Care Home: The Cottage

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What the care home does well The home continues to provide high quality and comfortable accommodation that has been furnished to meet the needs of the individual residents. The proprietor/manager and part time care support worker provide a flexible and person centred service which operates in the best interests of the residents. Residents are supported to maintain contact with family and friends and enjoy a lifestyle of their choosing. One resident stated `makes you feel like it`s your own home, wonderful food and service`. A relative added on their comment care `visiting times are extremely flexible for family and friends`. And an external health care professional stated `provides holistic homely care`. What has improved since the last inspection? There were no requirements or recommendations made following the previous inspection. The service continues to meet people`s needs in an individual homely way. What the care home could do better: One requirement is made following this inspection visit. The home must ensure that records are fully maintained and up to date at all times. Key inspection report Care homes for older people Name: Address: The Cottage Linstone Drive Norton Yarmouth Isle of Wight PO41 0RL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janet Ktomi     Date: 1 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: The Cottage Linstone Drive Norton Yarmouth Isle of Wight PO41 0RL 01983760527 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Sonia Mary Price care home 2 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 2 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The Cottage is a small well appointed home that is registered to provide care and accommodation for two elderly residents. It is situated in a quiet residential area by the coastal town of Yarmouth. The proprietor Mrs Sonia Price manages the home as a domestic scale unit, with the residents made to feel part of the family. Both residents are accommodated in their own ground floor rooms, one of which has an en-suite facility. In addition, there is an assisted bathroom with toilet and wash hand basin on the ground floor. Care Homes for Older People Page 4 of 25 Over 65 2 0 Brief description of the care home The home is a detached property that sits in its own grounds. There are various sitting areas around the well-stocked garden. The home backs onto open countryside and provides fine rural views. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report contains information gained prior to and during a visit to the home undertaken on the 11th January 2010. All core standards and some additional standards were assessed. The home was previously inspected on the 27th February 2007 and had an annual service review in February 2008 and January 2009. Prior to the inspection surveys were sent to the home for people who live at the home, their relatives and for external health and social care professionals. One completed survey was received from a service user, one from a relative and one from an external health professional. The proprietor/manager completed the homes AQAA and returned this in December 2009 following a reminder letter. Reference to this and other information such as notifications received is also included in this report. Care Homes for Older People Page 6 of 25 The visit to the home was undertaken by one inspector and lasted approximately three hours commencing at 10.30 am and was completed at 1.15 pm. During the visit to the home the inspector was able to meet both service users. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 managing proprietor ensures that the care needs of the people who live at The Cottage would be met by undertaking a proper assessment prior to their moving into the home. The home does not provide dedicated accommodation for short-term intermediate or nursing care or specialized facilities for rehabilitation. Evidence: Records relating to the admissions of both the people living at the home, discussions with both people and the manager are considered along with surveys received. Discussions with both people who live at the home evidenced that the manager had visited them prior to their moving into the home and that they had received information about the home. Care files contained a pre-admission assessment carried out by the manager which covered all the areas necessary to enable a decision to be Care Homes for Older People Page 10 of 25 Evidence: made as to whether the persons needs could be met at the home. One file contained information for social services. A survey was completed by a health professional who stated that the care services assessment arrangements usually ensured that accurate information is gathered and that the right service is planned for people. People living at the home stated that their needs were met and that they were happy living at the home. The home does not provide dedicated accommodation for intermediate care or specialist facilities for rehabilitation. The home could provide short stay respite accommodation if a suitable room was available. