Care Home: The Cottage Nursing Home

What the care home does well What has improved since the last inspection? The content of the individual plans of care have been improved following requirements made at the last inspection. Individual plans of care now include more details about individual preferences and how residents are supported to make choices within their daily lives. Detailed risk assessments are now in place for the risks of falls; falls from the bed and the risks associated with the use of bedrails and these are based on current best practice. Consent is also obtained for the use of bedrails. Risk assessments are now also in place to reduce and manage the risks of challenging behaviour and aggression between residents. There is now evidence that residents or their representatives are now involved in the development and review of the individual plans of care. Risk assessments are now in place for people who are unable to take their medication in solid format and need to have medication crushed and then added to food or drink. Consent is obtained from the resident or their representative, the General Practitioner and pharmacist. The medication profile provides staff with specific instruction as to how this is to be done.0More information is now included in the individual plans of care relating to the residents wishes regarding terminal care and death and this is based on up to date professional guidance. The management have now obtained more information about referring incidents to the local authority when abusive situations occur between residents and the manager seeks advice from the appropriate department regarding formal referrals. The staff group now has additional male staff, which means that people who use the service can be cared for by people of the same gender. Following a requirement made at the last inspection staff files have been reviewed to ensure that they contain all of the required information. Following the last inspection the management have introduced regular staff supervision both management and staff have told us that they have found this to be a valuable tool to improve standards and to support individuals in their work. The management are currently in the process of setting up a named nurse and key worker system. One staff member commented `The managers are always on shift and supervise every six to eight weeks which makes the work more interesting and relaxing`. The management now ensure that all notifications about incidents that affect the well being of residents are sent to us. What the care home could do better: The management have agreed to review the Statement of Purpose to ensure that it is up to date and contains all of the right information. The management continue to develop the individual plans of care and increase the amount of detailed information about resident`s routines and preferences. Staff need to continue to include more information in daily records to show how residents are supported to make choices within their daily lives Where it is suspected that a resident is unable to provide the consent for medication to be crushed and added to food or drink the risk assessment needs to be further developed to include evidence of formal assessment to demonstrate that the person involved does not have the mental capacity to provide consent. The management have agreed to ensure that this is done. The complaints policy needs to be more accessible to the people who use the service and their representatives. The management have agreed to ensure that a copy of the complaints procedure is displayed in the main reception area.1 CARE HOMES FOR OLDER PEOPLE The Cottage Nursing Home 80 High Street Irchester Northants NN29 7AB Lead Inspector Stephanie Vaughan Unannounced Inspection 9th March 2009 09:00 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 DS0000012649.V374519.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 DS0000012649.V374519.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cottage Nursing Home Address 80 High Street Irchester Northants NN29 7AB 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) 01933 355111 01933 355129 The Cottage Nursing Home Limited Mrs Agnes Ernestina Arthur Care Home 53 Category(ies) of Dementia - over 65 years of age (53) registration, with number of places The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Age range for service users in the category of DE 50 years and above. Nursing (N) to a maximum of 53 beds. The home may provide Personal Care (PC) for up to 3 Service users within the category DE (E) and DE. Room 54 must not be occupied by a wheelchair user. Date of last inspection 11th February 2008 Brief Description of the Service: The Cottage is a care home located in the village of Irchester, which is situated close to the main A45 road, and facilitates easy access to the main towns of Wellingborough, Rushden, Kettering and Northampton. The home can accommodate up to 53 service users in the category of Dementia, over the age of 50 years. Accommodation is provided over three floors, in a mixture of single and shared rooms. There are a number of communal areas throughout the building, and stairs and an elevator provide access to all floors. Weekly fees currently range from £ 377.95 per week for Local Authority Funded placements to £500.00 per week for privately funded placements. These fees do not include the top up fees for nursing care, which are provided by the Primary Care Trusts. Charges of £650:00 per week are made for residents eligible for Continuing Healthcare Funding. The fees are also dependent upon the choice of bedroom, en-suite facilities required and individual funding arrangements. Items not included in the fees include hair dressing, podiatry, toiletries, clothing and other personal items. The Cottage Nursing Home provides people who use the service with information about the home in the Service Welcome Pack. The Commission for Social Care Inspection reports are available in the reception area and relatives The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 5 are also informed of their availability through the Commission for Social Care Inspection web site. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. Prior to this statutory inspection, a period of four hours was spent in preparation. This comprised a review of the previous inspection record, previous report and associated requirements, the service history, the Annual Quality Assurance Assessment sent to us by the provider telling us about their service and other documentation including information that has been given to us since the last inspection. We received seven comment cards from the people who use the service; in some cases these had been completed with help from relatives. Ten Comment cards were returned from staff. All of these indicated a good level of satisfaction with the service provided at the Cottage Nursing Home and the comments have been used to inform the inspection activity. The Commission have received no concerns, complaints or allegations about this service about this service. The Commission have a focus on Equality and Diversity and issues relating to this are included in the main body of the report. This site visit to the home was conducted over a period of seven hours during which the inspector made observations and spoke to residents and staff. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where of a sample of four residents were selected and all aspects of their care and experiences were reviewed, including individual plans of care and associated documentation. The service specialises in the provision of care for people with dementia, as such discussion with the residents was limited due to their abilities to recall their express their experiences and views. In these circumstances observations are used to inform the inspection. The Registered Manager was present for the duration of this visit. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 7 What the service does well: Admissions to the home are managed well, people are provided with the right information and are encouraged to visit the home meet the residents, staff and management. The management make sure that they have all of the information necessary before the person is admitted to the home to ensure that they can look after them properly. One resident commented ‘We received enough information about the home before moving in, we met with Mrs Arthur and she spent time showing us around – we observed the food and she was very good at putting us at our ease’. Each person has an individual plan of care, this provides detailed instruction to staff about how residents are to be cared for and includes health, personal and social care, these are regularly reviewed. Healthcare is managed well at the Cottage; people have appropriate risk assessments in place for the risks of pressure and nutrition. People have access to the right equipment and expertise including general practitioners, dieticians, continence services, podiatrists, opticians and hospital services. This means that people who use the service have good health care outcomes. People who use the service were able to confirm that they felt that they were well cared for and felt safe. One relative commented ‘I find that all the staff very helpful and the owners do their best to make every one comfortable and see that their needs can be met’ Medication is managed well at the Cottage, the service has robust stock control systems in place and medication is given as prescribed. People who use the service are well presented and this supports their diversity and the dignity. Staff relate well to the residents and are respectful and mindful of their privacy. Residents or their representatives are invited to supply the service with a life history in order that provides information about the pervious lifestyles of the individual in order that the service can support them to sustain their chosen way of life as much as possible. The life histories are maintained by the occupational therapist who organises group and individual activities. Activities in the home are appropriate to the age and culture of the people who use the service. One relative commented ‘Mum is not able to take part in activities now but the ladies still visit her in her room and show her family photographs and put music on for her’. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 8 People who use the service are supported to access the local community and to maintain their links with family and friends. Visiting times are flexible, one relative commented ‘There are always activities going on, I observe people going in and out of the home all the time. There is always music and TV. The nurses talk to the patients’. Meals and mealtimes are managed well, four meals are served between the hours of 8am and 7pm and there are additional snack and drinks in between these hours. The resident’s food preferences are well known to the staff and alternatives to the menu are provided including access to special diets and pureed food. One resident said ‘the food is lovely here’. A relative commented ‘Mother always eats everything offered, even though she is now on soft food she still enjoys it’. The management of complaints is good, people are provided with the Statement of Purpose, which contains the Complaints Procedure. Residents were able to confirm that they could voice their concerns and that they were listened to. Staff are aware of the complaints policy and staff confirmed they