Inspection on 11/02/08 for The Cottage Nursing Home

This inspection was carried out on 11th February 2008.

CSCI found this care home to be providing an Adequate service.

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 Cottage Nursing Home 14/02/07

The Cottage Nursing Home 23/02/06

The Cottage Nursing Home 06/07/05

The Cottage Nursing Home 28/01/05

The Cottage Nursing Home 05/07/04

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

CARE HOMES FOR OLDER PEOPLE The Cottage Nursing Home 80 High Street Irchester Northants NN29 7AB Lead Inspector Stephanie Vaughan Unannounced Inspection 11th February 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Cottage Nursing Home DS0000012649.V356262.R02.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 Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cottage Nursing Home Address 80 High Street Irchester Northants NN29 7AB 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) 01933 355111 01933 355129 The Cottage Nursing Home Limited Mrs Agnes Ernestina Arthur Care Home 53 Category(ies) of Dementia - over 65 years of age (53) registration, with number of places The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Age range for service users in the category of DE 50 years and above. Nursing (N) to a maximum of 53 beds. The home may provide Personal Care (PC) for up to 3 Service users within the category DE (E) and DE. Room 54 must not be occupied by a wheelchair user. Date of last inspection 14th February 2007 Brief Description of the Service: The Cottage is a care home located in the village of Irchester, which is situated close to the main A45 road, and facilitates easy access to the main towns of Wellingborough, Rushden, Kettering and Northampton. The home can accommodate up to 53 service users in the category of Dementia, over the age of 50 years. Accommodation is provided over three floors, in a mixture of single and shared rooms. There are a number of communal areas throughout the building, and stairs and an elevator provide access to all floors. Weekly fees currently range from £366.94 to £500.00, dependent upon choice of bedroom, en-suite facilities required and individual funding arrangements. The fees are for accommodation and personal care only, and the nursing fee element is determined by the primary Care Trust and paid direct to the home. Additional charges are made for outings, personal items such as toiletries, hairdressing and chiropody. The Cottage Nursing Home provides people who use the service with information about the home in the Service Welcome Pack. The Commission for Social Care Inspection reports are available in the reception area and relatives are also informed of their availability through the Commission for Social Care Inspection web site. The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Prior to this statutory inspection, a period of four hours was spent in preparation. This comprised a review of the previous inspection record, the report, the service history and other documentation including information that has been given to us since the last inspection. Ten Comment cards were returned from residents, seven from their representatives and eight from staff. All indicated a good level of satisfaction and their comments have been used to inform the inspection activity. The Commission have received no complaints or concerns about this service. However two Safeguarding Adults allegations have been made within the last twelve months. Both of these have been independently investigated under the Safeguarding Adults procedures, which concluded that ‘ there was no evidence to prove that the residents deterioration was caused by a lack of care whist at the Cottage Nursing Home’. The Commission have a focus on Equality and Diversity and issues relating to this are included in the main body of the report. This site visit to the home was conducted over a period of seven and a half hours during which the inspector made observations and spoke to residents and staff. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where of a sample of three residents were selected and all aspects of their care and experiences were reviewed, including individual plans of care and associated documentation. The service specialises in the provision of care for people with dementia, as such discussion with the residents was limited due to their abilities to recall their express their experiences and views. In these circumstances observations are used to inform the inspection. The Registered Manager was present for the duration of this visit. The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 6 What the service does well: The service manages admissions to the home well and people who use the service have are provided with the right information to help them make decisions about whether they would like to live there. General healthcare is managed well; people appeared to be well presented and well cared for. Medication is managed well; the service keeps accurate records and makes sure that the residents receive their medication as prescribed. Staff relate well to residents and are able to spend time with them, they are respectful of the resident’s privacy and dignity. The service promotes the Equality and Diversity of the people living in the home. Residents are able to bring in their own property such as televisions, radios and CD players; they have access to regular in house activities and access to the local community. Residents are able to receive their chosen visitors in any of the communal areas or in their own rooms. The service offers home cooked food, that is well presented and of adequate portions, food preferences are known to staff and are being recorded. Arrangements are in place for residents to contribute to the menu planning and alternatives are