Inspection on 17/01/06 for The Cottage Nursing Home

This inspection was carried out on 17th January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Cottage Nursing Home 08/11/06

The Cottage Nursing Home 22/09/05

The Cottage Nursing Home 22/02/05

The Cottage Nursing Home 04/11/04

The Cottage Nursing Home 01/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Cottage Nursing Home, The 57/58 Blakenall Heath Bloxwich Walsall West Midlands WS3 1HS Lead Inspector Mrs Mandy Beck Announced Inspection 17th January 2006 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 Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cottage Nursing Home, The Address 57/58 Blakenall Heath Bloxwich Walsall West Midlands WS3 1HS 01922 712610 01922 712610 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) Acepay Limited Rosemary Elizabeth Broadhurst Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 26 frail elderly requiring nursing care 26 frail elderly requiring social care conditions 1 and 2 not mutually exclusive of which 5 may be terminally ill The home to accommodate a maximum of one person in an intermediate care bed. 22nd September 2005 Date of last inspection Brief Description of the Service: The Cottage Nursing Home as the name suggests is registered by the Commission to provide nursing care to a maximum 26 older people at any one time. One bed is funded on a contract basis for intermediate care. The home is located in a pleasant residential area. A bus stop is situated virtually outside of the home. The home was purpose built and first registered in 1992 by the present owners. The home comprises of 14 single and 6 double bedrooms. The intermediate room only, has en-suite facilities. The main lounge / dining room is located on the ground floor. A small lounge is available on the first floor. A number of assisted and non-assisted bathing facilities and toilets are located on both floors throughout the home. Bedrooms are available on both floors. The kitchen, treatment room, and offices are on the ground floor, staff room and laundry in the lower ground floor. The garden whilst attractive with its mature shrubs has limited usable space, as the grassed area is sloped. Limited car parking spaces are available at the front of the home. The owners have applied for planning permission to add extra 7 beds to the home, improve facilities and have the garden levelled. Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection which began at 08.15 and concluded at 16.00. The information and judgments made throughout this report are based upon findings from talking to residents and their families, staff members, a tour of the premises and pre inspection questionnaire completed by the manager prior to the inspection. A total of 6 comment cards were also received from a mixture of residents and their relatives. Three residents’ files were selected for case tracking this included looking at their assessment details, care planning and how the home involves the residents in this process. Staff records were also checked to ensure that recruitment and selection processes are safeguarding service users. What the service does well: What has improved since the last inspection? The home has taken positive steps to meet many of the requirements from the previous inspection. The maintenance and redecoration of the home has begun and most of the bedrooms have now been decorated. Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 6 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. Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 6 Residents can be assured that when they enter the home their needs can be met. Each resident has a written contract/statement of terms which details conditions of occupancy. Residents entering the home for intermediate care can be assured they will be encouraged to maximise their independence to enable them to return home. EVIDENCE: A terms and conditions document is now in place for all service users, they now detail which room the service user will be moving in to and the current fee. All of the prospective service users have their needs assessed prior to their admission this assures both the registered manager and the service user that when they move into the home their needs will be met. The home has one intermediate care bed, they have dedicated facilities for each person entering the home for this purpose. All of the staff have been given training in using techniques that promote independence and recovery programmes. Each service user is visited regularly by specialist services such as Occupational therapists and Physiotherapists. The manager is not always involved in the admission process for service users where intermediate care is Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 9 concerned and therefore may not be able to assure service users that their needs can be met prior to admission to the home. Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Residents needs are generally identified in an individual plan of care although some minor improvements are needed to ensure all needs identified have a plan. Medication is administered safely and stored securely, residents can be assured they are protected by the homes policies. Residents feel that they are treated with respect and dignity at all times. EVIDENCE: The home has core care plans for each resident and generally identifies most of their needs but not all of the residents needs identified in their assessment are transferred to a care plan. One residents file stated that they were incontinent but there was no plan to show how this need was being managed, similarly another assessment identified that the resident suffered from constipation and had medication prescribed to help treat the problem but this information had not been transferred to a care plan. The home needs to explore ways in which to involve residents in the review of their care needs. Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 11 The registered manager ensures that all residents have access to specialist medical, nursing, dental and chiropody according to individual need. The home has risk assessments in place for falls, pressure sore development, moving and handling and nutritional screening. The home benefits from the input of a community matron who visits the home regularly to monitor residents health and well being. If risks are highlighted the home takes active steps to reduce them with the provision of pressure relieving equipment and referral to the dietician in the case of one resident, whose skin has become fragile and broken. The home had also noted that the service user has lost weight and had sought the advice from the dietician and the speech and language therapist to help them manage the presenting needs. The home has robust systems in place to monitor all residents weights although some of the more dependent residents find it difficult to be weighed because it can cause them some discomfort at times, the manager should explore the possibilities of different methods of monitoring their weights. It was noticed whilst touring the premises one resident had a stair gate across their bedroom door, upon reading through their file there is no mention of this type of restraint and why it is in place. The manager must take steps to rectify this situation. Other avenues of observing this resident should be explored with all interested parties. Trained nurses administer medication, none of the residents self medicate at this time. Medicines are stored safely and securely in line with the homes policies. Controlled drugs are stored in a metal cupboard as recommended, at present none of the residents are prescribed a controlled drug. There was evidence of a destruction kit in the controlled drug cupboard to ensure that all drugs are destroyed before they are disposed of. There were still some medications within the controlled drugs cupboard that need to be disposed of, the home is seeking advice on the most appropriate way of doing this as the “Patches” cannot be destroyed with the destruction kit. The home has a contract for the removal of all pharmaceutical waste to ensure that all medicines are disposed of safely. There were unexplained omissions on Medication Administration Record charts staff were unable to confirm whether residents had had their medication or the reason for omission. Medicines stored in the fridge are stored safely and at the correct temperature however staff must ensure that all medicines are labelled with a date of opening this includes anti biotics. There was positive interaction with staff and residents throughout the day, residents comments included “they are pleasant and always willing to help”, “I am impressed by the cheerfulness of the staff”. The staff are aware of the preferred term of address for all residents. During a tour of the premises it was observed that there is appropriate screening for all residents sharing a double room to ensure that their privacy and dignity is not compromised when personal care is being given. Each resident has their own basket for laundry and can be assured that they are wearing their own clothes at all times. Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 12 Residents can receive their visitors in the lounge or in the privacy of their own rooms if they wish. The home was very busy during the day of the inspection with many visitors and this helped make the home feel very sociable. Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above standards were looked at during this inspection EVIDENCE: Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home needs to develop it’s current Protection of Adults policy to ensure that residents are protected from abuse. EVIDENCE: The home currently has a policy for dealing with suspected abuse but it needs to be developed further and in line with guidance from the Department of Health No Secrets and with the local adult protection team. The current policy does not include details of the Protection of Vulnerable Adults POVA and the circumstances in which referrals to the register would be made. Furthermore the home needs to develop it’s policy and practice regarding residents monies to ensure that all residents monies are kept safe and securely with appropriate records maintained. Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The home is clean and hygienic, it is well maintained and residents can feel assured of their safety. EVIDENCE: The home has undergone some decoration since the last inspection, most notably for the residents was the new lounge carpet. They were all pleased with the new colour. “we are having everything spring cleaned and painted” The home’s maintenance person has been working hard to redecorate the corridors, stairs, dining rooms and some of the bedrooms. There is still work to be done and plans for new carpets in the corridors are in hand. During the previous inspection it was noted that some bedrooms had vinyl type flooring, since then residents have been asked if they want this replacing with carpet, none of the residents said yes, preferring the vinyl flooring as this made them feel safer whilst walking about their bedrooms. “I like the red floor it’s comfortable and it feels safe when I walk on it”, another resident commented that “it’s easier for cleaning if I have an accident” Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 16 The laundry has been redecorated and is much improved since the last inspection, work is in progress to update the ironing room at this time. Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 All of the staff are encouraged to take part in training to enhance their skills and knowledge this means the care they deliver is based on current best practise. EVIDENCE: The registered manager has now completed a training matrix which details training for all employees. Arrangements have been made for all mandatory training to be completed this year and the home benefits from it’s own dedicated trainer. The trainer has recently undertaken refresher courses in moving and handling and fire safety. Some of the staff spoken to said that they were encouraged to take part in training and not just mandatory sessions. Trained staff are now enrolled on an infection control course, kitchen staff are encouraged to pursue food hygiene training with Chartered Institute of Environmental Health. There are a few residents who experience dementia at the home, the manager should consider arranging a “dementia awareness” training day for staff to further enhance their skills when dealing with residents who have this type of disability. Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 The home has suitable facilities for safe keeping of money on residents behalf. They need to produce a policy detailing how resident’s monies will be handled and how they will keep it safe so that residents can feel their financial interests are being safeguarded. EVIDENCE: The home provides secure facilities for the safe keeping of residents monies. The present storage system needs to be developed so that residents can feel confident their individual monies are safe. The current system of writing the amount of residents money on to the envelope is not adequate and the registered manager needs to put in place robust procedures and policies to address this. One resident has an arrangement with a member of staff to collect money for him from the bank, there is at the time of the inspection no written statement or record of this arrangement, the registered manager needs Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 19 to seek clarification in relation to this situation to protect both the residents and staff interests. Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 x x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 2 x x x x x x 2 STAFFING Standard No Score 27 x 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 1 x x x Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 23(2)(b) Requirement The registered person and manager must provide the CSCI with written timescales to inform when the following work will be carried out: The replacement of carpet in the ground and first floor corridors. The refurbishment of all bathrooms and toilets. The redecorating of communal areas. (previous timescale of 01/11/05 not met) 2 OP19 23(1)(a) The registered person and 01/03/06 manager must provide in writing, an up date on the proposed extension work. (previous timescale of 01/11/05 not met) The registered person and 30/04/06 manager must provide adjustable beds for service users’ who require assistance with DS0000020790.V271920.R01.S.doc Version 5.1 Page 22 Timescale for action 01/04/06 3 OP24 16(2)(c) Cottage Nursing Home, The moving and handling. (Previous Timescale of 01/06/05 not met) 4 OP26 13(3)18(1 ) The registered person and manager must ensure that all staff receive infection control training. Priority must firstly be given to nursing staff. (part met) The registered person and manager must ensure that the following are obtained (and retained on file) before any staff member is allowed to commence employment; A photograph. (previous timescale of 22/09/05 not met) The registered person and manager must formalise the results of feedback questionnaires. The results published and made available to current and prospective service users’ and other interested parties including the CSCI. (not assessed on 17/01/06) 01/12/06 5 OP29 19(1)(19) (4) 01/03/06 6 OP33 24 01/12/05 7 OP33 26 The registered persons must visit 01/03/06 the home unannounced at least on a monthly basis and compile a written report of their findings as per regulation 26. A copy of which must be provided to the CSCI. (previous timescale of 01/11/06) The registered manager must ensure that appropriate risk assessments are in place for the use of the stair gate in one service users bedroom door frame and there is involvement from all interested parties in this DS0000020790.V271920.R01.S.doc 8 OP7 13(4)(c)( 7)(8) 01/03/06 Cottage Nursing Home, The Version 5.1 Page 23 process. This process should be kept under regular review 9 OP7 15 The registered person must ensure that all of the residents needs identified in their assessment is reflected in their care plans The registered manager must ensure that the date of opening is written on all medicines this includes anti biotics. The patches stored within the controlled drugs cupboard must be disposed of. There must be no gaps MAR charts when administering residents medication. All omissions must be accounted for. The registered manager must develop the Protection of Vulnerable Adults policy in line with guidance from Department of Health no Secrets and local policy. The details of referral to POVA should also be included. The registered manager should also make arrangements for all staff to receive adult abuse awareness training The registered manager must put in place a policy and procedures for managing service users monies. The present system of recording transactions must be improved The arrangement between resident and employee collecting money should be examined with all relevant parties to eliminate the potential for exploitation and Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 24 01/04/06 10 OP9 13(2) 01/04/06 11 OP18 13(6) 01/04/06 12 OP35 16(I) 28/02/06 this should be documented and kept in the residents file. 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 OP30 Good Practice Recommendations The registered manager should give consideration to arranging dementia awareness training for all staff to ensure they have a basic understanding of residents needs who have dementia The registered manager should consider purchasing a ledger to record all transactions involving service users monies 2 OP35 Cottage Nursing Home, The DS0000020790.V271920.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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