Care Home: The Cottage Nursing Home

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What the care home does well What has improved since the last inspection? The care plan have been reviewed and revised with further developments planned for the next twelve months. The redecorating and refurbishment of the premises is ongoing to ensure the standard of the accommodation is maintained. What the care home could do better: To ensure people have information on the service the statement of purpose and service user guide should be reviewed to include current and correct details. The recommendations from other authorities (fire service etc) should be speedily complied with to ensure the continued safety of people living, working and visiting the home. The furniture and fittings at the home should be safe and assure comfort and privacy for the people in residence. Safe working practices should be adopted by the safe to reduce the risk of accidents and injury to people living at the home. CARE HOMES FOR OLDER PEOPLE The Cottage Nursing Home 57/58 Blakenall Heath Bloxwich Walsall West Midlands WS3 1HS Lead Inspector Joy Hoelzel Key Unannounced Inspection 14th February 2008 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 The Cottage Nursing Home DS0000020790.V350129.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. The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cottage Nursing Home Address 57/58 Blakenall Heath Bloxwich Walsall West Midlands WS3 1HS 01922 712610 01922 712610 sherlock12@btconnect.com 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) Acepay Limited Rosemary Elizabeth Broadhurst Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (with nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Older people (OP) 33 The maximum number of service users to be accommodated is 33. 2. Date of last inspection 8th November 2006 Brief Description of the Service: The Cottage Nursing Home as the name suggests is registered by the Commission to provide nursing care to a maximum 33 older people at any one time. The home is located in a pleasant residential area. A bus stop is situated virtually outside of the home. The home was purpose built and first registered in 1992 by the present owners. An extension to the premises was completed in 2007 to provide an additional seven beds and to improve the communal areas. The garden whilst attractive with its mature shrubs has limited usable space, as the grassed area is sloped. Limited car parking spaces are available at the front of the home. Information of the home and the provision of the service are available in the statement of purpose and service user guide contains information on the level of fees for the service. However the reader may wish to obtain more up to date information from the care service. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours on Wednesday 14th February 2008. It was conducted by one Commission for Social Care Inspection regulation inspector. Twenty three of the thirty eight National Minimum Standards for Care Homes for Older People were inspected as they are viewed as key standards for services. Thirty two people are currently living at the home and during the inspection were observed to be accessing all areas of the home. The registered manager was on the premises supported by two registered nurses, six care staff, and ancillary personnel. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with the CSCI areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to us within a given timescale. The registered manager completed this document and returned it to us. Comments from the AQAA are included within this inspection report. ‘Have your say’ surveys were distributed to a selection of people living, visiting and working at the home during to this inspection. The comments received are included in this report. The quality rating for this service is [3 star, 2 star, 1 star, 0 star]. This means the people who use this service experience [excellent, good, adequate, poor] quality outcomes The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Cottage Nursing Home DS0000020790.V350129.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 The Cottage Nursing Home DS0000020790.V350129.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): OP 1,3,6 Quality in this outcome area is good. The home provides a statement of purpose that is specific to the individual home and the resident group they care for. Good admission procedures have been adopted ensuring that the home is fully suitable for meeting a persons needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details of the service provision are available in the statement of purpose and service user guide; both documents are available on request at the home. Details of the weekly fees are included in the statement of purpose and should also be included in the service user guide. The documents were looked at after this inspection and found that some of the information included in them was incorrect. The previous regulatory body The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 10 (NCSC) is referred to in the complaint section of the service user guide as the point of contact when a person wishes to make a complaint. The case file of the person who recently moved into the home contains preadmission information from the local Primary Health Care Trust. The manager explained that they were unable to complete the usual pre admission assessments because this was an emergency admission. However an initial plan of care was completed at the point of admission to the home with reviews with the social worker arranged during the first week of the persons stay. Other case files looked at contained information and assessments from other outside agencies as well as the homes own assessments. The home does not offer an intermediate care service. The Cottage Nursing Home DS0000020790.V350129.