available for each meal. Records show that residents receive a varied and balanced diet. The home has a robust complaints policy and manages complaints well. The service continues to maintain the standard of both the interior and exterior of the building. There is a programme of maintenance with ongoing decoration of resident’s rooms. The home is spacious, clean safe and comfortable. Staffing levels are good and staff have the right checks conducted before they start working in the home. There is a good training programme so that the staff know how to care for residents properly. Management of the home is good, there are systems in place to regularly gain the views of residents and their representatives about the service and these views are used to make improvements. Arrangements are in place for staff to safely support residents in the management of their money. Regular checks are done on medication systems, accident records, fire systems, care plans, policies and procedures. The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The care plans need to have more information so that staff know how the residents like to be looked after and can be properly cared for, for all of their needs. Records need to show that the care specified within the care plan is being provided and how residents are supported to make decisions in their daily lives. Records also need to show clearly when and what advice has been obtained from specialists such as the dietician. Staff should receive training in the development of person centred care planning and the use of risk assessments. Risk assessments should be developed when solid medication needs to be crushed before being administered. The service needs to make sure that they have robust risk assessments in place to make sure that residents are protected from harm. These need to show what action is to be taken to reduce and manage the risks. The service needs to make sure that they obtain informed written consent form either the resident or their representative for the use of equipment such as bed rails. The service needs to make sure that they have the right information recorded regarding the management of terminal care and death. The complaints polices and procedures need to be updated to ensure that residents have access to up to date contact information. The service needs to make sure that they follow the Local Authority Guidelines on the Safeguarding of Adults, even when incidents occur between residents and there is no significant injury. Risk assessments need to be put in place when residents exhibit challenging or aggressive behaviour. The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 8 The service needs to make sure that staff have regular and frequent checks to make sure that they continue to do their jobs properly and are supported to develop their skills. Staff files need to be checked to make sure that they contain all of the right information and that it is kept up to date. 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 Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 9 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 Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 10 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): 2 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that their needs will be assessed prior to moving into the home. EVIDENCE: The Annual Quality Assurance Assessment indicates that all residents have a preadmission assessment prior to admission and that a welcome pack is provided, which includes the Statement of Purpose and Service Users Guide. Relatives are encouraged to visit the home to help them make a decision as to whether the home is right for their relative. One relative commented ‘I came to view the home and spent a few hours before moving my mother from another home’ A staff member commented ‘Relatives and friends are The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 11 encouraged to visit the home before making a decision’ One resident spoken to was able to indicate satisfaction with the admission processes. Individual plans of care evidenced that residents have comprehensive assessments before they are admitted to the Cottage Nursing Home, to ensure that the service is able to meet the needs of the resident. The management also ensures that copies of the Care Management assessments are obtained. Both assessments are used to develop individual plans of care before the resident is admitted. Samples of resident’s contracts were viewed and seen to contain appropriate information, the management confirmed that new contracts are issued as the fees change. The service does not provide intermediate care The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the individual plans of care is basic however the practical management of healthcare is good and this results in good outcomes for residents. EVIDENCE: Each resident has an individual plan of care, which is developed from information obtained during the assessment and admission process. Residents or their relatives are asked to provide information about their previous lives and lifestyles to enable staff to meaningfully engage with the residents. The plans contain the basic information to enable staff to know how the resident is to be cared for in their health, personal and social care needs. The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 13 However these would benefit from further development to ensure that they are person centred and contain the detail necessary to comply with the Mental Capacity Act 2005 and to provide detailed instruction to staff about the individualised management of dementia, challenging behaviour and associated risk assessments. The daily records would also benefit from being more detailed to demonstrate how residents are supported to