Key inspection report CARE HOMES FOR OLDER PEOPLE
Urmston Cottage Greenfield Avenue Urmston Manchester M41 0HN Lead Inspector
Sylvia Brown Key Unannounced Inspection 7th May 2009 09:30
DS0000006729.V375447.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Urmston Cottage DS0000006729.V375447.R01.S.doc Version 5.2 Page 2 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Urmston Cottage DS0000006729.V375447.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Urmston Cottage Address Greenfield Avenue Urmston Manchester M41 0HN 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) 0161 747 3738 no fax Urmston Cottage (Mcr) Ltd Mrs Kerry Lucie Griffin Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45), Physical disability (45) of places Urmston Cottage DS0000006729.V375447.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD The maximum number of service users who can be accommodated is: 45 Date of last inspection 25th November 2008 Brief Description of the Service: Urmston Cottage is an extended Victorian property offering care and accommodation with nursing support to 45 service users. There are several lounges and a dining area for service users communal use. Bedroom accommodation is on two floors and is for single and double occupancy. Some bedrooms have en-suite facilities. A passenger lift supports service users to reach all parts of the home. There are gardens to the rear of the property, which are well used in fine weather and parking space is available to the side of the home. The home is near the centre of Urmston, close to a number of shops and market place. It is close to local bus routes and the Metrolink. The current fees for the home range from £369:30 to £700 per week which does not include funded nursing care. Fees are dependant on care need support and individual funding arrangements. Urmston Cottage DS0000006729.V375447.R01.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 2 star. This means the people who use this service would experience good quality outcomes. The inspection report is based on information and evidence gathered by the Care Quality Commission (CQC) since the last key inspection, which was completed on the 8th September 2008. Following that inspection we completed a random inspection on 25th November 2008 to monitor compliance with requirements issued from the key inspection in relation to how medication was being managed, administered, recorded and disposed of. The pharmacist inspector identified that the service had not done everything we asked them to do to make sure that residents got their medication safely and properly. We decided that to make sure the service did as we asked, we needed to use out legal powers. We served a legal notice telling the service what they needed to do, and when by. We checked in January 2009 and found enough action had been taken to make the arrangements for medication safe. This Key inspection was conducted over two days, both visits were unannounced, which means the operations manager, manager of the home and the staff were not told that we would be visiting. The first visit was conducted early in the morning so we could look at morning routines of service users and staff members. The second site visit was conducted by the pharmacist inspector to specifically monitor the management of medication. As well as the site visit we gathered information from a number of people, which included talking with and seeking the views of service users. We sent out surveys to service users, relatives and members of staff. This gave them an opportunity to write to with us about their opinions on the services provided at Claremont. Comments received are included within the report. We looked in depth at the care and support provided to at least two service users which included looking at their records and care support provided. We also spent time sitting with service users and observing their day to day routines as they received care support from care staff. This helped us get a better view about how people living at the home are looked after and supported. In March 2009 the operations manager completed a self-assessment form which is called an Annual Quality Assessment Audit (AQAA) . This document should tell us what the home had been doing since the last key inspection to meet and maintain the National Minimum Standards. It should also include information about their thoughts on what they were doing well, how they had improved within the past 12 months and their plans to develop in the next 12 months. The document was completed in enough detail and gave us
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DS0000006729.V375447.R01.S.doc Version 5.2 Page 6 information on most aspects of the service. We have given advice to the manager of the home to make sure that they refer to our guidance when completing such documents to make sure that they include all the information and evidence to demonstrate their practice to maintain and develop standards in all areas. We also gather information through general contact with the service and through their reporting procedures, which are called Notifications. We have been consulting with the Local Authority through their protection of vulnerable adults procedures. There have been a number of allegations of abuse and poor practice made about the service which have been investigated by the Local Authority. This report is a public document and should be readily available for reading at the home. What the service does well:
Pre-admission procedures enable prospective service users to meet with someone from the home and have their needs assessed by them .They are able to visit Urmston Cottage and look around before they make any decisions about moving in. This means that because there is a good pre-admission procedure in place prospective service users or their relatives can take their time and make sure that the services offered at Urmston Cottage are suitable and meet their needs. One relative said I went to visit and was very impressed. The manager and office staff were very helpful, the home is modern and bright and the home was considerably more friendly, clean and welcoming and offered activities for my relative, more than all the homes that were suggested to me. All service users spoken with and who completed surveys told us they liked living at the home and felt they were treated with dignity and respect. Relatives indicated that in the main they are made to feel welcome and that visiting their relatives is a nice experience. Some relatives comments include on the whole staff are very caring and supportive I think we are very fortunate in placing my relative in Urmston Cottage and I would not and could not have chosen better. The quality of food and menu choices remains good. From information we have received we are not aware of any issues of complaint about the meals provided. Service users are able to have hot cooked breakfast items everyday and a choice at mealtimes, furthermore they receive cakes and light snacks between meals rather than routinely being served biscuits. Each service user has a nutritional assessment in place and their weight is monitored. This means that service users have the opportunity of receiving a well balanced and nutritious diet. What has improved since the last inspection?
