CARE HOMES FOR OLDER PEOPLE
The Cottage 1a Church Street Rastrick Brighouse West Yorkshire HD6 3NF Lead Inspector
Liz Cuddington Key Unannounced Inspection 8th August 2007 13:15 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.V339852.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. The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Cottage Address 1a Church Street Rastrick Brighouse West Yorkshire HD6 3NF 01484 718808 None gennymoffat@btopenworld.com 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 Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th August 2006 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 on a bus route and is close to 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 on two floors, with a stair lift linking the ground and first floors. There is a conservatory and patio to the rear of the property. The home has a small car park and there is parking on nearby streets. The current fees are between £331.00 and £347.50 per week. The fees do not include personal expenses such as hairdressing, chiropody and toiletries. The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The last key inspection of the home took place on 10 August 2006. I have not made any further visits to the home. The purpose of this inspection was to assess the quality of the care and support received by the people who live at The Cottage. The methods I used to gather information included a visit to the home, conversations with the people who live there, their relatives and the staff, looking in detail at the care and records of four people, examining other records and looking around the home. Before visiting, I sent out questionnaires for the people who live at the home to complete. I received six back. Feedback from these surveys is included in this report. The manager also completed the home’s pre-inspection questionnaire. These questionnaires provide valuable information to help me form a judgement about the quality of service offered at The Cottage. Although there are still areas for development, the home continues to make significant improvements. I would like to thank the people who live at The Cottage, their relatives and the staff, for their welcome and hospitality, for taking the time to talk to me during my visit and for completing the questionnaires. What the service does well:
The interaction between staff and the people who live at the home is relaxed and friendly. Staff maintain people’s dignity and privacy. They spend time with people but respect their right to be left alone if they wish. The care plans are centred upon the needs and wishes of each individual and reflect their preferences. The staff show a high level of knowledge and understanding about the people who live at The Cottage. People are protected by the home’s recruitment procedures. The house is clean and fresh and good hygiene and infection control measures are in place. All of the people who commented said that the home is always, or usually, fresh and clean. The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 6 All of the people who returned questionnaires said they can always do what they want to and that the staff treat them well. They all said they know how to raise any concerns if they need to. Everyone who commented said that the staff listen and act on what they say. In their questionnaires people wrote that ‘The staff are very friendly and quite approachable’ and said ‘The staff do a brilliant job….all the staff are worth their weight in gold’. One relative wrote in the questionnaire that ‘The staff are always friendly and helpful…’. One person commented that ‘I would not hesitate in placing someone at The Cottage’. One person who lives at the home wrote ‘This care home is warm and friendly…the care given…is exceptional’. Everyone I spoke with and who completed a questionnaire, said they like the meals. One relative wrote that her mother says ‘…the meals are excellent….a wide variety, always well presented’. What has improved since the last inspection? What they could do better:
The home’s management should explore ways of providing a wider range of activities that people will take part in and enjoy. One relative gave some examples of activities that could be offered and commented that it ‘would be lovely for some more activities to be held at the home…but none of these happen…’. The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 7 The staff need to complete essential safety and welfare training in order to make sure that people are protected and the home has a well trained staff team. Staff training records need to be kept up to date. The home’s manager needs to implement a system of regular one to one staff supervision. The new manager needs to apply for registration with the Commission for Social Care Inspection without further delay. The manager should begin studying for the Registered Managers’ Award. Any significant events affecting the people who live at the home must be notified to the Commission in writing. 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. The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 8 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.V339852.R01.S.doc Version 5.2 Page 9 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 Standard 6 does not apply People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose and Service Users Guide have now been updated to reflect the scope of the service. A comprehensive pre-admission assessment is carried out before offering someone a place at the home, to make sure that their needs can be met. EVIDENCE: The home’s Statement of Purpose and Service Users Guide have been updated and now reflect the services and facilities that the home can offer. The care plans I looked at showed that comprehensive pre-admission assessments had been carried out before offering someone a place. This is to make sure that the home can meet the person’s needs. A senior member of staff visits the person at home or in hospital to discuss their care needs. Social
