CARE HOMES FOR OLDER PEOPLE
The Cottage Nursing Home 80 High Street Irchester Northants NN29 7AB Lead Inspector
Irene Miller Key Unannounced Inspection 14th February 2007 10:00 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.V316107.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 Nursing Home DS0000012649.V316107.R01.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.V316107.R01.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 23rd February 2006 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 £515 to £575, 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. The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is based upon outcomes for Service Users and their views of the service provided. This inspection was a ‘Key Inspection’ that focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. The inspection took place over a period of approximately eight hours during which time the inspector spent two hours observing the care of five service users. The period of observation was carried out within the one of the lounge/dining rooms, between 12:05pm to 14:05pm. In addition to the observation period the care of three service users was ‘case tracked’ this involved reviewing the care that they received through inspection of the written information available on their care, such as the care plans (a care plan sets out how the home aims to meet the individual service users personal, healthcare, social and spiritual needs). Discussions took place with service users, staff, the registered manager, and registered provider, the homes policies and procedures and records in relation to staff recruitment, complaints, and general maintenance and upkeep of the home were viewed. Prior to the inspection taking place the inspectors spent three hours planning the areas to focus on, based upon information gained from reviewing the homes service history, the last two inspection reports and pre inspection data provided by the registered manager. The registered manager Mrs Arthur was available at the home throughout the inspection. What the service does well:
The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 6 During a two-hour observation period there was good staff interactions with the residents, there was evidence of staff providing residents with comfort, a sense of identity, attachment, occupation and inclusion. The care plans had information available to demonstrate that the resident’s physical and emotional health was closely monitored and that ongoing support was provided from healthcare professionals Within the main kitchen there was evidence that and food safety systems were followed, the cook was knowledgeable of the resident’s nutritional needs, dietary requirements, and food preferences. Many of the residents required full supervision and practical assistance during the meal times, and during the lunchtime meal the staff were observed providing support with sensitivity to individual residents needs. The communal areas had a range of seating available to include specialist seating for frail residents that required greater physical care and support. Residents and visitors spoken with during the inspection said that they were very happy with the care they received at the home, the registered manager and the registered provider promote a person centred philosophy that fully respects the resident’s rights to privacy, dignity and independence. The feedback gained from residents and their representatives both prior to and during the inspection was very positive, many relatives had completed feedback sheets on behalf of the residents, who due to their dementia did not have the capacity to complete the forms themselves. Relatives expressed how pleased they were with the friendliness of the staff, the openness and approachability of the management, the cleanliness of the home and the high standards of care. There was some concern about the need for staff to spend more time with residents sitting and chatting, however on the whole relatives felt that the home ensured that the residents health, personal, social, emotional and spiritual needs were being met. What has improved since the last inspection?
The home has complied with meeting the requirements set following the last inspection visit. The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 7 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 summary of this inspection report can be made available in other formats on request. The Cottage Nursing Home DS0000012649.V316107.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 Nursing Home DS0000012649.V316107.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): Standard 3 (standard 6 is not applicable to this service) Quality in this outcome area is good. Residents can be assured that their needs will be assessed prior to moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were viewed and there was evidence that full pre assessments of needs had been carried out. Prospective residents and their families were encouraged to visit the home informally, prior to making any decision about moving in. The information provided through the pre inspection data collection evidenced that many of the residents and their relatives had chosen The Cottage Nursing Home after visiting several other establishments. The feedback received from relatives was very positive all expressed satisfaction with the information that had been made available about the range of services at the home, which had enabled
The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 10 them to make an informed decision, as to whether the home was right for them. The Cottage Nursing Home DS0000012649.V316107.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): Standards 7,8,9 & 10 Quality in this outcome area is good. Resident’s needs are identified, and appropriate care is provided, however to ensure the information reflects the current risks and needs of individual residents, reviews need to be carried out more frequently and where necessary involve other healthcare professionals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Within the care plans there was information available to demonstrate that the residents physical and emotional health was closely monitored and that ongoing support was provided from healthcare professionals such as general practitioners, district nurses, community psychiatric nurses and optical and podiatry services. Records in relation to the storage and administration of medication in use within the home were sample checked and appeared well managed. During the two hour observation period, the staff were observed on several occasions to endeavour to encourage one resident to drink some fruit juice, it
The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 12 transpired through discussion with staff and through reading the residents care plan that the resident medication was given in drinks. The staff explained that the resident was unable to tolerate medication in tablet form. The resident appeared unaware of the importance of taking their medication, and refused the drink on several occasions. Upon viewing the residents care plan there was documentation available to demonstrate that the resident was considered incapable of giving their consent to receiving medication and that the home had sought the consent from the next of kin, however there was no record that the refusal of medication had been discussed during a medication review with the general medical practitioner. The homes medication policy did not fully address the protocol to follow when administering essential medication to residents who lack the capacity to give informed consent. The care plan did not include what involvement or discussion that may have taken place between the residents general practitioner, relatives and other healthcare professionals, such as seeking an alternative formulation of the medicine, that may be more acceptable. There was no record available as to what tablets were to be crushed and how it was to be given to ensure that the pharmaceutical properties of the medicine were not altered. The risk assessments had sufficient information available for staff to follow, that included the staff intervention required to prevent or reduce the likely hood of falls and pressure ulcers. One resident who had previously been at a high risk of falls, the assessment had not been reviewed for a considerable length of time, and changes had taken place in the health and safety needs of the resident, therefore the information within the assessment did not reflected the residents current safety needs, however when speaking with staff they were fully aware of the residents capabilities and the risks that were present. One of the residents case tracked was at risk of rolling out of bed, the home had gained the consent from relatives to enable bedside rails to be in use, however there was no detailed risk assessments in place for the use of bedside rails that addressed the compatibility of the equipment in relation to the individual resident/bed occupant. Staff were observed treating residents in a respectful and courteous manner. Residents were addressed by their preferred name. Residents said that they were very happy with the care they received at the home, the registered manager and the registered provider promote a person centred philosophy that fully respects the resident’s rights to privacy, dignity and independence. The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 13 The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 14 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): Standards 12,13,14 & 15 Quality in this outcome area is excellent. The care that is provided within the home matches the resident’s expectations, and meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During a two-hour observation period there was good staff interactions with the residents, there was evidence of staff providing comfort, a sense of identity, attachment, occupation and inclusion. One resident was observed to move about independently, taking great joy in looking out of the window at the garden, the resident talked about the flowers and the trees and how beautiful they were. Residents who were not independently mobile were observed to receive support from staff, and residents were observed chatting with staff, and other residents. Residents were observed playing a game of bingo with staff support, one residents was quietly singing along to some background music, residents were observed interacting with each other and staff, whilst others chose to passively watch the activities that took place, staff were sitting beside residents offering emotional and practical support.