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DS0000006729.V375447.R01.S.doc Version 5.2 Page 7 Care planning procedures continue to improve. New systems mean that appointed staff members are learning to consult more with service users about their individual needs and how they would like them met. The records we looked at were of quite a good standard and once the systems have been further developed and as staff members become familiar and confident with them they should make sure every service user receives their care support in an individualised manner and according to their wishes. The way medication is now managed, recorded and administered is good. A significant amount of time has been spent by the operations manager, manager of the home and nursing staff to make sure they support service users to take their medications safely. All staff members have received training and systems for recording and managing medicines within the home have developed appropriately. This means that service users are more likely to receive their medication as prescribed by people who are competent in medication administration and management procedures. The way social activities have been developed within the home is extensive. The appointment of a full time activities coordinator who has the skills, competency, enthusiasm and understanding of her role and responsibilities has meant that all service users have been consulted about what they would like to do both within and outside of the home. Numerous activities now take place each day and for those who do not like group activities one to one time is planned for which means everyone receives some support to socialise as they wish. Service users and relatives told us they were happy with the changes with nine of the eleven surveys saying that there was usually or always enough activities provided. We were told since the qualified activity organiser joined the staff team there has been regular and varied activities which have been excellent. She shows a genuine interest and concern for all residents. The young lady who arranges activities most days tries to include my relative. She appears to be very dedicated and keeping up-to-date activities on the board in the reception together with photos of events that have been staged. Service users and residents also have the opportunity of meeting together as a group to talk with the manager and staff members about activities and other issues relating to the services provided. This means that service users feel valued and are able to make valid contributions to the future development of the service as are their relatives. Since we last inspected improvements have been made to the way in which service users privacy and dignity are respected. From staff meeting records we could see that the manager has met with staff and explained clearly the standards required by her. We could see where staff had been given guidance in making sure that service users clothing was well cared for, that they receive support to maintain hairstyles and support to maintain their individuality in their dress. The manager has actively sought to encourage service users and relatives to talk with her about any aspect of the service they are not happy with, as a consequence everyone knows about the complaints procedure and how to
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DS0000006729.V375447.R01.S.doc Version 5.2 Page 8 action it if required. Because of the efforts the manager has made people have confidence in her and feel able to talk with her about any complaints they have. Within the surveys residents and relatives told us they knew who to speak to if they were not happy with one relative confirming the manager makes herself available saying I would contact the manager Sharron on my relatives behalf. Sharron is usually there one day over the weekend.” The environment has within the last twelve months undergone extensive upgrading and although this has at times been problematic the outcome is that service users are now living in a well maintained home which is furnished to a high standard. Every room has received attention with service users receiving a new bed, bedding and bedroom furniture. Plans are underway to continue with the upgrading by the provision of new flat screen televisions being placed in each room. Where service users prefer they are able to have their own furniture from home and each service users can choose their own colour schemes for decoration which means their rooms are individual to them. Prior to the inspection we consulted with staff members, four of whom returned their staff survey. From the information we received we could see that the way in which they were being managed had improved. They told us that they met with the manager regularly and that they were give enough information suitable to their role and responsibilities. They also told us that they felt they mostly had the skills and experience necessary for their staffing position and that they had access to lots of training and were supported well by the manager. We observed throughout the inspection that overall staff appeared more settled and organised with team working more in evidence. Because of this the atmosphere within the home was better, we could see staff and service users interacting well with each other and that staff did not talk over service users or ignore them. One service user told us that although she tends to ask for a lot the girls were smashing and she could not ask for anything more than she was already receiving. Since her appointment the manager has demonstrated that she has the skills and experience necessary for managing a care service. Her direct management style and openness to communicate with service users, relatives, visitors and staff has enabled the home to develop and has given people a confidence that the home is being managed by a person who is approachable and who sets standards by leading by example. What they could do better:
Whilst it is appreciated that considerable time, effort and expense has been made to upgrade the internal aspects of the home, externally parts of the home appear shabby. The main seating and garden area needs a substantial amount of work completing to make it an enjoyable suitable place for service users to sit during nice weather and in time for this summer. The front aspect of the home does not reflect the standards within the home or attention to