The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 10 Services’ assessments are also used to determine the care needs of the individual. People are welcome to visit the home before reaching a decision. The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 11 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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To maintain their health and wellbeing, people’s personal and healthcare needs are met. People are protected by the home’s medication systems. Medications are stored safely and their administration is accurate. To maintain their dignity, the staff treat people with respect and care at all times. EVIDENCE: I looked at three care plans in detail, to make sure that people’s health and personal care needs are being met in the way the person prefers. The plans cover each area of the individual’s health and care needs in detail. There are risk assessments in place, where needed, and these show how
The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 12 potential risks can be minimised. Each person who needs assistance with his or her mobility has a moving and handling plan. Details of visits by GPs and other healthcare professionals are kept. The plans showed that people are being weighed each month. Five people said in the questionnaires that they always receive the medical support they need and one person said they usually do. The new manager has started to re-organise the care plans to make them more relevant to each individual and easier to use. At present, the plans are not being reviewed regularly. The manager is aware of this and plans to carry out regular reviews, in consultation with the individual and, where needed, the person’s family. During my visit, I noticed that all the staff treat people with respect and maintain people’s dignity. The people I spoke with during my visit said that they receive the care they need and are supported to maintain their independence for as long as they are able. From my own observation, and comments made by the people who live at The Cottage and the staff, it was clear that the staff are fully aware of each person’s needs and preferences. The staff make sure they provide the help people need in the way they prefer. One person wrote in their questionnaire that ‘The care and support (is)…exceptional and for relatives too’. The Medicines Administration Record (MAR) charts are securely stored and kept up to date. Medicines are kept safe and secure and are well organised. I looked at the MAR charts, which must show clearly the quantities of medicines received and in stock for each person. These are up to date, demonstrating the accurate and clear recording systems the new manager has put in place. The member of staff must sign the MAR charts each time they administer a dose of medicine. This was being done. The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 13 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to maintain their independence and keep in contact with family and friends. Some leisure activities are provided to try and meet people’s recreational needs. People are offered a good choice of meals which meet their dietary and personal preferences. EVIDENCE: The atmosphere at the home is warm and friendly and the families and friends of the people who live at The Cottage are always welcome to visit. Each person is treated as an individual, and their choices and wishes are respected. People are supported to continue with their preferred activities, such as going out to socialise, reading the newspapers or listening to music.
The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 14 The home provides some activities but the questionnaires I received did suggest that people would like there to be more. Two people said there are always activities they can take part in, two said there are usually activities available, one said sometimes there are and one person said there are never any activities for them. The home’s management may like to explore ways of providing a wider range of activities that people will take part in and enjoy. All the people who commented during my visit, and on the questionnaires, said they enjoy their meals. There is a good variety of dishes on the menu and special diets are catered for. The chef and the rest of the staff are aware of people’s needs and preferences. Assistance is offered to people who are not able to manage to eat independently. One person commented that the food is ‘very enjoyable and nutritious’. Another said that the ‘food is excellent’. Mealtimes are relaxed and sociable occasions and each person takes all the time they need to eat. The tables are properly laid before each meal, including the individual tables for people who prefer to stay in the lounge to have their meals. The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 15 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home, and their relatives, are aware of how to raise a concern or make a complaint if they are dissatisfied with the service. Staff have not yet received suitable adult protection training which helps make sure that people living at the home are safe. EVIDENCE: All the people who completed the questionnaires said they know how to make a complaint or raise a concern if they need to. The complaints procedure is clear and easily available. None of the staff have had Adult Protection training. This needs to be arranged without further delay, to make sure the staff are fully aware of their role in protecting the people they support and care for. The relevant policies and procedures are up to date. The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 16 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, 20, 25 & 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, comfortable, well maintained and homely environment. EVIDENCE: There is a programme of re-decoration for the bedrooms, as well as for the rest of the house. The plans include replacing the carpets and will take place in the near future. During the past year, the house has been re-wired and there has also been major repair work to the roof. These expensive repairs have meant that other planned improvements, such as completing the kitchen refurbishment, have had to be postponed. The long-term improvement plans include replacing the existing baths and creating a shower room.
