CARE HOMES FOR OLDER PEOPLE
The Cottage Nursing Home 80 High Street Irchester Northants NN29 7AB Lead Inspector
Stephanie Vaughan Unannounced 6 July 2005 14:00 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 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 C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Cottaqe Nursing Home Address 80 High Street Irchester Northants NN29 7AB 01933 355111 01933 355129 mail@thecottgenh.com The Cottage Nursing Home Limited (Mr John Benjamin Arthur) Mrs Agnes Ernestina Arthur Care Home with Nursing 53 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of DE(E) Dementia - over 65 x 53 registration, with number of places The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 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 28-Jan-2005 Brief Description of the Service: The Cottage is a recently extended care home located in the village of Irchester. Irchester is situated close to the main A45 road, facilitating easy access to the main towns of Wellingborough,Rushden, Kettering and Northampton. The main reasons being that all patients medical needs come under Kettering General hospital and most of the patients come from the eastern part of Northamptonshire. 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 access to all floors is provided by lifts. The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection was conducted over a period of five and a half hours during which the inspector made observations and spoke to several residents. 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 reviewed, including individual plans of care and associated documentation. Three members of staff were spoken to and a selection of staff files viewed. Prior to the inspection a period of 90 minutes was spent in preparation, which included a review of previous inspection reports, previous requirements, the service history and comment cards received from residents and their representatives. A total of fifteen comment cards were received from residents and these indicated a good level of satisfaction with the services provided at The Cottage. A total of seventeen comment cards were received from residents’ representatives, three of these indicated a high level of satisfaction and sixteen indicated overall satisfaction with the service provided. However eight respondents indicated that they were unaware of the homes complaints policy and three negative comments were received. These related to access to a television in the lounge, access to private areas, other than the residents own room and staffing levels. The comments received were taken into account during the conduct of the inspection and are addressed within the body of the report. Six requirements were made following the previous inspection and all of these have been met. The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 Page 6 What the service does well:
Individual plans of care evidenced that detailed pre admission assessments are conducted by senior staff. This ensures that the home is able to meet the individual needs and expectations of the resident Individual plans of care evidenced detailed instruction to staff regarding the health personal and social care needs of the individual, regular monthly review and the involvement of the resident or their representative. Privacy and dignity is managed well at the home, residents have access to appropriate facilities and are supported to maintain their independence. Residents are well-presented and wear their own clothing. Staff relate well to residents and are respectful. The home has a range of communal areas, which include small private areas where residents are able to receive their chosen visitors in private should they wish to do so. Routines within the home are flexible and vary according to the individuals changing needs. Residents have access to leisure facilities such as televisions in the communal areas, music and daily newspapers. Residents have access to a range of individual or communal activities, which are arranged by an Occupational Therapist working in the home. The premises is an extended building and is suitable for its stated purpose. It provides a safe and well-maintained environment suitable to the needs of the residents’ with the provision of adequate communal and private accommodation. All aspects of the home were clean and hygienic. Staff are trained in infection control and the management have good systems in place to prevent infection. All visitors to the home are asked to use the antibacterial hand wash dispenser located in the entrance lobby, prior to entry and exit of the building. In addition the management have an additional system for use alongside the traditional laundry equipment for the control of infections such as MRSA (Methastatin Resistant Staphylococcus Aurous) Staff rotas indicate that the home works on a ratio of one member of staff to six residents during the daytime shifts and one to ten at night. Staffing levels are calculated according to the assessed dependency of residents and conform to the guidance issued by the Residential Forum. The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 Page 7 The home provides appropriate training for staff relevant to the specific needs of the residents such as dementia care and wound care. In addition staff have access to mandatory training such as induction. Movement and Handling, First Aid, Fire Safety, Infection Control Basic Food Hygiene and the Protection Of Vulnerable Adults, appropriate records are maintained. What has improved since the last inspection? What they could do better:
All plans included assessments for continence, nutrition, movement and handling, the risk of falls and pressure. However where assessments identify that the resident is at risk, further detail should be recorded to instruct staff about how the risk is to be managed or reduced. The choice of food at lunchtime appeared limited, with all residents having the pork casserole and rice pudding. The menu was viewed and seen to comprise a seasonal rolling menu that offers a balanced diet. However the choice particularly at lunch tomes is limited to one main course on most days.