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DS0000006729.V375447.R01.S.doc Version 5.2 Page 9 detail one would expect from a well maintained home. shabby in parts, and garden areas unkempt. Paintwork looked Service users should be encouraged to maintain their independence and where possible have the opportunity of pouring drinks for themselves and others. They should also be encouraged to pour milk on their cereals, butter and spread preserve on their toast and add their own sugar to their hot drinks if desired. Routinely providing this for service users and doing it on their behalf makes the service less personalised and reduces service users abilities rather than promoting them. Support to maintain a service users continence should be individual, and whilst it can be appreciated that some basic routines have to be in place when dealing with some aspects of group living it should not come at a cost to a persons individuality or need. We are recommending that service users have individual continence support plans in place. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Urmston Cottage DS0000006729.V375447.R01.S.doc Version 5.2 Page 10 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 Urmston Cottage DS0000006729.V375447.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 & 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have their needs assessed, are given information about the home and are able to look around the home before making any decisions about their future. This meant that they knew that their needs could be met before they made a decision to moved in. EVIDENCE: In the AQAA the operations manager stated that people, prior to a service user undergoing admission, a full pre admission process is carried out. The operations manager confirmed that all prospective service users are visited by
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DS0000006729.V375447.R01.S.doc Version 5.2 Page 12 him and that they are provided with all the required information about the services offered at Urmston Cottage and are invited to visit the home. To find out whether this was the case, we looked at a range of documents for two recently admitted service users. The pre-admission records in place were extensive and were very well detailed, however both appeared to have been completed after the actual admission of the service user. The operations manager explained that staff members had transferred pre-assessment information and admission information onto the new format without stating the actual dates of the assessments. When asked if pre-assessment records were kept the operations manager stated that they were not kept once they were transferred onto the service users files. Whilst we have no doubt that the pre admission process is completed, we are recommending that pre-admission processes are recorded appropriately and records maintained. Relatives confirmed they were provided with information about the service and were able to look around the home. We were told full information regarding the running of the home was given and I found it to be very helpful. Even though prospective service users are provided with the homes statement of purpose and service users guide, copies are provided in all bedrooms to make sure service users and their visitors have access to up to date information. Seven of the nine service users surveyed stated that they had received contracts of terms and conditions at the point of moving into the home. Urmston Cottage DS0000006729.V375447.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health and personal care needs were met in the way they needed and preferred. EVIDENCE: We found medicines stock and records to be well organised and securely stored. Our checks of the records and current stock showed medicines were being given and recorded correctly. A clear system of stock control was in place that helped make sure medicines did not run out of stock and helped make sure they could be fully accounted for. Medicines were regularly checked and detailed records of this were made, any mistakes that were found were acted upon immediately to try and prevent them happening again. Staff had
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DS0000006729.V375447.R01.S.doc Version 5.2 Page 14 received regular medicines training and their competency in handling medicines had been formally assessed. Nursing and care staff said they felt well supported by the manager and any training needs were met by formal training sessions, regular meetings and direct supervision. Regular checks on medicines, relevant training and competency checks help make sure staff have the necessary skills to handle medicines safely. We checked how controlled drugs (medicines that can be misused) were handled. The cupboard used for storage was secure and a special register was used for record keeping. Stock levels were correct and all entries were properly witnessed. Secure storage and detailed records help prevent mishandling and misuse. We looked at a sample of people’s care plans and found some good information about their medicines. However, one person that could not give consent to have their medicines given by staff had not had a thorough assessment of their capacity so there was a risk that their rights would not be properly considered. Another person that was looking after one of their own medicines had no information in their care plan about how they were to be supported so there was a risk that they might not receive the right amount of support from staff. There were also no formal procedures and paperwork to support the use of when required medicines such as painkillers and inhalers. We gave some advice to the manager about how to include medicines information in the care planning paperwork to help reduce the risk of mistakes when giving medicines. Each service users had a personal care based on 14 areas of need for each person. These included a safe environment, communication, breathing, dietary needs, elimination, hygiene and dressing, body temperature, mobility, social activities, skin integrity, sleeping and perception of health status. The service user or their relatives had been consulted about the care plans and had been able to contribute to their development. The care plans provided to staff were clear in their guidance as to how to meet their needs in a respectful manner. Care plans were also being reviewed regularly. Information about peoples health care needs and the outcomes of visits made by healthcare professionals, including doctors and nurses, was recorded separately so that any patterns in health-related issues could be seen. Risk assessments stated a range of risks associated with behaviour/harm to self and others, personal hygiene and dressing, a persons medical condition and mobility. Where a risk was identified there was a management of risk care plan in place. This means that risks to service users were known and minimised where possible. Records were made about each persons progress at least three times daily and all members of staff had received instruction and guidance in how to