make choices within their daily lives and to engage in meaningful activities. There is evidence that residents have basic risk assessments for the risk of falls, however these need to be reviewed to ensure that they comply with current best practice and include appropriate detail to reduce the risk such as the use of appropriate footwear. There is also some evidence that residents are assessed for the risks associated with falls form the bed, again these are basic and would benefit from more detail. All of the resident’s case tracked had bedrails in place to prevent falls form the bed however there was no evidence that consent had been sought from the residents or their relatives for these to be used. In addition there was no evidence that risk assessments had been conduced regarding the risk of entrapment. There is evidence that residents or their relatives are involved in the care planning process and that care plans are reviewed on a regular basis. Although the individual plans of care contained only basic information, outcomes for resident’s healthcare appear to be good. Residents were clean, comfortable and well presented. They have access to regular fluids and showed signs of being well hydrated; the individual records relating to nutritional and fluid intake confirmed this. Oral hygiene appears to be well managed. One relative commented ‘The care is excellent; staff are friendly and always willing to help’. A staff member commented ‘ We try to work closely in partnership with relatives and friends to provide the best support and care for the individual. We continue to listen to the views of relatives friends and staff and continue towards meeting their needs.’ All residents’ case tracked had appropriate assessments for the risks associated with pressure. These are regularly reviewed and contain instruction to staff about how these risks are to be managed. Residents have access to appropriate pressure relieving equipment and outcomes are good. However the individual plans of care would benefit from more detail being included regarding the progress of pressure sores, in line with the guidance issued by the National Institute for Health and Clinical Excellence. The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 14 Residents are weighed on a regular basis and are also assessed for their nutritional risks; these are reviewed on a regular basis. Two of the resident’s case tracked were identified as being at high risk, which indicated that a referral to the dietician should be made. Although the individual plans of care did not evidence that these referrals had been made residents were in receipt of prescribed nutritional supplements and the Registered Manager confirmed that both the General Practitioner and Dietician had been consulted. There is evidence that residents have access to other external health professionals such as the continence advisory service, podiatry services, community psychiatric nursing services and consultant specialists. Medication systems were reviewed and seen to be in good order. Medication is stored appropriately and Medication Administration Records were been to be in good order, indicating that residents are receiving their medication as prescribed. Controlled drugs are also stored appropriately and the corresponding records maintained accurately. Nursing staff receive training in the Safe Administration of Medication. Following the last inspection a Requirement was made regarding the management of covert administration of medication. This Requirement has now been met; individual plans of care contain consent forms that are signed by both the relatives and the pharmacist. There is a new policy on the covert administration of medication, which indicates that this is a last resort and that the General Practitioner is consulted so that wherever possible liquid medication is prescribed. However where medication is not soluble or liquid and the medication has to be crushed individual risk assessments should be conducted to ensure that there are no adverse effects. There is evidence that residents are treated with dignity and respect, staff relate well to residents and are aware of their preferences, they address them by their preferred name and knock on their bedroom doors before entering. Individual plans of care evidenced that staff are instructed to maintain the privacy and dignity of residents at all times including the provision of health and personal care. Staff comments regarding privacy and dignity include ‘The home ensures that the privacy and respect policies are adhered to at all times and staff are encouraged to talk and explain procedures to residents’. Individual plans of care contained minimal information regarding the residents and wishes on terminal care and death. The Cottage Nursing home specialises in the care of residents with Dementia it is therefore strongly recommended that the individual plans of care, policies and procedures are reviewed to ensure that they comply with the Mental capacity Act 2005 and the Guidelines ‘Decisions relating to cardio pulmonary resuscitation’, issued by the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing, dated October 2007. The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both managed well, are creative and provide daily variation and interest for people living in the home. EVIDENCE: The Annual Quality Assurance Assessment indicates that the service aims to treat people as individuals and equal. Individual plans of care specify the resident’s country of origin, religion and marital status. The Cottage has a policy on Equality and Diversity and also a policy on Sexuality. The environment is accessible to wheelchair users and is also suitable for those with other disabilities such as dementia. Residents have access to appropriate equipment