Inspection on 20/05/09 for Isle Court Nursing Home

This is the latest available inspection report for this service, carried out on 20th May 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Isle Court Nursing Home Isle Lane Bicton Shrewsbury Shropshire SY4 8DY Lead Inspector Pat Scott Unannounced Inspection 20th May 2009 10:20 DS0000073169.V375486.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. DS0000073169.V375486.R01.S.doc Version 5.2 Page 2 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 DS0000073169.V375486.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Isle Court Nursing Home Address Isle Lane Bicton Shrewsbury Shropshire SY4 8DY 01743 232005 01743 247779 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) www.morriscare.co.uk Morris & Co Limited Mrs Elizabeth Florence Hallen Care Home 53 Category(ies) of Dementia (53), Old age, not falling within any registration, with number other category (53), Physical disability (7) of places DS0000073169.V375486.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 53 Dementia (DE) 53 Physical Disability (PD) 7 The maximum number of service users to be accommodated is 53. 2. Date of last inspection 09/03/09 Random Unannounced inspection. Brief Description of the Service: Morris Care is a division of Morris and Co Ltd, a long established family firm based in Shrewsbury, Shropshire. Morris Care commenced in 1987 providing services to the community in care homes and domiciliary care within Shropshire and Cheshire. Isle Court is a brand new service situation along a quiet lane in Bicton, off the main Shrewsbury to Montford Bridge road. The home is set in beautiful, landscaped gardens surrounded by countryside. There are ample car parking facilities. Morris Care makes its services provided by Isle Court known to people in the ‘Guide to Isle Court’, which is available in the foyer and bedrooms. Current fees range from £695 to £895 depending on assessment of need. DS0000073169.V375486.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is * Two star good service. Isle Court is a new service registered 22/12/09. We, the commission, looked at all the information that we have received, or asked for, since the service was registered. This included: • Information we have about how the service has managed any complaints. • What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. • The registration report and the results of any other visits that we have made to the service since registration. • Relevant information from other organisations. • What other people have told us about the service. • Some people who use this service have a form of dementia. Many are unable to make comment and so we looked at how the service seeks their views and opinions about their care. What the service does well: The provider has many years experience of providing care within the care home sector. The provider has appointed a manager who is qualified, competent and experienced to deliver the quality of care that Morris Care expects of itself. This is achieved by listening to people about what they want and how they want it to be done. The service is resident-led and has exceeded most of the outcome areas set out in the national minimum standards. Privacy is provided within the home’s environment and in the staffs’ approach to care. Care plans viewed, address each person’s needs in a way that promotes dignity and enables independence and choice. People clearly contribute to these plans and so have a programme of care tailored to their individual preferences. The staff are cheerful, friendly and helpful and encourage people to enjoy themselves but also try to make sure that they are safe and well looked after. The service provides a supportive environment for the care staff and each has individual training plans that allow them to develop their potential as well as meet mandatory regulations. The service offers an excellent range of activities so that people can pursue hobbies and interests. DS0000073169.V375486.R01.S.doc Version 5.2 Page 6 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. DS0000073169.V375486.R01.S.doc Version 5.2 Page 7 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 DS0000073169.V375486.R01.S.doc Version 5.2 Page 8 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3. 6 is not applicable. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provider understands the importance of having information about their service so that people can choose a home that will meet their needs and preferences. The assessment process is thorough so that all people are given consideration to their individual needs, concerns and anxieties before moving into care. EVIDENCE: In its statement of purpose, the provider acknowledges that people should have the opportunity to choose a home which will suit their needs and abilities. To facilitate choice the provider clearly tells people in its information what services they can and cannot offer. It tells people that every person will have their needs assessed before a decision on admission is taken, so that people are reassured that any anxieties will be listened to. We looked at four care plans of people who had recently been admitted to the home. The manager had obtained a summary of the assessment undertaken through care DS0000073169.V375486.R01.S.doc Version 5.2 Page 9 management arrangements, where appropriate. Privately funded people have a complete pre-admission assessment taking into account wishes and preferences about their care. Information is gathered from a range of sources including that from other health professionals such as GPs, community psychiatric nurse, hospital staff and district nurses. DS0000073169.V375486.