ needs are fully understood at all times. Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 19 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, 33, 35 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from an excellently managed home that ensures the quality of the facilities and services are constantly monitored and improved where necessary. Good systems and training are in place to ensure the safety of residents, staff and visitors. EVIDENCE: The provider, who also manages the home, has many years of experience of caring for older people. Her qualifications include NVQ level 4 in care and the Registered Manager’s Award. She keeps herself up to date in care and health matters through regular training. This ensures residents are cared for by an Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 20 experienced and qualified person, therefore protecting their health, welfare and safety. The provider sends satisfaction questionnaires to residents and relatives each year to ensure they are fully satisfied with the services they receive. Health care professionals are asked their views on the home during most visits. The provider intends to record their responses to form part of their quality assurance system. Care plan reviews, updates on polices, procedures and risk assessments ensures the quality of care delivered is monitored, reviewed and are up to date at all times. Regular staff and residents’ meetings give everyone the opportunity to have an input on how the home is run and if improvements could be made. These meetings are carried out in an informal and friendly manner. The fire safety logbook was found to be up to date and accurate. Fire risk assessments and staff training were completed, therefore protecting residents’ safety and welfare. The CSCI obtained information before the inspection. The information includes confirmation that all necessary policies and procedures are in place and are up to date. These were not inspected on the day but the information is used to help form a judgement as to whether the home has the correct policies to keep residents and staff safe. In this instance policies and procedures were in place and understood. These along with risk assessments will be reviewed regularly and are up dated where necessary, to ensure they are appropriate and reduce risks to staff and residents. The home does not hold any money on behalf of residents. All costs are met within the fee structure. A resident, who chooses to look after their money, has been provided with a lockable box to ensure safekeeping. Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 21 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 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 4 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 4 Elm Cottage DS0000021931.V309738.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. 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 OP9 Good Practice Recommendations All handwritten entries to medication administration sheets should be checked and signed by two people to reduce the risk of errors being made. 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