The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 Page 8 The menu should be amended and displayed to ensure residents are informed about the alternatives available. Criminal Records Bureau Clearances and povafirst checks are conducted on all new staff. However this was not evident from the files seen. Through discussion with the management the inspector understands that the applications are sought through an umbrella body and that the results are telephoned through to the home to enable staff to commence employment before written confirmation is received. Staff files should contain evidence that this has been obtained prior to the commencement of employment. Residents are generally assessed for falls from the bed and the use of bed rails and protectors, however care plans should be reviewed to ensure that this is consistent for all residents. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Admission processes are good and ensure that the home is able to meet the needs and expectations of residents. EVIDENCE: Individual plans of care evidenced that detailed pre admission assessments are conducted by senior staff. This ensures that the home is able to meet the individual needs and expectations of the resident. Individual plans of care also contained records of assessments conducted by other health care professionals. Individual plans of care are developed form the information obtained by the pre admission assessments. Residents confirmed that their representatives had received written information about the services provided by the home and that they had been able to visit the home before deciding if it was suitable for the needs of their relative.
The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 Page 11 The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Health and personal care is managed well at the home, however care plans should include comprehensive details about interventions to reduce or manage identified risk. EVIDENCE: Individual plans of care contain detailed instruction to staff regarding the health personal and social care needs of the individual. Care plans evidenced regular monthly review and the involvement of the resident or their representative. All plans included assessments for continence, nutrition, movement and handling, the risk of falls and pressure. However where assessments identify that the resident is at risk, further detail should be provided to staff about how the risk is to be managed or reduced. For example some residents were seen to be assessed as high risk for pressure and to have access to pressure relieving equipment. However there was limited information regarding the use of routines, the provision and management of pressure relieving equipment recorded within the individual plan of care.
The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 Page 13 Residents have access to national health and specialist services. The management experience some difficulty in obtaining dental services for residents; however continue to address this through the appropriate authorities. Medication systems were reviewed and two requirements made following the previous inspection have now been addressed. Medication administration records are now appropriately maintained and good stock control systems are in place. A spot check was conducted and found to correspond with the records. A pharmacist has conducted a recent audit, the outcome of which was satisfactory. Privacy and dignity is managed well at the home, residents have access to appropriate facilities and are supported to maintain their independence. Residents are well-presented and able to wear their own clothing and this is supported by the laundry service. Residents are spoken to in their preferred from of address as specified within the care plan and staff were seen to relate well to residents. In addition staff were seen to knock on the doors of residents individual accommodation and to await permission prior to entering. The home has a range of communal areas, which include small private areas where residents are able to receive visitors in private should they wish to do so. The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 Daily life and social activity is managed well, however the menu should e improved to inform residents of the alternatives available. EVIDENCE: Routines within the home are flexible and vary according to the individuals changing needs. Residents have access to leisure facilities such as televisions in the communal areas, music and daily newspapers. Resident’s interests are recorded within the individual plans of care and the home has a games room where residents are able to participate in crafts. The home also employs an occupational therapist and an assistant who organise individual and communal activities. These were involved in one to one activities with residents during the inspection and residents confirmed that regular communal activities were available. An activities programme is displayed in the main entrance and includes professional artists and musicians. Residents confirmed that hey were able to receive their chosen visitors in private and that visiting times were flexible. Information about flexible visiting is included within the Service Users Guide. The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 Page 15 The lunchtime service was viewed, and seen to comprise pork casserole, broccoli and mashed potatoes, with rice pudding for desert. The food appeared to be well presented, of adequate proportion and to be well received by residents. The food was served from at heated trolley at appropriate temperatures in a variety of locations. Some residents receiving their lunch in their private accommodation, others remained in the lounges whist others used the dining room facilities. Residents requiring assistance are supported by staff in a sensitive and patient manner and residents are positioned to reduce the risk of choking. However the choice of food at lunchtime appeared limited, with all residents having the pork casserole and rice pudding. The menu was viewed and seen to comprise a seasonal rolling menu that offers a balanced diet. However the choice particularly at lunch tomes appeared limited to one main course on most days. Staff confirmed that alternative choices to the menu were always available, that individual preferences were know to them and that preferences and special diets are catered for. Residents confirmed general satisfaction with the food provided at the home. The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Residents