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care needs and risk assessments are set out in their individual plans of care which ensures that all care needs have been addressed and will be fully and safely met. The manager understands the need to comply with safe medication systems and staff training ensures that the homes procedures are complied with and that residents health matters are safely addressed. The actions of staff and their approach to care ensures that people are treated with respect and their right to privacy is upheld. EVIDENCE: The statement of purpose gives an outline for people of what they can expect in terms of health and personal care provision, based on the individual’s rights of dignity, equality and respect. DS0000073169.V375486.R01.S.doc Version 5.2 Page 11 We looked at four care plans in detail. Preferences relating to personal support needs are stated in the plans and the daily records show that these are adhered to. Records also show that health appointments are maintained. Care plans are regularly reviewed with input from the person and their family or representative. One comment seen read:’we are impressed with Mother’s care-we feel at complete ease that she is cared for well’. Assessments for potential problems such as pressure area fragility, promotion of continence, dietary requirements and moving and handling are carried out and recorded well. People have a named nurse and keyworker allocated to them. There is a card in each room with these details written on it so that people are reminded whom their main carer is. The manager intends to include a photograph of the staff member on this card. One person spoken with knew who her allocated carer is and commented that she has been helped to ‘get back on her feet by kind helpful staff’ after a period of convalescence. Staff spoken with know about the people they care for. They demonstrate an understanding of how a condition, such as dementia, can affect a person and are alert to changes in mood, behaviour and general well being and take necessary action. Staff were seen to provide support to enable people to do things in their own time. Full assessments of the types of restrictive practice the home operates are in progress. The service has not, so far, needed to apply for a deprivation of liberty authorisation to make sure that person is safe in their treatment and care. On 9/3/09 we conducted a random unannounced inspection to this service to review compliance with The Care Homes Regulations regarding provision made for the health and welfare of residents at the home. It was considered that the assessment process and care planning was of good quality. General information about the person including a past medical history is obtained on initial enquiry, with a more in-depth assessment undertaken after admission. However, there was a mistake when an error of administration of medication occurred through lack of attention to procedures and poor communication both within the home and from the transferring hospital. The service took steps to put this right and as a result have made changes to ensure that the policies and procedures of the service will be adhered to in future. At this inspection, medication record charts show that receipt, administration and disposal of medicines are properly accounted for. Risk assessments are in place for those people wishing to self-administer any medication. Specific, named staff are responsible for managing medicines on set units in the home. People who leave the home after a period of respite care complete questionnaires. A sample seen scored excellent outcomes in all areas of service delivery. DS0000073169.V375486.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with social activity and can keep in contact with family and friends. Social, cultural and recreational activities meet peoples expectations through assessment, consultation and choice. People receive a healthy diet according to their assessed requirement and preference. EVIDENCE: Care files seen show that individual assessments are carried out regarding preferred activities for each person taking into account, interests, capacity and diversity. Emphasis is placed on considering a person as an individual rather than a collection of symptoms, and discovering ways to work with, and alongside, the person to enhance their social quality of life. The service has a social life co-ordinator who organises the regular programme of events, individual and group actvities. A varied programme of activities is provided by the home for people to enjoy with something happening most days. A very informative monthly newsletter is produced and delivered to each bedroom. There are regular resident meetings to discuss policy issues and other matters of interest. Dates for resident/next of kin meetings are included in this DS0000073169.V375486.R01.S.doc Version 5.2 Page 13 letter. People recently enjoyed a coffee morning, flower arranging, ‘extend’ exercise class and a film night. An in-house christian service is held once a month. Details of other local church services and contacts for ministers of other denominations are available. A variety of games and puzzles are available in the sitting roms. A library trolley provides a varied choice of books to read. There are facilities for playing compact disks in the sitting rooms and watching big screen films in the cinema lounge. One person was seen enjoying one of his films in here. Residents were seen to enjoy a social chat in the hairdressing room and looked at ease in their surroundings. Another spoke of the bird watching she did in the past and now enjoys the same at Isle Court. The menu is displayed in the entrance to the home. This is changed regularly and is also on view on each floor of the home. A member of staff was seen to ask people their preference of meal for the day. Special diets are catered for by an experienced head cook. This months newsletter contained an article about the head cook so people in the home can know who cooks their meals. There is flexibility in eating times for people with dementia so that they can make the most of the times that they want to eat food. Following the manager’s research into dementia care, the service has changed its water glasses to inlcude coloured ones. These are are more visible to people with particular sight problems and therefore they drink well and improve their hydration. DS0000073169.V375486.