Care Home: Old Wall Cottage

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What the care home does well At the time of the inspection the home was extremely busy with workmen visiting health care professionals, the organisations representatives and the general workings of an operational care home, yet despite this scene the atmosphere was very relaxed. Consistent feedback was received from relatives and staff that despite the chaos the refurbishment has been managed extremely well with residents showing no signs of anxiety. This is to be commended. Comments about the environment included: "warm and cosy but a bit like a rabbit warren" "Level of care now is really good, walk into a family home cant praise this enough we can put up with a bit of mess while they finish off the refurbishment" "environment brilliant" and "environment incredible the place is transformed lot more health and safety considerations less steps and slopes". A sample of comments made by relatives regarding their experiences of the home included: "Since my mothers been here she has now really stabilised seems very settled" "Not a Bad word to say about the place" and "Absolutely marvellous its like a family he has been there three years cant fault them in any way". Residents have received a wide range of specialist and general health care intervention to ensure that all of their health care needs are being appropriately addressed. Personal support is offered in ways, which promotes and protect resident`s privacy and dignity. Residents are helped to exercise choice and control over some aspects their lives with flexible routines now being an integral part of daily practice at the home. Links with families are valued and strongly supported by the home with relatives commenting upon how welcomed they are made to feel when they visit which included being offered refreshments. Dietary needs of residents are well catered for with a balanced and varied selection of food provided that meets resident`s tastes and choices with residents generally receiving sensitive support. A resident said that although there was no choice of menu if they did not like what was on offer they were provided with something else. Another resident described her pudding as "Lovely". Resident`s lives continue to be highly enriched by the home providing an excellent range of innovative and appropriate opportunities for occupation and activities. Staff make a positive contribution in residents lives as residents benefit from a trained and enthusiastic staff team that know them and who are employed in sufficient numbers as is necessary to meet their needs. Comments about staff included " There has been certainly an upheaval over the last year but having the same staff around has certainly helped reduce any stress for my husband while all the building works are going on" "Staff very kind and very observant they always notice if any problems" and "general friendliness they make you feel at home cant fault it they have coped really well with the alterations". Resident`s clearly benefit from an enthusiastic, committed manager who provides a clear sense of leadership and direction which enable staff to provide good quality care to residents. A sample of comments about the manager included: "very happy with management now there is a definite hierarch, who seem to have a hand on running the home" "very good" "lovely considerate very helpful" and "cant fault him" "much better than before". A health care professional said "Manager friendly goes out of this way to help and if he does not know the answers will find out". What has improved since the last inspection? What the care home could do better: The manager is aware of the need to now review the homes admission criteria and the overall aims and objectives of the service in line with changes to the environment and greater awareness of the range of residents needs the home is able to meet safely and the limitations of parts of the building to meet the needs of residents who have complex physical needs. The manager was able to demonstrate their plans for sustaining the improvements made to date and further improve practices in line with revised aims and objectives of the service. Prospective and existing residents need to have information about the full terms and conditions of residency at the home so they know what to expect when living at the home and are aware of their rights and responsibilities while residing there. Due to highlighted accessibility issues and the changing environment it is necessary that a qualified person makes an assessment of the premises, in relation to the suitability of equipment and environmental adaptations. CARE HOMES FOR OLDER PEOPLE Old Wall Cottage Old Reigate Road Betchworth Surrey RH3 7DR Lead Inspector Jane Jewell Unannounced Inspection 15th December 2008 09:30 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 Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Wall Cottage Address Old Reigate Road Betchworth Surrey RH3 7DR 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) 01737 843029 01737 845223 oldwallcottage@ehguk.com European Healthcare Group plc Manager post vacant Care Home 43 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0), Old age, not of places falling within any other category (0) Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) 2. Old age, not falling within any other category (OP) The maximum number of service users to be accommodated is 43. Date of last inspection 20th June 2008 Brief Description of the Service: Old Wall Cottage is a care home providing nursing care and accommodation for forty-three older persons some of whom have dementia or a past or present mental health condition. Since May 2005 the home has been owned by European Health Care Group Ltd, which own further registered homes across the country. The home is currently undergoing a major refurbishment and therefore the number of placements available is currently reduced. The refurbishment is planned to be completed by march 2009. The home is located in a rural setting in the village of Betchworth near to Dorking Town. The home is a converted domestic dwelling set in its own grounds with entry via electronic gates. The home is presented across two floors with the first floor now converted into office space making all residents accommodation on one floor. Communal space currently consists of two lounges and two dinning rooms. There is a secure garden at the rear of the property which has some level access patio areas. Resident’s accommodation consists of twenty-four single and nine double rooms. Some bedrooms are accessed via small steps. Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 5 The homes literature states that it aims to provide excellent nursing care at all times, with overall objective being that service uses live in a clean, safe and comfortable environment. The fees for residential care are currently £449.17 to £751.00 per week, depending on the services and facilities provided. Extra’s such as: newspapers, hairdressing, chiropody, toiletries are additional costs. Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use the service experience GOOD quality outcomes. The information contained in this report has been comprised from an unannounced inspection undertaken over seven and a half hours and information gathered about the home. This is the second Key unannounced inspection of the home within six months. The inspection was facilitated by Mr Paul May (The manager). Subsequent to the inspection Mr May was successful in his application to become the registered manager of the home. The focus of the inspection was to assess the progress made towards addressing the areas of shortfall and serious concerns noted at the previous inspection and to look at the experiences of life at the home for people living there. Signs of resident’s well-being/ill-being (terminology used for observing behaviour for people with dementia) were observed. The inspection involved a tour of the premises, observation of the daily practices and interactions with staff, examination of records and discussion with residents. Seven staff were interviewed and five relatives were consulted about their experiences of the home including two relatives who were involved in the previous inspection process. A health care professional was also contacted for their updated views and experiences of the home. Ann Mcafarlane an “expert by experience” accompanied the inspector for four hours as part of the inspection process. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating supports the inspector to look at the quality of the outcomes for the people who use the service. They did this by focusing on specific outcomes for residents including privacy and dignity, occupation and suitability of the environment for disability access. They obtained this information by observation, discussion with residents, staff and a tour of the premises. Their outcomes are included in this report. The home is currently undergoing significant changes in its environment with a major refurbishment and renovation program underway. This involves closing down sections of the home while it is being refurbished, which therefore restricts the number of placements available. There were twenty-three residents living at the home at the time of the inspection. Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 7 In order that a balanced and thorough view of the home is obtained, this inspection report should be read in conjunction with the previous inspection reports. The Inspector would like to thank the residents, staff and management for their assistance and hospitality during the visit. What the service does well: At the time of the inspection the home was extremely busy with workmen visiting health care professionals, the organisations representatives and the general workings of an operational care home, yet despite this scene the atmosphere was very relaxed. Consistent feedback was received from relatives and staff that despite the chaos the refurbishment has been managed extremely well with residents showing no signs of anxiety. This is to be commended. Comments about the environment included: “warm and cosy but a bit like a rabbit warren” “Level of care now is really good, walk into a family home cant praise this enough we can put up with a bit of mess while they finish off the refurbishment” “environment brilliant” and “environment incredible the place is transformed lot more health and safety considerations less steps and slopes”. A sample of comments made by relatives regarding their experiences of the home included: “Since my mothers been here she has now really stabilised seems very settled” “Not a Bad word to say about the place” and “Absolutely marvellous its like a family he has been there three years cant fault them in any way”. Residents have received a wide range of specialist and general health care intervention to ensure that all of their health care needs are being appropriately addressed. Personal support is offered in ways, which promotes and protect resident’s privacy and dignity. Residents are helped to exercise choice and control over some aspects their lives with flexible routines now being an integral part of daily practice at the home. Links with families are valued and strongly supported by the home with relatives commenting upon how welcomed they are made to feel when they visit which included being offered refreshments. Dietary needs of residents are well catered for with a balanced and varied selection of food provided that meets resident’s tastes and choices with residents generally receiving sensitive support. A resident said that although there was no choice of menu if they did not like what was on offer they were provided with something else. Another resident described her pudding as “Lovely”. Resident’s lives continue to be highly enriched by the home providing an excellent range of innovative and appropriate opportunities for occupation and activities. Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 8 Staff make a positive contribution in residents lives as residents benefit from a trained and enthusiastic staff team that know them and who are employed in sufficient numbers as is necessary to meet their needs. Comments about staff included “ There has been certainly an upheaval over the last year but having the same staff around has certainly helped reduce any stress for my husband while all the building works are going on” “Staff very kind and very observant they always notice if any problems” and “general friendliness they make you feel at home cant fault it they have coped really well with the alterations”. Resident’s clearly benefit from an enthusiastic, committed manager who provides a clear sense of leadership and direction which enable staff to provide good quality care to residents. A sample of comments about the manager included: “very happy with management now there is a definite hierarch, who seem to have a hand on running the home” “very good” “lovely