CARE HOMES FOR OLDER PEOPLE
Hope Cottage 5-7 Pilkington Road Southport Merseyside PR8 6PD Lead Inspector
Mike Perry Unannounced 24th June 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. Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Hope Cottage Address 5-7 Pilkington Road Southport Merseyside PR8 6PD 01704 536286 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) Hope Cottage Ltd Mrs Joan White PC - Care Home Only 26 Category(ies) of DE(E) - Dementia - Over 65 - 26 registration, with number of places Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 26 DE (E). 2. The service should employ a suitably qualified and experienced Manager who is registered with the CSCI. Date of last inspection 27th September 2004 Brief Description of the Service: Hope Cotage is a residential care home that specialises in caring for older people with dementia. The home is Registered for 27 residents and is owned by Hope Cottage Ltd. The Responsible Person is Mr T Yilmaz. The Manager is Joan White. Hope Cottage is situated within a suburb of Southport and is within easy reach of the town centre [ 1 mile]. The home has been extended to include a conservatory and further bedrooms, bathrooms and tiolets. The facilities are spread over 2 floors with a passanger lift serviving the first floor. All day space is on the ground floor and includes lounge, conservatory and dining room facilities. there is an enclosed garden to the rear of the buiding and parking space at the front. A ramp has been added to provide disabled access. 3 of the bedrooms can provide for residents to share. Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day. During the visit, a partial tour of the premises took place and observations were made. A selection of care, staff and service records were also viewed. The home manager, 5 care staff members, residents and 2 relatives were spoken to during the visit. Leaflets were also left in the home to enable residents and others to comment on the service provided. A visiting professional also completed a questionnaire. What the service does well:
Senior staff assess residents prior to admission and also following admission to the home. This ensures that care needs can be planned for and met. The plans of care are drawn together with relative involvement to varying degrees and are generally easy to follow and provide a good description of the care. The regular care reviews held with relative involvement are particularly helpful and follow good practice guidelines. The staff maintain good communications with external health care support such as community nurses and General Practitioners [GP’s]. Referrals are made when required so that residents’ health needs are met. Relatives commented on the caring nature of the staff and how they were supportative and try to personalise the care as much as possible. Relatives commented that staff are helpful and friendly. There are activities planned for residents mainly in the afternoon. Staff were observed talking to and mixing with residents. The meals provided offer good quality and choice. Staff take care to lay tables and present the meals attractively. There is a good complaints procedure and relatives feel that their concerns are listened to and acted on. Staff spoken to were knowledgeable about resident care needs. The training offered by the home is good and some of this is specific to dementia care. The home is clean and well maintained. Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 6 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. Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 [ no intermiediate care provided] The assessments carried out by the home are good and help ensure that the home can meet the needs of residents admitted. EVIDENCE: Four residents files were seen. All residents had been assessed prior to admission and there was reference to community assessments from professionals. The homes assessment is very detailed and covers all aspects of the care standards including history of falls and self-medication assessments. The perception of the service users representatives was also recorded. Assessments also include mental state, risk and nutrition. There is a very useful mental assessment tool that is also useful. The assessments provide information so that the home can make a decision as to whether they can meet the care needs adequately. Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 9 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, 8,10 Individual care plans are of a general good standard and some display evidence of relatives being involved so that routine care is managed effectively. Routine auditing by the manager and a better understanding of the care model would help provide more consistency. There is good liaison with health care support services so that residents are referred appropriately. Care staff have a good understanding of the personal care needs of residents and these are met within the confines of some challenging behaviour. EVIDENCE: All residents have a plan of care. The clarity of the care plans varied over the four reviewed. 3 were clear and well written with clear aims and interventions. One plan lacked clarity and was more generalised with no specific planned aims or objectives so the plan was difficult to evaluate. The plan was not signed or dated. All care plans displayed varying levels of resident / relative involvement. This could be made clearer on the care plan. Relatives interviewed said that they felt involved in the care although could not remember seeing a care plan. The home has regular care meetings involving relatives and all aspects of care are discussed at that time.
Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 10 The care plans are based around a model of care called ‘Activities of daily living’ so that staff can assess and plan care around routine daily activities such as washing, eating and self care. A deeper understanding of the care model may assist some staff in developing clearer plans of care. The care records indicated that appropriate referrals for health care are made by the home. There was a visiting doctor [GP] on the day of the visit who felt that the home communicated resident needs very well and that staff understood the health care needs of the residents. One resident had been admitted with infectious skin problem and it was clear that the home had managed this well with relevant input from hospital and community based professionals. General observation of residents confirmed that appropriate dress is maintained and that standards of hygiene are good. Relatives spoken to were also pleased with this aspect of the care and felt that staff worked hard to maintain a good standard. Relatives felt that staff were approachable and patient with residents. Staff interviewed were clear about the principals of care relating to privacy and dignity and this could be observed as they went about their job. Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 11 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) 12,13,15 Activities are provided and continue to be developed in the home and assist in providing some quality of life for all residents. Arrangements to involve relatives in the home and in the care of residents are good so that relatives feel supported and in contact with events. Daily choices of meals are always available and nutritious meals and special diets are provided, to ensure residents received a wholesome balanced diet. EVIDENCE: There are some very good social assessments recorded for each resident with the assistance of residents [when possible] and relatives, which help personalise and identify preferences for activities. There is a relaxed atmosphere in the home and staff were observed to spend some time talking with residents. There is a list of activities planned and advertised and there is a daily routine of some activity planned for the afternoon. Some residents were seen to be enjoying some physical activity organised by a staff member in the conservatory. Residents make use of the garden and there are occasional trips out locally. Staff reported that a mini bus will become available in the future so that this aspect can be developed and provide for improved quality of life for some residents. Relatives spoken with feel involved in the home and were pleased with the care reviews that are held by the care staff. Visiting is flexible and open. One
Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 12 relative always likes to take her mother to all hospital appointments and the staff liaise well regarding this. The dining room is pleasant and encouraged interaction. Tables are set and staff were observed to be assisting residents were necessary. The menu is varied and offers choice for residents. The new cook has started home baking and will review all menus in the near future. Residents clearly enjoy the food and relatives were also pleased with mealtime arrangements. Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 13 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 The home have a complaints procedure and complaints are listened to and investigated so that residents and relatives feel that their concerns are dealt with. The investigation of allegations of abuse must include alerting outside agencies so that all appropriate action can be planned and coordinated and residents are properly protected. EVIDENCE: The home has a complaints procedure and this is included in the information guide for the home. Relatives interviewed were only vaguely aware of the process however and the displaying of the procedure in the home would be recommended. The complaints are recorded and there have been 3 complaints since the last inspection in Sept 2004. 1 complaint concerned an allegation of abuse made anonymously regarding a care staff [alleged to use bad language]. This had been investigated thoroughly by the management and was unsubstantiated. Another complaint also came under the heading of abuse [also unsubstantiated]. The home did not alert any outside agencies such as the Commission, which would be indicated as part of the reporting and investigation of such allegations. The other complaint was around cleanliness and the smell of urine in the home, which was investigated by the Commission and, at the time, was not founded. Residents and relatives spoken to felt that the homes staff were approachable and would listen to any concerns.
Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 14 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 Hope Cottage is well maintained and is clean so that residents live in a safe environment that meets their needs. The carpeting in some day areas is in need of replacement in order to remove any malodorous smell. EVIDENCE: Since the last inspection the owner has installed a ramp for disabled access to the home. The programme of replacing / upgrading windows has continued and these are now nearly all completed. The home is well maintained and the manager was able to discuss future plans and further upgrading of the home. The provision of a larger disabled toilet on the ground floor near the lounge remains a recommendation. There is also an outstanding requirement for the covering of radiators to protect from the risk of burns although this programme is nearly completed. Two relatives spoken to, whilst pleased wit the general facilities in the home, said that they found difficulty on regular occasions leaving the home as they had to find a member of staff [who might be busy] in order to open the exit
Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 15 door. A keypad might prove useful here so that relatives can leave the home with more freedom. The home employs adequate domestic staff and all areas seen were clean. There are areas in the home where the carpets have a smell of urine and this is now noticeable in the lounge and conservatory. The owner is renewing all carpets in the near future and is also to provide a new carpet cleaner. Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 16 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 is consistent in the home and provides enough minimum numbers to meet resident’s needs satisfactorily. A training programme is provided for staff so that they are equipped to carry out their role and meet general care needs of residents in a safe manner. The procedures for the recruitment of staff do not include necessary CRB checks on all staff, which are needed to help ensure protection to people living in the home. EVIDENCE: For 26 residents there was the manager, one senior carer, 3carers, 2 domestics, a cook and a laundry assistant on the day of the inspection. The duty rota confirmed that these numbers are consistent. There has been no use of agency staff since the last inspection and staff interviewed were very settled in the home. 3 staff files were seen of staff recruited since the last inspection. 2 were overseas staff. The records included relevant identification documents as well as references from previous employment. Of those staff from overseas only one had a record of police check through the Criminal records Bureau [CRB] and this was from the staffs country of origin. 1 staff member had been in the country for a number of years. CRB checks are required on all staff prior to employment. The manager organises training for staff. Ongoing training includes NVQ’s and 8 of the 18 care staff have NVQ or equivalent training. Care staff interviewed described the induction process in the home and this was very inclusive. The
Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 17 manager has arranged specific training in dementia care for some of the staff so that care can be planned more effectively for the residents. A training matrix on the office wall lists statutory training such as fire safety and manual handling. Relatives interviewed felt confident in the staffs ability and were very positive in their support saying that staff were ‘helpful’ and ‘friendly’. Residents were relaxed in the presence of staff. Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 18 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) not assessed EVIDENCE: Not assessed. Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 19 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 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 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x 2 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x x x x Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 20 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 7 Regulation 15 Requirement Timescale for action 1.12.05 2. 18 13 3. 25 13 4. 29 19 Care plans must be of a consistent standard for all residents and must display evidence of resident/relative involvment when possible. All allegations of abuse must be Ongoing reported through the appropiate channels as described in Seftons Adult Protection Proccedures. All radiators in the home must 1.12.05 be covered to ensure saftey from risk of burns to residents [ last requirment date 1.2.05 not met]. All staff including overseas staff 30.7.05 must have an updated CRB completed prior to employment. 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. 2. Refer to Standard 7 16 Good Practice Recommendations Some training around the homes model of care should help care staff to complete clear plans of care. It is recomended that the complaints procedure be displayed in the home.
F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 21 Hope Cottage 3. 4. 5. 21 26 19 The creation of a single disabled tiolet facility near the main day room should be considered. Carpets need replacing in the main day areas to remove any smell of urine. The provision of a key pad on the main door to the home is recomended following relatives comments. Hope Cottage F53 F03 Hope Cottage S51273 V235257 24.06.05 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Burlington House, 2nd Floor, South Wing Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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