The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 15 The staff recognised the importance of ensured that residents sense of being was promoted, staff were observed talking with residents, showing an interest about their families, enquiring how their son/daughter was, likewise residents asked staff about their children, this promoted natural open discussions. The home cares for residents who have a diverse range of physical and emotional needs, the residents appeared relaxed in the company of staff and were observed initiating contact with staff, the staff responded appropriately to resident’s using, touch and verbal and non-verbal body language. One resident was observed gaining great comfort from using a teddy bear as a cushion, the resident clearly got comfort from this object and the staff recognised the import role that the teddy played in giving the resident comfort and a sense of well being. The main kitchen was viewed, and food safety systems were followed, the cook was knowledgeable of the resident’s nutritional needs, dietary requirements, and food preferences. Many of the residents required full supervision and practical assistance during the meal times, and during the lunchtime meal the staff were observed providing support with sensitivity to individual residents needs. The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 16 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): Standards 16 & 18 Quality in this outcome area is good. Residents and their representatives can be assured that their rights are protected, however a clear policy encompassing the covert administration of medication would ensure that the residents health and welfare is fully promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a complaints procedure available and the provider or the Commission for Social Care Inspection had not received any complaints since the last inspection visit. Staff training had been provided on the protection of vulnerable adults, and the home had a copy of the Northants Inter Agency Policies and Procedures on reporting abuse should the need arise. The care plans did not include what involvement, discussion or decision had taken place between the resident’s general practitioner, relatives and other healthcare professionals, when administering essential medication covertly to residents who lacked the capacity to give informed consent. The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 17 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): Standards 19 & 26 Quality in this outcome area is good. Residents live in a home that is clean, pleasant and well maintained This judgement has been made using available evidence including a visit to this service. EVIDENCE: During a limited tour of the building the home appeared well maintained, clean and hygienic, the bedrooms viewed had been personalised, and pressurerelieving equipment and moving and handling equipment were seen to be available. The communal areas had a range of seating available to include specialist seating for frail residents that required greater physical care and support. There was a high standard of cleanliness within the home and hand sanitisers were seen to be in use throughout the home to help in reducing the risks of cross infection.
The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 18 The main kitchen was clean and tidy and there were records of food safety checks being carried out. The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 19 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): Standards 27,28,29 & 30 Quality in this outcome area is good. The staff team are trained and competent within their roles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of inspection there was sufficient staff on duty to meet the needs of the residents, it was noted that during the lunchtime period there was a high proportion of residents that required full staff support and assistance. The home had accommodated this through increasing the staff ratio at this time of day. The staff training records covered mandatory training on health and safety, fire, protection of vulnerable adults, moving and handling and food hygiene, and training had been provided in dementia care levels 1 and 2 and conditions of old age, such as osteoporosis awareness and loss and bereavement. The staff said that they received good support and that there were good training opportunities, some of the staff spoken with were undertaking the National Vocational Qualification (NVQ) level 3 training. Staff employed from oversees are recruited through an employment agency specialising in providing staff for the care sector.
The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 20 The staff records seen demonstrated that the recruitment and supervision procedures are thorough and robust. The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 21 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): Standards 31,33,35 & 38 Quality in this outcome area is good. The ethos leadership and management style of the home ensures that resident’s health safety and welfare are promoted and protected This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager and registered provider had in-depth knowledge of the needs of the residents living at the home and are well respected by residents, staff and visitors. There is an open and inclusive atmosphere within the home, when speaking with staff they said that they feel supported, and that training opportunities were made available.
The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 22 During the inspection the registered manager was observed communicating and interacting with residents and staff and visitors in a relaxed and professional way, it was evident that residents felt comfortable and valued within the home. The feedback gained from residents and their representatives both prior to and during the inspection was very positive, relatives who completed the Commission for Social Care resident survey forms, acting on behalf of residents who were unable to do so themselves, said that they were very impressed with the friendliness of the staff, the openness and approachability of the management, the cleanliness of the home and the high standards of care. The homes record keeping in relation to resident’s financial affairs and personal information were stored securely The registered manager is committed to further improving the management systems and the outcomes for residents living at the home. The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 23 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
S CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X 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 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 24 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 OP9 Regulation 13 Requirement In circumstances where covert administration of medication is considered, such as to prevent a service user missing out on essential treatment. The registered manger must have in place a covert medication policy that involves consultation with the multi professional team and the service users carers or relatives. Timescale for action 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Cottage Nursing Home DS0000012649.V316107.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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
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