Inspection on 18/12/07 for Rose Cottage Residential Home

This inspection was carried out on 18th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Rose Cottage Residential Home 28/09/06

Rose Cottage Residential Home 17/02/06

Rose Cottage Residential Home 05/10/05

Rose Cottage Residential Home 24/08/04

Rose Cottage Residential Home 06/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Rose Cottage Residential Home School Road Broughton Cambridgeshire PE28 3AT Lead Inspector Dragan Cvejic Unannounced Inspection 18th December 2007 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 Rose Cottage Residential Home DS0000015105.V356770.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. Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rose Cottage Residential Home Address School Road Broughton Cambridgeshire PE28 3AT 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) 01487 822550 01487 824783 john@tillisch.co.uk www.rosecottagecare.com John Tillisch Limited Josephine Mary Brown Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th September 2006 Brief Description of the Service: Rose Cottage offers accommodation, care, and support to up to 38 older people. All rooms are for single occupancy and are on the ground floor; 35 of the rooms have en-suite facilities, one is used for respite or short-term care. Residents have access to a range of communal areas including four lounges and a small kitchenette, which has been equipped for residents and relatives to make drinks and snacks. The home is located in the middle of the village of Broughton, which has a church and popular public house. The village is situated about four miles from Huntingdon, and a two-minute drive from the small town of Warboys. The home is also within easy reach of the facilities offered by Peterborough, Cambridge, and St. Ives. The building surrounds an attractive courtyard; to the front, a patio area has been built around a mature pond and there is a level path around the perimeter of the building. The home has a parking area to the front with wellmaintained borders, trees and shrubs. The building backs onto open countryside and many of the rooms have pleasant views of the surrounding meadows. A domestic cat lives in the home and is loved by service users. The fees were in range £438 to £610 (for one only) per week. Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the service. The surprise visit by an inspector and by an expert by experience was carried out during the morning hours and included lunchtime as well. During the visit 4 service users, 3 staff, the manager and the owner spoke to the inspector, while the expert by experience spoke to service users and observed processes in the home. Three service users’ files, three staff files and some other documents were inspected, such as medication and money records, training records and information provided about the home. The home had sent in their self-assessment, AQAA, which is used for this report. We conducted a survey through questionnaires and received 9 service users, 5 staff and 7 relatives comments. This information was analysed and the findings also informed this inspection. Some quotes were used from the questionnaires. What the service does well: What has improved since the last inspection? Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 Page 6 A deputy manager started doing initial assessments with the manager, as a part of the personal development programme. In reference to improvements the AQAA stated: “Care planning review is carried out on a systematic basis; we have added to the number of specialist nursing beds with pressure relieving matresses to provide comfort and relief to people who need extended periods of rest. New hoisting equipment to assist some residents who have impaired motor ability. Ability to have flexible staffing in time of increased dependency amongst our client group.” The home made significant changes in the environment. The AQAA stated and explained, and the site visit confirmed: “We have invested £350,0000 in last 12 months in upgrading many of our rooms to have en-suites and building new larger rooms with en-suites. We have reduced the number of rooms without en-suites from 13 to 3 and increased the number of rooms with ensuite showers from 5 to 15. We have also created a new staff room. We have invested in a new laundry process using a proprietory system called Otex which is effective in dealing with MRSA and other known bugs; As a result of feedback from the 2007 survey, we have invested in a new clothes labelling device which allows us to generate clothes labels in-house and improve the speed at which clothes can be labelled”. 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. Rose Cottage Residential Home DS0000015105.V356770.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 Rose Cottage Residential Home DS0000015105.V356770.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): 1,3,4, Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service was highly efficient in obtaining a summary of any assessment undertaken through the care management arrangements and insisted on receiving a copy of the care plan. The outcomes for service users were excellent. EVIDENCE: The home updated their statement of purpose and service users guide and provided accurate information about the service and provisions. These documents were available in large print and were made available to existing users in their rooms. The initial assessment process was improved and the home started introducing it in personal development for the deputy manager and planned to extend it to senior carers, too. Two service users, a husband and wife, explained how they chose this home and concluded: “I have been to other homes too, but this is by far the best.” Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 Page 9 The manager explained an emergency admission, when a user was discharged from hospital with no package at all, but the management of the home obtained all information within 3 days and this user settled in very well, although her status was still respite care, thus giving her an opportunity to decide if she wanted to become a permanent user. Service users’ files checked confirmed through records that all assessed needs were met. Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The care plan was devised in consultation with service users, devised in detail, thus ensuring users needs were met in the way they preferred and above minimum standards. EVIDENCE: Three service users’ files were inspected and showed that care plans were devised from the initial assessments. Care plans were detailed and covered not only the assessed needs, but gave instructions to staff on how to meet these needs with respect of service users wishes and preferences. Dependency profiles, a part of the file clearly indicated users abilities. Records of bath, shower, bed change and body-wash indicated that users were receiving assessed care according to plan-for example, as one plan indicated every second day, records confirmed that it was indeed done every second day. Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 Page 11 Another file indicated the need to monitor a user’s weight. A nutritional chart was introduced into the file, as well as regular reviews of progress, rigorously observed and monthly. Health care needs were ensured and a relative provided a comment confirming excellent outcomes: “If a resident has an accident, the relative is notified immediately so you have a chance to be there when the paramedics come.” Another relative commented that a bed bound user had not developed a bedsore despite having been bed ridden for 4 years. Plan of chiropody visits was displayed in the office, on the board, ensuring regular monitoring of these visits. The home carried out a survey and found that: “. 82 of people surveyed said they were either saitsified or very satisfied with personal care delivered and 87 were either satisfied or very satisfied with their health care.” The manager was observed administering medication and the medication records for four users and procedure was inspected. Records were accurate, medication, including controlled drugs, was safely stored. Only the manager, a deputy and two senior staff were dealing with medication, thus reducing the risk of mistakes. Service users that were selfmedicating, had updated risk assessments in their files, as seen in two inspected files. In addition, three service users stated that they were happy with medication procedure in the home. The aspects of medication process exceeded minimum standards. Privacy and dignity were fully respected as confirmed by all three service users spoken to. An extra staff member was engaged to sit with a user in palliative care, showing respect, sympathy and understanding of this specific type of care. Some staff stated that they wanted to join training to ensure that more staff would be in the position to offer this type of care. Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 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. 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 home considered activities to be as important as healthcare, thus showing respect for users abilities and preferences, ensuring they led as fulfilled a life as possible, and promoting independence, choice and autonomy. EVIDENCE: The AQAA explained and provided evidence for this group of standards, confirmed by users spoken to, by a visitor and by records in users files: “Have an activity programme led by activities organiser which is varied and also encourages family involvement. We have a number of regular events and publish a calendar of social events 3 months in advance so that residents and families can arrange to participate. The village holds a monthly whist drive at the home in which several residents participate. We also employ a counsellor whose focus is to spend one-to-one time each week with anyone who wishes to see her. She runs a weekly trolley shop visiting residents and booking time to see them. She runs a monthly family support group to which families can come and discuss confidentially matters of concern about the mental well being of their relative. We offer a well balanced diet and a varied menu, which reflects Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 Page 13 choice. We have our diabetic clients under control as indicated by recorded blood sugar levels.” The home had recently engaged a volunteer co-ordinator, to further improve activities, especially group activities for users with similar needs, ranging from the fully capable to these with the first signs of dementia, or those with cognitive impairments. The outcome comments in users’ surveys related to food showed that users were thinking how to improve this area, not that food was not to their satisfaction, but demonstrating that most outcomes were so positive that individuals could concentrate on improvements rather that putting things right. The menu showed that 25 users required a cooked breakfast. The home realised that serving chosen food was not the end of choice for service users and were considering how to further improve choice by putting extra plates with vegetables on each table. The expert by experience stated in his report: “The cook said that plenty of fresh fruit was available. She said that the fruit in bowls was not well used and agreed that fresh ‘finger’ fruit on a platter was “worth considering”. This showed again that the home initiated improvements themselves, rather than relying on the inspection to show them a way forward. This area was, again, well beyond minimum standards. Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 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. 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 were fully protected by the existing complaints procedure and protection measures that were in place. EVIDENCE: The complaints procedure was displayed in the entrance to the home. It was also in the service user’s guide, in each individual user’s bedroom. The home had received two complaints that were investigated and the outcomes satisfied complainants. Users felt safe and protected. A service user spoken to stated: “I would not tolerate it if I see any service user being abused. I would report it straight away.” This comment showed that not only staff, but also users themselves were fully aware of protection issues. The home also valued protection issues very highly. All staff attended POVAProtection of Vulnerable Adults-two day training, while the home engaged the agency to cover shifts during these two days. Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pleasant and homely environment was appreciated by service users and ensured better conditions for appropriate care and better protection of service users and staff. EVIDENCE: The owner and the management ensured that environmental standards were high and listened and acted upon service users’ comments to provide a comfortable, pleasant and homely environment. The tour of the home showed that the home was clean, free from offensive odours, bright and well maintained. In their self assessment, the home stated: “We have invested £350,0000 in last 12 months in upgrading many of our rooms to have en-suite facilities and Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 Page 16 building new larger rooms with en-suite. We have reduced the number of rooms without en-suite from 13 to 3 and increased the number of rooms with en-suite showers from 5 to 15. We have also created a new staff room. We have invested in a new laundry process using a proprietory system called Otex which is effective in dealing with MRSA and other known bugs; As a result of feedback from the 2007 survey, we have invested in a new clothes labelling device which allows us to generate clothes labels in-house and improve the speed at which clothes can be labelled”. All responses in questionnaires about the environment were positive and showed satisfaction with the environment. Even the plan presented in AQAA demonstrated how determined the home was to provide excellent service to the users: “We are going to create a private dining area, so that residents and their families can dine together. We plan to print off and issue clothes labels to send out to new residents (permanent or respite) before they move in so that clothes can be quickly identified from the outset of their stay; we will begin to mark out parking bays in the car park.” The laundry room was inspected during the site visit and infection control measures were in place, protecting service users, staff and visitors. Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff were an asset to the home and ensured that their skills and knowledge were relevant to the service users’ group and that individual assessed need were met. Meeting these needs was regularly monitored and feedback sought from service users. EVIDENCE: Three staff files were inspected and contained all relevant proofs that ensured better protection of service users. The flexible staff rota that was designed according to the users’ needs ensured a good standard of care. Nine service users commented through questionnaires on the quality of staff and their skills- staff listened when they were spoken to by users and were available when called. Relatives were also complimentary of staff. One of them stated: “They do an excellent job”. One relative compared staff in the home with staff from the other care homes where her mother was prior to admission: “In Rose Cottage you feel that the level of competence is above the other homes in the district.” The home exceeded the minimum required level of 50 of NVQ trained staff. A new staff handbook and induction also improved the staffing skills. Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 Page 18 A visitor commented: “Staff are always with service users. They are well trained.” Staff training also exceeded minimum mandatory training and included Dementia training and Palliative care training. Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The well managed home ensured protection of service users through an open and constructive atmosphere, through safe working practices, through their quality assurance review and an excellent day-to-day organisation of the work that meant excellent outcomes for service users. EVIDENCE: In their self assessment the home presented their attitude to standards: “Dayto-day operations are well managed between the Registered Manager,the deputy manager, the administrator and the registered provider; the ethos of the home is to encourage warmth and openess with residents and staff; we Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 Page 20 pay particularly strong attention to quality assurance, both in the personal attention paid to detail by the owner, as well as by soliciting feedback from regular meetings of residents and relatives, the annual Laing and Buisson customer satisfaction survey, as well as from feedback received directly from residents and/or their family; there is good financial management of the home with an up-to-date business plan and forecasting models; accurate and up-todate records are kept of service users money when held on their behalf. We keep accurate and up-to-date records of staff and residents. We support the staff group by running an employee assistance programme which benefits all staff who need counselling support. We hold regular staff meetings to discuss matters of mutual interest.” During the site visit, certificates of insurance and registration were displayed, as well as results from the quality assurance review. The staff supervision records displayed on the wall showed regularity. The staff member spoken to confirmed that she was “very well supported” in her role. Records of helping service users with their finances were checked for 3 users. Two users spoken to confirmed that they controlled their finances independently. A visitor stated that the home was helping his mother with money and he was shown all records and receipts regularly, thus ensuring financial protection. The expert by experience stated in his conclusion: “My overview in 1. is in itself a conclusion. For it’s carefully selected residents and price structure one would expect a good performance. In fact the performance is extremely good; I’m happy with the word excellent. Whilst I have indicated a few areas for improvement, overall the management of the home seems to nicely combine personal caring with impressive efficiency and a willingness to listen and develop.” Safe working practices were in place. The home was inspected by Environmental Health and by the Fire service; their reports showed that there were no gaps in safety systems. Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 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 4 4 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 4 10 4 11 4 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 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 X 3 3 X 3 Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 Page 22 No 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. 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. Refer to Standard Good Practice Recommendations Rose Cottage Residential Home DS0000015105.V356770.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. 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