Care Home: The Cottage Residential Home

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What the care home does well The home is in a quiet and peaceful wooded setting. A visitor commented that a reason for choosing the homewas that it had a good reputation in the village area. People are cared for in a clean and comfortable environment and the home is decorated to a good standard. All people spoken with made positive comments about the care they received; one said it would never be home but it was the next best thing and another said that she enjoyed sitting on the decking area at the rear of the building in sunny weather. The staff group is well trained and knowledgeable about the people living at the home and how they prefer to be cared for. The manager and senior staff work well as a team and there is a very stable staff group, enabling good knowledge of the needs of people. People are encouraged to make choices about their daily lifestyles and individual likes and dislikes are catered for. What has improved since the last inspection? Additional information and signage has been displayed around the building to help service users with dementia around the home. Positive changes hae been made in order to move away from task based care and towards inclusive personalised care. There have been reductions in the medication administered to combat anxiety/restlessness and an approach to support from person centred care is now priority. The service has become a member of the National Association for Providers of Activities (NAPA) for Older People. An Activities Co-ordinator has been employed and has introduced new ideas and encouraged residents to participate more. Environmental improvements have included refurbishment of the main dining area with new tables and chairs, carpet and curtains, redecoration of many of the bedrooms and replacement of many carpets and curtains throughout the home. Some of the lounge chairs have also been replaced. Two bathrooms one on the upper floor and one on the ground floor has been completely refurbished. Training has been increased to include other aspects of care and the percentage of staff trained to NVQ 2 & 3 exceeds the standard requirements. What the care home could do better: Several doors throughout the building were scuffed and the pieces of carpet protecting them from wheelchair marks were missing or damaged. Key inspection report Care homes for older people Name: Address: The Cottage Residential Home Nocton Hall Nocton Lincs LN4 2BA     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: Julie Western     Date: 2 3 0 7 2 0 0 9 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 23 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 23 Information about the care home Name of care home: Address: The Cottage Residential Home Nocton Hall Nocton Lincs LN4 2BA 01526320887 01526323055 info@thecottagenocton.co.uk www.thecottagenocton.co.uk BSB Care Limited care home 34 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: BSB Care Limited is registered to provide personal care for service users of both sexes at The Cottage Residential Home whose primary needs fall into the following categories:- Old age, not falling within any other category (OP) Dementia, over the age of 65 years DE(E) The maximum number of service users to be accommodated at The Cottage Residential Home is 34. Date of last inspection Brief description of the care home The Cottage Residential Home is a period converted two storey building situated seven miles from the south of the city of Lincoln in the grounds of Nocton Hall. The home provides personal care for up to 34 residents over the age of 65 years of age. The home is approached by a long tree lined driveway and is on the edge of the village Care Homes for Older People Page 4 of 23 Over 65 34 34 0 0 Brief description of the care home of Nocton. At the bottom of the driveway a bus route runs to Lincoln. Car parking is available to the front of the home. There are gardens surrounding the property, which are on one level and easily accessible for pedestrians and wheelchair users. There are also garden chairs and tables at the front of the home and a recently built large decking area towards the back of the home provide additional garden seating. Accommodation is provided on both ground and first floors. The first floor is served by a shaft lift. The care fees range from £390 to £470 per week. Care Homes for Older People Page 5 of 23 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 was an unannounced visit and it formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to The Care Quality Commission (CQC). The visit lasted approximately three hours and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Before we made our visit the provider had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. We sent out surveys to people before we visited the service. The main method used to carry out the inspection is called case tracking, which includes following the care of a sample of four people through their records and Care Homes for Older People Page 6 of 23 assessing their care. We spoke with six people who use the service and saw rooms of those people who said we could. We spoke with two visitors and three staff members. The manager was present throughout the visit and the general outcomes of the visit were discussed with her. Care Homes for Older People Page 7 of 23 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 23 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 23 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. People who use this service have good information about the home in order to make an informed decision about whether the service is right for them. The home does not provide intermediate care. Evidence: The manager said that she or a senior member of staff always visited prospective residents at home or in a care setting such as a hospital to undertake a thorough assessment of all their care needs. Records we saw confirmed this. We saw written admission records that were clear and gave staff all the information they needed to meet the needs of people. The statement of purpose we saw contained all the infomation needed including the facilities of the home, conditions and contracts. The service user guide we saw was comprehensive and contained useful information for the service user. Some of it was not in language easy for people to understand. A resident we spoke with described how she had visited for the day before she was sure Care Homes for Older People Page 10 of 23 Evidence: she wanted to move in permanently. A relative told us that this home had been chosen because it was the best of the ones they saw. A staff member described the admission process and the importance of making new residents and their families welcomed. Care Homes for Older People Page 11 of 23 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. Care plans are in enough detail to ensure that the health care needs of people can be met. Evidence: Care plans we saw contained information about the health and personal care needs of poeple. They included risk assessments, a Mental Capacity Act assessment and a life profile. They were reviewed regularly and signed where possible by people or their relatives or advocates. We saw a medication policy that was clear and comprehensive. The pharmacist visited regularly, the last visit being on 28/04/2009 and no issues were identified. People received regular visits from district nurses and other agencies involved with their care. A visiting nurse said that the care standard at this home was good and the staff members were friendly, reasonably knowledgeable and communication was good. We saw staff carrying out their duties with kindness and sensitivity towards