CARE HOMES FOR OLDER PEOPLE
Hope Cottage 5-7 Pilkington Road Southport Merseyside PR8 6PD Lead Inspector
Mr Mike Perry Unannounced Inspection 6th January 2006 09:30 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 Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 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. Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Hope Cottage Address 5-7 Pilkington Road Southport Merseyside PR8 6PD 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) 01704 536286 Hope Cottage Limited Mrs Joan White Care Home 26 Category(ies) of Dementia - over 65 years of age (26) registration, with number of places Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 26 DE (E) The service should employ a suitably qualified and experienced Manager who is registered with the CSCI. Date of last inspection Brief Description of the Service: Hope Cottage 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 toilets. The facilities are spread over 2 floors with a passenger lift serving the first floor. All communal space is on the ground floor and includes lounge, conservatory and dining room facilities. There is an enclosed garden to the rear of the building 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 DS0000051273.V276556.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5.5 hrs on one day. During the visit, a partial tour of the premises took place and observations were made. A selection of the care, staff and service records were also viewed. The home manager, 3 care staff, and residents were spoken to. Leaflets were also left in the home to enable residents and others to comment on the service provided. One of these was returned from a visiting professional. Care Homes are routinely inspected twice yearly and this is the second inspection at Hope Cottage, the previous being in June 2005. The inspection concentrated on the requirements from the previous inspection as well as those core standards not covered on that inspection. For a complete picture of all of the core standards this report needs to be read in conjunction with the previous inspection report. What the service does well:
The management try and include the relatives in the plans for the care of residents by having regular review meetings for example. Relative’s views are also canvassed with respect to the ongoing running of the home and the results of these surveys are made available in the resident and relative information guides [service user guide]. The feedback is generally very positive with the majority of the relatives satisfied with the standards in the home. The staff interviewed displayed a good understanding of the need for residents to exercise control over their lives as much as possible. They were able to give examples of how this can be achieved with a resident group who lack the capacity to exercise total autonomy. For example staff help residents choose their clothing and also facilitate a choice of food at meal times. The manager displays and open and accountable style and is easy to approach. This was evidenced by her willingness to accept criticism during inspections and complaints and act on any findings. There are good systems in place so that the quality of delivery of the care in the home is constantly monitored and improvements made. Relatives and residents views are obtained and considered. The home is generally maintained in a clean and hygienic manner although some recommendations have been made. There are good staffing numbers maintained so that the delivery of care can be consistent. Staff are keen and skilled at supporting residents with dementia.
Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 Page 6 They display an understanding of the care skills needed. There is an ongoing training programme in place so that staff can continue to develop skills and knowledge. What has improved since the last inspection? What they could do better:
There was some detailed discussion around the underlying idea of the way the care plans are constructed and written and the manager aims to do some work on this so that staff are better able to relate to the way residents are assessed and the care is planned. Currently the care staff on night duty have not undergone any formal training in medication administration and there some medicines are being dispensed by care staff on days and left for night staff to administer. Errors can occur because of this process. This must not occur and an immediate requirement was issued. Staff on nights must be suitably trained. It is also important that the temperature of the room where medicines are stored is monitored. There has been a complaints investigation undertaken by the Commission since the last inspection. The findings indicate that the manager must take all
Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 Page 7 concerns and complaints seriously and investigate each issue so that relatives and residents can have a satisfactory outcome. The recommendations from the previous inspection around the provision of a disabled toilet facility and new carpeting still need to be further considered. The policies and procedure file need to be better maintained and indexed so that policies can be located easier. 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 DS0000051273.V276556.R01.S.doc Version 5.1 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 Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed on this inspection. EVIDENCE: Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 EVIDENCE: All residents have a plan of care. These were discussed in detail on the previous inspection and some general requirements were made around trying to ensure more depth and consistency as the clarity of the care plans vary. For example the care plans seen, although giving a satisfactory overall idea if the care, could be more detailed around identifying needs and giving more specific interventions. All care plans displayed varying levels of resident / relative involvement. This again could be made clearer on the care plan but it was noted that relatives are invited to care planning meetings on a regular basis 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. This was
Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 Page 11 discussed on the previous inspection. The manager has agreed to perhaps do some training around this. There is a problem in identifying regular reviews of the care plan, as the present system is confusing. Some suggestions were made regarding the recording of evaluations [in the general care notes] and the manager will follow this up. The home has medication policies and procedures and the staff interviewed were aware of these. Due to issues of mental capacity there are no residents self-medicating although there is a procedure available if required. Following a review of practice in the home it was observed that there is no routine recording of temperatures in the medicine storage room [should not be more that 25 degrees centigrade]. There is also evidence of secondary dispensing [liquids] into small pots so that night staff can then administer. The issue here is that the staff on nights have not yet completed the medication training although this is planned imminently. The secondary dispensing must cease immediately and night staff should administer medications from the original container to ensure best practice and reduce the risk of errors occurring. The training should follow as planned. Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 The home is able to demonstrate an understanding of need for residents with dementia to exercise some control over their lives so that their rights are respected EVIDENCE: The personal exercise of choice and control over resident’s daily life in the home is a difficult balance to achieve given the lack of mental capacity of the resident group. There were examples however of how the home were trying to achieve a good balance. For example staff interviewed were aware of individual residents likes and dislikes in terms of dress and food preference. Individual bedrooms displayed photographs and ornaments, which reflected individual’s history and personality. One care staff described how she assisted residents to get ready for the day each morning and understood the need for time to chose preferred clothing and also, later on in the day, to join in an appropriate activity which is linked to a personal interest if possible. Personal furnishings are discussed on admission with relatives. One resident has her own TV. One resident able to give an opinion stated that she was able
Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 Page 13 to stay in bed in the morning if she wished and that some residents stay up late if they choose. Staff are aware of the importance of advocacy and understand its use. There are reviews of the care plan held with relatives so that they can have some input. Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 There is a complaints procedure in the home so that residents and their representatives can raise issues and feel they are listened to although the evidence from a recent complaint is that all concerns raised must be investigated on each occasion so that relatives and residents can feel there concerns are acted upon. EVIDENCE: There is a complaints procedure clearly available in the residents’ information guide [service users guide] and the procedure is also displayed following recommendations from the last inspection. There has been one complaint since the previous inspection and the Commission investigated this. The complaint was from the elative of a resident in the home. The complaint had four elements to it: 1. The resident had a number of falls in a 2 week period 2. There was a delay in getting treatment for one of the falls, which had resulted in injuries. Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 Page 15 3. The care staff were insufficiently skilled and also lacking in numbers to provide the care. 4. The manager had not undertaken a full and proper investigation following concerns raised Following the investigation 3 of the allegations were upheld and 1 partially upheld. The partially upheld complaint was number 3 because inspectors felt that there was sufficient staff on duty but that they lacked the skills in dealing with the particular residents needs. There were 5 requirements and 1 recommendation made following the investigation. The manager has replied and put forward a plan to deal with the findings. Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21,25,26 There remains some radiators that require covering so that residents are protected against the risk of burns. The home is generally maintained in a clean and hygienic condition although there remain some recommendations that would further improve the environment. EVIDENCE: This standard was assessed with reference to a requirement from the previous inspection. This was for all radiators in the home to be covered so as to protect residents from the risk of burns. This has been completed to the extent that only the radiators in the lounge are now uncovered. There are two outstanding recommendations from the previous inspection. One is for the conversion of the present toilets near the day room to a single disabled facility and the second for the replacement of carpets in the lounge area. Both of these remain as they are associated with helping to control the occasional odour of urine that emanates principally from this area of the home
Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 Page 17 due to regular use of these toilets and the poor circulation of air. The manager reported the replacement of the carpets in the very near future. Generally the home is kept clean and hygienic however and there is a compliment of domestic staff to ensure this. Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29 Appropriate staffing numbers are maintained in the home so that care needs can be met. There is a staff-training programme ongoing which has nearly met the standard for 50 of care staff to be trained to NVQ level so that care is delivered safely and reference good practice. Residents are protected by the homes recruitment processes, which include appropriate checks for all staff. EVIDENCE: On the day of the inspection, which was unannounced, the home had 23 residents and was staffed accordingly with the manager and 4 care assistants. There was also ancillary staff working in the kitchen and for cleaning. The duty rota confirmed regular staffing numbers. There is 17 care staff in total and 6 of these currently have an NVQ qualification at level 2 or above. There are 6 other care staff that are soon to commence NVQ training. The requirement from the previous inspection for all staff to receive completed CRB [Criminal Records Bureau] checks as part of the recruitment was discussed with the manager. There has been no new staff employed at The Home since the previous inspection so staff files were not checked on this visit [seen previously]. The manager was able to report that all recruitment is now completed through the domiciliary care agency also managed by the same
Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 Page 19 provider. Completed CRB checks would be forwarded to Hope Cottage however if staff were recruited for the home. Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 The manager of the home has the experience and qualifications to ensure that Hope Cottage is run satisfactorily and that residents best interests are maintained. The quality systems in place ensure good monitoring and ongoing improvements take place so that resident care can be progressed. There are good health and safety systems operating so that residents and staff can feel secure in the home. EVIDENCE: Joan White is the Registered Manger. She has been in post for 3 years and holds an NVQ qualification in Management. She continues to update her skills and has more recently completed an update in medication. Joan displays a good understanding of the organisational structure and receives supervision
Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 Page 21 sessions from the Responsible Person and this will now include the new Area Manager. [The organisational structure was seen and identifies ‘Cedar Care Group’ as the company owning Hope Cottage but the home is registered currently under ‘Hope Cottage Ltd’. This possibly needs clarifying.] The home undergoes an external audit on a yearly basis in order to monitor and improve quality. The manager has her own objectives displayed in the office and these are linked to both the audit and CSCI inspections. There are regular QA meetings with key staff. Resident and relative feedback is canvassed on a 6 monthly basis and the comments seen were very positive in general. The results of the surveys are published. The manager as a follow interviewed one relative, who reported concerns, up. The various policies and procedures for the home are reviewed on a regular basis and staff reported that the manager communicates any change in policy on a regular basis. The policies seen were rather disorganised and not easy to find [for example the policy on the management of residents finances could not be found although the manager reported that one did exist]. A better indexing system was suggested. The management of resident’s finances was discussed and records were seen of petty cash and valuables kept in the safe. The home manages only 3 resident’s personal allowances. Health and Safety records are maintained. Policies and procedures as well as maintenance certificates such as Gas safety and Electrical safety were seen [Gas Safety cert was not signed or dated although manager reports it has been completed fairly recently]. Staff reported an understanding of their role in health and safety and some have completed updates in this area. Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 x X X X X X X 2 x STAFFING Standard No Score 27 3 28 2 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 Page 23 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 2 3 Standard OP9 OP9 OP16 Regulation 13(2) 13(2) 22 Requirement Timescale for action 06/01/06 3. OP25 13(4) The secondary dispensing of medication must cease immediately. Staff on night duty who have 01/03/06 not completed the necessary training must do so. All complaints and concerns 01/03/06 raised by service users must be investigated and responded to by the manager. All radiators in the home must 01/03/06 be covered to ensure safety from risk of burns to residents [last requirement date 1.12.05 not met]. 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 OP7 OP7 Good Practice Recommendations Some training around the homes model of care should help care staff to complete clear plans of care. The recommendations around the recording of evaluations
DS0000051273.V276556.R01.S.doc Version 5.1 Page 24 Hope Cottage 3 4 5 6 7 OP9 OP21 OP26 OP28 OP31 8. 9 10 OP33 OP35 OP38 of the care plan should be followed. The temperature of the room where medicines are stored should be monitored and maintained below 25 C. The creation of a single disabled toilet facility near the main day room should be considered. Carpets need replacing in the main day areas to remove any smell of urine. A minimum of 50 of care staff should be trained to NVQ level 2. The organisational structure was seen and identifies ‘Cedar Care Group’ as the company owning Hope Cottage but the home is registered currently under ‘Hope Cottage Ltd’. This needs clarifying. The policy and procedure files should be referenced for easy access. The policy relating to the management of residents finances needs to be easily located and referenced in the file. The Gas Safety certificate should be signed and dated. Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 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 Hope Cottage DS0000051273.V276556.R01.S.doc Version 5.1 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