such as wheelchairs, nursing beds and specialist equipment. The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 16 The service encourages visits form local church representatives to meet religious needs, Holy Communion is offered to the bed bound residents and provision is made for others to attend local churches. The staff team come form different backgrounds and countries, however the majority of residents are white British in origin. Comments have been made by both relatives and staff about the standard of English spoken by staff from overseas. The management have systems in place to ensure that all staff use the English language to communicate whilst they are on duty and staff are provided with training to develop their communication in the English language. The Annual Quality Assurance Assessment indicates that the Activities programme is now reviewed on a six weekly basis to reflect the needs of the existing residents. There was evidence that staffing levels are adequate, that staff are able spend time with residents and that they relate well to residents. The service also employs dedicated staff to involve residents in one to one and group activities, these were ongoing during the morning and appropriate music was played in the communal areas during the afternoon. One resident commented ‘I take part in bingo’. External entertainers are also booked to attend the Home on a regular basis. Residents have access to personal equipment such as televisions, CD player and radios in their bedrooms. The Annual Quality Assurance Assessment also indicates that the service has good links with the local community so that residents can access local services and activities. There was evidence that visitors are made welcome within the home, visiting times are flexible and residents are able to receive their chosen visitors either in their bedrooms or one of the communal areas. Residents are supported to maintain their independence and are able to move around the home, choose where to sit and access the garden areas in fine weather. Where possible residents are encouraged to participate in planning and reviewing their care. When they are unable to do so relatives and in some cases advocates are involved. Resident’s individual records identified that they receive a varied and balanced diet. The Annual Quality Assurance Assessment indicated that changes to the menu have been made following suggestions made at the residents meetings. One the day of inspection the lunchtime service was viewed and seen to comprise of cottage pie and vegetables followed by sponge pudding and custard. Most of the residents appeared to have opted for this choice however individual members of staff confirmed that alternatives were available and that individual preferences are known to the staff. There was some evidence that resident’s food preferences have begun to be recorded in the individual plans of care. One resident was able to confirm satisfaction with the food provided and a relative commented ‘The food is cooked fresh and dietary needs are The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 17 met’. Residents requiring soft diets had their meals appropriately pureed and staff were seen to provide sensitive support to residents requiring support with feeding. The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a robust complaints procedure in place however the lack compliance with the Safeguarding Adults procedures means that residents are not consistently well protected. EVIDENCE: Residents and their relatives are provided with the Statement of Purpose and Service Users Guide on admission and there is also a copy of the Statement of Purpose displayed in the main reception area. This document informs residents and relatives about the homes complaints policy and includes appropriate information about timescales for response and investigation. However some of the external contact information is now out of date and should be updated. There have been two Safeguarding Adults allegations regarding this service, both relating to the management of residents with dementia and the development of pressure sores. Both of these have been subject to independent investigation under the Safeguarding Adults guidelines. The The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 19 investigations concluded that there was no indication that the residents condition had been adversely affected by the care that was received which the residents was at The Cottage. The management were able to confirm receipt of the new Local Authority Guidelines on the Safeguarding of Adults and access to staff training in the Safeguarding of Adults and the Mental Capacity Act 2005. However the individual plans of care for two of the resident’s case tracked identified that there had been incidents between individual residents where one resident had hit another and the other had been hit. As neither of these incidents had resulted in injury the Registered Manager confirmed that no further action had been taken. There had been no referrals to the Adult Care Squad and there was no evidence of any risk assessments having been developed. The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Quality in this outcome area is good. Residents live in a home that is clean, pleasant and well maintained. EVIDENCE: The Annual Quality Assurance Assessment indicates that maintenance and improvements in décor have been made to the exterior of the old part of the building and that there is a programme of decoration for the interior with ongoing decoration of bedrooms. The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 21 The premises are fit for purpose and well maintained. There is adequate signage to the exterior of the premises to divert visitors form the old entrance to the main entrance in the