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DS0000006729.V375447.R01.S.doc Version 5.2 Page 15 complete the records appropriately. This means that when the records are read the reader is more likely to be able to know what support has been provided, when and by whom. Work is still being done on the daily records to make sure that they are reflective of the service users daily routines and achievements. Since we last inspected improvements have been made to the way in which service users dignity is respected. From staff meeting records we could see that the manager has met with staff members to explain clearly the standards required by her. We could see where staff had been giving guidance in making sure that service users clothing was well cared for, that they receive support to maintain hairstyles and retain their individuality in their dress. Throughout the inspection we saw that staff were more courteous when addressing and speaking to service users and that service users were wearing clean, well pressed and maintained clothes. It was also evident that time and attention had been given to support service users to match clothing and make sure that where preferred ladies were supported to wear stockings, shoes, jewellery and makeup. When we asked them about the care they were receiving, service users told us the girls are smashing and they take care of me very well and you couldnt ask for more. One relative told us on the whole staff are very caring and supportive. but they also added when I visit she has to be changed due to having regular accidents. Another relative also pointed out that support given to service users to maintain continence is not always frequent enough when I see her she looks well, I think occasionally they could take her to the lavatory more often. Although another relative had sympathy for the demands placed on staff they stated I think they might take her to the lavatory a little more. We discussed toileting routines within the home with the operations and general manager, it was accepted by them that although there are general routine toileting times, work could be done to develop a more personal approach to maintaining service users continence. Urmston Cottage DS0000006729.V375447.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have control over their lives and can maintain their own day to day routines as they individually desire. EVIDENCE: Each service user at Urmston Cottage had an activities care plan and profile, this means that their preferred hobbies and interests were recorded and that a social history was obtained. Service users had been consulted about their past life which included their family, education, at work experiences, current hobbies, interests, dreams and aspirations. The service employs a full-time activities coordinator who has the experience, background and qualifications to provide meaningful activities to older vulnerable people. The activities provided were extensive, service users have the opportunity of joining in general games such as bingo, armchair sports, keep fit, painting, quizzes, tai chi and baking and they also have the opportunity of having a cinema like experience each week. Furthermore
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DS0000006729.V375447.R01.S.doc Version 5.2 Page 17 activities are regularly and routinely planned for outside of the home which means that service users are given the opportunity to visit places of interest within the community. During the course of the inspection we saw service users receiving support to go shopping to purchase their own daily items. Displayed throughout the home were up-to-date photographs and information on activities recently completed and planned activities. For those service users who do not wish to join in group activities or are unable to do so, one-to-one support is given from the activities co-ordinator. Service users are consulted about their preferred social events at residents monthly meetings and friends, family and advocates are also consulted about activities at monthly focus groups held by the manager. We have advised that systems are put into place to make sure that the provision of activities are not dependent solely on one person and that other members of staff are supported, made aware of and trained in ways to provide social stimulation and daily activities to service users. This will make sure that in the absence of the co-ordinator the level of activities continue. When we spoke with service users and relatives about activities they told us The young lady who arranges activities most days tries to include my relative. She appears to be very dedicated and keeping up-to-date activities on the board in the reception area together with photos or events that have been staged. The manager said that clergy from mainstream religions visit the home regularly to meet with service users. It was evident that the manager aims to support service users to follow their own spiritual beliefs. Care plans had lots of details of each persons nutritional needs and included assessments and any special diets they may require. Since the last inspection, menus have continued to be developed with alternative choices at every meal. Relatives have told us I have seen the local butcher van delivering to the Service users are able to have a full home, he is a first-class butcher. English cooked breakfast every day and full day menus choices were displayed on dining tables. Both cooks at the home work hard to provide good home cooked quality meals for service users with most of the dishes being homemade which has reduced the use of any convenience packets. Service users are able to receive visitors any time during the day or evening and with prior arrangements, visitors can receive a meal with the service user. When we spoke with them about the meals served relatives said the meals seem to be varied and well cooked. The choice of having a main meal in the evening instead of at lunchtime is so much better. My mother is well managed and I have seen staff at mealtimes sitting with residents who need assistance with eating. I believe there are two chefs I always see one on duty when I visit at weekends.