considerate very helpful” and “cant fault him” “much better than before”. A health care professional said “Manager friendly goes out of this way to help and if he does not know the answers will find out”. What has improved since the last inspection? It is acknowledged, the significant amount of work, expenditure and commitment by the organisation in addressing the shortfalls and areas of serious concern noted at the previous inspection. This has resulted in all of the previous requirements assessed as now met or are in the process of near completion. This has significantly improved residents safety and well being, through better medication practices, risk management and manual handling techniques. Increased staffing levels and training has resulted in resident’s privacy and dignity being actively promoted with staff having more time to promote residents choices. A staff member said: “incredible amounts of training have improved the care practices no end”. Another staff member said: “residents a lot happier, talk more and communicate more with not only staff but with other residents”. Increased awareness of dementia care has developed into further good practices at the home with regard to food, occupation and in the promotion of choice. Relatives commented: “Happy with everything very comfortable homely place now” and “Definite improvement in the home and in the management”. A staff member said “we are getting better all the time”. The management of the home has significantly improved with the appointment of a competent manager who promotes good practices in the care of older people and who provides a clear sense of leadership and direction which enable care staff to deliver good quality care to residents. Considerable work has been undertaken to improve the care planning process to enable staff to have the guidance to provide consistent care. Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 9 The ongoing refurbishment programme continues to significantly improve the standard of décor and facilities at the home. The meal time arrangements now enable residents to receive largely dignified support in a timely manner. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Old Wall Cottage DS0000064426.V373524.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 Old Wall Cottage DS0000064426.V373524.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 4 and 5 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective and existing residents have information available to them about what services are provided and what to expect when living at the home in order to help them make informed decisions. This information needs to be updated with clearer information on the terms and conditions at the home. The homes aims and objectives are to be reviewed in light of the significant improvements to services and facilities and the range of needs the home is now able to meet. There is a more robust process in place to ensure that only resident needs which can be safely met are now admitted to the home. EVIDENCE: The home’s Statement of Purpose and Service User Guide has been updated to provide a range of information to prospective residents and existing residents about the home, in order to help them make informed choices and be aware of Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 12 the facilities and services provided. The manager spoke of their plans to also provide information about the home on a CD to help aid resident’s further understanding. A resident gave permission for a picture they had painted to be used as the front cover for the information booklets given out to prospective residents and their representatives. The manager agreed that there is a need to now review the aims and objectives of the home in light of the significant improvements made to services and facilities at the home and a reduction in the wide range of residents needs being accommodated. This is necessary in order to identify the level of need the home can now cater for and any areas of specialist care that the home could offer, for example dementia care, independent living. This is to ensure that the homes practices including the admission criteria for the home are clearly identified in the homes literature. Residents are provided with a written contract of terms and conditions of residency with the home. However there is need to ensure it includes a description of the services offered, the arrangements for charging and paying of additional services and a statement whether any of the above conditions are different where a residents care is being funded by another party other than themselves. This is to ensure that residents are aware of the full range of any additional costs and their rights and responsibilities while residing at the home. There have not been any new admissions to the home since February 2008, due mainly to the home gradually reducing the number of residents during the refurbishment of the home. The manager demonstrated a much clearer understanding of the level of needs the home can safely now meet and is in the process of developing revised admission criteria in readiness for admitting further residents into the home. The majority of residents at the home are assessed as having medium to high needs including residents who have complex dementia and physical needs. Much work has been undertaken to the homes practices, documentation and environment since the previous inspection to ensure that the home can now provide evidence that it is able to meet most needs of residents. Both the inspector and expert by experience noted many signs of wellbeing in residents, this included positive body posture, smiling, initiating conversation and physical contact. Staff consistently commented upon how much happier and relaxed residents were, a staff member saying “residents a lot happier, talk more and communicate more with not only staff but with other residents”. A sample of comments made by relatives regarding their overall views and experiences at the home included: “Happy with everything very comfortable homely place now” “Since my mothers been here she has now really stabilised seems very settled” “Not a Bad word to say about the place” “Absolutely marvellous its like a family he has been there three years cant fault them in Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 13 any way” and “definite improvement in the home and in the management”. A staff member said “we are getting better all the time”. The manager confirmed that the first four weeks of occupancy is looked upon as a trial occupancy. Where social services are the placement authority it is usual practice that within this period a review be undertaken to determine whether the residents wishes to stay permanently or not. Intermediate care is not offered at the home therefore this standard is not assessed. Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 and 11 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. New care planning process enables residents assessed needs to be identified and appropriate guidance for staff provided. Residents have received a wide range of specialist and general health care intervention to ensure that all of their health care needs are being appropriately addressed. Procedures and practice in the home allow for the safe administration of medicines Personal support is offered in ways, which promotes and protect resident’s privacy and dignity. EVIDENCE: Much work has been undertaken to improve the care planning process and address previous shortfalls. This has resulted in new care planning documentation being implemented which provides complex assessments undertaken for each resident. As part of their implementation, the care Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 15 planning format remains under review and the manager was aware of the need to further change elements of care plans to make them more relevant to the needs of residents and the revised aims and objectives of the home. The manager spoke of their plans to now engage care staff more in the care planning process in order to further promote consistency of care. Care staff consulted with showed a much clearer understanding of the assessed needs and preferences of residents and were more confident in being able to meet them. Good practices were noted in the care of people who have dementia in the compilation of personal histories as a central part of their care plan. Although only recently implemented care plans have been regularly reviewed to ensure that any changes in residents needs and preferences are promptly identified and Comprehensive individual risk assessments are now in place, which covered core and specialist areas of risks and records the actions to manage any identified risks. Any risks faced by a resident that the inspector noted during the course of inspection had been recorded within an individual assessment. Good practices were noted in the review of risk assessments following falls. Records of medical intervention showed that the home continues to work closely with other health care professionals including GP’s, chiropodists, opticians and dentists to ensure residents receive a good range of health care intervention. Where residents had raised requests to receive health care input to the expert by experience, evidence was seen that the home had previously identified this and this was being addressed in a timely manner. Relatives confirmed that staff have acted promptly when they have requested medical intervention on behalf of their relative. Since the previous inspection there has been a significant input from a range of specialised health care professionals in order to support the home in raising standards of care practices. This has included continence advisors, nutritionists, Occupational therapists, rehabilitation team and speech and language therapists. This has resulted in the home providing a wide range of health care support and improving resident’s safety through better manual handling practices. In addition some proactive practices including nutritional drives and continence programmes have been developed to help promote long term health. The system for the administration of medication is good with more robust systems in place to ensure resident’s medication needs are being safely met. This now includes a weekly monitoring of medication practices by management to ensure the homes medication policy and good practices are being followed. New medication polices have been developed to ensure the safe management of “as prescribed medication”. A good standard of laundering clothes continues resulting in residents dressed appropriately, in accordance with preserving their dignity, prevailing weather Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 16 and individual style. The manager and staff spoke of their increased awareness of promoting residents privacy and dignity and were able to give many examples of how practices have improved including the more discrete naming of clothing, and carrying out all personal care tasks in private. Staff were aware of residents preferences to receive personal care from female carers only. Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 and 15 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s lives continue to be highly enriched by the home providing a range of innovative and appropriate opportunities for occupation and activities. Links with families is valued and strongly supported by the home. Residents are helped to exercise choice and control over aspects their lives with flexible routines now being an integral part of daily practice at the home Dietary needs of residents are well catered for with a balanced and varied selection of food provided that meets resident’s tastes and choices with resident’s generally receiving sensitive support. EVIDENCE: An activities co-ordinator has been in post for six months and their appointment had begun to make a positive contribution to the quality of life for residents. They were extremely motivated and skilled at empowering and engaging residents in a variety of occupations and activities. This included horticultural, arts and crafts and music. Their role was to also empower staff Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 18 with the confidence, skills and equipment to be able to also engage residents in meaningful occupation in their absence and this was starting to have effect with the development of individual social care plans and one to one time being set aside for each resident. Good practices were observed in a staff member reading from a book and sharing the pictures it contained with a resident. A resident said that if they wanted to write a letter or card, a staff member would help them. Residents have access to a mobile library and newspapers and magazines were made readily available. At the time of inspection the atmosphere was very relaxed with the vast majority of residents engaged in some form of stimulation at various points throughout the day. Much humour and laughter