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): OP 7,8,9,10 Quality in this outcome area is good. Each individual has a care plan but practice of involving people who use the service in the development and review of the plan is variable. Personal healthcare needs including specialist health, nursing and dietary requirements are generally recorded in each persons plan; they give an overview of their health needs and act as an indicator of change in health requirements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people living at the home have a case file, which includes risk and healthcare assessments; a plan of care is developed as soon after admission to the home as practicably possible. The manager explained that a computerbased system is being trialled currently to further improve the monitoring and auditing of the care plans. The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 12 Four case files were selected for inspection and generally contained information of an individuals assessed care needs. Verbal comments are recorded in the care plans of discussions with relatives involved with the care planning process; there was no evidence of the individual being consulted. It is acknowledged that some people living at the home do not wish to or are unable to contribute to the care planning processes, but efforts should be made to involve people if they wish to. One person has a specific medical condition that requires daily interventions from the staff, the care plan was informative and detailed and provided clear instructions of the care needed and the action to be taken in the case of an emergency. Another care plan included information on particular cultural and dietary requirements and for assistance with personal care to be provided by female staff. The care plans of two people who have dementia were looked at. All evidence points to the specialised care needs of these people are being satisfactorily met. Whilst it was not possible to engage them fully in conversation both were well dressed, clean, tidy and appeared quite happy in their surroundings. Inspection of medicine storage and administration records, demonstrated that generally the home’s practices meet the guidelines of the Royal Pharmaceutical Society. The manager stated that further training in the safe handling of medication is being arranged for the nurses as part of their continual professional development. The Cottage Nursing Home DS0000020790.V350129.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): OP 12,13,14,15 Quality in this outcome area is adequate. Generally people using the service are given the opportunity to take part in a variety of activities both within the home and in the community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not have a social activity coordinator; the acting manager explained that care staff arrange the activities in addition to their care duties. During the day there was very little structured activity taking place, but people looked happy and contented and were either chatting with each other or watching the television. Comments included in the ‘Have your say’ survey completed by visitors regarding what the home could do better – ‘More leisure interaction between staff and residents’ The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 14 But people living at the home indicated that they thought the activities had improved in particular to – ‘Activities and flower arranging’ Through out the day there were many visitors popping in and out and stated that they visit often, always felt welcome and able to visit at different times. It was evident that good relationships had developed with the staff, as there was lots of chatter and discussions happening. Two visitors discussed the improvement in their relatives condition since being resident and stated the staff are ‘very good at providing the care needed’. People are supported with maintaining their cultural and religious interests, with arrangements for religious observance arranged in the home and in the community. The AQAA completed by the manager describes some recent amendments made ‘The local church used to hold services in the lounge but after discussion with service users those wishing to attend these services go to a separate area’. The cook stated that a revised rotational menu has been planned and would shortly be in operation. Following a meeting with the people in residence and suggestions for the menu a roast dinner midweek has been included in the new menu. The cook stated that alternatives are offered if the menu is not to a person’s preference and that various dietary requirements are catered for. The Cottage Nursing Home DS0000020790.V350129.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): OP 16,18 Quality in this outcome area is good. The service has a complaints procedure that is clearly written and easy to understand and is displayed in a number of areas within the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed at the entrance to the home and is included in the statement of purpose and service user guide. The manager confirmed that the documents would be amended to include our new contact details so people can contact us if they so wish. The manager stated that no complaints or safeguarding adults referrals have been made since July 2007. We have received no concerns or complaints regarding the service since this date. One visitor discussed the action and amendments to staff working practice made following their need to make a complaint to the home and went on to discuss their relatives specific care needs and that generally they are satisfied with the service provided. The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 16 The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this have been maintained and fully receipted. The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 17 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): OP 19,24,26 Quality in this outcome area is good. The home provides a physical environment that is appropriate to the specific needs of the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was warm and clean with people state they are happy and satisfied with the accommodation. The manager stated that refurbishment and the redecoration of the home continues as and when needed. Currently the flooring in certain areas is being replaced. The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 18 The private and communal areas are well furnished and homely, some wardrobes provided by the home have not been secured to the wall to prevent them from toppling over and causing injuries. A locking facility has been provided in the private rooms in the new