Care Home: Osborne Cottage

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• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
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What the care home does well What has improved since the last inspection? What the care home could do better: CARE HOMES FOR OLDER PEOPLE Osborne Cottage York Avenue East Cowes Isle Of Wight PO32 6BD Lead Inspector Neil Kingman Key Unannounced Inspection 8 November 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Osborne Cottage DS0000012519.V349798.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. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Osborne Cottage Address York Avenue East Cowes Isle Of Wight PO32 6BD 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) 01983 293523 01983 297631 Sue.linington@islecare.org Islecare `97 Ltd Miss Susan Linington Care Home 36 Category(ies) of Dementia - over 65 years of age (8), Learning registration, with number disability over 65 years of age (2), Old age, not of places falling within any other category (36), Physical disability (1), Physical disability over 65 years of age (9) Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28 September 2006 Brief Description of the Service: Osborne Cottage provides a service for up to 36 older people and offers long term and short-term respite residential care, and day care. In addition, an area of the home has been developed to accommodate and meet the needs of those individuals with mental frailty and illness associated with dementia. Ms Susan Linington manages the home on behalf of the proprietors, Islecare ’97 Ltd. The home is a large two storey Victorian property set in quite extensive grounds and situated on the outskirts of East Cowes. A regular bus service is available close to the home. The town of East Cowes with its shops and amenities is about a mile away. There is a range of mostly single rooms on both the ground and first floors, accessible to residents via a passenger lift. Substantial off-road parking is located off the driveway with a large turning area in front of the building. The home and gardens are accessible to wheelchair users. The home provides 24 hours staffing. Weekly fees range between £389 and £470. The manager states that a copy of the home’s service user’s guide is provided to all residents or their representatives where applicable. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the results of an evaluation of the quality of the service provided by Osborne Cottage and brings together accumulated evidence of activity in the home since the last key inspection on 28 September 2006. The report also focuses on the home’s response to three outstanding requirements identified at the last inspection. Part of the process has been to consult with people who use the service. To this end we have received written responses to several surveys, i.e., seventeen from people who live in the home, some completed with support from someone independent of the home, and seven from visiting friends or relatives. We received no responses to surveys sent to relevant healthcare professionals. Included in this inspection was an unannounced site visit to the home by an inspector on 8 November 2007. The registered manager Miss Linington was available throughout the day. At the visit we had an opportunity to speak with staff on duty, and several residents who were able to give informed views about the service. We also toured the building and looked at a selection of records. Prior to the site visit the manager sent to the Commission a detailed selection of information about the service including an Annual Quality Assurance Assessment (referred to as ‘the assessment’ during the report), which has been used with other information to inform the various judgements made about the service. What the service does well: As at the last inspection it was noted the service performs well in the following areas: Moving into the home – good assessments are carried out on individuals who may want to use the service. This gives assurance that the home is likely to meet their needs. Often people who move in for residential care have experienced the home as day care users. Health care and support – personal plans, which are subject to regular review, provide evidence of the quality of care provided. Peoples’ views taken during the sight visit and those expressed in the written surveys support the view that the home performs well in this area. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 6 Daily life and activities – the evidence is that outcomes for people have improved in this area with the creation of more activities co-ordinators providing in increased choice, and more frequent trips out from the home. Management and leadership – comments from service users both verbally and in the surveys were very positive. The manager is held in high regard, as are the staff. At the time of the inspection morale in the home was seen to be good. What has improved since the last inspection? What they could do better: There were two areas identified as needing attention: • Plans for replacing old and stained divan beds and decorating the outside of the building must be produced and a copy supplied to the Commission. To ensure that the needs of people who use the service are consistently met staffing levels must be reviewed to increase numbers at weekends and evenings. • Please contact the provider for advice of actions taken in response to this inspection. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 7 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. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 - People who use 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. The manager ensures that peoples’ care needs will be met by undertaking a proper assessment prior to them moving into the home. The home does not provide dedicated accommodation for short-term intermediate care or specialised facilities for rehabilitation. EVIDENCE: Pre-admission assessment People should know that their needs will be met when they move into a home. An important part of ensuring this happens is the pre-admission assessment process. The manager described the home’s admissions process in general, and specifically in relation to the newest person to be admitted for respite care: Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 10 • • • The manager or one of the trained seniors visits the person who may want to use the service either at their home address or hospital where applicable. The manager visited the most recently admitted resident at the hospital and carried out an assessment of needs. While a range of information was gathered during the process this person had been a day care user at the home, therefore much was already known about their needs. The information was recorded on a form designed for the purpose. The manager showed a good understanding of the importance of a thorough pre-admission assessment in the process of choosing the right home. A copy of the pre-admission assessment was available on this person’s file and information from it used in the production of a plan of care. Similar assessment forms were noted on all files viewed during the site visit. The assessment tool used by the manager is a corporate document and used extensively throughout the Islecare ‘97 older persons’ homes. A comment about the admissions process in one of the services users surveys was, “I needed a placement quickly and there was a vacancy here. It has turned out to be ideal.” Intermediate care People living at Osborne Cottage tend to be long term. The home does not provide dedicated accommodation for short-term intermediate care or specialised facilities for rehabilitation. However, respite care is provided when accommodation is available. There was no evidence that this has a negative impact on the long-term resident group. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • Prior to the initial assessment, prospective service-users are given a copy of the homes statement of purpose and the service-users guide. The pre-admissions assessment is undertaken in the individuals home or hospital in the presence of family or friends if the prospective client requests. The individual is then invited to view Osborne Cottage and have lunch or tea with other service-users. After a full assessment has been undertaken the person is invited to a trial two-week stay - This helps to ensure the person has time to make the right decisions for themselves. All information from the initial assessment to the implementation of the full care plan is documented - The pre-admission assessment is DS0000012519.V349798.R01.S.doc Version 5.2 Page 11 • • • Osborne Cottage • • • transferred to the care plan. The service-user is then given a Key worker who will help them to settle into the home and familiarise them with their new environment All assessments are undertaken by the Manager or a senior member of staff. We ensure we are fully able to meet the needs of the individual before accepting them at Osborne Cottage If we are unable to meet a persons needs, we clearly explain why and inform the person and their care manager and family. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 - People who use 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. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Care planning – The home has a system of care planning with an individual personal plan for each resident. We looked at a sample of three plans. The intention was to look at the outcomes for people who use the service in general by assessing all areas of care for those sampled. The sample included the newest admission to the home, a person with fairly high care needs from the dementia care wing and a person who had been resident for nearly five years. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 13 Plans showed that needs are identified and a plan of care developed to include guidance for staff on how the care is to be provided. Significant events are recorded on a daily basis. Senior staff carry out monthly reviews in consultation with juniors and in the sample seen reviews were up to date. Information in plans includes: • • • • • • • • • • • Pen picture/life history. Essential information. Pre-admission assessment. Risk assessments. Falls risk assessment including, “What controls must be put in place.” Individual care plan, which includes the care to be given in respect of a range of identified needs. Medication profile. Various charts and assessments relevant to the needs of the individual. Healthcare visits. Daily recording of relevant information. Regular reviews. At the last inspection shortfalls were noted in the link between the assessments and the plan of care resulting in problems not being picked up. From viewing the sample of plans at this site visit the situation was noted to have improved with most of the information being clear and person centred. However, looking through the files for information was somewhat cumbersome and it is fair to say that the system could be improved. It was noted that the basic care plan model had been produced in 1998. There was a mixed reaction from residents when asked about their individual care plans. Responses varied from those who were confused about the existence of such a document to a minority who were well aware of their care plan. Health and access to care services The manager confirmed, and records evidenced the regular contact with GPs, optician, dentist, chiropodist and mental health specialists for those with dementia. People spoken with said that the home always contacted a doctor if they needed one. The manager and care staff confirmed that there was a risk of pressure sores with a minority of residents. The manager made the point that staff are always vigilant and at the first sign of a problem the Community Nurse is always contacted. Staff were very clear about what was required to ensure that pressure sores did not develop, i.e., suitable equipment, good liaison with the Community Nurse and care practices. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 14 The home accesses the local health centre in East Cowes at which there are several GPs. Other healthcare professionals visit the home on a regular basis and more specialist ones e.g., Community Psychiatric Nurse, Psychiatrist and Psychologist are called upon as and when required. During the site visit we had an opportunity to observe staff transferring a resident by means of a hoist. The operation was carried out with confidence, sensitivity and good humour. Nine of the seventeen responses to the service users survey indicated they are always given the care and support they need and eight indicated usually. Fourteen of the seventeen indicated staff listen and act on what they say. Thirteen indicated they always receive the medical support they need, two indicated usually and two sometimes. Comments made in the surveys included: “I am being well looked after.” “I’ve been given a lovely raiser bed to aid getting in and out.” “Nurses are excellent – always taken to hospital for appointments.” “I would like to see a GP more frequently.” Medication Medication is dispensed by means of a monitored dosage (blister pack) system by senior staff who have completed medication training, and been deemed competent by the manager. A list of nominated staff was available on file. The home has a policy and system to ensure residents’ medication is stored, administered and recorded safely. During the site visit we looked at the arrangements in place and noted medicines were stored under secure conditions and accurate records of receipt, administration and disposal of medicines maintained. In discussions with the manager it was agreed that individual PRN protocols for ‘as required’ medicines would be made more accessible to staff. We had an opportunity to observe staff administering medicines at lunchtime and noted standards of hygiene and recording were appropriate. Staff were seen to witness the medication being taken before making the appropriate record. This had been an issue subject of a requirement at the last inspection. Privacy, dignity and respect The importance of treating people who use the service with dignity and respect is covered in the induction training for new staff. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 15 On the day of the site visit we toured the building and spent time with residents in the communal areas and in the privacy of their room. There were opportunities to observe staff at work. Staff spoke kindly to people and showed patience with those who are confused. The interactions between them were warm and friendly. Those people able to give an opinion were full of praise for the staff and their approach to care and support. Staff address people by the names that they prefer and knock on doors and wait for an answer before entering rooms. All residents have locks on their room doors and can come and go as they please. It was identified at the last inspection that people in the dementia wing may have their privacy compromised by the general lack of space, especially areas that could be used for private meetings or consultations, other than an individual’s own room. This is clearly difficult to reconcile at present. However, it is known that a major development of the service is planned for the future. There is a payphone available for residents’ use, which is sited in an area that is reasonably quiet. The home will arrange for private installations in bedrooms on request. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • All service-users health, personal and social care needs are set out in an individual care plan, The care plan is compiled from the pre-admissions assessment and Social services plan of care. All care plans are reviewed on a monthly basis or more often if care needs have changed. The service-user’s key worker and a nominated senior member of staff will review the care plan and revise it if changes have occurred, Risk assessments and manual handling assessments are also reviewed. The Service -user is invited to contribute to the plan of care at this time. All service -users relatives are invited to attend the review. This is documented in the service-users care plan. Where it is identified that specialist care is required we work with the district nursing team/GPs/Mental health team and other outside care professionals. All senior staff have a full induction and on-going medication training through BTEC courses and Pharmacy courses, Company medication training is also given. Where a service-user self-administers their prescribed medications, a full risk assessment is undertaken. The service user is made aware of DS0000012519.V349798.R01.S.doc Version 5.2 Page 16 • • • • • • Osborne Cottage • • • • • • correct storage and dispensing of the medications. All staff are aware of a service users right to privacy and that they must treat the service-users home with respect, Staff will only enter a clients room after knocking on their door. Service users have their own bedroom door key, visitors may visit and anytime of the day, and service users are able to come and go from the home as they please. By service-users observing care staff caring for a person near and at the time of death they will I am sure be reassured that they themselves will be treated with dignity, kindness and respect. The monitoring of care plans have become more robust. A clear review system is now in place. I monitor all care plans on a regular basis and discuss care planning at care meetings Care staff are more pro-active in care plan reviews, They have a clearer understanding of the process and communicating information to senior staff. Osborne Cottage DS0000012519.V349798.