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DS0000006729.V375447.R01.S.doc Version 5.2 Page 18 Notwithstanding such a good mealtimes service provision, service users do not have the opportunity of pouring hot or cold drinks for themselves, butter their own toast or spread preserve, add milk to their cereals or sugar to hot drinks. We observed staff members pouring hot drinks from the communal teapot. Some service users have the ability to pour drinks for themselves and for others if given the opportunity. The current practice of servicing everything complete does not promote service users independence. Urmston Cottage DS0000006729.V375447.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users were confident that the manager and staff would listen to their concerns. Staff training in the protection of vulnerable adults ensured that people were safeguarded from abuse. EVIDENCE: In the AQAA, the operations manager stated that Urmston Cottage has an excellent complaints procedure which is displayed in the reception area and in all residents bedrooms . Response times are excellent and investigations are thorough with action plans formulated to address any shortfalls. All staff are aware of our whistle blowing policy and the management team has an open door policy and undertakes flexible working practices to regular meet with families to resolve issues out of hours and at weekend. During the course of the inspection we observed that complaints procedures are displayed throughout the home and available to each service user in their rooms. Service users and relatives comment stated we have not had cause to complain and If I had any complaints I would approach the manager. Urmston Cottage DS0000006729.V375447.R01.S.doc Version 5.2 Page 20 Families and residents are encouraged to speak with the manager and members of staff about any concerns they may have. Since the last inspection the manager has commenced holding residents, relatives and advocates focus group meetings within which they are provided with information about the home, general updates on some policies and procedures and are invited to make comment on the service. We had the opportunity of reading the minutes of those meetings and can confirm that all participants are able to express their concerns openly with the manager. We saw the record of complaints which included details of investigations of complaints and a copy of a letter to a complainant advising them of the outcome of their complaint. Urmston Cottage has policies and procedures concerning the protection of vulnerable adults, we also know that the manager operates the Local Authorities Protection of Vulnerable Adult Procedures (POVA). There have been some concerns raised within the last twelve months which has meant that POVA procedures have been actioned. Because of this the manager is familiar with her role and responsibilities when an allegation or suspicion of abuse is made. Within the AQAA it was stated all but four staff members have completed the protection of vulnerable adults training and at the time of the inspection two more had completed the training. The manager has made sure that staff are kept aware of the importance of being vigilant to report any suspicions of abuse and has spoken with staff during staff meetings about their responsibility and duty to report all concerns appropriately. Staff surveys stated that the staff felt able to share any concerns they may have with the manager and that they knew how to protect the service users whom they support. They told us if anyone has a problem regarding the home I tell them they can speak to the manager or contact the commission for advice and we are constantly reminded about POVA and often asked on the spot what it means and the responsibilities of whistleblowing. Urmston Cottage DS0000006729.V375447.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,24,25 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefited from living in a warm, clean, safe and well maintained environment that is maintained to a high standard. EVIDENCE: In the AQAA, the operations manager stated all service users live in a homely atmosphere. Our observations would confirm this, during the inspection we saw service users living in clean, bright, comfortable surroundings which have been and continue to be upgraded to a high standard. We spoke with a number of service users during the inspection all of who only had praise for the home. Comments within the surveys included the rooms, and communal
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DS0000006729.V375447.R01.S.doc Version 5.2 Page 22 rooms, dining rooms and bathroom are very modern well decorated and bright All nine surveys stated that the home was maintained well and was fresh and clean. During the inspection there were no unpleasant odours evident. One relative told us I visit every week and have always found the home is kept clean and tidy and only occasionally is there a urine smell around. Another said just occasionally there is a faint whiff of something but otherwise the home is clean and bright. Every room used by service users has been upgraded, communal areas are bright and cheery places with large flat screen televisions enabling all service users to see the television. Fixtures and fittings throughout the home are to a good standard, new bedroom furniture has been provided, all rooms have been redecorated and provided with new curtains, bedding and personal items. Service users are able to bring in their own furniture if desired and can change the colour schemes of their room if the wish. Urmston Cottage DS0000006729.V375447.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive support from experienced and committed staff who have been recruited and trained appropriately. EVIDENCE: The AQAA stated eighteen of the thirty staff members have completed a National Vocational Qualification at level 2 or above. The operations manager told us at the inspection that a further ten members of staff were due to complete the training . This means that the service exceeds the 50 standard we expect. We looked at four staff files and assessed if recruitment and selection procedures were robust. Though two of the files were in disarray and information was difficult to obtain we observed that all four staff members had completed an application form, attended for interview and provided references. Criminal Records Bureau (CRB) checks were undertaken for each staff member employed. This means that the manager ensured that prospective staff were suitable to work with vulnerable adults. The operations manager told us that he was aware that previously staff have been recruited by a number of