treated any concerns seriously and that minor concerns are addressed as soon as they are brought to the attention of the staff. Neither the home nor the Commission have received any formal complaints about this service since the last inspection. One relative commented ‘Mother has been at the Cottage for 10 years in that time I have had no cause to make a compliant’. The standard of the environment is good; most of the home is purpose built and provides people with space and comfort. The home is accessible to wheel chair users in most areas and appropriate fixtures and fitting are in place including a passenger lift and chair lift. Resident’s bedrooms are of a good standard being fitted with appropriate fixtures and fittings. People who use the service are encouraged to personalise their rooms with small items of furniture photographs and other personal items. One resident told us ‘ I like my room its lovely and cosy’. No hazards were identified and the home is well maintained, clean and hygienic. A relative commented ‘I was attracted to the home for it’s clean and freshness, it always smells lovely’. Staffing levels are good and the service makes sure that they have the right mix of staff on duty for each shift and wherever possible that this reflects the gender and culture of the people who use the service. The management ensure that staff whose first language is not English have additional training to help their communication with residents and other staff. Recruitment procedures were reviewed and processes were found to be safe and well managed. Staff have all the right training in place this includes training for new staff so that they know how to do their jobs safely. There is a comprehensive training programme in place that ensure that staff have the The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 9 right training at the right time. Staff also receive training that is specific to the needs of the individual residents including comprehensive training in the care of people with dementia. One staff member commented ‘Induction coverered Health and Safety, Fire Safety, Care and Confidentiality’. Another commented ‘Training is always available to help me with my work. I also attend English classes, which helps me to communicate better with the service users and relatives. On resident commented that the ‘nurses were lovely’ and that they had time to talk to them and to help them. A relative commented ‘The staff act on what I say, they arranged for mothers hair to be cut and it was done by the next time I visited, they call me day or night if needed’. Th Registered Manager is both well qualified and experienced in providing nursing care to this client group. Both of the providers spend most of their time on the premises and this enables the service to be responsive to the needs of individuals. The management make sure that they conduct regular checks to make sure that the people who use the service are safe and well cared for. They actively seek the views of the people who use the service and their representatives and use their views to develop the service. One person commented ‘The Cottage is very caring and put the people who use the service first at all times’. The storage of resident’s money is safe and well managed. What has improved since the last inspection? The content of the individual plans of care have been improved following requirements made at the last inspection. Individual plans of care now include more details about individual preferences and how residents are supported to make choices within their daily lives. Detailed risk assessments are now in place for the risks of falls; falls from the bed and the risks associated with the use of bedrails and these are based on current best practice. Consent is also obtained for the use of bedrails. Risk assessments are now also in place to reduce and manage the risks of challenging behaviour and aggression between residents. There is now evidence that residents or their representatives are now involved in the development and review of the individual plans of care. Risk assessments are now in place for people who are unable to take their medication in solid format and need to have medication crushed and then added to food or drink. Consent is obtained from the resident or their representative, the General Practitioner and pharmacist. The medication profile provides staff with specific instruction as to how this is to be done. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 10 More information is now included in the individual plans of care relating to the residents wishes regarding terminal care and death and this is based on up to date professional guidance. The management have now obtained more information about referring incidents to the local authority when abusive situations occur between residents and the manager seeks advice from the appropriate department regarding formal referrals. The staff group now has additional male staff, which means that people who use the service can be cared for by people of the same gender. Following a requirement made at the last inspection staff files have been reviewed to ensure that they contain all of the required information. Following the last inspection the management have introduced regular staff supervision both management and staff have told us that they have found this to be a valuable tool to improve standards and to support individuals in their work. The management are currently in the process of setting up a named nurse and key worker system. One staff member commented ‘The managers are always on shift and supervise every six to eight weeks which makes the work more interesting and relaxing’. The management now ensure that all notifications about incidents that affect