Inspection on 21/02/06 for The Cotswold Home

This inspection was carried out on 21st February 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Cotswold Home 15/05/07

The Cotswold Home 22/09/05

Similar services:

Flint House

St Vincents

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

Hillyfield Rest Home

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

CARE HOMES FOR OLDER PEOPLE The Cotswold Home Woodside Drive Bradwell Village Burford Oxfordshire OX18 4XA Lead Inspector Philippa MacMahon Announced Inspection 21st February 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Cotswold Home Address Woodside Drive Bradwell Village Burford Oxfordshire OX18 4XA 01993 824225 01993 824226 pat.hamilton@elizabethfinn.org.uk 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) Elizabeth Finn Homes Ltd Mrs Marie Patricia Hamilton Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51), Physical disability (51), Terminally ill (51) of places The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. On admission persons should be aged 60 years and over. Maximum of 30 persons with nursing needs. The total number of persons that may be accommodated at any one time must not exceed 51. 22nd September 2005 Date of last inspection Brief Description of the Service: The Cotswold Home was purpose built in 1998 and is situated in open countryside two miles from Burford. The Cotswold Wildlife Park is nearby and residents who have the mobility and independence to walk to the Wildlife Park can do so if they wish. Country walks are also accessible from the home. The home is registered for 51 residents with a maximum of 30 places for people requiring nursing care. Two GP surgeries provide medical cover and on admission residents are asked which surgery they wish to be registered with. A dentist visits the home to assess residents but treatment is carried out at the dental surgery. Transport can be arranged in the home’s minibus. Physiotherapy is available twice a week. The services of an optician and chiropodist are also available. Accommodation is provided on two floors. The ground floor has 30 single bedrooms and these are for those residents requiring nursing care. The first floor provides 21 single rooms for residents with low to moderate dependency levels. Many of the residents on the first floor are fully independent. All bedrooms are equipped with en-suite toilet and hand basin. A passenger lift provides access to the first floor. There is a wide range of recreational activities available and the home has a group of committed volunteers who help the residents in a variety of ways. The Cotswold Home has a delightful courtyard garden, as well as a garden at the rear of the home, providing pleasant outdoor space for the residents and their visitors. The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection undertaken by two inspectors, Philippa MacMahon and Jane Handscombe, and the second to take place in the inspection year. There was a very warm welcome provided by the registered manager and her team and all co-operation was given throughout this inspection. The home has two discrete wings; one is for people requiring nursing care and the other provides residential care. The inspectors each inspected one wing and this report covers the whole home. The inspection process included a tour of the premises, meeting with residents, and staff, and examining records required by regulation. The registered manager provided core pre-inspection information and this along with comment cards provided by the Commission for Social Care Inspection for residents, relatives/visitors, and professionals, were used to gather further information. What the service does well: The home provides a gracious, homely, comfortable home. The care provision is of a very high standard and is very much focused on the individual person’s needs and lifestyle. The communication systems that are in place ensure that the residents are involved in all aspects of the service delivery and future developments. Comments from the residents included: “I don’t think you could be in a better home than this. The staff are marvellous”; ‘If you had to go anywhere you couldn’t better it, everyone is very kind’; I’m doing more-or-less what I do at home here.’ The staff are very well motivated and this is reflected in the number of care staff who are qualified which is in excess of 70 . The training and development of all staff is considered by the registered manager to be of high importance and every opportunity is provided for all staff. Comments from staff included: “Matron is very good, she is excellent”; “ it is very enjoyable working here, we get time to spend with the residents’. Staff spoken to take great pride in their work and feel privileged to work in such a beautiful home. The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 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. The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. All prospective residents have a comprehensive assessment of their care needs carried out prior to being admitted to the home, and assurance that the home can meet those needs. The home provides clear information that is used by prospective residents to help them choose a home that is right for them. Intermediate care is not provided at this home. EVIDENCE: The registered manager or her deputy carries out all pre-admission assessments. The assessment is undertaken in collaboration with the individual and/or their representative. A sample of assessments was examined and found to be comprehensive and formed the basis of the development of the care plan. The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 Page 9 Wherever possible, prospective residents, family and friends are given the opportunity to visit the home and join fellow residents, in order to gain