Urmston Cottage
DS0000006729.V375447.R01.S.doc Version 5.2 Page 24 managers and differing systems were in place to obtained information. A review of the companys staff filing systems has highlighted the need for one easy to use format which will ensure that managers of a service have all the correct information to hand for reference and inspection purposes. We were able to confirm that new starters completed the Skills for Care Common Induction programme and that the records maintained were being completed correctly. Two staff members told us induction procedures covered all aspects of their work very well with the other two stating it mostly covered everything. They told us they received good training with one saying if the service user has a specific condition, I am required to undergo training so that I can meet the needs of that individual. We saw that staffing levels were sufficient to meet the needs of people and this was confirmed by the staff although some staff members would wish for higher staffing levels so they could spend more time with service users. When we asked service users about staff they told us they are smashing girls One relative said the majority of the staff appear very caring. Urmston Cottage DS0000006729.V375447.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Urmston Cottage is a well run home which is managed in the best interests of service users. EVIDENCE: The manager since the last inspection has submitted an application with us for registration. She has also completed NVQ training at level four and the Registered Managers Award and training records confirmed that she continues with her training and receives routine and regular training from the company in
Urmston Cottage
DS0000006729.V375447.R01.S.doc Version 5.2 Page 26 order to continue with her learning and development. She receives supervision from the operations manager who attends the home weekly. We observed the manager throughout the inspection talking to service users who all responded positively, clearly recognised her and felt able to talk freely. She was observed supporting a service user who was taken ill and directed staff in a calm and control manner ensuring other service users were not unduly stressed by the situation. Directors of the company conduct monthly regulation 26 visits, which means they conduct small focused assessments of various aspects on the service to find out the outcome of service provision, this includes speaking with service users, relatives and staff, assessing the building and looking at records. We have been provided with a number of copies of detail of those visits and can verify that service users spoke positively about the support they received. The record keeping regarding these visits are good and demonstrate good practice by the company to monitor that standards are being maintained. The manner in which service users small balances are maintained were good. Fees are paid directly to the company and small amounts of income are recorded on expenditure sheets for the individual service user. These are audited weekly by the administrator and checked by the manager. Each month service users and their next of kin receive copies of the balance sheets to confirm that correct auditing has been completed. The manager used both informal and more formal quality assurance processes. The informal process included talking to people on a daily basis to ask their opinions and holding resident, relatives and staff meetings to get peoples views on the service. The more formal process involved people who use the service and staff completing questionnaires about the way the service is run. We have not received a formal report of the homes annual quality audit and we are not sure the information has been made public as is required. This was recommended at the last key inspection. Urmston Cottage DS0000006729.V375447.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x x 3 3 3 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 3 3 x 3 x x 3 Urmston Cottage DS0000006729.V375447.R01.S.doc Version 5.2 Page 28 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. Standard Regulation 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. Refer to Standard OP3 OP9 OP10 Good Practice Recommendations Pre-admission procedures should be recorded including any visits to the service or assessments made. Care plans and supporting paperwork should have important information about how medicines should be given to people to help make sure they are used properly. The promotion of continence and support routines should be personal to the individual service user. Such support should be clearly identified within the care plan and its success monitored. Service users should have the opportunity to pour their own drinks unless it is assessed that this is an unacceptable risk. They should also be encouraged to serve themselves during meal times which promotes their independence. An annual quality assurance audit should be completed with a public report being made available of the outcome and which is supplied to us.
DS0000006729.V375447.R01.S.doc Version 5.2 Page 29 4. OP15 5 OP33
Urmston Cottage Urmston Cottage DS0000006729.V375447.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk
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