the well being of residents are sent to us. What they could do better: The management have agreed to review the Statement of Purpose to ensure that it is up to date and contains all of the right information. The management continue to develop the individual plans of care and increase the amount of detailed information about resident’s routines and preferences. Staff need to continue to include more information in daily records to show how residents are supported to make choices within their daily lives Where it is suspected that a resident is unable to provide the consent for medication to be crushed and added to food or drink the risk assessment needs to be further developed to include evidence of formal assessment to demonstrate that the person involved does not have the mental capacity to provide consent. The management have agreed to ensure that this is done. The complaints policy needs to be more accessible to the people who use the service and their representatives. The management have agreed to ensure that a copy of the complaints procedure is displayed in the main reception area. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 11 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. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 12 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 DS0000012649.V374519.R01.S.doc Version 5.2 Page 13 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are appropriately assessed prior to moving into the home ensuring that their needs can be met. EVIDENCE: The service has a Statement of Purpose, which in general complies with the criteria set specified in Schedule one of the National Minimum Standards. However it was last reviewed in June 2007 and does not contain all of the required information such as the sizes of rooms and reference to the The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 14 Commission for Social Care Inspection reports. This was discussed with the provider who has agreed to make the necessary amendments. It is produced in a reasonable sized font so that it is easier for people to read and it shows that the service is inclusive and promotes the rights, values and beliefs of the people who use the service. One recently admitted resident was case tracked; the individual plans of care showed that a thorough preadmission assessments was conducted by the management to ensure that the service was able to meet the needs of the individual. The pre admission assessment enables management to take into account the equality and diversity needs of the individual such as disability, religion, gender, sexuality and ethnicity. People who use the service are admitted to the Cottage within their categories of registration and expertise. Commission for Social Care Inspection reports are available in the home and can be accessed on request. The Registered Manager also stated that prospective residents or their representatives are encouraged to review the reports on the Commission for Social Care Inspection website. There was also evidence that the service manages admissions appropriately people are encouraged to visit the home meet other resident, the staff and the management. One resident commented ‘We received enough information about the home before moving in, we met with Mrs Arthur and she spent time showing us around – we observed the food and she was very good at putting us at our ease’. Each resident has an up to date contract which sets out their terms and conditions and specifies the room that is to be occupied, trial periods and periods of notice. The service does not provide intermediate care. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 15 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 & 11 Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. Residents have a detailed plan of care, which indicates that they are treated as individuals and that their health care needs are fully met. EVIDENCE: We case tracked four people who use the service during this inspection to assess the standard of care that is received by the people who use the service. We also reviewed compliance with four outstanding requirements relating to this outcome group. Each resident has an individual plan of care, which is developed from the pre admission assessment and ongoing assessment of need following admission. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 16 Following a Requirement made at the last inspection the standard of the care plans has been significantly improved. These now provide more detailed instruction to staff about how the resident’s healthcare needs are to be met and provide more information about how residents are to be supported to make choices in the course of their daily lives. Following a Requirement made at the last inspection the content risk assessments have been improved. There are now detailed risk assessments for falls; falls from the bed and the risks associated with the use of bedrails and these are based on current best practice. Consent is also obtained for the use of bedrails. Following a Requirement made at the last inspection detailed and person centred risk assessments are now in place to reduce and manage the risks of challenging behaviour and aggression between residents. Individual plans of care are now more detailed and set out the personal health and social care needs of the individual and are becoming more person centred. The management continue to develop the individual plans of care and increase the amount of detailed information about resident’s routines and preferences. Each resident has an appropriate assessment for the risks associated with pressure; these are based on current best practice, are accurate and are regularly reviewed. Residents have access to appropriate