was noted which residents were clearly enjoyed. Since the previous inspection more opportunities have been provided for residents to access the community. This has included some residents going Christmas shopping and a sea side outing. A relative spoke of their enjoyment at receiving pictures of a recent pub visit their relative had attended. There is a car which is used to support residents to access the community however this is limited to those residents who are ambulant. Due to the semi rural location of the home residents are reliant on relatives or staff to support them to go out. To further enhance residents quality of life there are plans to eventually have access to transport with wheelchair access. Relatives continue to comment that they can visit at any time and how welcomed they are made to feel during their stay, this included being offered beverages or meals and staff being friendly and approachable. A sample of their comments included: “Everyone is so carrying they care about the relatives as well” and “I have visited late evenings and they have always been very accommodating they are very helpful towards families”. A newsletter provides relatives with regular updates about the refurbishment but also of events at the home. Much work has been undertaken to promote residents individuality and choice. Staff consistently said that they were no longer tasked focused and could spend more time with residents promoting choice and respecting residents individual needs and preferences. Residents confirmed that they went to bed and arose when they wanted. A staff member commented: “care plans now say when resident want to go to bed and we have the time to make sure residents go to bed when they want and you can tell residents are much happier about this”. For a few people living at the home, being able to exercising their choice was difficult due to their level of dementia. Staff were seen using a variety of methods to ensure that residents were given some choice over their daily routine, for example a staff member was seen to use a simple communication board to ensure that a resident was given the choice of beverages. Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 19 Currently one resident has an advocate appointed to them to make “best interest” decisions on their behalf. An example was noted whereby access to advocacy services would also benefit a resident in supporting their relationship with their family and this was feedback to the home. In order to address the shortfalls noted at the previous inspection, dinning arrangements have been radically reviewed creating two meal sittings. Those residents that need support to eat are now enabled to sit at tables and are supported at the first sitting. All staff consulted with spoke about the positive effects these new arrangements had for residents and that now residents get one to one support and that they have more time. Staff were generally observed providing one to one support in a sensitive dignified and relaxed manner, however an example was noted whereby a staff member was easily distracted by another staff member resulted in them leaving a residents whom they were support to help eat, which did not aid continuity. A resident was observed asking a staff member what was for pudding and the staff member did not respond. This was feedback to the manager to address. The meal presented at inspection looked appetising with residents individual preferences observed. A resident said that there was no choice of menu but if she didn’t like what was offered the Chef would produce a different meal. Another residents described her pudding as “Lovely”. A new chef has been appointed who although did not have any formal experience in working with older people or people who have dementia was extremely motivated in continuing to improve the food and meals provided. This included the introduction of fresh fruit and sweets on dinning room tables which residents are able to access independently or are supported by staff. They were currently in the process of developing menus based on resident’s needs and pictures of meals to support resident’s being able to make a choice, as the current pictures used did not reflect the menu clearly. Residents spoke of being offered a cooked breakfast. The manager spoke of a “nutritional drive” they have embarked upon to ensure that residents receive the correct balance of nutrients which has resulted in the use of some full fat products and in some cases vitamin supplements. In addition to meals drinks and snacks are made available with a resident commenting: “Staff are very happy to bring a drink, but I wouldn’t want to ask”. Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is an effective complaints system with evidence that relatives feel that their views are listened to and acted upon. Staff have the guidance and training necessary to show them what to do if abuse is suspected. EVIDENCE: There continues to be an accessible complaints procedure for residents, their representatives, and staff to follow should they be unhappy with any aspect of the service. All relatives consulted with felt at ease to inform the manager of any concerns that they had and where they had done so their concerns have been listened to and prompt action taken to address. The home has written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff have received formal training in safeguarding adults and prevention of abuse and the staff consulted with showed an understanding of their roles and responsibilities under safeguarding adults guidelines. Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 21 There has been one safeguarding referral made by the Commission to social services following the previous inspection. This investigation has now been concludes with all recommendations made by social services having been addressed or are in the process of being addressed. Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents continue to live in a clean and homely environment with significant progress made towards improving standards and the suitability of the premises through the ongoing major refurbishment of the home. Despite the considerable upheaval and noise during the refurbishment it is to be commended how well this has been managed with minimal impact on residents, relatives and staff. To ensure the suitability of the aids, adaptations and facilities the environment must be assessed by a suitability qualified person. EVIDENCE: The premises consist of a converted domestic dwelling, which has been gradually extended by the previous owners over the years. There is currently a Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 23 major refurbishment of the premises which is being completed in phases and which is due for overall completion in March 2009. At inspection the home was extremely busy and sometimes noisy with workmen working and living on site. Despite this scene the atmosphere at the home was extremely relaxed with residents showing no visible signs of anxiety regarding the works around them. All relatives consulted with confirmed this, with one relative saying “that when it gets noisy they shut the door or put music on they just work around it”. There is project manager on site most days that showed a very flexible approach when undertaking work in an operational care home. Consistent feedback was received that the manager and organisation are seeking and listening to feedback regarding the refurbishment to date and making the necessary alterations based on this feedback, this includes the repositioning of plugs and the changing of heavy doors. A sample of comments made about the environment included: “warm and cosy but a bit like a rabbit warren” “Level of care now is really good, walk into a family home cant praise this enough we can put up with a bit of mess while they finish off the refurbishment” “environment brilliant” and “environment incredible the place is transformed lot more health and safety considerations less steps and slopes”. Since the previous inspection some orientation prompts have been put into place in the first phase of the refurbishment. This includes picture signs, different coloured doors and memory boxes on doors which have been developed with residents and their families. Resident’s bedrooms are personalised and all were observed to be clean. During the refurbishment programme the manager highlighted five residents who are in temporary rooms until more appropriate larger rooms have been refurbished, therefore it was not possible to asses whether these rooms were suitable for their long term needs. The garden area was also undergoing a refurbishment with the creation of a level access patio area. There is a further patio area which is currently being used for horticultural activities and a sloped grassed area. Some equipment was evident around the home to support residents mobility and independence, this included height adjustable beds, raised toilet seats, walking aids, ramps, grab rails and hoists. The main ground floor bathroom and toilet did not promote independent use or ease of wheelchair accessibility. This included the positioning of light pulls, taps, toilet roll holder and hand rails. It was reported that this bathroom is due to be refurbished in the next phase. Level access has been provided to some parts of the building, access to some ground floor bedrooms will remain through small corridors and steps internal wheelchair access around the building will remain difficult due to some tight corridors with narrow corners. The manager demonstrated a much clearer understanding of the limitations of the building and bedroom sizes on the level of physical needs that can be safely accommodated at the home and the Commission was assured that new Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 24 admissions would be subject to the homes revised admission criteria and aims and objectives. In light of the mobility and accessibility considerations and the changing environment it is required that the manager demonstrates that a qualified person has made an assessment of the premises, in relation to the suitability of equipment and environmental adaptations. This information would also be significant in the development of the admission criteria and aims and objectives of the service. The second phase of the refurbishment was near completion and the manager was aware of their responsibility to ensure that this phase met with the National Minimum Standards before residents moved back into this area. Although works seen had been completed to a high standard some consideration should be given to the following points. This includes varying the height of arm chairs to suite different people’s height, the use of sofas to aid social interactions the use of colour in decor. Fitted throughout the home are call points, which enable assistance to be summoned when pressed. These consist of boxes, which are portable or can be stored on the wall with extension cords provided so they can be reached from the main living areas in bedrooms. Residents consulted with said that when they have had to press it staff usually respond quickly. Good systems are in place for the control of infection and staff consulted with said that they had undertaken training in infection control. Staff were observed to be working in ways that helped to minimise the risk of infection, by wearing disposal protective clothing when required. Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 and 30 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff make a positive contribution in residents lives as residents benefit from a trained and enthusiastic staff team that know them and who are employed in sufficient numbers as is necessary to meet their needs. Robust recruitment practices ensure that staff are suitable vetted before they commence employment. EVIDENCE: Residents, staff and relatives consulted with all felt that there was sufficient number of staff on duty as is necessary to meet resident’s needs in a timely manner. A sample of comments made about staff included: “ There has been certainly an upheaval over the last year but having the same staff around has certainly helped reduce any stress for my husband while all the building works are going on” “Staff very kind and very observant they always notice if any problems” “general friendliness they make you feel at home cant fault it they have coped really well with the alterations”. The consensus of staff was that following a review of staffing levels and practices they now have more time to spend with residents with a staff member saying “Residents are so much more relaxed as staff more relaxed”. Once the home starts to re-admit residents the manager demonstrated an understanding of the needs based approach to Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 26 establishing staffing levels and had the confirmed that they had the authority to set levels accordingly. A relative commented that there was a high ratio of male carers, but felt that their