people, especially when attending to their personal needs. Care Homes for Older People Page 12 of 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities are regular and are tailored to suit the individual needs of residents. People have a choice of meals from a balanced and varied menu. Evidence: We found that the home has an activities coordinator from Monday to Friday, who provides a variety of activities for residents including entertainers, indoor games such as board and card games and trips to local pubs and shops. On the day of the inspection two people had hand care and massage and four went for a walk accompanied by carers. Another went out for a meal with a friend. People we spoke with all said they had a choice of whether or not to take part. Some told us they preferred to sit in a quiet lounge instead and one said she went on regular outings in the minibus. Clergy visit the home and offer services to those who wish to attend. The activities programme is displayed on a notice board in the entrance area, to ensure that all residents are kept informed. People we spoke with all said they enjoyed the meals served; one said the mid-day meal was very good and another that you could have one of two meals each day. The menu for the week was displayed in the dining room and offered alternative choices of meals. The cook has the National Vocational Qualification in nutrition and food hygiene at Level 2. She was knowledgeable about the nutritional needs of service users and Care Homes for Older People Page 13 of 23 Evidence: described cooking for people on various diets and pureeing food for those who could not eat solids Care Homes for Older People Page 14 of 23 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 procedures for addressing complaints and for protection from abuse are clear. People and their families are confident that their comments and concerns will be listened to. Evidence: We saw a complaints procedure that was clear and east to understand. The complaints pre-inspection questionnaire recorded that that one complaint had been made since the last inspection. This was regarding communication with an outside agency and was partly substantiated. People spoken with were aware of how to make a complaint and knew who to speak to if they were unhappy. Three people we spoke with said they had no complaints at all. People commented that they felt safe and that there was always somebody there to talk to about anything. Staff members we spoke with had all received training in safeguarding and knew the correct procedures to take in the event of abuse happening in the home. Recorsd we saw confirmed that training had taken place. Care Homes for Older People Page 15 of 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and pleasant environment with both private and communal space that is generally suitable for their needs. Evidence: We looked at the building and found that overall, the standard of decoration internal was good and gave people a comfortable and clean place to live. Several doors had chipped paint and pieces of carpet put on the bottoms of the doors had come unstuck or were worn. The manager said there were plans to replace these and repaint the doors. The grounds were wooded and overlooked by the ruins of Nocton Hall, which was fenced off and had barbed wire in places, detracting from the general views. However, the owners had made a sheletered decking area to the rear of the property, offering a comfortable place for people to sit out in good weather. Several people sitting there spoke with us and said how much they liked being outside resting and chatting. Staff told us how any maintenance issues were addressed quickly by the maintenance personnel. Recent improvements included refurbishment of the main dining area with new tables and chairs, carpet and curtains and redecorated, redecoration of many of the bedrooms and replacement of many carpets, curtains and lounge chairs throughout the home. Two bathrooms one on the upper floor and one on the ground floor have also been completely refurbished. Care Homes for Older People Page 16 of 23 Evidence: There were safety notices around the building to prevent the spread of infection and COSHH regulations were observed throughout. The most recent visit from the Environmental Health Officer found no issues of concern and the service had been awarded a good standard with four stars in their award scheme.. The building smelled clean and fresh throughout. Care Homes for Older People Page 17 of 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers are in sufficient quantity for them to be able to care for people. Staff members are suitably trained, qualified and competent. Evidence: The daily staff rota showed that there was a senior carer, a lead carer and six staff members for 34 people. In addition the manager worked from Monday to Friday. The home also employed a cook and kitchen assistant, three domestic staff and a gardener/handyman. We spoke with people and staff, who all said there were enough staff to complete their tasks in good time. We saw records showing that 13 staff members had NVQ [a nationally recognised qualification] at level 2 and 9 had level 3. The manager said that all staff members were contracted to take NQV at level 2. A staff member recently employed described how she had an interview, gave three references and underwent CRB/POVA checks. She took an induction course which she said was very helpful. We saw staff training records showing that statutory training has been undertaken and that there had been training courses on specialist issues such as dementia. Staff received regular supervision and we saw minutes of this and regular staff meetings. We saw records that showed very little staff turnover and staff spoken with confirmed this. Care Homes for Older People Page 18 of 23 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. The home is well managed and the health, safety and welfare of people are promoted. The views of people are listened to and they are involved in decisions affecting them. Evidence: The manager has been in the caring profession for 19 years and had been in post for 5 years. She has the Registered Managers Award. She is supported by two deputy managers and senior care staff. People we spoke with all made positive comments about the way the manager ran the home, finding her approachable and supportive. Staff members praised her management style and said that there was a strong sense of team spirit. There is a sound quality assurance procedure, with separate questionnaires for people, their relatives/visitors and staff. The findings are recorded on a chart and acted upon. Health and safety policies were well documented and showed a clear commitment to ensuring the safety and wellbeing of people. Records were well maintained. We saw minutes of the last residents meeting and this showed that residents have a voice and feel free to express opinions. There are a range of policies and procedures Care Homes for Older People Page 19 of 23 Evidence: available in the home relating to fire safety and fire risk assessments. Care Homes for Older People Page 20 of 23 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 21 of 23 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 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 1 1 The service user guide should be written in plain English and should be easy for people and their families and advocates to read and understand. Doors around the home should be in good decorative order, including the strips at the bottom to prevent marks and scratches from wheelchairs. 2 19 Care Homes for Older People Page 22 of 23 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. 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