pressure relieving equipment and the care plans specify appropriate care and treatment that is to be provided. The management of pressure sores is good at The Cottage, many of those with sores have had them on admission, the documentation is robust and shows significant improvement in the outcome for individual residents. The management of nutrition is also good people who use the service have nutritional assessments in place these show that residents are weighed regularly and that their intake of food and fluid is promoted. When risks are identified appropriate referrals are made to the General Practitioner and dieticians this enable appropriate guidance and additional supplements to be provided. Each resident has a movement and handling assessment in place which shows how the individual resident is to be supported, the number of staff required and the equipment to be used. Staff spoken to indicate that all equipment was regularly service and maintained I good order. Care plans show that residents have access to a range of primary and secondary health care services including General Practitioners, dieticians, continence services, podiatrists, opticians and hospital services. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 17 Daily records demonstrate that the care is provided as specified within the care plans and continue to improve to include information about how residents are supported to exercise choice within their daily lives. There is evidence that residents or their representatives are now involved in the development and review of the individual plans of care and these are reviewed on a monthly basis or more frequently if required. People who use the service were able to confirm that they felt that they were well cared for and safe. Relatives commented ‘The staff inform me when mum has been seen by the doctor’. ‘The carers are wonderful. Also we get continuity, which is especially important when dementia is setting in. Mrs Arthur is often about keeping an eye on things’, ‘I find that all the staff very helpful and the owners do their best to make every one comfortable and see that their needs can be met’ ‘The Staff are always very caring’. Medication systems were reviewed and found to be in good order. Each resident has an individual Medication Administration Record, this includes a photograph for identification purposes, a medication profile and up to date administration record. Medication is supplied by a local high street chemist in boxed format and the service has robust stock control systems in place. Records showed that medication is administered as prescribed. In some cases residents are unable to take medicines in solid format, in these circumstances liquid medication is obtained when possible. In cases where this is not possible risk assessments are in place for the crushing of medication to be administered in food or drink. In these circumstances the consent from the resident or their representative is obtained. Where it is suspected that the individual is unable to provide the consent themselves the risk assessment needs to include evidence of formal assessment to demonstrate that the person involved does not have the mental capacity to provide consent. The management have agreed to ensure that this is included in the risk assessment. However consent is also obtained from the General Practitioner and pharmacist and this is documented. The medication profiles provide instruction to staff about how the medication is to be administered. The service has an appropriate storage for controlled drugs and the management of these is good, sufficient stocks were available for individuals and the appropriate records were maintained. Residents were seen to be well cared for and their appearance and presentation supported their diversity and dignity. Staff were noted to be mindful of the residents privacy, to relate well to residents and to have the time to spend talking to them. Discreet and sensitive assistance was provided The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 18 and the staff spoken to were knowledgeable about the needs of the individual residents. Individual plans of care contained information about the resident’s wishes regarding terminal care and death and in appropriate circumstances there was documentation relating to decisions not to actively resuscitate in the event of collapse based on current professional guidelines. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 19 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. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both managed well and provide daily variation and interest for people who use the service. EVIDENCE: Individual plans of care now contain more information about the preferences of people who use the service and these need to be further developed to identify residents preferences regarding preferred routines such as times of rising and retiring to bed, never the less individual preferences are known to staff and in some cases are displayed in the individuals rooms. Residents or their representatives are invited to supply the service with a life history in order that provides information about the pervious lifestyles of the individual in order that the service can support them to sustain their chosen way of life as much as possible. The life histories are maintained by the The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 20 occupational therapist who organises group and individual activities. An activities programme is displayed in the communal areas and people who use the service are free to opt in or out, as they prefer. There is also access to music, which is appropriate to the age and culture of the people who use the service and a visiting entertainer