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. We have made this judgement using a range of evidence, including a visit to this service. People who use service are able to make choices about their life style and activities are offered to suit their individual needs and expectations. Friends and family are made to feel welcome and can visit at any time. Residents’ nutritional needs are satisfied with a varied and balanced diet of good quality food. EVIDENCE: Routines and activities – The home’s assessment shows and the manager confirmed that residents are encouraged and supported to exercise choice and control in their lives. Routines for residents are kept as flexible as possible, e.g., they have choice over where and when they have their food served, what time they like to be woken and the time they like to retire, where and when they like their breakfast served etc. This was confirmed in discussions with those who were able to give informed views. The home’s assessment outlined the steps taken to provide people with a Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 18 range of activities. It was confirmed by the manager during the site visit that Islecare has recently employed three activities co-ordinators working between all Islecare older persons homes on the Island. This has enhanced the level of activities and provided increased opportunities to change the previous programme. The programme of activities, displayed on the notice board, includes cooking, reminiscence, flower arranging, music, games, quizzes and bingo sessions. A newspaper produced monthly entitled ‘The Beatrice Bugle’ includes puzzles, colouring, birthdays, crosswords and weekly activities. It was confirmed by the manager, staff and residents that trips out in the mini-bus are now provided twice weekly, although this is popular with some but not all of the residents. Over lunch staff were taking numbers of those interested in a trip out that afternoon. We noted several people showing an interest but just as an example on one table only one of the three people seated there showed some enthusiasm, but it was a demonstration of choice being exercised. The home caters for all religious denominations and will support those who like to attend Church Services. The home receives a regular visit from the local parish clergy and those who wish can take communion in the privacy of their rooms. Ten of the seventeen responses to the service users survey indicated there are always activities arranged that they can take part in, six indicated usually and one sometimes. Visiting arrangements – Details of the home’s visiting arrangements are clearly documented within the brochure literature, provided to all those who may wish to use the service, and accessible within the entrance hallway. In general terms visitors are welcome at any time. People can receive visitors in their own rooms or any of the communal areas. There is a quiet room known as the library where privacy can be assured. Personal autonomy and choice – Residents were spoken with individually in the lounges, dining room and in private. Those who were able to express views said they were given choices regarding routines in the home, e.g., times of rising, going to bed, activities, meals, personal care, going out etc. The manager confirmed that all residents have either a family member or the Court of Protection to support them independently of the home. People are encouraged to bring with them pictures, ornaments and personal items for their room. During the tour of the building it was noted that some rooms were Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 19 very well personalised, and others less so, according to peoples’ individual tastes and preferences. The management of residents’ finances is covered later in the report but in a general sense they are encouraged, with support from family or a representative, to handle their own financial affairs for as long as they are able. Meals and mealtimes – We had an opportunity to sit with the residents over lunch. The atmosphere in the dining room was quite sociable and friendly and staff were available to assist residents as and when required. A minority of individuals needed more assistance than others and staff were seen to show patience and understanding, while providing help and encouragement. Food served looked appetising and was well presented. There was a choice of two main meals consisting of a meat dish with fresh vegetables. A sweet trolley is then brought round and people had a choice of five different sweets including fresh fruit. All residents who were able to give a view made very complimentary remarks about the lunch and confirmed that the standard of food was consistently high. People generally take their meals together in the dining area, or individually in their own rooms, according to choice. It was noted that people from the dementia care unit now take their meals with everyone else in the dining area. This arrangement has been in place since the last inspection and according to all those spoken with has proved successful in integrating people with diverse needs. Menus are arranged over a three-week cycle and show food to be varied, appealing and well balanced. The cook said that she uses fresh produce and meals are freshly prepared on a daily basis. She has a good understanding of peoples’ likes, dislikes and special dietary needs. Records are maintained of what residents are actually served on a daily basis. We noted that drinks and light snacks were offered through the day between meals. Ten responses to the survey indicated service users always liked the meals at the home, six indicated usually and one sometimes. Comments from the survey were: “Things are there for me to choose.” “I don’t like the doughy bread.” “A bit disappointed with the quality of the food.” Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 20 Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • When we have undertaken the service-users’ assessment and prior to them moving to the home, we review their social, cultural, and recreational interests this ensures their move to an unfamiliar environment is undertaken with a minimum of anxiety for the serviceuse. We can then ensure their interests and cultural needs are met as quickly as possible. We encourage family and friends to visit and stay for lunch and/or tea and to continue to maintain contact with clubs and interests outside of the care home. We encourage service-users to have afternoon tea with friends in our library. Service users are encouraged to personalise their bedrooms on admittance, Some relatives help to personalise the accommodation before the service-user moves to the home (especially if the serviceuser is being transferred from hospital). Service-users are given varied menu choices. Lunchtime menus cater for varied diets and likes and dislikes and allergies, including diabetic menus, hot dishes/light dishes and salads. Service-users choose their meal requirements for the day at breakfast. Meals are then prepared using fresh ingredients. Service-users that require assistance with their meals are assisted in a discreet and respectful