extension. The home is spacious and provides residents with a variety of communal areas. The premises are well ventilated, heated and lighted. Most of the bedrooms are for single occupancy and are fitted with wash hand basins and there are adequate supplies of hot water. Rooms are fitted with privacy locks. Both communal areas and bedrooms are fitted with appropriate safety devices such as radiator guards and window restrictors. No hazards were identified. A sample of individual bedrooms were reviewed and seen to be well maintained and appropriately furnished with fixtures and fittings including call bell facilities. Residents are able to personalise their bedrooms with ornaments, photographs, pictures and small items of furniture. They are also able to have their own personal electrical items such as TV’s and CD players. One relative commented’ The place is always spotless and odourless’. One staff member commented that there are robust Infection Control procedures in place in the home. There was evidence to support both statements – infection control is managed well, hand wash facilities are available at the entrance and all people entering and leaving are requested to use this. Appropriate policies and procedures are in place, there are separate laundry facilities and the home is clean and hygienic. The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 22 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, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service employs appropriate numbers of inducted and trained staff to ensure that the residents needs are appropriately met. EVIDENCE: One resident commented ‘Sometimes staff are too busy to spend time with the residents’ and a relative commented ‘The staff make life a comfortable as possible’ another relative commented ‘The care is excellent; staff are friendly and always willing to help’. There are currently 46 residents living at The Cottage, resident’s dependency is calculated on a regular basis and this is used to inform staffing levels. Current staffing levels include 9 care staff on duty throughout the daytime shifts and five at night. There is always at least one registered nurse on duty, in addition there are sufficient numbers of domestic, kitchen, maintenance and activity coordinators to support the care staff. Staff spoken to were able to confirm that they felt that staffing levels were adequate and ensured that the needs of residents could be met. The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 23 The Annual Quality Assurance Assessment indicates that recruitment is done in a fair and open way, all nurses are registered with the NMC and at least 50 of care staff have National Vocational Qualification in Care level 2. Three staff files were viewed, the file for the most recently employed staff member identified that appropriate Criminal Records Bureau Clearances and references had been obtained prior to her appointment. The staff file also evidenced a through induction training programme. The staff files for two of the existing staff had some of the required information missing, however the Registered Manager took immediate and appropriate action to address the shortfalls and ensure the protection of residents. There is some evidence that staff have an appraisal twice yearly, however there is no evidence of regular staff supervision as specified within the National Minimum Standards. This was discussed with the Registered Manager who confirmed that appraisals were done twice yearly however that these have not been commenced for this year. The Registered Manager was advised that the National Minimum Standards state that staff supervision should be conducted for individuals at least six times a year. Staff files also evidenced that staff receive mandatory training and training appropriate to the specific needs of the residents. The service has an annual training programme, which specifies which staff members require updating in specific topics. Subjects covered last year included, Hoist training, Movement and Handling, Health and Safety, Basic Food Hygiene, First Aid, Mental Capacity Act 2005, Fire Safety and Infection Control. Other training included the Management of Challenging Behaviour, Dementia Care, Managing Percutaneous Endoscopic Gastrostomy Feeding, Funeral awareness and Motor Neurone Disease. Training in the management of pressure sores was last conduced in 2006; further training is scheduled for May 2008. There is some evidence within staff files that staff have received some training in record keeping the Registered Manager agreed to provide further training in record keeping and the planning of person centred care. One of the relatives commented that ‘Staff need to have better English’ however staff comments and the Annual Quality Assurance Assessment indicated that the service has put systems in place to support staff whose first language is not English. This was also confirmed by the staff who were spoken to during the inspection. The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 24 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): 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Quality in this outcome area is good. The leadership and management style of the home ensures that resident’s health safety and welfare are promoted and protected. EVIDENCE: The Annual Quality Assurance Assessment indicates that the Registered Manager has over 20 years of experience in care, is a Registered General The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 25 Nurse and Registered Mental Health Nurse, she holds the National Vocational Qualification level 4 in Management. The Annual Quality Assurance Assessment also indicates that the providers ensure that the views of people who use the service are taken into account through