once a month, which is much enjoyed. There are also seasonal activities to celebrate festivals such as Christmas and Easter. Comments from relatives include – ‘There are always activities going on, I observe people going in and out of the home all the time. There is always music and TV. The nurses talk to the patients’ ‘Mum is not able to take part in activities now but the ladies still visit her in her room and show her family photographs and put music on for her’. ‘There are sometimes activities such as Christmas plays, music and other entertainment’ All of the existing residents are white European and of a Christian background the service supports people to access to appropriate religious denominations and Holy Communion is available every month. Staff explained how residents are supported to access the local community, through going on walks with residents to the local pub or park either on foot or in a wheel chair. There was also evidence that groups such as the salivation army visit to meet the residents’ play music and sing. Visiting times are flexible, visitors to the home were seen to be coming and going at various times of the day. Residents can receive their chosen visitors in the communal areas or in their private accommodation. Weekly menus are displayed in the communal areas and these show that residents have access to a varied and balanced diet, appropriate records of food taken are also maintained. Meals of adequate proportion and presentation are served throughout the day commencing with breakfast from 08.00hrs comprising toast, cereals, porridge or fruit. Lunch is served at approximately 12.00 hrs, and comprised a cooked main course with meat and vegetables and a desert. Teatime is served at approximately 16.00 hrs and comprised sandwiches or other savoury dish such as quiche. Supper is also provided at approximately 19:00hrs of sandwiches and or desert. Fluids are also regularly served throughout the day. The resident’s food preferences are well known to the staff and alternatives to the menu are provided including access to special diets and pureed food. One resident said ‘the food is lovely here’. A relative commented ‘Mother always eats everything offered, even though she is now on soft food she still enjoys it’ The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 21 Staff were observed to offer sensitive and discrete assistance to residents who required support to take meals and fluids. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 22 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. This judgement has been made using available evidence including a visit to this service. A comprehensive procedure for handling complaints and abuse is in place ensuring that residents are fully protected. EVIDENCE: The service has an appropriate complaints procedure, which is included in the Statement of Purpose; this is a document that is provided to residents and their representatives prior to admission. However the complaints procedure is not otherwise easily accessible in the home and the management have agreed to make sure that a copy is displayed in the main reception area. We have received no concerns, complaints or allegations about this service since the last inspection. The complaints file was reviewed and showed that the home have not received any complaints about the service either. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 23 There have been no safeguarding allegations about this service since the last inspection. However there have been three occasions involving minor incidents between individual residents. The management have sought guidance for the appropriate authorities and have obtained the associated documentation necessary to make a referral. Staff spoken to were clear about their responsibilities in the safeguarding of residents and had a good understanding of the actions necessary in the event of an abusive situation. People who use the service told us that they would feel able to speak to the Registered Manager if they were unhappy about anything; they also told us that they felt safe living at the Cottage Nursing Home. Other comments include ‘My mother has been at The Cottage for the last 6 years and I have always found the staff to be very helpful’ Mrs Arthur is often about keeping an eye on things’ ‘Mother has been at the Cottage for 10 years in that time I have had no cause to make a compliant’. Comments made by staff included Any concerns raised are investigated so that solutions can be found – concerns are discussed with the Registered Manager. ‘As a senior nurse I will intervene if anyone expresses concerns about the service if it is beyond me I pass it onto the manager’. Another member of staff told us that complaints were unusual and those that did come up usually related to a misplaced item of laundry and were soon resolved before escalating to a formal compliant. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 24 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. This judgement has been made using available evidence including a visit to this service. The standard of the environment is good and provides the people who use the service with a comfortable and safe place to live. EVIDENCE: The Cottage nursing home is a period building that has been extended to provide purpose built and spacious facilities over two floors. There are three spacious sitting rooms where people who use the service can move around and maintain their personal space. There is a passenger lift in the new part of the building and a stair lift in the older part of the building. There are appropriate aids and adaptations throughout the home to assist those with physical The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 25 disability and