The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 17 All other parts of the house are fresh, clean, comfortable and well looked after. People who commented agreed that the house is well kept. One person wrote on their questionnaire that ‘Usually the home is clean and well presented’. There are good infection control systems in place and staff use protective gloves and other measures, where needed. A wash hand basin has been installed in the laundry; this supports the home’s infection control procedures. The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 18 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are employed to meet people’s needs. The people who live at The Cottage are protected by the home’s recruitment procedures which ensure that staff are suitable to work with older people. More than half of the care staff have a suitable NVQ award. Other training is provided but more is needed to make sure staff have all the skills and knowledge they require to help them to meet people’s needs. EVIDENCE: The staff rotas confirmed my observations that there were enough staff on duty to meet the needs of the people who were living at The Cottage when I visited. One person commented in their questionnaire that ‘staff seem very busy…at times a little short staffed…’. This may depend on the time of day. When I was there, staff seemed to have time to spend with people and meet their care and support needs. All staff complete an application form and provide two written references. Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA)
The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 19 register checks are obtained and new staff do not begin work until these checks have been completed satisfactorily. Six of the 10 care staff have a relevant National Vocational Qualification (NVQ) at level 2 and one person plans to take the level 3 award. Four staff are enrolled to start the NVQ level 2 award. New care staff are encouraged to take the qualification. The home’s training records are not completed adequately. The management needs to make sure all the staff have up to date training in all the mandatory areas, including health and safety, moving and handling and adult protection. New care staff must follow an accredited induction and foundation training programme. The home has these training courses available but the records to show whether or not new staff have completed the training satisfactorily were not available. This basic training makes sure staff have a good understanding of their role and responsibilities, and provides a sound basis for NVQ study. The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 20 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, 33, 35, 36 & 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe and well managed and people who live and work at the home can contribute to the decision-making processes. EVIDENCE: The new manager has the skills to manage the home effectively. The manager needs to start the NVQ level 4 Registered Managers’ Award with minimal delay, to equip her with the qualification she needs as a care home manager. There is a good management structure within the home, which supports the manager. The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 21 The management team promotes an open and inclusive management style and everyone is involved in the decision-making processes. My own observations, and comments from other people, confirm that everyone’s views are valued and taken into account. The home has carried out a quality assurance survey of people’s relatives, in order to gain their views on the quality of care and support provided. This was a basic questionnaire and the owner of the home plans to expand this on the next occasion. The results of this survey show that most people believe The Cottage offers a good or very good service, with some people saying they think it is excellent. The policies and procedures are kept up to date to make sure they provide relevant information to guide staff on how to act in every situation. All the regular health and safety checks for the home are carried out in a timely manner. These measures make sure that the health, safety and welfare of the people at the home is promoted and safeguarded. The home looks after small amounts of people’s money, to pay for their dayto-day expenses. The records and monies are accurately kept and safely stored. Staff one to one supervision is not being carried out yet. A new supervision form has been developed and the manager plans to implement this soon. All new staff must follow accredited induction and foundation training courses to make sure they have the skills and knowledge they need to provide good quality care and support for the people who live at the home. When a significant incident occurs, such as admission to hospital or to the accident and emergency department, or the death or of someone who lives at the home, the Commission for Social Care Inspection must be notified. This is not being done at present. The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 23 YES 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 OP30 Regulation 18(1)(c) (i) Requirement For the safety and wellbeing of the people who live at the home, and the staff, essential staff training must be kept up to date and accurate records kept. All new staff must follow accredited induction and foundation training courses to make sure they have the skills and knowledge they need. To support their professional development, all care staff must have regular, individual supervision sessions with their line manager. This is brought forward from the last inspection: dated 31/01/07 The home’s manager must apply for registration with the Commission for Social Care Inspection. The manager needs to start the NVQ level 4 Registered Managers’ Award with minimal delay, to equip her with the qualification she needs as a care home manager. The Commission for Social Care
DS0000000986.V339852.R01.S.doc Timescale for action 31/12/07 2. OP30 18(1)(c) (i) 31/10/07 2. OP36 18(2) 31/10/07 3. OP38 8(2) 31/10/07 4. OP38 9(2)(b)(i) 31/12/07 5. OP38 37 30/09/07
Page 24 The Cottage Version 5.2 Inspection must be informed in writing of any significant events affecting the people who live at the home. 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 OP12 Good Practice Recommendations The home’s management should explore ways of providing a wider range of interesting and stimulating activities, to meet the social and recreational wishes of the people who live at the home. The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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. Extracts may not be used or reproduced without the express permission of CSCI The Cottage DS0000000986.V339852.R01.S.doc Version 5.2 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