a ‘feel’ of the home and meet staff before making a decision as to whether the home is suitable. The registered manager explained to the inspector that if any resident is admitted to hospital they would always be reassessed before they return home to The Cotswold. One resident had been assessed as requiring nursing care following being in hospital and the registered manager agreed to carry out a further assessment after 6 weeks to see if the person could return to the residential wing of the home. This is good practice and commendable. The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10. Overall the medication systems within the home are in good order and these are supported by polices and procedures, and training. Risk assessments are undertaken where a resident wishes to administer and store their own medication. The inspector has made good practice recommendations in relation to this aspect of care. All residents have an individual plan of care, setting out their personal and social care needs. Residents are treated with dignity and respect at all times, and their right to privacy is upheld. EVIDENCE: The medication systems in the home were examined by the inspectors and overall found to be in good order. The inspector noted that there were gaps in the medication administration record where ointments or inhalers had been prescribed. The deputy manager explained that this was because the care assistants had applied the ointments so the nurses were unable to sign. It is a The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 Page 11 good practice recommendation that an omission code should be created to explain when care assistants apply topical medication. Those residents who administer their own medicines have a risk assessment carried out on admission to the home to ensure that they are able to safely take the medication and store it. A copy of this assessment is filed in the residents personal files. The inspector noted that a 6 monthly monitoring/assessment is also carried out and documented. The inspector examined the homely remedies agreement that allows the nurses to treat certain minor ailments without necessarily consulting with the residents GP. This was found to contain individual residents names some of which are no longer living in the home. It is recommended that the homely remedies agreement should be reviewed in accordance with Royal Pharmaceutical Society’s guidelines, “The administration and control of medicines in care homes.” Arrangements have been made with a licensed company for the disposal of any unused medication in accordance with the new directives. All care staff are trained in how to administer medication and the head of care in the residential unit was observed giving out the medication. The trolley was clean and orderly and notes on each resident’s medication was clear. The medicine room was checked in the presence of the head of care and all was in good order. A random selection of medication was checked including the controlled drugs against the medicines administration charts and this was found to be satisfactory. During the inspection, staff were observed to demonstrate particular sensitivity upon entering bedrooms, bathrooms and WCs and addressed residents in an appropriate manner. A sample of residents’ files was viewed and found to be comprehensive and detailed giving a good picture of the assessed needs and how these needs are to be addressed. Reviews of care are undertaken on a monthly basis. The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these outcomes were addressed on this occasion. EVIDENCE: The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 &18. There is a clear complaints procedure for residents to raise any concerns or complaints. All residents are able to take part in the civic process if they so wish. The registered manager considers that training for all staff in the protection of vulnerable adults is of high importance. All residents are able to take part in the civic process if they wish to. EVIDENCE: The inspector examined the complaints procedure, and discussed with the registered manager how complaints are dealt with. There had recently been a complaint and this had been dealt with in accordance with the home’s procedure. The residents take part in the civic process if they wish to. Some are able to attend the local polling station whilst others chose to have a postal vote. The induction programme examined by the inspector showed that training in the protection of vulnerable adults is mandatory for all staff working at the home. The deputy manager told the inspector that further training in this subject is available to all staff on an ongoing basis. The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 &26. The home and grounds provide a gracious, immaculate, and safe environment for the enjoyment of both the residents and staff. EVIDENCE: The inspectors toured the building and found all areas of the home to be cleaned and maintained to a very high standard. All areas were immaculate. Staff spoken to take great pride in their work and feel privileged to work in such a beautiful home. The home has a plan of routine maintenance both indoors and outdoors, including the renewing of fabric and decoration of the premises. One Wing is in the process of redecoration and new carpets have been laid in a number of individual rooms. Further decorating of the dining room is planned to take place April/May, which will include a loop system and a microphone system. The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 Page 15 The manager informed the inspectors that residents have requested that specialist shower be put in place upstairs in addition to the recently installed shower on the first floor, which the residents found beneficial. The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30. The