residents, relatives and friends meetings. One relative commented ‘We have relatives meetings to review the service and needs’. Another commented ‘They do all that they can I would not change anything’. There is evidence that the service consults residents and relatives about their views of the home, a sample of those surveyed in November 2007 were reviewed and seen to demonstrate a good level of satisfaction. Analysis of the Service history and the Annual Quality Assurance Assessment indicates that the Commission have not received all of the required notifications relating to events that adversely affect the well being of residents. The management have agreed to review the guidance issued by the Commission on the professional website and the arrangements for submitting notifications to the Commission. The service holds small amount of money for residents, a sample was reviewed and found to be in good order, receipts of expenditure are retained and accurate records are maintained. Money corresponds with the recorded balance and is stored within individual wallets within a locked facility. The Registered Manager confirmed that regular audits were conducted to ensure that money is stored safely and that records and balances correspond. The Annual Quality Assurance Assessment indicates that appropriate policies and procedures are in place and are regularly reviewed. The Registered Manager has complied with the requirement made at the last inspection regarding covert medication. Individual plans of care evidenced that appropriate accidents forms are completed when residents have accidents or injuries and that they are monitored thereafter for adverse side effects. The management confirm that the accident records are reviewed on a regular basis to ensure that trends can be identified and used to inform service developments. The Annual Quality Assurance Assessment indicates that the service complies with requirements form the local fire service. There is evidence that fire systems are regularly checked and the maintenance was on going during the inspection. Appropriate fire records are maintained. No hazards were identified. The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 26 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 2 X 3 The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 OP7 Regulation 15 Requirement Timescale for action 30/04/08 2. OP7 15 3. OP7 13 4. OP7 13 Individual plans of care must be further developed to ensure that they contain detailed instruction to staff about the management of the residents health, personal, mental and social care and comply with the Mental Capacity Act 2005. To ensure the health and welfare of residents. Risk assessments for falls and 30/04/08 falls from the bed must be reviewed to ensure that they comply with current best practice and that they comply with the guidance issued by the Health and Safety Executive. To ensure the health and safety of residents. Risk assessments, based on 30/04/08 current best practice and guidance issued by the Health and Safety Executive, for the use of bedrails must be conducted to assess and manage the associated risks, including entrapment. To ensure the health and safety of residents. Risk assessments based on 30/04/08 current best practice and DS0000012649.V356262.R02.S.doc Version 5.2 The Cottage Nursing Home Page 28 5. OP18 13 6. OP29 13 guidance issued by the Health and Safety Executive, must be conducted regarding the risks associated with challenging behaviour and aggression between residents. To ensure that residents are protected from abuse. Incidents where abuse has taken 30/04/08 place between residents must be referred to the appropriate authorities and action is to be taken in line with the Local Authority Guidelines. To ensure that residents are protected from abuse. Staff files must contain all of the 30/04/09 required information. To ensure that residents are protected from abuse. 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. 4. Refer to Standard OP7 OP7 OP7 OP8 Good Practice Recommendations Staff should be trained to ensure that the individual plans of care are developed and maintained in a person centred style and comply with the Mental Capacity Act 2005. Written consent for the use of bedrails should be sought from the resident or their representative. Staff should receive training in the management of risk and the development of risk assessments. Individual plans of care should be reviewed to ensure that they comply with the guidance issued by the National Institute for Health and Clinical Excellence on the Prevention and Treatment of Pressure Sores. Individual plans of care should be reviewed to ensure that they clearly evidence the involvement and recommendations made by health specialists such as the dietician. Risk assessments should be developed in the event of DS0000012649.V356262.R02.S.doc Version 5.2 Page 29 5. OP8 6. OP9 The Cottage Nursing Home 7. OP11 8. 9. OP16 OP36 solid medication being crushed prior to administration. Individual plans of care, policies and procedures should be reviewed to ensure that they comply with the Mental Capacity Act 2005 and the Guidelines ‘Decisions relating to cardio pulmonary resuscitation, issued by the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing’ dated October 2007. The complaints policies and procedures should be reviewed to ensure that they contain accurate and up to date information Formal staff supervision should be conducted and documented for individuals at least six times a year. The Cottage Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG 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 Nursing Home DS0000012649.V356262.R02.S.doc Version 5.2 Page 31 - 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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