manner. If a service-user prefers, they may have their meal later in the day or in their bedroom. If going out or attending an appointment we can prepare a picnic lunch. Activities are undertaken daily, service-users make decisions on what activities they would like to see in the care home at their meetings. Flower arranging/pamper time/painting and quiz and bingo sessions are always very popular. We have the use of a mini-bus and driver, supplied through RSVP, we currently have two weekly outings, Service-users make the decisions on where they would like to go for their outings and where they would like to stop for refreshments. Osborne cottage has relaxed visiting hours and friends and relatives may visit at any time (if the service-user is in agreement). The service-users arrange visits and outings with friends and relatives independently. Communion is available to all service users, times and dates are displayed on the service-user notice boards. • • • • • • • • • • • Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 21 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. We have made this judgement using a range of evidence, including a visit to this service. The home treats residents’ complaints seriously and responds appropriately. The home’s policies, procedures and practices ensure that residents are safeguarded from abuse. Procedures for responding to suspicion or evidence of abuse are robust. EVIDENCE: Complaints – The home has a complaints policy and procedure, summarised in the statement of purpose and service user’s guide, which is given to all residents or their representatives. Contact details for the Commission for Social Care inspection are included in the information and are also displayed on the residents’ notice board. People spoken with on the day of the site visit were not familiar with the detail of the complaints procedure, but were very confident about raising any concerns with the manager. All seven responses to the visiting friends/relatives/advocates survey indicated they knew how to make a complaint. Ten of the fifteen responses to the service users survey indicated they always knew who to speak to if they are not happy, three indicated usually and two sometimes. Ten responses to the Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 22 survey indicated they knew how to make a complaint and five indicated they didn’t. The home’s pre-inspection information indicated that no formal complaints had been made about the service since the last inspection. We viewed the home’s complaints register, which demonstrated that complaints are treated seriously and dealt with appropriately, in writing where appropriate. Safeguarding adults – The home has an Adult Protection (Safeguarding) policy and procedure in place, which follows local authority guidance. The protection of vulnerable adults is covered in the NVQ training for staff. In addition, staff attend a specific Safeguarding Vulnerable Adults training course provided by the local authority. Staff spoken with were very clear about how to recognise abuse, what to do, and the importance of reporting issues of concern without delay. They confirmed that training was given. Since the last inspection there has been one safeguarding of adults referral to Social Services, which has been investigated. The results showed that the issue was dealt with appropriately by the home. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • Osborne cottage has a robust and effective complaints policy and procedure. All staff are made aware of the complaints procedure on induction and through further in-house training. Within the care office a clear display of the complaints and adult protection procedure is avaliable to all staff. Seeking your views and who to report a complaint to are clearly displayed throughout the home. A record of complaints is kept in the home. This lists the full details and statements of all complaints received and the outcomes. Referrals to CSCI are displayed on the service-users notice board given the contact details and how to report a complaint. All service-users and their family/or friends are given a copy of the homes complaints procedure. This is found in the statement of purpose. • • • • Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 23 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 and 26 - People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables residents to live in a safe, and comfortable environment, which encourages independence. All areas of the home are kept clean, hygienic and there are no unpleasant odours. However, externally the building is not well maintained and internally attention needs to be paid to the replacement of old and worn furniture. EVIDENCE: Environment Osborne Cottage has been a residential care home for older people in Cowes for many years and while not purpose built has been adapted over the years to be suitable for its stated purpose of providing a safe, and comfortable environment for the people who live there. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 24 The home is located on the outskirts of East Cowes. A regular bus service is available close to the home. The town of East Cowes with its shops and amenities is about a mile away. People who live in the home have rooms on the ground and first floors. Those with mental frailty and illness associated with dementia are accommodated in a separate wing on the ground floor, accessible via a keypad system. The home has a passenger lift, which affords access to all rooms on the first floor. There is level access into and around the home. The home is generally comfortable, well furnished in places and generally well decorated, rooms being decorated as they become vacant. However, it was recognised by the manager that improvements are needed in areas identified during our tour of the building. The furniture (arm chairs) in the second lounge is scheduled for replacement. The manager confirmed that arrangements have already been made to address this. It was noted that many of the divan beds and headboards in residents’ rooms are old and stained. Those in need of replacement were pointed out to the manager. On the positive side areas for improvement in the dementia