most of the building is accessible to wheelchair users by ramps, wide corridors and doorways. We looked at all of the rooms occupied by the residents selected for case tracking purposes. Most of the bedrooms are for single use however appropriate screening is provided to maintain privacy in double rooms. Many of the rooms have ensuite facilities, all have appropriate fittings such as call bells, light fittings, furnishings, privacy locks, lockable storage space, radiator guards and window restrictors. Residents are encouraged to personalise their bedrooms with small items of furniture, photographs and other personal items such a televisions. All areas of the home are tastefully decorated, well maintained and free from offensive odour. No hazards were identified, chemicals were stored appropriately, and there were adequate supplies of hot water and sound infection control procedures in place. The laundry equipment was seen to be in good working order, all areas of the home were appropriately heated, well ventilated and appropriately light. Staff confirmed that all equipment was in good working order and was appropriately maintained. There are two terraced areas that are safe and accessible to the residents in fine weather. One resident told us ‘ I like my room its lovely and cosy’. Other comments include‘I was attracted to the home for it’s clean and freshness, it always smells lovely’ Staff comments included ‘The home is always clean and fresh’ and ‘The home is always clean and tidy’. We make sure that the residents are comfortable, happy and well looked after. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 26 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service employs appropriate numbers of inducted and trained staff to ensure that the residents needs are appropriately met and that they are in safe hands at all times. EVIDENCE: The service has a duty rota, which shows that there is always a registered nurse on duty. Registered Nurses have either a General Nursing qualification or a Mental Health Nursing qualification. Staffing levels are calculated according to the needs of the individual residents; during the daytime shifts there are two registered nurses on duty and seven care staff on duty. During the nighttime shifts there is one registered nurse and four carers. Additional care staff cover the lunchtime service to assist with feeding. In addition to the nursing and care staff the service employs reception staff, domestic and catering staff, one maintenance staff member who is on call during non-working hours. The service also employs and full time occupational therapist and deputy to manage resident’s activities and entertainment. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 27 The service now employs three male nursing / care staff this means that residents can have personal care provided by a person of the same gender. The management are mindful of the need to reflect the culture of staff group with the culture and ethnicity of the residents group. Staff who are employed whose first language is not English are supported to attend Spoken English classes. Some of the comments received from relatives’ suggest that there are occasions when there are staff shortages. However staffing levels appear to be good and this is supported by comments made by staff ‘ I think that there are enough staff on duty to meet the needs of the residents, additional staff come on at 11 am to help with supporting people to take their lunch ‘. ‘An occupational therapist comes in on week days to initiate activities and stimulation’. ‘There are always enough staff on duty especially at meal times when we have extra help’. We have handovers at shift changes and have staff meetings’. A selection of staff files were reviewed and these were found to be in good order and to demonstrate robust recruitment procedures. Following a requirement made at the last inspections files showed that the appropriate clearances and two appropriate references are obtained before staff are able to commence working in the home. All other documentation was in good order. Staff spoken to during the inspection confirmed that they had undergone appropriate recruitment procedures. One comment included. ‘I have given 2 references and waited for my Criminal Records Bureau Clearances before starting in my job’ New staff undertake a comprehensive induction programme which involves getting to know the residents and their needs, shadowing a senior member of staff and familiarising themselves with the policies, procedures and working practices used at the Cottage. Staff spoken to during the inspection were able to confirm that they had been provided with appropriate information and training during their induction programme. One comment included ‘Induction coverered Health and Safety, Fire Safety, Care and Confidentiality’. The management are proactive in the development of staff and encourage care staff to obtain National Vocational Qualification in Care level 2 and 4. Registered nurses are encouraged to obtain management qualifications. Staff also have access to a programme of training in mandatory subjects and subjects specific to the needs of the individual residents. A selection of staff files were viewed and these showed that staff have had recent training in Mental capacity Act 2005, Basic Food Hygiene, Deprivation of Liberty The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 28 Standards, Movement and Handling, First Aid, Safeguarding Adults, management of pressure and record keeping skills. One staff member commented ‘I have had training in Fire Safety, Health and Safety, Hoist Training, Basic Food Hygiene, communication skills and risk and risk assessment. Recent training includes Mental Capacity Act 