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 ensures that residents privacy and dignity are respected at all times. Each person has an individual care file although some records relating to care and medication administration were not fully up to date. Evidence: Both care files were viewed which included medication administration records. Discussions with both residents, the manager and surveys received are also considered. Both service users stated that they received the health and personal care they required and that care was provided in a way that ensured their privacy and dignity. Both residents were able to give an informed opinion and spoke very highly of the way they are treated. Residents rooms are for single occupancy one with en suite facilities and the other with an assisted bathroom located close by. Each resident has an individual personal file containing a plan of care. The inspector looked at both files. One person was new to the home and their file contained limited Care Homes for Older People Page 12 of 25 Evidence: information with the care plan section detailing actions that the manager had taken rather than identifying care needs and how these should be addressed. The care plan in the other file did detail needs and how these should be met. Care plans contained few risk assessments. The manager who provides most of the care was able to speak with authority on the specific needs of both residents and had clearly identified potential risks and acted to minimize these however these had not been fully documented. The comment card from a health professional stated that the home provides holistic homely care, and that residents social and health care needs are usually properly monitored, reviewed and met by the home. They also stated that the care service always seeks advice and acts on it to meet peoples personal and health care needs and improve their well being. Records viewed and discussions with the manager indicated that appropriate medical support is accessed when required. The manager stated that she always attends medical appointments with the residents. Both residents are mobile with the support of walking frames and one person. The home has a wheelchair for use outside the home if this is required. The home has the equipment necessary to support people to use the bath and to protect pressure areas. Daily records of care provided and other issues such as contact with health professionals are recorded in a diary. This was noted to have not been completed for the week prior to the inspection visit. The manager was aware that records were not up to date. The home has storage facilities for medication, neither service user adminsiteres their own medication. One care file contained a medication administration record however this was not present in the other persons file. When the inspector arrived at the home medication was noted to be on the kitchen worktop however the manager was preparing breakfast and stated that medication was normally locked away. The manager must ensure that all records are up to date at all times. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Cottage offers a personal and flexible service where choices and preferences are encouraged and supported. Activities are offered to suit the needs of residents and visitors are welcome and can visit at any time. Residents nutritional needs are satisfied with a varied and balanced diet of good quality fresh food. Evidence: Discussions with the two people who live at the home, information in care plan files and discussions with the manager are considered. Both residents confirmed that they are happy with the activities and lifestyle at the home, activities are individually arranged and chosen by the service users. The home has a car that is used for outings and excursions chosen by the people who live at the home. These have included mainland trips and meals out on the island. The service encourages visitors and both service users stated they could have visitors at any time. The manager has also facilitated visits for people to meet relatives. The home being domestic in character has many visits from neighbours and the managers family and friends. During the inspection visit one relative telephoned to say that they would not be visiting as planned due to the severe weather conditions. The manager Care Homes for Older People Page 14 of 25 Evidence: passed the phone to the service user so they could have a telephone call instead. As described previously it was evident that people who live at the home are supported to do whatever they want in their lives. People confirmed that they can get up at whatever time they wish and retire to bed when they want. The manager offers residents food that they like, which is varied, nutritious and home cooked. All vegetables are fresh, some having been home grown. Both residents were full of praise for the meals provided and confirmed that mealtimes are arranged around their own preferences and at times suitable to them. Records of food served daily are kept by the home and demonstrate the quality and variety of food provided. The home has been awarded five stars (the maximum) by the local environmental health food hygiene assessor. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 concerns and complaints seriously and would respond appropriately. Residents should be safeguarded from abuse. Evidence: Discussions with both service users and the manager are considered. Being a small family run home the interaction between the proprietor and the residents is close and informal. While there is a formal complaints procedure (which was viewed in the homes policies file) in reality people would address any concerns or complaints directly to the manager in whom they have every confidence. This was clear from discussions with the residents, observations during the site visit and from comments in surveys received. The home has an adult protection policy and procedure which follows local authority guidance. The manager demonstrated an awareness of the procedure and what would be required if any concerns came to light. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The location and layout of the home is suitable for its stated purpose in providing a safe and comfortable environment for the residents. The facilities, fabric and decoration of the home are all above standard. All areas of the home are kept clean, hygienic and there are no unpleasant odours anywhere in the home. Evidence: Both residents are accommodated in rooms on the ground floor. The inspector was able to speak with each resident in private and view their rooms and facilities. Each room is well laid out so as to provide provide ease of movement and clear access to wardrobes etc. Furniture and decorations are to a high standard. One of the rooms has an en-suite toilet and wash hand basin while the other is sited directly opposite an assisted bathroom, which has a toilet and wash hand basin. The home has central heating and is double glazed throughout. The manager stated that all wash hand basins and the bath are fitted with valves, which safely control the temperature of hot water. Each resident has their own comfortable arm chair. The home has a large landscaped rear garden and patio area that backs onto open countryside. It is readily accessible for both the residents. Care Homes for Older People Page 17 of 25 Evidence: The ground floor bathroom is fitted with a hoist to assist residents with getting into and out of the bath. The home has a range of additional equipment such as oxford hoist, wheelchair, walking frames etc that can be utilized if required. Service certificates were viewed for equipment. The home has a purpose built laundry and utility area that is appropriate for the size of the home. At the time of the visit to the home all areas of the home to which the residents have access were clean and hygienic with no unpleasant odours anywhere. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 staffing arrangements for the home are suitable for the number and needs of the current residents. The manager and part time care worker have completed some training however neither has a recognized qualification in care however there was no evidence to suggest that residents are not in safe hands at all times. The home has not recruited new staff since the previous inspection. Evidence: Discusions with the residents, manager and observations during the inspection are considered. The home is run by the proprietor/manager who also lives on the premises. She employs one care support worker on a part time basis who has worked at the home for a number of years. The manager stated that this person was employed at the home at the time of the previous inspection. The previous report stated that the records relating to this staff member had been checked, therefore recruitment records were not viewed again on this visit. The manager outlined the recruitment procedures that would be used if new staff were employed and these would ensure that all the required pre-employment checks would be undertaken. In addition there is a part time handyman who ensures the premises are at all times well maintained. With just two residents the current staffing arrangements ensure that they receive a safe, flexible and personal service throughout the week. Care Homes for Older People Page 19 of 25 Evidence: In the context of a small domestic scale home that has operated successfully for many years the needs of the residents continue to be well met by competent staff. The manager showed the inspector a certificate she has for palliative care training attended in March 2009. The manager stated that over the past year the part time worker has attended manual handling, medication and personal care training. Both residents were full of praise for the way they are treated by the manager and part time staff member. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home which is run in their best interests by an experienced manager. The manager must ensure that all records are up to date at all times. Evidence: The responsible person Mrs Price has owned and managed the home for many years. She has a nursing background and in excess of fifteen years experience providing care for elderly residents and was able to talk with authority on the care needs of the present residents. Although she does not have a management qualification the manager has undertaken some training relevant to the needs of the people who live at the home. The standard relating to quality assurance is assessed in the context of the size and nature of the home. There was ample evidence to show that the home is run in the best interests of the residents. Both people living at the home are able to give an informed opinion and it was clear that their views are regularly sought by both the manager and the care support worker. Care Homes for Older People Page 21 of 25 Evidence: The home is regularly maintained to a high standard and provides a safe and comfortable environment with positive outcomes for the residents. Policies and procedures and practices are appropriate for the aims and objectives of the home. Prior to the inspection visit the manager was sent an Annual Quality Assurance Assessment (AQAA) to complete. This was not received by the return date and a reminder letter sent. This has now been received and provides information relevant to the service. The manager explained that it is the policy of the home not to involve itself in the residents financial affairs. Both the homes residents have family members who assist them in this respect. Residents confirmed this during the inspection. As part of this inspection various records were viewed. Records relating to care and how people had spent their time and meals received had not been kept up to date. The manager stated that this was because she had been busy assisting a neighbour who had been ill however the manager must ensure that informal responsibilities do not compromise the standards at the home and that records must be well maintained, up to date at all times. The home has a range of policies and procedures relating to the health and safety of residents. The homes equipment and facilities are subject to regular safety checks and servicing with records viewed for these. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 37 17 The responsible person must 01/02/2010 ensure that records are well maintained and up to date at all times. So that people are safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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