Inspection on 20/06/06 for Hoylake Cottage Hospital

This inspection was carried out on 20th June 2006.

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

The inspector 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

Hoylake Cottage Hospital 11/07/07

Hoylake Cottage Hospital 14/12/05

Hoylake Cottage Hospital 23/05/05

Hoylake Cottage Hospital 05/01/05

Hoylake Cottage Hospital 24/08/04

Hoylake Cottage Hospital 23/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hoylake Cottage Hospital Birkenhead Road Hoylake Wirral CH47 5AG Lead Inspector Jeanette Fielding Key Unannounced Inspection 20th June 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 Hoylake Cottage Hospital DS0000020909.V290048.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. Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hoylake Cottage Hospital Address Birkenhead Road Hoylake Wirral CH47 5AG 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) 0151 632 3381 0151 632 4544 Hoylake Cottage Hospital Trust Limited Maureen Patricia Keymer Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Four named persons under the age of 65 years Date of last inspection 14th December 2005 Brief Description of the Service: Hoylake Cottage Hospital is a nursing home for elderly people set within the Cottage Hospital environment. It is registered to provide nursing care to forty elderly people. The home is located on the main thoroughfare through Hoylake and is fully accessible by public transport. The building is a former hospital that has had some internal modifications to enable it to operate as a nursing home. Twenty-eight of the bedrooms are for single occupancy with six double rooms being available. Plans have been prepared to replace this home with a purpose built, modern building, to provide a high quality facility for the care of elderly people. The building of the new premises is due to commence in autumn 2006. Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit was undertaken as part of the key inspection and was completed in one day over a period of eight hours starting at 9:30 am. Time was spent sitting and talking with service users and observing the dayto-day routines of the home and care staff as they provided support. The inspector looked around the building to assess its suitability to provide a comfortable, homely environment for the enjoyment of all service users and to ensure their safety. A selection of records that are kept were looked at and the inspector also checked that the requirements made at the last inspection had been completed. The main focus of the inspection process was to understand how the home was meeting the needs of the service users and how well staff were themselves supported by the organisation to make sure they had the skills, training and support to meet the needs of the residents. Time was spent speaking with service users, staff and managers to obtain their views of the home and to gather greater insight into how the home was achieving their aims and objectives. What the service does well: What has improved since the last inspection? What they could do better: The inclusion of additional information in care plans would benefit the staff in the provision of care. Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 Page 6 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. Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 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 Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 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 the following standard(s): 1, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sound systems in place to ensure prospective service users care needs are identified and that the service can be confident that their care needs can be satisfactorily met. Intermediate care is not provided in this service. EVIDENCE: The Statement of Purpose and Service User Guide are regularly reviewed and updated to reflect the changes within the home. These documents are informative and give all necessary information regarding the service offered by the home. Copies of these documents are held in the home and are available on request. Inspection of the care files of those service users recently admitted to the home for long term care, provide evidence that pre admission assessments Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 Page 9 have been undertaken. These assessments are made by the care manager or one of the qualified nurses. The format used for the assessments has improved to allow for additional information to be recorded. These assessments provide sufficient information for the initial plan of care to be prepared. Service users who are admitted for respite care are assessed prior to their initial stay at the home. Many of the respite service users are accommodated at the home on a regular, and often frequent basis. The records of previous stays at the home are held and discussion takes place with the service user and their carers prior to admission to identify with any changes in their care needs since the previous stay. The relative of one service user recently admitted for respite care has provided the home with comprehensive written details of the service users needs and preferences. This has proved extremely helpful to the staff and enables that the service users care, social and emotional needs to be met to promote continuity of care. Hoylake Cottage Hospital DS0000020909.V290048.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, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements in the care planning process and management of care ensures that service users are protected and that information on care needs is given to all staff. The health needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. EVIDENCE: Individual care plans are prepared for each service user. These care plans have recently been reviewed and the format used has been changed to ensure that the service users specific care needs are identified. The new format clearly identifies all risks to enable individual risk assessments to be made. Risk management plans are then set in place to reduce or remove any potential risk to the service user. Records are held of discussions with the service user and their representatives to provide evidence of their agreement to the care plans and of where changes to plans have been made. The home has an effective system to ensure that each care plan is reviewed and updated Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 Page 11 monthly and arranges additional reviews when changes take place. The care plan is used as a working tool and is understood by all staff. It is