wing identified at the last inspection have been, or are being addressed. The lounge carpet has been replaced, the walls repainted, new blinds put up in the windows and a large flat-screen TV introduced. This has helped overcome the institutional feel that it once had. Plans to extend the lounge into a conservatory area are underway. This will, when completed, open up the lounge and create a less cramped feeling. A comment in one of the responses to the surveys was, “The EMI unit needs more space & extra comfortable chairs.” Some good practice was noted in the dementia wing with clear and recognisable signage having been introduced to assist residents with their orientation around the home. The home has two large lounges and a quiet room, known as the library. The dining room is spacious bright and airy, reasonably well decorated and comfortably furnished. Since the last inspection the carpet in the main lounge has been renewed and new curtains put up at the windows. There are sufficient bathing and toilet facilities on each floor. However, the problem of lack of storage space in the dementia wing is difficult to overcome. The manager said that it would be addressed in the major development of the home, which is planned for the future. The front of the building has a large turning area and ample off road parking is available on site. There are country views of the Osborne estate from some of the bedroom windows. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 25 Outside the window frames are showing signs of extreme wear, with flaking paint and rotting wood. A wooden balustrade on the veranda to a resident’s room was noted to be badly rotting. These matters must be addressed as a priority. People spoken with during the inspection seemed happy with the standard of their accommodation. However, they were referring to the main part of the building where rooms are more spacious and personalised. The home has a person responsible for maintenance, who has been employed to undertake minor remedial works and decorative duties around the home. Larger jobs, etc., are referred back to the company’s estates department or managed via service level contracts. Cleanliness All areas of the home were found to be clean and generally free from unpleasant odours. There is a laundry sited on the ground floor with a machine capable of washing articles at appropriate temperatures. The room itself is no more than adequate, as limited space does not help for ease of transferring soiled articles. The home’s assessment confirms it has policies and procedures for the control of infection and safe handling and disposal of clinical waste. The manager and staff confirmed that training in infection control procedures is scheduled and refreshed. During the tour it was noted that all bathrooms and WCs were equipped with liquid soap and disposable towels. Twelve of the seventeen responses to the service users survey indicated the home is always fresh and clean, and five indicated usually. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • Osborne Cottage provides a safe and well maintained (internally) enviroment for service users. Communal areas are spacious and clean with quiet areas for private visits. There is ample outside areas to relax and enjoy the scenary and gardens. The location of Osborne cottage is central and convienent for visitors, we provide ample parking facilities for client own vechicles and staff and DS0000012519.V349798.R01.S.doc Version 5.2 Page 26 • • Osborne Cottage visitors to the home • We are close to ferry links and the main bus routes. • An on-going Maintainence plan is in operation and areas that require decoration or general improvement are identified by the Manager and service-user. We endeavour to re-decorate a service-users bedroom using their preferance of colours. The maintenance man has a set work and improvement plan. This is reviewed and updated by the manager on a regular basis. • The building complies with fire services,enviromental and health department regulations. • Policies and procedures for the control of infection are in place. Training is given to all staff in relation to infection control on a regualr basis. • We ensure a high standard of cleanliness within the home. This ensures we live and work in a safe, clean and odour free enviroment. • We assess and provide equipement which enables service-users to maximise their independence, e.g., electric chairs and walk-in showers. • All service users have their own bedroom, which are cleaned daily by the Domestic staff. Bedrooms are personalised by the service users. Additional storage or shelving is added if requested. • Service-users with visual impairments can maintain there independence within the enviroment through the use of hand rails that are provided along all corridor walls • The home and gardens are fully accessible to wheelchair users. • The Dementia care wing lounge/dining room remains a small and confined space. We are currently awaiting planning permission to have a conservatory added to the side of the lounge, which will improve the area and give the room an additional dining room and greater communal space. • The Dementia wing is cleaned daily by the care staff working within the wing. Although they do this to a good standard it does take the staff member away from interacting with the service-users ( only one member of staff on duty cleans the bedrooms) Externally the home is looking shabby and neglected. The IOW county council have written to us to improve the outside area ( Facing the main road), This is currently being reviewed by Somerset care. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 27 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. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained and given the necessary skills and experience to meet the needs of the people who live there and support the smooth running of the service. However, there is a need to review staffing numbers during the evenings and at weekends. EVIDENCE: Staffing levelsOn the day of the site visit there were thirty-three people resident in the home. In addition, provision is made for up to three day care service users each day. The manager confirmed and records showed that the home employs thirtyseven care staff including bank staff. There are two main shifts throughout the day when a minimum of four care staff are on duty at all times. There are five care staff on duty between 07:30 and 14:30 each week day as these are considered peak hours. The needs of those people in the dementia care unit mean that a minimum of two care staff are assigned there at all times. This leaves two care staff to meet the needs of twenty-five residents in the main part of the building. During the day the manager is on duty, as is a senior who works until 20:00. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 28 The manager and all staff spoken with highlighted the need for an extra member of staff during the evenings as this was considered another peak period in which residents require support in bathing. This was also the case on alternate weekends when levels dropped to four on duty during the day. In discussions with the manager it was understood that an advertisement for additional staff has been published, with to date, little response. A comment in one of the responses to the service user survey was, “I wish they had a few more staff as sometimes there is quite a delay in response, though I know they are trying.” In response to the question, “How do you think the care home can improve?” a visiting relative commented, “Perhaps in staff numbers.” Another commented, “Weekends, it’s not fair for 2 people to do 4 people’s work – makes them bad tempered.” This was echoed in discussions during the site visit with one of the more able residents who highlighted the fact that she often did not trouble staff because they were so busy. The home employs additional catering, domestic and maintenance staff. There are also some hours allocated to administration duties. Overnight there are two waking and one sleep-in night staff. NVQ training – Records showed and the manager confirmed that currently eleven of the thirty-seven care staff have achieved the National Vocational Qualification (NVQ) at level 2 or above, with four undertaking the training. This equates to 30 , which is below the minimum standard. However, there is a NVQ training programme in place and in the home’s assessment a plan for improving in the next twelve months is “to increase the number of workplace based NVQ assessors to enable a faster and more efficent assessment process.( The night supervisor and one assistant manager is currently undertaking the A1 certificate).” Recruitment Individual staff recruitment files were available for inspection. The manager confirmed that six new staff had been recruited since the last inspection when this standard was assessed. All six recruitment files were checked and found to be in order. Two written references and Criminal Record and Protection of Vulnerable Adults (POVA) checks are carried out on all staff before they commence working in the home. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 29 Staff training – The home continues to move forward with training opportunities for staff. Records show that that the training for mandatory subjects has been scheduled throughout the year. Staff training records were available to evidence training achievements. Staff training includes: Manual handling Food hygiene Appointed persons Health and safety Dementia awareness B/Tech Medication Safeguarding vulnerable adults Fire training Infection control Health and hygiene The home provides an induction/foundation training programme for new staff, which now follows the ‘Common Induction Standards’ recommended by Skills for Care. Staff spoken with confirmed that the Company “is hot” on training and mandatory subjects are refreshed every year. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • All staff at Osborne cottage are encouraged and assisted in undertaking an NVQ qualification. Staff that do not have vocational qualifications are inducted and trained on an on-going basis using the company training programme. Staff rotas are published monthly and all staff have access to the rota which is kept in the care office. The Rota is managed and reviewed on a daily basis by the manager and assistant managers. Any shortfalls due to staff absence are covered as soon as possible We endeavour to ensure a mix of qualified and un-qualified staff are on duty, which are appropriate to the needs of the service-users. Staff receiving induction do not assist with service-users care until formal monitoring and review has been undertaken by a senior member of staff. Osborne Cottage employs one Kitchen Assistant and three part-time Domestic assistants to maintain and ensure standards of hygiene and cleanliness are maintained. The home employs two wakeful night care assistants or one night supervisor and one care assistant. DS0000012519.V349798.R01.S.doc Version 5.2 Page 30 • • • • Osborne Cottage • • • • • • Two care assistants are employed within the dementia wing between 0730 and 2130. Three care assistants are on duty in the residential wing from 0730-1430 and two care assistants from 1430-2130. An assistant manager is on duty 0700-2000. Recruitment procedures are robust. Prior to appointing a new member of staff they are interviewed by the manager and the deputy manager. Two references are obtained and a POVA and CRB check is undertaken. People are employed in accordance with the company code of conduct and practise set by the GSCC. Staff receive a contract stating the terms and conditions of employment. A training plan is in place for all employees, with qualifications and courses attended, and future development needs. When an assessment of needs are undertaken for a prospective serviceuse. We ensure all training requirements relating to their care needs can be met or we put additional training in place prior to the person moving to the home, e.g., Stoma Care/MRSA. All staff attend a minimum of three training days per annum. Training needs are identified through the staff training plans. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 31 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. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, and has effective quality assurance systems developed by a competent manager. EVIDENCE: Management – The registered manager Miss Linington has many years experience of working in services for older people and has been in post at Osborne Cottage for just over two years. She has achieved the Registered Managers Award (RMA) and has almost completed the NVQ at level 4 in care. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 32 In addition, she updates her knowledge, skills and competence with periodic training in care related subjects specific to the service provided by the home, in particular Person Centred Dementia Care. Miss Linington completed the home’s Annual Quality Assurance Assessment clearly and fully, and returned it to the Commission promptly. Staff spoken with during the site visit confirmed that regular staff meetings and formal supervision sessions were taking place. They felt the home was well managed; staff morale was high and communication was good. During the site visit we had an opportunity to observe in a general sense the way the home functions. It was clear from the interactions between the manager, staff and the residents that the manager is well thought of. She showed kindness, understanding and patience towards all the residents. Comments from the responses to the visiting relatives survey include: “The Manager is very approachable.” “Management and staff are most approachable.” “The chain of command from top to bottom is very professional.” “The home is well run.” Quality assurance – The home has a Quality Assurance policy and a system of seeking the views of people who use the service by way of a survey questionnaire, copies of which were available for inspection. Records showed that the results are summarised and made available for interested parties and forwarded to the Company for use in their quality audit. The manager confirmed that the results are used to improve the service. Other areas that inform the home’s quality assurance are: • • • • • Monthly in-house care plan reviews. Yearly care reviews with the Care Manager, service user, relative/representative and key worker. Regular staff meetings and supervision sessions. A yearly formal Company audit. The Investors in People Award. Residents’ monies – Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 33 The home prefers the residents or their representatives to take responsibility for their own financial affairs. However, with the needs of the current resident group it is appropriate to have in place a system to safeguard the monies of those who are unable to make other arrangements. At the site visit we checked the system by way of dip sample and found it to be in good order, with receipts for purchases kept. Transactions were accurately recorded and balanced against expenditures. Health and safety – The home’s pre-inspection information sent to the Commission by the manager confirmed that policies and procedures are in place to ensure safe working practices in the home. A sample of records was viewed during the site visit including accident records, fire alarm tests, equipment servicing, public liability insurance, and gas and electrical tests, all of which were in good order. Staff training records showed, and staff confirmed that statutory training is scheduled and updated in manual handling, first aid, fire training, infection control and food hygiene. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • Since commencing employment with Islecare I have obtained a basic certificate in Dementia care mapping, This tool as been used with good results at Osborne Cottage. I follow a managers development plan which is undertaken and refreshed on a regular basis. Senior staff are given regular training through the company and through outside agencies in recognising conditions associated with old age. All staff are aware of their roles and responsabilities as reflected in their job profile. Senior staff are aware of reporting procedures, Clear guidance is given through company flowcharts which are kept in the care office. I endeavour to maintain a transparent and open atmosphere at Osborne cottage, Service-users and staff are aware of the open door policy of managing the care home. I hold regular senior staff/general and departmental meetings, All meetings are fully documented and published to the appropriate people.All service users and staff have the right and the opportunty for developing changes and improvement. I actively encourage all staff to communicate new ideas and thoughts to me - at the time of review and appraisal and on a daily basis. I endeavour to be clear in all forms of communications. DS0000012519.V349798.R01.S.doc Version 5.2 Page 34 • • • • • • • Osborne Cottage • • • • • • The Manager and deputy Manager have obtained the manual handling train the trainer certificate, This as enabled us to identify and offer a more flexable training programme for manual handling and assessments. Regular feedback is sought from the service-users - through daily informal conversation, meetings and quality assurance questionaires. Visitors are encourged to discuss areas of concern or things which may be of benefit to the home and its service-users. All service users are encouraged to manage there own finances, Safeguards are in place to potect those that may lack capacity. All finanacial transactions are documented and reviewed, Audits are undertaken by the manager to ensure procdures remain secure. I ensure the health, safety and welfare of service-users and staff are promoted through following all leglislation and company policies and procedures. Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 35 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 36 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 23 Requirement Plans for replacing old and stained divan beds and decorating the outside of the building must be produced and a copy supplied to the Commission. To ensure that the needs of people who use the service are consistently met staffing levels must be reviewed to increase numbers at weekends and evenings. Timescale for action 31/12/07 2 OP27 18 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Osborne Cottage DS0000012519.V349798.R01.S.doc Version 5.2 Page 38 - 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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