CARE HOMES FOR OLDER PEOPLE
Osborne Cottage York Avenue East Cowes Isle Of Wight PO32 6BD Lead Inspector
Neil Kingman Unannounced Inspection 6th October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 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. Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Osborne Cottage Address York Avenue East Cowes Isle Of Wight PO32 6BD 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) 01983 293523 01983 297631 lesley.todd@ic97.co.uk Islecare `97 Limited vacant Care Home 36 Category(ies) of Dementia - over 65 years of age (8), Learning registration, with number disability over 65 years of age (2), Old age, not of places falling within any other category (36), Physical disability (1), Physical disability over 65 years of age (9) Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26 April 2005 Brief Description of the Service: Osborne Cottage is a home providing care and accommodation for up to 36 older people. Ms Susan Linington manages the home on behalf of the proprietors Islecare 97Ltd. Ms Linington has only recently been appointed as the manager and has yet to undergo the registration process. The home is a large two storey Victorian property set in quite extensive grounds and situated on the outskirts of East Cowes. A regular bus service is available close to the home. The town of East Cowes with its shops and amenities is about a mile away. There is a range of mostly single rooms on both the ground and first floors, accessible to residents via a passenger lift. Substantial off-road parking is located off the driveway with a large turning area in front of the building. The home and gardens are accessible to wheelchair users. Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second of two inspections at Osborne Cottage and took place unannounced over 6 hours. The atmosphere although friendly and relaxed, was quite busy throughout the day with relatives and the chiropodist visiting and staff training in the afternoon. The inspector toured the building and looked at a selection of records. Two carers, eight residents and four visitors were spoken with and several questionnaires were sent in by residents and visitors. As at the last inspection comments about the service were positive with special mention being made of the consistently good food and the high standard of care given by staff. Core standards not assessed on this occasion had been assessed at the last inspection. What the service does well: What has improved since the last inspection? What they could do better:
Since the last inspection the home has experienced two management changes. Apart from some slippage in the programme of staff supervision, which is now back on track there was no evidence of any negative impact on the service. The new manager is still getting to know the staff, residents and the service in general, and is confident of being able to positively effect the future provision of service for the residents. The current lack of an activities co-ordinator is being addressed by way of advertisement. The home was found to be meeting the standards assessed, however, during the tour of the building the inspector identified a potential health and safety hazard in a rusted step on the outside fire escape. At the time of producing this report CSCI has received a timescale for this requirement to be addressed.
Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 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. Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 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 Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 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): 5 and 6 Osborne Cottage encourages and provides opportunities for prospective residents to visit the home and to move in on a trial basis, before they and/or their representatives make a decision to stay. Osborne Cottage does not provide dedicated accommodation for short-term intermediate care or specialised facilities for rehabilitation. EVIDENCE: Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 Page 9 Residents are routinely admitted to the home on a four-week trial basis and every effort is made to ensure that admissions are planned. The manager, although new to the home had been involved with the admission of a resident about three weeks before the inspection. The inspector looked at the process using this and one other recent admission as examples. It was clear from records that a pre-admission assessment had been carried out and a visit made to view the room available, meet staff and decide whether to move in. The inspector spoke with one of these residents who said that she chose Osborne Cottage initially because of its reputation in the community. Most residents at Osborne Cottage are long term. The home does not provide dedicated accommodation for short-term intermediate care or specialised facilities for rehabilitation. The home’s Statement of Purpose includes the provision of respite care, which is offered when accommodation is available. There was no evidence that the provision of this service has a negative impact on the resident group. Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 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): 10 The home ensures that staff respect residents’ privacy and dignity at all times and responds to issues as and when they are raised. EVIDENCE: The home provides written guidance for staff to ensure that residents’ privacy and dignity are respected at all times. It forms part of the induction programme for new care staff. During the tour of the building the inspector noted that staff knocked before entering residents’ rooms. Staff address residents by their preferred name. One resident told the inspector that due to several residents in the home having the same first name she preferred staff to address her by another name. This arrangement was recorded in her care plan and taken up by the staff. A pay phone is available to all residents together with a portable phone for ease of use. Some residents have their own installations in their rooms. The manager said that residents had raised the issue at a recent residents’ meeting that the pay phone was too public for them to have a private conversation. Minutes of the meeting confirmed the matter had been raised and would be
Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 Page 11 resolved. One resident with a hearing impairment mentioned the lack of privacy with the phone to the inspector but was very clear that staff always treated residents with dignity and respect. The manager said that steps would be taken to move the phone to a quieter area, which afforded more privacy. Medical examinations are generally undertaken in service users’ own rooms. However, there is a room used as a library which can be made private should the need arise. At the time of the inspection there were no rooms shared. Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 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 and 13 Residents are encouraged to maintain their independence with flexible routines within the home. While once there was a range of activities provided for residents throughout the week, the recent departure of the activities coordinator has limited the activities now on offer. Visitors are welcome at all reasonable times and are able to meet with residents in private. EVIDENCE: The inspector spent the lunchtime with three residents who said that within the constraints of group living routines for them were fairly flexible. They could rise and retire when they wished and generally do whatever they liked in the home. Mealtimes are unhurried affairs and there is no pressure on residents to keep to rigid times in the dining room. Some residents can take breakfast on a tray in their room if they wish. All but one of those spoken with felt mealtimes were quite convenient for them. Details of therapeutic activities and trips for residents are included in the home’s Statement of Purpose and up to date information on activities is published on the residents’ notice board. However, the manager said, and residents confirmed that activities were neither regular nor structured since the dedicated activities coordinator left.
Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 Page 13 The manager confirmed that she was currently advertising for a new coordinator and was confident the full range of activities would soon be available. The residents’ spiritual needs are met by the home on request. There is a monthly visit from a lay preacher; communion for those who wish to take it and the home could arrange transport for those who may wish to attend a church service. Residents’ family, relatives and friends are encouraged to visit regularly and maintain contact by letter or telephone. Visiting arrangements can be found in the Service Users Guide. Visitors are welcome at all reasonable times but the home asks them to respect meal times. Residents can receive visitors in their own rooms, or any of the communal areas. There is a library room, which is quiet, and can be used to receive visitors in private. The inspector had an opportunity to speak with two visitors during the inspection. They were full of praise for the staff and the service provided. They knew who to speak with if they had a concern or needed any information. Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 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): 18 The home has a one-page adult protection summary guidance conspicuously displayed for staff, to ensure responses to suspicion or evidence of abuse are robust. The Company’s policy and procedure is under review and not currently being used. EVIDENCE: The inspector has looked at Islecare’s adult abuse policy and procedure, updated in June 2005. It was noted that the policy did not adequately reflect the Social Services role as the lead agency in adult protection. A representative of the Company has withdrawn the policy and staff rely on the one page summary guidance that is conspicuously displayed in the office. Care staff are fully aware of local reporting procedures and confident about reporting issues of concern without delay. Issues arising in the home since the last inspection have demonstrated the robustness of the home’s procedures. Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 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): 20 and 21 The home’s communal areas are comfortable and spacious. Outdoor space is accessible to those in wheelchairs. Toilet, washing and bathing facilities are provided in sufficient numbers to meet the needs of the residents. EVIDENCE: Communal space includes two dining rooms, a private room used as a library, a hair salon and three lounges. Collectively these areas provide for communal space, which exceeds the National Minimum Standard for Older People. Furnishings in communal rooms were seen to be domestic in character and of reasonable quality. Residents in the extra care unit are able to go into the garden in safety. The home provides four assisted bathrooms, one shower room and three ensuite facilities equipped with showers. Additionally there are two further bathrooms, which are available but not used by service users. Toilets are
Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 Page 16 provided in sufficient numbers to meet the National Minimum Standards, five of which are located in close proximity to the communal dining and lounge areas. Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 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): 28 and 30 Staff at Osborne Cottage have the necessary skills and experience to meet residents’ needs and ensure they are in safe hands. EVIDENCE: At the time of the inspection 42 of care staff had achieved the NVQ at level 2. The home is taking steps to meet the minimum standard of 50 through ongoing training and assessment. Currently four staff are undertaking the training and five more are scheduled to start the training. The new manager confirmed that she is a qualified NVQ assessor and was confident of being able to progress the training to meet the standard. Five members of staff have achieved the NVQ at level 3. The staff training standard was assessed at the last inspection and a recommendation made for more dementia awareness training for staff. The staff-training matrix showed, and staff confirmed that additional dementia awareness training had been provided during the month of July. Additionally, those spoken with said the training was very instructive and worthwhile, providing a valuable insight into the needs of the residents in the extra care unit. Since the last inspection staff have received training in infection control and B/Tech medication. Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 36 The manager is new to the home and has yet to undergo the process for registration. Staff are appropriately supervised. EVIDENCE: The manager Ms Linington has only been in post for three weeks. She replaced a temporary manager who stood in for three months following the departure of the previous long-standing manager. Ms Linington has achieved the Registered Managers Award and has almost qualified for the NVQ at level 4 in care. She has several years experience as a deputy manager of a home for older people. The manager and staff said that documented formal staff supervision takes place, covering work practice, philosophy of care and development needs.
Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 Page 19 Informal supervision of staff takes place on a daily basis by the manager and senior staff as part of the ongoing management process. Currently there are no volunteers working at Osborne Cottage. The manager said that with the recent lack of a permanent manager the programme of formal staff supervision had faltered but was now re-established. The inspector saw evidence of the recent documented supervision. The standard relating to health and safety in the home was assessed at the last inspection. However, during the tour of the building the inspector noted the paintwork on the outside fire escape was in such a poor state that one step had rusted through, causing a potential health and safety hazard if the fire escape were to used in an emergency. Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 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 x x 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 x 4 3 x x x x x STAFFING Standard No Score 27 x 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x x 3 x 2 Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 Page 21 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. 1 Standard OP38 Regulation 13(4) 23(2)(4) Requirement To provide an adequate means of escape (repair and make good the fire escape stairs) Timescale for action 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Osborne Cottage DS0000012519.V249008.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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