Inspection on 06/06/07 for Old Wall Cottage

This inspection was carried out on 6th June 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Old Wall Cottage 20/06/08

Old Wall Cottage 13/02/07

Old Wall Cottage 14/12/05

Old Wall Cottage 09/08/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Old Wall Cottage Old Reigate Road Betchworth Surrey RH3 7DR Lead Inspector Lesley Garrett Unannounced Inspection 6th June 2007 09:50 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 Old Wall Cottage DS0000064426.V343116.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. Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Wall Cottage Address Old Reigate Road Betchworth Surrey RH3 7DR 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) 01737 843029 01737 845223 oldwallcottage@ehguk.com European Healthcare Group plc Post vacant Care Home 43 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (20), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (32), Old age, not falling within any other category (6) Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th February 2007 Brief Description of the Service: Old Wall Cottage is a care home providing care and accommodation for fortythree older persons some of whom have dementia. The home is located in Betchworth Village near to Dorking Town. The home provides accommodation in twenty-four single and nine double rooms on one floor except for the three rooms in the attic. There is communal space available, including a well maintained garden to the rear of the property. Electronic gates leading to a car park in the front of the home also secures the home. Old Wall Cottage is now part of European Health Care Group Ltd. since May 2005. The fees for the rooms are between £525 and £800. Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 0950 and was in the service for 5 hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner and acting manager, and any information that CSCI has received about the service since the last inspection. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. We did not have the benefit of survey forms for this site visit as the home only received them in the post on the day of the visit and will therefore not be available for this report. What the service does well: What has improved since the last inspection? The home has appointed a new manager who has an understanding of the previous report and has already addressed some of the issues. A requirement was made in February 2007 for risk assessments to be in place for all service users who were subject to restraint with bed rails or bucket chairs and this has now been completed. Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 Page 6 The documentation for individual plans of care has been reviewed and all plans are in place with regular reviews with service user or relative involvement. The acting manager has also undertaken a review of the staffing numbers and the home is now staffed according to the assessed needs of the service users. A quality audit system is now in place and the views of the service users or their relatives have been sought and further audits concerning clinical issues are being developed. 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. Old Wall Cottage DS0000064426.V343116.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 Old Wall Cottage DS0000064426.V343116.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. All service users have a pre-admission assessment prior to moving into the home and this is incorporated into the care plan. The home does not provide intermediate care. EVIDENCE: The acting manager stated that he plans to review the current paper work for the pre-admission assessments. All service users are assessed prior to admission to the home and either himself or the deputy does these. We sampled three individual plans of care and found these assessments were in place and care plans were then based on this assessment. Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 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. 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. Service users have individual plans of care and they reflect the care and support that they require. Medication policies and procedures are in place and are used appropriately by staff to protect the service users and the privacy and dignity of the service users are respected. EVIDENCE: We sampled three individual plans of care and found that these were improved from the last site visit in February 2007. At the last visit two systems for documentation were in use but this has now been reviewed. The plans contain risk assessments for the use of bed rails and bucket chairs. The bucket chairs were discussed with the manager and he stated that as part of the refurbishment of the home the bucket chairs would be replaced with more appropriate seating. We also observed in the plans a checklist for the night staff to complete to demonstrate that any service user with any form of restraint is observed every hour. Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 Page 10 All the plans had been reviewed every month and there was evidence that the relatives or representatives had also signed to agree them. There was evidence this time that suitable fluids were available to service users and they were able to access them when sitting in the lounge or their bedroom. The home has the support of a local General Practitioner (G.P.) who will visit weekly and in between if necessary. The acting manager also stated that the home has links with the incontinence nurse and that the home has now trained some nurses at the home to do the incontinence assessments. The opticians and dentist are also regular visitors we were told. The home had the benefit of an inspection by the provider of all medications in the home. This was a detailed report, which we observed, with no concerns noted and therefore the system was not looked at in great detail during this site visit. The home still has some shared rooms but we observed curtains in place to provide privacy for personal care. We observed staff knocking on bedroom doors prior to entering and using service users preferred name. The inspector observed that in the individual plans of care the name that service users would prefer to be called was documented. Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a programme of activities, which could be further, developed to meet service users recreational needs and preferences. Contact is maintained with family and friends and service users are helped to exercise some choice over their lives. Service users receive a balanced diet. EVIDENCE: A recommendation was made during the site visit in February 2007 for the home to further develop the activity provision in the home to reflect the needs of the service users. The acting manager told us that this was an area that he wanted to develop and was looking at this fairly quickly. We observed that the home has developed a social activity care plan so any activity that service users take part in is now documented. A further recommendation will be made at the end of the report for the manager to look at activities within the home. The home had purchased a car and the acting manager told us that this had been used recently to take two service users to the pub for lunch. The acting manager told us that various religions are supported in the home with staff having a good understanding of these. One member of staff told us that a Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 Page 12 particular service user enjoys the bible being read to her and they know which is her favourite psalm. The acting manager stated that visitors are welcome at any time and on the day of the visit we observed relatives in the home. One family member told us that they were more than happy with the care their family member receives and had even noticed some improvement in their condition since admission. The acting manager said that no service user is able to handle their own money as a result of their needs. Choice is given where it is possible but for meal choices the manager stated that the staff would speak to relatives or friends to determine service users food preferences. The inspector observed that many of the bedrooms had been personalised and service users can bring in items of furniture from home. We observed the lunchtime meal being served and the service users who require assistance are served first. Staff were observed sitting with service users supporting them with their lunch. The environment is still poor and this will be mentioned later in the report. Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 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. 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. Service users and their relatives can be sure that any complaint will be taken seriously and acted upon, and are protected from abuse as staff had good knowledge of the safeguarding procedures. EVIDENCE: The acting manager told us that since the last site visit the home has received one complaint, which has been investigated, and the acting manager has spoken with them to resolve the issue satisfactorily. The complaints policy is available to all relatives and representatives and is displayed in reception. The acting manager has a good knowledge of the adult safeguarding procedures and has received training. Staff have also received training and this was demonstrated to us with the training plan for the home. During the last site visit in February 2007 staff demonstrated a good awareness of these procedures and informed that they had also received training. Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment for the service users to live in remains poor with no change to the environment since the last visit. EVIDENCE: Since the site visit in February 2007 there has been no improvement in the environment of the home. We have received regular feedback from the provider and the acting manager showed us the proposed plans for the home. The acting manager explained that this is a three year plan and the home is still waiting for the plans to be approved. Requirements made in February 2007 have been repeated but we are aware that a refurbishment programme is planned but service users are still living in a poor environment. The home does now benefit form a full time maintenance person who spoke with us and demonstrated a good knowledge of all the routine checks that must be made. Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 Page 15 There are many corridors in the home with steps leading to some bedrooms. There are no ramps available making movement around the home in wheelchairs difficult or when trying to move a hoist when necessary. This has not been resolved since the last site visit and the requirement has been repeated. The bathrooms still remain of poor quality but again the acting manger stated this would be resolved once the refurbishment plan was implemented. In the meantime service users do not have the use of well-equipped facilities that meet their assessed needs. The inspector observed that a large number of beds in the care home are the divan type. This has not changed since the last site visit. The service users at the home are increasingly frail and the acting manager should look at the provision of beds to ensure they meet the needs of the service users. Wallpaper in some bedrooms is peeling and carpets remain old and worn. Furniture in some of the bedrooms is not adequate and is also worn. Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 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 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 good. This judgement has been made using available evidence including a visit to this service. Service users needs are met by the number and skill mix of the staff that have all been trained. The home has good recruitment procedures. EVIDENCE: The acting manager told us that since he has been in post staffing numbers have been assessed and due to the needs of the service users they have maintained the numbers even though the home has some empty beds. He told us that the skill mix of the staff is looked at prior to completing the rotas. The acting manager told us that over 50 of the care staff have the National Vocational Qualification (NVQ) and this training is on going so all staff can participate. Three recruitment files were sampled by us and found that all the necessary checks are in place prior to any new staff joining the home. Following the last site visit in February 2007 the administrator started a review of all the employment folders and this work is now almost complete. The acting manager told us that the company now has a training manager who delivers some of the training for the home. A training plan was observed and we were told that mandatory training is either planned for the year or has Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 Page 17 taken place, this includes fire, manual handling, food hygiene and safeguarding adults. Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 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 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 good. This judgement has been made using available evidence including a visit to this service. The manager is appropriately qualified and fit to be in charge of the home and is run in the best interests of the service users. Service user’s financial interests are safeguarded, and the health and safety arrangements in the home have now improved which ensures that the health, safety and welfare of service users are promoted and protected. EVIDENCE: The acting manager has been on post for three months but for some of this time he has been away from the home and this was the reason the preinspection documentation (AQAA) was not returned to the commission in time for the site visit. The acting manager is fit to be in charge and has knowledge and experience in care homes. He told us that he works closely with his deputy and he was also present for most of this site visit. Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 Page 19 The acting manager told us that he has had the opportunity to look at the previous report and all areas of the report relating to nursing or care issues have now been addressed but the remaining requirements relate to the environment issues. The acting manager told us that he had recently completed a survey to seek the views of the service users and relatives but they had not been analysed yet as they had only recently been returned to him. We were told that regular relative meetings take place and minutes are kept of these and are available if anyone wishes to read them. The deputy stated that he will be developing an audit system to look at all aspects of care and clinical issues and will then devise an action plan. The manager told the inspector that no service user’s personal money accounts are kept at the home. The home now employs a full time maintenance person who showed us the regular checks that he makes in the home. Since the last site visit in February 2007 the central heating system has been serviced and the fire alarms are tested weekly. The manager also stated that all fire extinguishers had also been checked recently. The two rooms on the lower ground floor have now been closed and this area will be addressed during the refurbishment. The attic rooms are still in use and accessed by the chair lift. The deputy stated he would phone the service company to see if the parts are available for this piece of equipment in the event of a breakdown. The refurbishment plans include a shaft lift to service these rooms. The lighting throughout the home remains dull but again this is another area to be addressed during the proposed refurbishment. Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 Page 20 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 17 18 1 X X X X X X 1 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 3 X 3 Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP19 Regulation 23(2)(d) Requirement The registered persons must ensure that all parts of the care home are kept clean and reasonably decorated. There must be a programme for redecoration and replacement of carpets, curtains and furniture. Outstanding requirement from February 2007 not met by 28/05/07 but home has plans in place for refurbishment. The registered persons must ensure that rooms occupied by service users have adequate furniture, bedding, and other furnishings including curtains and floor coverings and equipment suitable to meet the needs of service users. Outstanding requirement from February 2007 not met by 28/05/07 but home has plans in place for refurbishment. The registered persons must ensure that suitable adaptations are made, regarding ramps in the home, for service users who are old and infirm or physically DS0000064426.V343116.R01.S.doc Timescale for action 06/09/07 2 OP22 16(2)(c) 06/09/07 3 OP22 23(2)(n) 06/09/07 Old Wall Cottage Version 5.2 Page 22 disabled in order to improve access and safety. Outstanding requirement from February 2007 not met by 28/03/07 but home has plans in place for refurbishment. 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 OP12 OP33 Good Practice Recommendations It is recommended that the home further develops the social contacts and activities in the home and that this is documented to reflect the needs of the service users. It is recommended that the home seek the views of all stakeholders in the home to improve their quality audit systems. Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Old Wall Cottage DS0000064426.V343116.R01.S.doc Version 5.2 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. 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