Care Home: Sable Cottage Nursing Home

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What the care home does well What has improved since the last inspection? The statement of purpose hand service user guide has been up dated to provide all information needed to make a choice about living in the home and is in a "user friendly" format. What the care home could do better: It is important for the home to maintain the standards that they are currently achieving. The inspector considered the home looked after people very well. CARE HOMES FOR OLDER PEOPLE Sable Cottage Nursing Home Chester Road Kelsall Cheshire CW6 0RZ Lead Inspector Joan Adam Key Unannounced Inspection 14th October 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 Sable Cottage Nursing Home DS0000018816.V372786.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. Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sable Cottage Nursing Home Address Chester Road Kelsall Cheshire CW6 0RZ 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) 01829 752080 01829 752098 care@sablecottage.fsnet.co.uk Mrs Celia Ann Minshaw Gillian Ann Johnson Care Home 38 Category(ies) of Dementia (15), Old age, not falling within any registration, with number other category (23) of places Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only Care home with nursing: Code N, to people of the following gender: Either. Who’s primary care needs on admission to the home are within the following categories: Dementia: Code D 15 Old age, not falling within any other category: Code OP 23 The maximum number of people who can be accommodated is 38 Date of last inspection 13th November 2006 Brief Description of the Service: Sable Cottage is a care home providing both nursing care for 23 older people and personal care for 15 people with dementia (Rainbow Unit), two of whom may be under 65 years of age. The home is located in a quiet residential area in the village of Kelsall, which is eight miles from Chester. Local amenities such as shops, churches, pubs and restaurants can be found within a short distance of the care home. It is served by local transport. Nursing care is provided on the two lower floors and a separate unit on the top floor is provided for people with dementia. Sable Cottage nursing care unit provides 19 single en suite rooms, plus one double with adjoining bathroom and two double rooms with en suite. The Rainbow Unit provides 15 rooms, all having en suite facilities. A passenger lift and staircases provide access to all levels. Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 2 stars. This means that people who use the service experience good quality outcomes. This unannounced inspection took place on 14th October 2008 over a period of six hours. This was to assess if people’s needs were being met at the home. A tour of the premises took place and included the kitchen and laundry, all of the bedrooms and all shared areas such as the lounge and dining room, shared bathrooms and toilets. The owner, several staff and people cared for were spoken with and their views contributed to the inspection of the home. This visit was just one part of the inspection. Before the visit the home was also asked to complete an annual quality assurance assessment to provide up to date information about services at the home. Questionnaires were also made available for residents, relatives and other professionals to find out their views. Other information since the last key inspection was also reviewed. Feedback was given to the owner and manager at the end of the visit. What the service does well: Individualised care and attention is provided and there is a welcoming, cheerful family type environment so that people who are cared for feel comfortable and at home. The home had an established staff team who were keen for standards to be maintained. Residents’ plans of care were well documented and reflected each resident’s needs. Meals were varied and reflected each person’s preference. They offered choice and variety. The home provides a varied range of activities so that the people who live in the home have enough to do. Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 6 A good standard of hygiene was seen throughout the home and the standard of décor was good. Residents surveys received said that “you couldn’t be better looked after”, “and “the food was good.” Other comments included “the staff are really nice”. The staff are well trained so they are competent to meet the needs of the people who live in the home. There are enough on duty at all times to make sure that the needs of the people who live in the home are met. Observations made during the site visit included discussions between the manager and the staff team and interactions between residents and staff. Staff were respectful towards residents and had an easy and friendly manner. Staff were also seen providing support to residents in a caring and sensitive manner. The home has been awarded a Platinum award from the Chester and District “Eat Well “award. What has improved since the last inspection? What they could do better: It is important for the home to maintain the standards that they are currently achieving. The inspector considered the home looked after people very well. Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 7 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. Sable Cottage Nursing Home DS0000018816.V372786.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 Sable Cottage Nursing Home DS0000018816.V372786.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): 1,3 Quality in this outcome area is good. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Detailed information is given to residents and relatives before they choose to live at Sable Cottage. Residents are assessed before they move in to the home so that they know their needs can be met. EVIDENCE: The statement of purpose and service user guide have been up dated and rewritten in a user friendly format to give prospective residents and their families all the relevant information needed to enable them to make an informed choice before they live in Sable Cottage. Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 10 The care records of a resident who has recently moved in to the home was looked at. The resident had been assessed by the manager before they moved in to the home so that they knew their needs could be met. This information was used to write a plan of care for the resident. Documentation from the hospital and social services was also present in the file. The home does not provide intermediate care so this standard does not apply. Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is good. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The residents’ health, personal and social care needs are met by the staff team who enable them to maintain their privacy and dignity. EVIDENCE: The care plans of three residents living at the home were looked at. The care plans of a newly admitted resident had been written within forty-eight hours of the person moving into Sable Cottage so that any risks were quickly identified and a suitable risk assessment provided. This also means that staff had been told promptly about what they needed to do to meet the care needs of these people. Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 12 Each care plan contained adequate information to enable care staff to know how to care for each person. Social activities were recorded. Care plans had been reviewed monthly and some of these reviews were detailed, however, some could contain more detail to enable staff to be aware of changes that had taken place. All visits to health care professionals such as dentists and opticians were recorded within the care plan. Visits to the home by GP’S or district nurses were also recorded. The daily record sheets were written each day by the care staff working at the home. Some daily record sheets seen showed day-to-day activities of each resident, however, some could be more detailed especially those written by night staff. Staff interaction was observed during the site visit and it was obvious that the staff knew the residents well as there was good banter between staff and people who lived in and visited the home. The staff were attentive to residents needs and helped them when required. The general atmosphere within the home was warm and friendly. Comments made by residents in surveys received were “ the home is lovely” “staff are friendly” Medicines are managed well. Policies and procedures are in place for the safe management of medications. The home uses a blister pack system for medication. All medication administration sheets had been completed and the home had an auditing system for monthly medications received in to the home. Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Residents’ were able to take part in a range of activities of their choosing. Meals and meal times were a positive experience. EVIDENCE: The home has an activities co-ordinator in post and activities listed were varied. There is a list of the activities on offer on the notice board and weekends were also covered. Visiting is at any time and visitors were made very welcome. Residents are supported to follow their individual religious beliefs and this was documented within the care plan. Clergy visit the home on a regular basis. Residents’ privacy and dignity is discussed with staff during the induction process. During the visit all the bedrooms were seen and residents’ own belongings, photographs and personal mementos were in the bedroom. The home has two shared rooms and all personal items had been clearly labelled to enable staff to be aware of which item belonged to which resident. Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 14 Menus were varied and food provided was of a good standard. The chef has completed the environmental health Chartered Institute of EHO studies. People living at the home said the food was “very good”. The home has adopted a “quiet time” during meals. No medication is given out and the dining room has restful music playing. Staff change in to black and white waitress style uniforms to serve meals making the experience positive. Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 15 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): 16,18 Quality in this outcome area is good. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Clear policies are in place to ensure that residents were protected from abuse, neglect and self-harm. EVIDENCE: The policy on complaints was seen and relevant paperwork was available in the event of a complaint being received. The Commission had not received any complaints since the last visit. The home had received few complaints and these had been dealt with and action taken recorded. The home had policies on the prevention of adult abuse, whistle blowing, challenging behaviour and harassment. These policies were consistent with the “No Secrets” guidance from the Department of Health. The homes policy included information on the types of abuse such as physical, verbal, sexual and neglect, signs and symptoms and reporting abuse. Safeguarding is a part of the induction and NVQ training and staff had undertaken training on Adult Protection. Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 16 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): 19,26 Quality in this outcome area is good. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home provides a good, clean and comfortable environment for the people to live in. EVIDENCE: The home was furnished in a domestic style with additional equipment such as grab rails, raised toilet seats and hoists provided as necessary to meet the residents’ needs. There was a good standard of décor throughout. Bedrooms have been decorated as they become empty and decoration is ongoing throughout the home. During the visit all the bedrooms were seen and residents’ own belongings, photographs and personal mementos were in the bedroom. Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 17 The home has two shared rooms and all personal items had been clearly labelled to enable staff to be aware of which item belonged to which resident. The garden area is enclosed and residents are encouraged to sit outside during the better weather. The home was clean, tidy and free from any unpleasant smells. Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 18 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): 27,28,30. Quality in this outcome area is good. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home has adequate numbers of staff on duty to give care and support to people living at the home. Staff members have received training to support them in their work and to enable them to provide competent care. EVIDENCE: The staffing rota was checked and showed there were appropriate staffing levels and skill mix deployed on each shift. The percentage of staff holding National Vocational Qualification (NVQ) Level 2 in care was well above 50 . Individual records of training are kept. Induction training, health and safety, fire safety, moving and handling, dementia awareness, mental health capacity act and all other training continues to be provided. Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 19 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): 31,33,35,38. Quality in this outcome area is good. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home is well managed so that it is run in the best interests of the people who live there. EVIDENCE: The manager of the home has been in post since 2007 and has been registered with CSCI. She is an experienced and well-qualified nurse with a Diploma in management, Diploma in pain management and pain assessment, Diploma in death and dying. She holds a mentorship course fro student nurse placements and is an assessor in clinical practice. Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 20 The manager of the dementia care unit holds a diploma in dementia studies and NVQ level 4 in management. Formal supervision takes place on a regular basis and this is recorded. The home did not handle residents’ financial affairs. If a resident did not wish to or was unable to handle their own affairs, and there were no family to undertake this task, a solicitor was appointed. A quality assurance process was in place. This included service users surveys, staff meetings and day-to-day contact with residents. The results of the surveys are recorded in the service user guide. A staff newsletter is also in place. The home is accredited by Investors in People Sable Cottage seeks to ensure the health and safety of all the people who live and work at the home. There is a health and safety policy that confirms individual and management responsibilities for managing health and safety and ensuring safe working practices. The manager ensures that risk assessments are carried out for all safe-working practices; significant findings are recorded and reviewed so staff and people who live at the home are safe. Routine maintenance checks are carried out on all appliances and services. Precautions are taken against the risk of fire including routine fire drills and fire awareness training for staff and people who live in the home so they know what to do in the event of a fire Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 21 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 X x 3 Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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 Sable Cottage Nursing Home DS0000018816.V372786.R01.S.doc Version 5.2 Page 24 - 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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