2005, Catheter Care, First Aid, Basic Food Hygiene, Parkinson’s disease, Dementia Care, Communication skills and National Vocational Qualification in Care level 2 &3. Another commented ‘Training is always available to help me with my work. I also attend English classes, which helps me to communicate better with the service users and relatives. People who use the service told us that the staff were nice to them and that they were responsive to their needs. On resident commented that the ‘nurses were lovely’ and that they had time to talk to them and to help them. Other comments include – ‘The Staff are always very caring’. ‘The staff do very well, sometimes under difficult circumstances’. The staff act on what I say, ‘they arranged for mothers hair to be cut and it was done by the next time I visited, they call me day or night if needed’. ‘I visit at any time of day or night and there is always a member of staff at hand’ ‘I undertake training and am aware of all the policies and procedures. We have had training in the Safeguarding Adults and material regarding the Mental Capacity Act 2005’. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 29 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The leadership and management style of the home ensures that resident’s health safety and welfare are promoted and protected. EVIDENCE: The Registered Manager is a well-qualified and experienced nurse having over 20 years of experience in care. Her qualifications include Registered General Nurse, Registered Mental Health Nurse; she holds the Community Psychiatric Nursing Certificate and has the National Vocational Qualification level 4 in Management. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 30 The service sent us their Annual Quality Assurance Assessment, which provided us with all the information that we had requested. Following the previous inspection a total of six requirements were made all of these have since been met demonstrating that the providers work with us to achieve better outcomes for the people who use the service. Both providers work full time in the home and the Registered Manager has a high profile, people who use the service knew her well and were confident in approaching her. The management have a quality assurance system in place, there is a suggestion box in the main entrance and a sample of surveys are issued each month to residents or their representatives. These are collated and used to inform service development. A sample of responses was reviewed and these were all favourable. In addition the management carry out regular audits of systems such as accident records, care plans, staff files and medication systems. Residents are supported to manage their finances, the service holds small amount of money for them to access, this is stored securely and appropriate records and checks are conducted. Appropriate arrangements are in place for residents who are unable to manage their own finances and do not have access to family members. Discussion with staff and management show that there are clear lines of accountability in the home, this has been recently formalised by the introduction of a system for staff supervision, both management and staff have found this to be a highly useful system of support and monitoring performance. Staff records were available to show how this is being done and the frequencies involved. The management are currently in the process of setting up a named nurse and key worker system. The management ensure that notifications about incidents that affect the well being of residents are sent to us. One example was an outbreak of diarrhoea and vomiting in six residents, this was reported to the Environmental Health Offices whose investigations concluded that the outbreak was viral in origin probably transmitted via a visitor to the home. No hazards were identified during this inspection; staff have access to appropriate training e.g. Induction, Health and safety, Basic Food Hygiene, Fire Safety, Movement and Handling, First Aid, Infection Control Safeguarding Adults and risk assessment. Fire records were reviewed and seen to be in good order with regular checks being conducted on equipment necessary for the prevention and emergency fire fighting. Staff spoken to had a good understanding of their roles in the event of fire and evacuation procedures. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 31 Some of the comments that we received about the management of this service include ‘The owners do their best to make every one comfortable and see that their needs can be met’ ‘Mrs Arthur will be available to talk with’. ‘The manager calls me for supervision every 2 months and talks to staff at any time there needs to be discussion’. ‘The managers are always on shift and supervise every six to eight weeks which makes the work more interesting and relaxing’. ‘We have scheduled relatives support meetings’. ‘The management are always on site and give the staff support. I also receive supervision every 2 months.’ ‘We have conversations with relatives and handovers’. ‘The Cottage is very caring and put the people who use the service first at all times’. ‘I have been happy working here for a long time’. The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 32 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 3 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 3 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 3 X 3 The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 33 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 The Cottage Nursing Home DS0000012649.V374519.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 DS0000012649.V374519.R01.S.doc Version 5.2 Page 35 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!