written in clear language and can be used in an emergency by people who are not familiar with its content i.e. when agency staff work in the home. More information is now recorded in the daily reports completed by the staff. These reports provide evidence of the actual care given to further demonstrate that the service users care needs are being met. Some additional information is necessary to ensure that specific nursing care needs are being met in relation to one service user. No record is held of a minor medical condition or of where a prescribed cream is to be applied or of the frequency of that application. No information regarding this is held on the plan of care. Records are held of visits made to service users by other health care professionals and the care plans reflect the recommended changes in care and treatment by these professionals i.e. dietician, tissue viability nurse, speech and language therapist and doctors. One risk assessment is required in respect of the use of bed rails where an overlay pressure relieving mattress is used. The home operates to a well developed and efficient medication policy, procedure and practice guidance. Staff all have access to the written information and understand their role and responsibilities. All medications inspected were found to be ordered, stored, administered, recorded and disposed of in accordance with good practice. The acting manager is currently developing a protocol for those service users who wish to administer their own medications within a risk management plan. Service users are accommodated in single or double bedrooms. Screens are provided in shared rooms to protect the privacy and dignity of service users. Staff were observed to speak to service users discreetly regarding personal issues. Service users spoken to during the inspection said that their care was excellent and the staff so friendly and helpful. One service user who had reached a milestone birthday said that the staff gave her a wonderful day with a party attended by a local celebrity. One service user said that they had come to this home because their spouse had been given such good care when they were in the home. Hoylake Cottage Hospital DS0000020909.V290048.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): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The range and number of activities within the home is good, providing service users with stimulation and social interaction. Service users rights to follow and practice their religious beliefs are acknowledged and well promoted. EVIDENCE: A high number of activities are provided for the service users. An activities coordinator is employed to provide stimulation and records are held regarding each service users involvement with the activities. Service users spoken to said that there was always something that they could do during the day from chatting on a range of subjects to games or joining in with the lunch club. Ministers of religion visit the home on a regular basis and provide services for service users in small groups or on an individual basis as requested. The home has details of ministers of other religions who can be contacted to meet service users specific needs as necessary. Visitors are welcome at the home at any time and can meet with the service user in their bedroom or in one of the communal areas. Some family members Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 Page 13 have requested to be part of the care provision and visit the home on a regular basis to assist their relative with meals. Visitors spoken to at the time of the inspection spoke highly of the staff and the care they gave. One relative said ‘there is no way I could care for my relative at home but I can still be part of the care here’. One service user attends a day centre and some service users are taken out on a regular basis by their relatives or friends. Service users take their meal in the dining areas or in their bedroom as they choose. A selection of meals is available at each meal time and inspection of the menus provides evidence that a varied and balanced diet is offered and that meals are attractively served and presented. Special diets can be provided either on request or on the advice of GP or dietician. The kitchen area was clean and well stocked. All foods are stored appropriately and the cooks are qualified and experienced. The home provides the catering staff with the necessary equipment and all was seen to be in good condition. One service user spoke of the lunch club that has been established within the home. This club is used by the majority of service users in rotation to give them the opportunity to take their meals away from the main dining room and to meet with service users from areas of the home that they would not normally socialise with on a daily basis. The service user said that they enjoyed these events and that the change of environment was refreshing. Hoylake Cottage Hospital DS0000020909.V290048.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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have a good understanding of adult protection issues that helps protect service users from potential harm or abuse. EVIDENCE: The home has a comprehensive complaints procedure which is regularly reviewed and updated. Information on how to complain is detailed in the Statement of Purpose, the Service User Guide and is displayed on the notice board within the home. Three complaints have been received by the home since the last inspection. All were found to have been investigated thoroughly and appropriate action taken to resolve the issues to the satisfaction of the complainants. Full records of the investigation process and the action taken by the home are held. No complaints have been received by CSCI in respect of this service. Training has been given to staff on all aspects of adult protection and staff spoken to were aware of the whistle blowing policy. The care manager, and the staff spoken to were able to demonstrate their knowledge of adult protection protocols and of their own role within this. Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 Page 15 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): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff strive to provide a pleasant environment for service users to provide them with an attractive and homely place to live. EVIDENCE: All bedrooms and communal areas are located on the ground floor of the building and are fully accessible. The home provides 28 single bedrooms and six double rooms. Six rooms are provided with en-suite facilities. The home is on one level to provide full access to those service users who require to use a wheelchair or have mobility difficulties. The washing and toilet facilities in some areas remain unsatisfactory. Some bedrooms do not have a washbasin and so service user are required to wash in bathrooms. This issue will be addressed by the provision of the new home. Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 Page 16 Discussion is currently taking place between the home and CSCI regarding the home to ensure that service users continue to be accommodated in the most positive way during the forthcoming building work. It is expected that some of the building work will impact on the facilities provided for service users and so work is taking place to ensure that any impact is not detrimental and is kept to a minimum. The home comprises an older building which has been adapted over the years to provide service users with the best possible environment under the circumstances. Former wards within the building have been transformed to provide single bedrooms although the walls of these rooms do not reach the ceiling which prevents total privacy as conversations can be heard outside of these rooms. Staff were seen to speak discreetly to service users in these rooms as they are aware that voices can be overheard if conversations are conducted loudly. The domestic staff work hard to maintain a clean environment and all areas were found to be clean at this unannounced inspection with the exception of one carpet. This carpet is located along the corridor by rooms 6-9 and is stained and worn. The acting manager said that she is arranging for a commercial carpet cleaning machine to be hired to clean the carpet. In the event of the stains not being removed by cleaning then it will be necessary to replace the carpet. Staff and relatives have ensured that service users bedrooms are personalised to reflect the tastes, preferences and lifestyle of the service users. Rooms are decorated and furnished to a good standard. Two WC’s were out of order on the day of the inspection and arrangements had been made for these to be repaired. Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected through a robust recruitment procedure and the provision of a well trained staff team. EVIDENCE: The home employs qualified nurses who are supported by care staff at all times. In the morning, two qualified nurses are supported by eight care staff, two qualified nurses with six care staff later in the day and one qualified nurse with five care staff at night. The hours worked by the acting manager and deputy manager/care manager, are supernumerary. The home has a robust recruitment procedure and the staff files inspected provided evidence that all checks are made on staff prior to them commencing work at the home. Staff records were found to be in order. A programme of recruitment has currently taken place and the home now has a full complement of staff. All new staff are required to follow a set induction training programme. The home is committed to ensuring that staff training continues. Records are held of all training undertaken by staff and a list of forthcoming training opportunities was displayed. Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 Page 18 Recent training by staff includes Fire Safety, Food Hygiene, First Aid, Protection of Vulnerable Adults, Manual Handling and Customer Care. All staff are required to complete a comprehensive induction training programme prior to commencing work at the home on a permanent basis. Planned training includes Protection of Vulnerable Adults, Syringe Driver training, Health and Safety, Venepuncture and NVQ training. Specialist training is given to nurses to ensure that they can meet service users specific care needs where necessary. The home now employs 77 of staff who have attained NVQ qualifications and additional staff are currently working towards this. Volunteers work in the home, mainly on reception duties. These volunteers have been vetted in line with the homes recruitment policy and procedure. Within the service there is evidence of a good awareness and understanding of equalities and diversity. Discussion with staff showed that they are able to translate understanding into positive outcomes for residents in the areas of age, sexuality, gender, disability and belief. Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The acting manager has a clear development plan and vision for the home. Planning is in place and wet out how this improvement was going to be resourced and managed. EVIDENCE: A new manager has been appointed to the home as the previous manager retired. The acting manager has applied to CSCI to be registered and this application is being processed. She is a qualified nurse who has considerable experience in the management of care of elderly people. Some changes have been made to the systems and procedures within the home and these have proved to be beneficial. The acting manager is currently Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 Page 20 reviewing the policies and procedures to ensure they are up to date and contain all information in line with changes in legislation and good practice. A programme of review and audits has been prepared and these are now the responsibility of designated staff to further ensure that the home runs efficiently and protects both service users and staff. Staff spoken to during the inspection said that the manger was efficient and had an open door policy. They said they felt comfortable in approaching her at any time. The home also employs a care manager who deals with all matters relating to the care of the service users and is also responsible for the supervision of staff. The home does not deal with service users finances but will hold small amounts of money for service users at their request for convenience of access and security. Full records are kept of all monies held on service users behalf and these records are accessible to service users or their representative as appropriate, at all times. Record keeping within the home has improved. Safety certificates inspected were found to be in place and up to date. Records are held of tests made on fire detection equipment and hot water temperatures to ensure the protection of both staff and service users. Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 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 OP7 Good Practice Recommendations The care plans would benefit from the inclusion of additional information. Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Hoylake Cottage Hospital DS0000020909.V290048.R01.S.doc Version 5.1 Page 24 - 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. 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