home is staffed in accordance with the needs of the residents. The registered manager is firmly committed to the training and development of all staff. The staff are all trained and motivated to further develop their skills and knowledge. The home follows a thorough recruitment process to ensure that residents are in safe hands. EVIDENCE: Staff rotas were examined by the inspectors in both wings of the home and showed that adequate numbers and skill mix of staff are on duty at all times. The home has a “Bank” of staff who they call on when there are any gaps in the rota. Agency staff have not been used for 2 years. The home has a full staff complement at the moment and there is very little staff “turnover”. The nursing wing have introduced a “twilight shift” from 4.30 to 8.30, that has been successful and they are now actively recruiting to cover this shift. This came about as a result of looking at the workload and realising that this busy period was causing a lot of pressure on the staff and the residents. It is The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 Page 17 commendable that the home is actively looking at the care provision on an ongoing basis. The home has exceeded the 50 target of trained care staff by 2005, and now has 75 of the staff with NVQ level 2. Many have gone on to level 3, and to become assessors. The deputy manager, and manager of the residential care unit are both undertaking the NVQ level 4 in management. This is commendable and shows a real commitment by the registered manager to the training and development of staff. The recruitment procedure was discussed with the administrator, and a sample of staff files was examined. These were found to be in good order and complete. The deputy manager is responsible for leading on the training and development of all staff. The inspector discussed this aspect of management and examined staff files and documents in relation to this and found that the staff are well trained in all aspects of care. All staff follow an induction training programme and are supervised for at least 2 shifts. If the person recruited is going to work night shifts, they have to work 2 shifts on days, and 1 on nights before working alone. This is good practice. One of the staff is a qualified first aid trainer, and it is hoped to increase the number of staff with first aid qualifications in the near future. The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 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): 31,33,35 & 38. The registered manager is well qualified and experienced and manages an excellent home that is very much in the best interest of the residents. Quality systems in place are robust and will ensure the continuous improvement of the service. The home has very good systems in place to safeguard the residents financial interest. EVIDENCE: The registered manager is a very experienced and committed manager who has created a very open, positive and inclusive atmosphere. Residents, volunteers, and staff spoken to all feel very much part of the life and working of the home. The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 Page 19 Discussion with the registered manager about the quality systems in place showed that all aspects of the running of the home are audited on a regular basis by the company, and as the home is a charity by an independent body also. The inspector regularly receives reports from the home in accordance with Regulation 26 showing the outcomes of these visits. The registered manager also presented a customer satisfaction questionnaire to the residents last December, that covered all aspects of the care provided. The results of this have been fed back to the residents and an action plan has been developed. This survey is carried out annually. A copy of the report of this survey was provided to the inspector following this inspection. There is a comments book in the dining room that residents regularly contribute to and the Hotel Services Manager always responds to these comments on a daily basis. Regular residents meetings, social gatherings and the registered manager’s open door style of management provide good communication systems and the inclusion of the residents in any future developments and planning. The inspector met with the administrator and discussed the management of the residents’ finances. The systems and records were examined and found to be in good order and provided a clear audit trail to safeguard the residents’ financial interest. There are secure facilities provided for the safekeeping of money and valuables. All the records required by regulation for the protection of the residents were examined and found to be up to date, complete, and stored appropriately. The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 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 4 X X N/A 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 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 3 3 3 3 3 The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 Page 21 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. 1 2 Refer to Standard OP9 OP9 Good Practice Recommendations It is a good practice recommendation that an omission code should be created to explain when care assistants apply topical medication. It is recommended that the homely remedies agreement should be reviewed in accordance with Royal Pharmaceutical Society’s guidelines, “The administration and control of medicines in care homes.” The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 Page 22 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: 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 The Cotswold Home DS0000065413.V272768.R02.S.doc Version 5.1 Page 23 - 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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