CARE HOMES FOR OLDER PEOPLE
The Cottage 1a Church Street Rastrick Brighouse West Yorkshire HD6 3NF Lead Inspector
Liz Cuddington Unannounced Inspection 16th January 2006 10:45 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 Cottage DS0000000986.V278822.R01.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 Cottage DS0000000986.V278822.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Cottage Address 1a Church Street Rastrick Brighouse West Yorkshire HD6 3NF 01484 718808 None 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) Mr Ian Robert Moffat Mrs Jennifer Moffat Mrs Elaine Wood Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places The Cottage DS0000000986.V278822.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th July 2005 Brief Description of the Service: The Cottage is a converted property situated on the main road into Rastrick, coming from Huddersfield. Although the road can be busy during the day it is quiet at night. Once inside the home the traffic noise is minimal. The home is close to some local shops. The Cottage is a family owned home providing personal care and accommodation for nineteen men and women over the age of 65 years. The living accommodation is over two floors with a stair lift linking the ground and first floors. There is a garden to the rear of the property with a conservatory and a patio. The home has a small car park and there is parking on nearby streets. The Cottage DS0000000986.V278822.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. During the inspection I had conversations with seven service users as well as with members of staff and one relative who is a regular visitor to the home. I took a tour of the premises and was told about the home’s plans for an extensive updating and refurbishment programme. I assessed fifteen of the thirty-eight National Minimum Standards; most of the other standards were assessed during the previous inspection in July 2005. Although four of the five statutory requirements have been brought forward from the last inspection there has been significant progress towards making the improvements outlined in these requirements. The home’s owners and management are to be commended for their hard work and commitment to improving the care planning and the facilities at The Cottage. I would like to thank the service users, visitors, staff and management for their warm welcome and hospitality during the inspection, and for taking the time to talk to me and express their views. What the service does well: What has improved since the last inspection?
Since the last inspection the home has put a lot of work and resources into improving the service users individual care plans. These have been completely changed and updated and, although the process is not yet complete, the new format shows much more clearly how each person wishes their care to be provided. The regular reviews will be much more straightforward and, because the plans are clearer, service users and their families will be able to take part more easily.
The Cottage DS0000000986.V278822.R01.S.doc Version 5.1 Page 6 The home’s management have started to address my concerns about the excessive use of the kitchen by other staff while the chef is preparing meals. Although there is still more work to be done to reduce the risks to safety and food hygiene to an acceptable level, a good start has been made. 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 Cottage DS0000000986.V278822.R01.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 Cottage DS0000000986.V278822.R01.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): 1&3 Standard 6 does not apply The Statement of Purpose and Service Users Guide do not contain all the necessary information. The process of updating all the service users plans of care is still underway. At present the plans do not all show that they are based upon a comprehensive pre-admission assessment. EVIDENCE: The Statement of Purpose and Service Users Guide were examined and still do not contain all the information outlined in the Care Homes Regulations 2001 and Schedule 1 of the Regulations. It has been a statutory requirement since the 1st April 2002 that all registered care homes produce these documents and that they must include all of the information specified in the Regulations. At present the care plans are being updated and therefore do not all show that they are based upon either a Social Services’ pre-admission assessment or the home’s own assessment of needs. The Cottage DS0000000986.V278822.R01.S.doc Version 5.1 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 the following standard(s): 7, 8 & 9 The improvements to the plans of care need to be completed to bring them to the required standard. Individual healthcare needs are assessed and the plans show that they are given the proper attention. The service user, or their representative, needs to be involved in developing their own care plan. The medication administration systems are accurate and secure. EVIDENCE: The service users individual plans of care are considerably improved since the last inspection. The process of transferring all the information is not yet completed. The indications are that when this is finished everybody’s plan of care will be well organised and contain clear information about how the individual wants their care to be provided. There will be sufficient detail to enable staff to meet the person’s needs, without being too full of unnecessary and often outdated information. The plans continue to be reviewed monthly by the care staff. None of the plans showed evidence that the service user, or their representative, had been involved in developing the care plan or agreeing any significant changes. The Cottage DS0000000986.V278822.R01.S.doc Version 5.1 Page 10 The health care elements of the care plans demonstrated that all the identified health needs are given the proper attention. Where needed there are continence assessments, emotional assessments and weight and nutritional assessments. These are used to inform the way each area of care is to be provided. Pressure relieving mattresses and cushions are used if an individual may be at risk of developing a pressure sore. The medication records are accurately completed. There is suitable storage and a record book for any