relative’s preference to receive personal care from female staff only was respected. Another relative commented that “Although some staff turnover I don’t think this has had any negative impact on the standard of care” Staff interactions with residents in the main were positive, residents were observed initiating conversations with staff, showing signs of recognising staff and showed relaxed body posture around staff. Some humour and laughter was observed in interactions. Many letters of compliment were seen from relatives who praised the kindness of staff. The manager reported that they are still trying to create further opportunities for staff to undertaken National Vocational Qualifications, as currently few staff member have achieved this training. Staff spoke about the significant amount of training that as been undertaken since the previous inspection. This has included areas of mandatory training such as manual handling, in order for staff to work safely with residents. Staff spoke of areas of specialist training they have also undertaken in pressure sore prevention, nutrition, infection control and dementia. A staff member spoke of how their understanding of dementia has changed which has ultimately improved their practices following recent dementia training. Another staff member said that “incredible amounts of training have improved the care practices no end”. The personal files of a newly appointed staff member were inspected and these showed that a robust recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 36 and 38 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s clearly benefit from an enthusiastic, committed manager who provides a clear sense of leadership and direction which enable staff to provide good quality care to residents. They have been instrumental in helping to improve standards at the home. A culture of openness enables residents, staff and relatives to feedback about the quality of services and facilities for the manager to act upon them and make further improvements. A range of regular health and safety checks helps to promote the health and safety of residents and staff. EVIDENCE: Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 28 Subsequent to the inspection the manager’s application to become the registered manager of the home was accepted by the Commission. Prior to this they were the deputy manager and acting manager since June 2008. The manager trained as a nurse and is in the process of completing the necessary management training qualifications. They demonstrated a clear understanding of the day to day management of a care home for older people and showed good practices in their own interactions with residents, relatives, staff and professionals. Without exception all persons consulted with spoke positively about them with particular reference to their helpfulness and their drive to improve standards. A sample of comments about the manager included: “very happy with management now there is a definite hierarch, who seem to have a hand on running the home” “very good” “lovely considerate very helpful” and “cant fault him” “much better than before” . A health care professional said “Manager friendly goes out of this way to help and if he does not know the answers will find out”. The home and manager have received significant input from external organisations such as social services as well as the organisations own senior management in order to help improve standards at the home, following the serious concerns raised at the last inspection. The manager demonstrated an awareness of the need to now ensure the sustainability of the improvements and showed a clear understanding of how he was going to achieve this. This included using their own professional skills and knowledge to determine which advice and support they will continue to draw from and which is now no longer needed. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or other responsible person external to the home. The administrator reported that they do hold small amounts of money for a few residents, which are kept secure and records maintained of any expenditure. There is a good programme of formal supervision and appraisals for staff, with staff reporting that the manager now works closely with them on a daily basis and feedbacks any areas for improvement directly. Consistent feedback was received from relatives and staff as to how receptive the management is to feedback. Relatives spoke of changes to care practices as a result of their feedback and staff spoke of changes to the environment. The required Regulation 26 visits by the provider to monitor standards are the home are now regularly being undertaken by a person appointed by the provider. The manager reported that systems were in place to support fire safety, which included: regular fire alarms and emergency lighting checks, staff training and Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 29 maintenance of fire equipment and fire drills. The manager reported that a fire risk assessment had been undertaken on the home by a member of the organisation, which recorded the actions necessary to ensure fire safety at the home, there were aware of the need to keep this constantly updated during the alterations to the building. Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 30 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 2 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 2 2 3 2 x 2 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 x 3 x 3 3 x 3 Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 31 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 OP2 Standard Regulation 5(1)(b) (ba) (bb) (bc) (bd) Requirement Timescale for action 28/02/09 2 OP22 23(2)(n) That for service users admitted since the 1/09/06 the terms and conditions of residency include a description of the services offered, the arrangements for charging and paying of additional services and a statement whether any of the above conditions are different where a service users care is being funded by another party other than the service user. That the registered person 30/03/09 demonstrates that a qualified person has made an assessment of the premises, in relation to the suitability of equipment and environmental adaptations. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 32 Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Old Wall Cottage DS0000064426.V373524.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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