Inspection on 26/07/05 for Sable Cottage Nursing Home

This inspection was carried out on 26th July 2005.

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

Sable Cottage Nursing Home 13/11/06

Sable Cottage Nursing Home 20/12/05

Sable Cottage Nursing Home 11/01/05

Sable Cottage Nursing Home 23/06/04

Sable Cottage Nursing Home 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 Sable Cottage Chester Road Kelsall Cheshire CW6 0RZ Lead Inspector Gill Matthewson Announced 26 July 2005 09:30 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 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. Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Sable Cottage Nursing Home Address Chester road Kelsall Chester CW6 0RZ 01829 752080 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Celia Ann Minshaw Mrs Julie Cummings Care Home 38 Category(ies) of Dementia - over 65 years of age (15) registration, with number Old age, not falling within any other category of places (23) Dementia (2) Physical disability (1) Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 This home is registered for a maximum of 38 service users including:* Up to 23 service users in the OP category (old age not falling within any other category) * Within the 23 OP beds up to 1 agreed service user in the PD category (physical disability under 65 years of age) may be accommodated * Up to 15 service users in the DE(E) category (old age with dementia) *Within the 15 DE(E) beds up to 2 service users in the DE category (dementia under 65 years of age) may be accommodated 2 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Date of last inspection 11/01/05 Brief Description of the Service: Sable Cottage is a care home providing both nursing care for 23 older people and personal care for 15 people with dementia (Rainbow Unit), two of whom may be under 65 years of ageThe home is located in a quiet residential area in the village of Kelsall, which is eight miles from Chester. Local amenities such as shops, churches, pubs and restaurants can be found within a short distance of the care home. It is served by local transport. The care home has a pleasant and well laid out garden to the side of the building, which is accessible from the dining room. There is car parking to the rear of the care home.The premises are purpose built and comprise three floors. Nursing care is provided on the two lower floors and a separate unit on the top floor is provided for people with dementia. The care home provides a number of communal living areas. Sable Cottage nursing care unit provides 19 single en suite rooms, plus one double with adjoining bathroom and two double rooms with en suite. The Rainbow Unit provides 15 rooms, all having en suite facilities. A passenger lift and staircases provide access to all levels. Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The lead inspector spent two hours planning the inspection by reviewing previous inspection reports and the service history over the last twelve months. The inspection took place over six hours and included a tour of the building, inspection of records and discussion with three residents and seven staff. Comment cards were received from twenty four residents, ten relatives, two social workers and one GP. All, apart from one relative, were positive about the home. One resident said ‘Overall, I am very satisfied with the facilities provided here.’ Another said ‘Some of the staff are excellent. I get on well with them.’ A relative said ‘The family have the greatest admiration for the help given to all the residents.’ Feedback was given to the registered provider and management team immediately following the inspection. What the service does well: The home has a strong management team who are well motivated and strive to achieve continuous improvement for the home. There is an excellent quality assurance programme in place, which takes into account the views of residents, relatives and other visitors to the home. Residents are all assessed prior to admission to ascertain their needs and wishes and these are incorporated into a detailed plan of care. Care is delivered by a team of well trained staff. The home employs an activities coordinator and all staff are involved in providing opportunities for residents to participate in activities both inside and outside the home. Meals are well balanced, varied and nicely presented. The home is well maintained. Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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. Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 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 standard(s) 3 Prospective residents are assessed prior to admission to ensure that the home can meet their needs. EVIDENCE: Three residents’ care files were examined as part of the case tracking exercise. The registered manager had performed a pre-admission assessment on the resident requiring nursing care . The manager of the Rainbow unit had accompanied the registered manager for the assessments of the residents with a dementing illness. A standard pre-admission assessment form was used to collate the information. The assessment was based on the activities of daily living to assist in identifying the service users’ needs. Social interests, hobbies, cultural needs and personal safety and risks were recorded. Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8 Residents are involved in drawing up a plan of care that provides detailed instructions to staff on how to meet their health, personal and social care needs. EVIDENCE: Plans of care had been devised for all identified needs, which set out in detail the action needed to be taken by staff to ensure that all aspects of the health, personal and social care needs of the residents were met. Plans were reviewed monthly and updated as required. The resident of the nursing unit who was part of the case tracking exercise had been seen by a tissue viability nurse on the morning of the inspection. Advice had been given regarding dressings and the care plan had been immediately updated. There was evidence of involvement of residents and their relatives in care planning and everyone on the nursing unit had the care plan in their room. The unit manager of the dementia unit was in the process of implementing a new person-centred care planning system based on the assessment of residents’ strengths and risk assessment. Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 Page 10 Care plans demonstrated that residents’ personal and oral hygiene were maintained. All residents were assessed as to their risk of pressure sores using the Braden risk assessment tool and appropriate equipment was identified and provided. One nurse in the home were identified as being responsible for tissue viability. The care plans contained evidence of links with the local continence adviser, one nurse in the home being identified as being responsible for continence liaison. The home had a falls prevention strategy in place and exercise classes were held. Residents were assessed in relation to their nutritional needs. One nurse in the home was responsible for liaison with the dietitian and gastrostomy nurse specialist and also had responsibility for residents with diabetes. Residents were registered with a GP of their choice and care plans contained evidence of access to other health professionals e.g. speech and language therapist, community psychiatric nurse, dentist, optician, audiologist. Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 & 15. Residents are encouraged to maintain control over their lives, maintain links with family and friends and the local community and participate in an an active social life, if they wish. Meals are nutritious and balanced and offer a healthy, varied diet. EVIDENCE: Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 Page 12 Residents could choose when to rise and retire, and were assisted by care staff to wash or bathe and dress in the morning. The registered person employed an activities coordinator and there was an activities plan posted on the notice board, however this plan could change in accordance with the wishes of the residents. There was an individual social activities record and plan in each resident’s file. Residents could visit the local garden centre or local shops and pubs and any events in the local village. Recently residents had been involved in making the home’s entry to the village scarecrow competition, had a barbeque and been entertained by a team of Morris dancers in the garden. They were also looking forward to the village treasure hunt. The activities coordinator organised outings, which included shopping trips to Chester, a visit to Frodsham market, a canal trip and a visit to Chester zoo. All special occasions were celebrated in the home and there was a newsletter compiled by the activities coordinator. One resident had recently celebrated her 90th birthday with a small party at the home. The local mobile library visited the home every month. There were also monthly quiz mornings and Holy Communion. The home had a pet cat, a parrot and three rabbits. The registered provider also brought in her dog to visit residents. One lady particularly enjoyed petting the dog. Residents and visitors confirmed that there was an open visiting policy. The only restrictions were that visitors were requested to avoid mealtimes unless dining with a resident and to ring first if they will be arriving after 9.30pm. Residents could receive visitors in private and choose whom they wished to see. Residents could exercise choice. For example they could choose where they ate their meals, whether to see their visitors or not and had the choice whether to engage in planned activities. Residents could also manage their own finances if their capacity allowed. The manager stated that residents who did not have any family or friends were put in touch with an advocacy service. Residents’ rooms were well personalised with small items of furniture, ornaments, photographs etc. that they had brought with them into the home. Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 Page 13 Breakfast was served between 8am and 11am, lunch was at 12.30pm, the evening meal at 5pm and supper at 8.30pm. Menus rotated on a four weekly basis and there was always a second choice on the menu. Residents confirmed this when in discussion with the inspector. The main meal was served at lunchtime, with a lighter meal in the evening. There were policies on nutrition in the home. Residents’ likes, dislikes and special diets were recorded and the head chef was aware of those who required a special diet. He was in the process of devising a menu specifically for those who required pureed food. A pastry chef had recently been employed. Food for special occasions such as birthdays and anniversaries was provided. Residents could choose to eat in their rooms or in the dining room. They could also eat on the patio in fine weather. Lunch on the day of inspection was lamb casserole or meatballs in tomato sauce, followed by sticky toffee pudding. Tea was poached egg on toast or fish goujons with beans, followed by cheese and biscuits. Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 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 standard(s) 16 Complaints are handled appropriately and residents have confidence that their concerns will be taken seriously. EVIDENCE: There was a satisfactory complaints policy and procedure on display and a complaints leaflet was made available to residents and their relatives. The complaints procedure was also printed in the Statement of Purpose. Residents said they would inform the registered manager or deputy manager if they wished to raise any concerns or complaints and felt confident they would be listened to. The home had received one complaint since the last inspection. The complainant (a relative) was not satisfied with the response from the registered manager and the complaint had been referred to the registered provider. Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 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 standard(s) 19, 22 & 26 EVIDENCE: Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 Page 16 The home was nicely decorated, furnished to a good standard and well maintained. There was an ongoing programme of maintenance, redecoration and refurbishment. Bedrooms were redecorated for each new resident. The garden and patio area were kept tidy, safe and attractive. The kerb had been lowered and parking access improved to assist visitors wishing to take residents out. There was a range of equipment and adaptations in the home, including grab rails along corridors, specialist beds, pressure relieving mattresses, raised toilet seats, wheelchairs and hoists (bath and freestanding). The care home had a passenger lift and a call system in all bedrooms. Twelve new profiling beds and mattresses had been provided in the nursing unit since the last inspection. The home was clean throughout. Sluicing, laundry and hand washing facilities were also satisfactory. Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29&30. Recruitment procedures, staffing levels and staff training all ensure that residents are protected and well cared for. EVIDENCE: The home was providing accommodation for 14 people in Rainbow Unit and 19 people in the nursing unit. There were three staff working in Rainbow unit from 8am to 10pm. In the nursing unit there were four staff from 8am to 4pm and three staff from 4pm to 10pm, with an additional member of staff to help with the evening meal. From 10pm to 8am there were four staff throughout the home. There was always a first level registered general nurse on duty. Seventy eight percent of the care staff had an NVQ Level 2 or equivalent in Care. Five staff files were reviewed. They contained documentary evidence that all required checks were carried out and required information obtained prior to offering employment. The home had high standards in relation staff training. All staff underwent an induction process linked to Skills for Care standards. The home actively encouraged ongoing personal development for all staff and had an excellent training programme. Staff who attended external training were expected to disseminate the information to other staff. Training attended since the last Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 Page 18 inspection had included moving and handling, food hygiene, fire safety, control of substances hazardous to health (COSHH), nutrition, oral hygiene, continence awareness, tissue viability, customer awareness and communication, falls risk assessment and death and dying. Copies of training certificates were kept on file. All staff, including domestic staff, had a training and development file. Staff were encouraged to complete a personal journal, reflective diary and a learning log. The management of the care home acknowledged achievement with an in house annual awards ceremony. The home had achieved the Investors in People award and were due for an external audit. This time they also were hoping to successfully achieve accreditation for providing staff with opportunities to maintain a work/life balance. Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35, 36 & 38. The home is well run by a strong management team who provide leadership, guidance and direction to staff to ensure that residents receive consistent, quality care. EVIDENCE: The registered manager is a registered nurse with 20 years post registration experience in caring for older people. She has completed ENB N35 Management in the Private Healthcare Sector and a Business Link Managers course and has managed the home the past nine years. She is supported by a deputy who also has a Diploma in Management and the unit manager of Rainbow unit who has the Registered Managers’ Award and is undertaking a Diploma in Dementia Care Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 Page 20 The home’s training package was externally accredited by Investors in People and had achieved the Profile Standard in August 2003. Customer satisfaction surveys were carried out six monthly and the results were published in the service user guide. These were sent to all key stakeholders. The manager conducted regular audits of urinary tract infections, accidents and pressure sores. She also audited the home against the National Minimum Standards. A system was in place to benchmark care practices in relation to nutrition, management of continence, tissue viability, mental health, oral hygiene, maintaining a safe environment and record keeping. The home was accredited by the Nursing and Midwifery council to provide training for three overseas nurses on supervised practice placements and educational audits were carried out by Manchester Metropolitan University. Policies and procedures were last reviewed in February and June 2005. The home did not handle residents’ financial affairs. If a resident did not wish to or was unable to handle their own affairs, and there were no family to undertake this task, a solicitor was appointed. The home only retained spending money up to £50 for each resident. Individual records were maintained, which included a running balance. Receipts were given or obtained for all transactions. Three were chosen at random, audited and found to be accurate. Records were also maintained of valuables handed over for safe keeping. Monies and valuables were kept in the safe. Staff were supervised as part of the normal management process on a continuous basis. The registered manager had implemented formal, documented supervision for all care staff working at the home. New supervision records had been devised, which covered all aspects of care practice and the General social Care Council Code of Conduct and Practice. Staff also received an annual appraisal, which covered performance and career development needs. The registered manager carried out risk assessments and ensured that staff received health and safety training. Core training included fire safety, manual handling, infection control, food hygiene and COSHH training. The registered nurse on duty assumed the responsibility for first aid in the home. A fire risk assessment had been carried out, which included an assessment of the risk of charging the hoist in the stairwell. This did not cover the risk of fire Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 Page 21 spreading up the stairs. The home did not have anywhere else to charge the hoist during the day if all bedrooms were occupied. It was suggested that the risk assessment included a control measure that said that the hoist should be charged in a lounge or dining room with the door closed at night, and in an unoccupied room with the door closed during the day, if one was available. The emergency procedures were reviewed. These included the action to take in the event of fire, flood or a power cut. It was suggested that these be expanded to include gas leak and bomb scare. (See Recommendation 1.) Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x 3 x x x 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 4 x 4 x 3 4 x 2 Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 Page 23 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. 1. Standard Regulation Requirement None made. 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 OP38 Good Practice Recommendations The fire risk assessment and emergency procedures should be amended as suggested. Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Sable Cottage F51 F01 S18816 Sable Cottage V232228 260705 Stage 4.doc Version 1.30 Page 25 - 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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