extension but not provided on the doors in other areas. The manager states that locks can be fitted if the resident requests this. To offer people a true choice of whether they wish to lock their doors or not this facility should be available on all bedroom doors. Hand wash facilities have been provided in all communal areas and at the point of the delivery of care to reduce the risk of any cross infections. The local fire officer visited the home in May 2007; the manager confirmed that the all but one recommendations made have been complied with prices for a gas isolator in the kitchen being sought from outside contractors. The Environmental Health Officer visited the premises in January 2008 with the cook confirming that immediate action was taken following recommendations made at the time of the visit. The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 19 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): OP 27,28,29,30 Quality in this outcome area is good. There appear to be enough staff available to meet the needs of the people using the service, with the staffing structure based around delivering outcomes for the people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A rota is maintained to show which staff are on duty at any given time of the day or night. During the inspection the registered manager was supported by two registered nurses, six care staff, with catering and domestic staff additional. Thirty two people are currently residing at the home. During this inspection all people looked well cared for and although the staff were obviously busy there did not appear to be any delay when assistance was required. People commented that the staff were ‘very good’ and that they had no particular concerns and were generally satisfied with the care they received The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 20 Four staff personnel files were looked at; the records examined showed they contained all the necessary information, which demonstrates potential staff are well screened before they are deemed suitable to start work at the home. A training matrix has been developed for ease of reference in determining the subject, date and attendance of the training opportunities. The manager identifies some barriers to successfully completing the training programme ‘Staff development suffers from lack of time to always follow through’ and has identified plans during the next twelve months ‘To continue to review training and try and ensure all staff have adequate training to enable them to provide what is required by our service users’. Information provided in the AQAA includes – ‘All care staff have completed Level 2 in care National Vocational Qualification and level 2 Dementia Care or are in process of obtaining qualification’. The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 21 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): OP 31,33,35,38 Quality in this outcome area is good. The manager has the required qualifications and experience and is competent to run the home. Generally systems are in place for to ensure that the health, safety and welfare of people living, working and visiting the home are upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs Rose Broadhurst has been the registered manager at the home for 4 years, is a registered nurse and ahs the skills and knowledge to manager the home on a day-to-day basis. Through out this inspection Mrs Broadhurst The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 22 demonstrated an in depth knowledge of the current resident group and their individual requirements. The annual quality assurance and monitoring arrangements are due to in March/April, with questionnaires and surveys being distributed to people involved with the home. The provider of the service regular visits the home and discusses the daily management with Mrs Broadhurst, a report is not produced of these visits. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this have been maintained and fully receipted. Documents were seen for the routine weekly, monthly and annual safety checks (fire alarms, hot water, etc). General risk assessments for safe working practices are due for review at the end of February 2008. During the inspection staff were observed to be transporting people in wheelchairs without using the footrests, and using the Standaid hoist in an unsafe way. This was discussed with the staff and the manager amendments to the working practice must be made to ensure that people remain safe when equipment is being used. The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 23 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 2 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 2 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 2 X 3 X X 2 The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 24 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(4) Requirement The recommendations made by the fire officer must be fully complied with to ensure the safety of people living, working and visiting the home. Amendments must be made to staff working practice when using equipment provided by the home. This will reduce the risk of accidents and potential injuries of people in residence. Timescale for action 31/03/08 2 OP38 13(4)(c ) 29/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP1 OP1 OP24 Good Practice Recommendations The service user guide should include information of the level of fees for the service. The statement of purpose and service user guide should be amended to include our contact details. The wardrobes provided by the home should be securely fixed to ensure the safety of people living, working and DS0000020790.V350129.R01.S.doc Version 5.2 Page 25 The Cottage Nursing Home 4 5 OP24 OP33 visiting the home. To offer people a true choice of whether they wish to lock their bedroom doors or not, suitable door locks should be fitted. A written report should be available to the registered manager, and available for inspection, of the monthly visits to the home by the provider of the service. The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 The Cottage Nursing Home DS0000020790.V350129.R01.S.doc Version 5.2 Page 27 - 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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