controlled drugs. The medications are stored in a locked room. The home also has a refrigerator to keep medicines that need a constant cool temperature. For additional security it would be advisable for the key to the medication cupboards to be kept separately. The Cottage DS0000000986.V278822.R01.S.doc Version 5.1 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 the following standard(s): 12, 14 & 15 The plans of care record service users interests. The people who live at The Cottage manage their own financial affairs for as long as they are able. The food is appetising and there is a choice of dishes available. EVIDENCE: The care plans I examined showed that each service user’s interests and preferred activities are recorded and the records show how these needs are to be met, in accordance with the service user’s wishes. Service users are encouraged and supported to manage their own financial affairs for as long as they are able to do so. When they move into The Cottage people are able to bring some of their own possessions with them to personalise their room. Everyone who commented said how nice the food is and how much they look forward to their meals. There is a choice of dishes and the chef is aware of any particular dietary needs. Mealtimes are unhurried and any assistance offered is done so in a discreet manner and taken at the service user’s own pace. The Cottage DS0000000986.V278822.R01.S.doc Version 5.1 Page 12 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 & 18 The complaints procedure needs to be re-written to make it more straightforward. There are suitable policies and procedures in place for handling any allegations of abuse. There is a ‘whistle-blowing’ policy and procedure in place. EVIDENCE: The revised version of the complaints procedure has made the process appear rather more complex than it needs to be. The management are to re-write the procedure, keeping it straightforward and clear. There is a ‘whistle-blowing’ policy and procedure in place giving guidance and reassurance to staff on reporting any occurrences of poor care practice or suspected abuse. The Cottage DS0000000986.V278822.R01.S.doc Version 5.1 Page 13 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 is about to undergo an extensive refurbishment programme. The home is clean and hygienic. The laundry needs a separate wash hand basin for staff to use after handling soiled laundry. EVIDENCE: The present furnishings and décor are past their best. During the tour of the premises the home’s renewals and refurbishment plans were outlined. When completed the whole appearance of the home is expected to be improved and updated. Records of routine maintenance tasks are now being kept. The house is kept in a clean and hygienic condition. The laundry has an open sink for sluicing soiled laundry. To promote infection control a washing machine with an integral sluice programme would be advisable. Also there should be a separate wash hand basin for staff to use after handling soiled laundry. The Cottage DS0000000986.V278822.R01.S.doc Version 5.1 Page 14 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): All these standards were met when inspected in July 2005. EVIDENCE: The Cottage DS0000000986.V278822.R01.S.doc Version 5.1 Page 15 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 & 38 The registered manager has the necessary experience and qualifications to enable her to carry out her role. An effective quality assurance system has not yet been developed. Regular staff fire drills need to be carried out. EVIDENCE: The registered manager has two years experience as the manager of The Cottage. In addition she has completed the Registered Managers’ Award and is a qualified National Vocational Qualifications (NVQ) Assessor. As an assessor the manager is able to support the care staff who are taking an NVQ qualification in care. The home’s management have not yet developed a quality assurance system to enable them to assess and monitor the home’s performance and gather information to inform their improvement plans.
The Cottage DS0000000986.V278822.R01.S.doc Version 5.1 Page 16 Although a recent nearby emergency, causing the staff to evacuate all the residents very quickly, demonstrated that the staff are able to respond calmly and effectively in a crisis it is still important that this is reinforced with regular fire safety drills. They should form a routine part of the staff’s mandatory training updates. The Cottage DS0000000986.V278822.R01.S.doc Version 5.1 Page 17 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 1 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 1 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 1 The Cottage DS0000000986.V278822.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4&5& Sch 1 Requirement The Statement of Purpose and Service Users Guide must contain all the information required by the Care Home Regulations 2001. This is brought forward from the last inspection. Original timescale: 31/10/05 Each service user must have an up to date plan of care based on the Social Services, or the homes own, needs assessment. This is brought forward from the last inspection. Original timescale: 31/10/05 Each service user’s plan of care must reflect their individual care needs and be agreed with the service user or their representative. This is brought forward from the last inspection. Original timescale: 31/10/05 Staff hand washing facilities, separate to the sluice sink, must be fitted in the laundry. All staff must have two fire lectures each year. This is brought forward from
DS0000000986.V278822.R01.S.doc Timescale for action 31/03/06 2. OP3 15 31/03/06 3. OP7 15 31/03/06 4. 5. OP26 OP38 13(3) 23(4)(d) 30/06/06 30/06/06 The Cottage Version 5.1 Page 19 the last inspection. Original timescale: 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP16 OP33 OP38 Good Practice Recommendations The complaints procedure would benefit from being written in more straightforward language. The quality assurance systems need further development in order to obtain useful information. The use of the kitchen for purposes other than the preparation of meals needs to be addressed. The Cottage DS0000000986.V278822.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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