are able to raise concerns and are protected. EVIDENCE: The complaints procedure has been amended following a requirement made at the previous inspection. The policy now contains all of the required information. This is also included in the Service Users Guide, which is distributed to residents and their representatives. The information is also included in the Statement of Purpose, which is displayed on the notice board in the main reception. Comment cards received from representatives indicated that a significant number of representatives were unaware of the complaints policy. This had also been identified by the Registered Manager who has now addressed this. Following a requirement made at the last inspection the home has now obtained an updated copy of the Local Authority Guidelines on the Protection Of Vulnerable Adults. In addition staff have received training in the Protection Of Vulnerable Adults, staff spoken to were able to demonstrate knowledge and competence in this subject. Residents confirmed that they felt safe living at the home, would feel able to raise any concerns with the Registered Manager with confidence that their concerns would be addressed. The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The standard of the environment is good and suitable for the individual and collective needs of residents. Infection control is managed well. EVIDENCE: The premises is an extended building and is suitable for its stated purpose. It provides a safe and well-maintained environment suitable to the needs of the residents’; with the provision of adequate communal and private accommodation. A limited tour of the premise was conducted and a selection of the individual accommodation viewed. All areas were seen to have appropriate aids and adaptations and to be appropriately furnished. Individual accommodation evidenced personalisation and fittings such as privacy locks. All aspects of the home were clean and hygienic. Staff are trained in infection control and the management have good systems in place to prevent infection.
The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 Page 18 All visitors to the home are asked to use the antibacterial hand wash dispenser located in the entrance lobby, prior to entry and exit of the building. In addition the management have recently purchased an additional system for use alongside the traditional laundry equipment for the control of infections such as MRSA (Methastatin Resistant Staphylococcus Aurous.) The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Residents benefit from adequate staffing levels and well trained staff. Recruitment processes protect the safety of residents however records should be improved. EVIDENCE: One of the comment cards received form a residents representative indicated that there might not be sufficient staff to ensure that the residents’ needs are met. However staff rotas indicate that the home works in a ratio of one member of staff to six residents during the daytime shifts and one to ten at night. Staffing levels are calculated according to the assessed dependency of residents and conform to the guidance issued by the Residential Forum. In addition, residents are supported by activities, maintenance, domestic and catering staff. Staff spoken to during the inspection confirmed that there were sufficient staff to meet the needs of residents and this was also confirmed by observations made during the inspection. A selection of staff files were viewed and seen to contain the required documentation including references. Criminal Records Bureau Clearances and povafirst checks are conducted on all new staff. However this was not evident from the files seen. Through discussion with the management the inspector
The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 Page 20 understands that the applications are sought through an umbrella body and that the results are telephoned through to the home and staff commence employment before written confirmation is received. The home provides appropriate training for staff relevant to the specific needs of the residents such as dementia care and wound care. In addition staff have access to mandatory training such as Induction. Movement and Handling, First Aid, Fire Safety, Infection Control Basic Food Hygiene and the Protection Of Vulnerable Adults, appropriate records are maintained. The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The health and safety of residents is managed well however further improvements are recommended. EVIDENCE: The management ensure that staff have access to mandatory training to ensure the health and safety of residents. Movement and handling practices were observed and seen to comply with current guidance and good practice. Residents have appropriate risk assessments in place for the use of equipment such as wheelchairs and these are now used safely. Residents are generally assessed for falls from the bed and the use of bed rails and protectors, however care plans should be reviewed to ensure that this is consistent for all residents.
The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 Page 22 Appropriate accident records are maintained and evidence subsequent monitoring of the residents condition. The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 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
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 4 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 3 The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation None Requirement Timescale for action 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 8 15 29 38 Good Practice Recommendations Assessments that identify that a resident is at risk, should provide instruction to staff about how the risk is to be managed or reduced. The menu should be amended and displayed to ensure residents are informed about the alternatives available. Staff files should contain evidence that a satisfactory povafist check has been obtained prior to the commencement of employment Care plans should be reviewed to ensure that this all residents are assessed for the risk of falls from the bed, the use of bedrails and protectors. The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection First Floor Newland House Campbell Square Northampton NN1 3EB 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. Extracts may not be used or reproduced without the express permission of CSCI The Cottage Nursing Home C51 C08 S12649 The Cottage V237014 060705 Stage 4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