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18 People using the 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 service has a complaint procedure which is accessible so that people who use the service have information of how to make complaints about the home. Training is provided so that people are protected from abuse and have their legal rights protected. EVIDENCE: The home has a complaints policy and procedure. People and their families are given information in the service user guide. A record of all complaints and action taken is held with the senior management board reviewing each concern and responding accordingly within their timescales. A random inspection took place on 9/3/09 to review compliance with The Care Homes Regulations regarding complaints following a concern sent to the commission. It was considered that the service had taken the concern seriously, investigated it fully and taken steps to resolve the issue with a full explanation and response given to the complainant. People are registered on the electoral roll and are given verbal and written correspondence relating to elections, with advocacy arrangements being made if required. All staff working at Isle Court have the relevant criminal record bureau (CRB) and protection of vulnerable adults (POVA) checks including references. Staff confirmed they are provided with training on abuse. Referrals and procedures are followed from the Multi-agency protection procedures issued by Shropshire Council. There have not been any referrals made through these procedures since the home opened. DS0000073169.V375486.R01.S.doc Version 5.2 Page 15 Care plans seen provide clear instructions for staff to manage verbal and physical aggression by the person in their care. DS0000073169.V375486.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home has been carefully developed so that people live in a safe, well maintained and comfortable environment. EVIDENCE: A tour of the home showed that it is a safe, comfortable, immaculately presented place to live. There are large comfortable sitting and dining rooms on all floors. The main garden is landscaped and accessible to all with garden seating. People with dementia have a sensory courtyard garden adjacent to the unit. The buildings and grounds are in excellent condition. Appropriate washing and bathing facilities are provided to ensure accessibility to all residents. Each bedroom is provided with an electric bed to allow people, who are able, to adjust their position themselves. A nurse call system is provided and was responded to promptly. There are no odours and systems are in place to prevent the spread of infection. DS0000073169.V375486.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff care roles and responsibilities are well defined so that they provide personalised care with good communication. Staff get access to training, supervision and support they need from the manager so that people receive planned care. Staff in the home are trained and recognise the importance of care planning so that peoples changing needs are identified and acted upon EVIDENCE: The statement of purpose states that the service provides staff with a range of training including induction to the home and philosophy of care. Since registration the service has gradually increased its numbers of permanent staff to meet the increasing number of admissions. Staff confirm that numbers are maintained at an appropriate level to the assessed needs of the people who live in the home and to the upkeep of the home and its facilities. Staff files seen show that staff have POVA and CRB checks before being confirmed in employment at the end of the probationary period. Inductions are provided within recommended time frames and supported by a mentor and external courses. All staff receive regular training as identified in their individual training plan. The service continues to invest considerably in training, encouraging staff with NVQ and distance learning courses. DS0000073169.V375486.R01.S.doc Version 5.2 Page 18 Staff seen on the units were observed to be approachable, accessible and good listeners and communicators. Staff spoke of their skills and experience to effectively support the needs of people with dementia. Staff have received a basic training on deprivation of liberty. Staff communicate face to face at handover, within a communications diary (daily and weekly) and staff meetings. Staff report that teamwork is good and residents are cared for well. People spoken with said that staff looked after them with kindness and respected their wishes at all times. DS0000073169.V375486.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,32,33,35,38 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is based on openness and respect. The service has quality assurance systems in place so that people are assured that the overall conduct of the home is taking into account their views. Peoples’ opinions are central to how the home develops and reviews its practice, and the service is developing appropriate ways of making sure they get things right. So, people have confidence in the care home because it is run and managed well. EVIDENCE: DS0000073169.V375486.R01.S.doc Version 5.2 Page 20 The manager, Mrs Hallen, is a level 1 registered nurse. She is able to demonstrate a very good theoretical knowledge and understanding of managing a care home providing nursing care for the categories of people that the home is registered for. She is clear about the service’s statement of purpose and what her role and responsibilities as a registered manager are. The manager understands the importance of quality assurance and confirmed that there is a quality assurance system that is used by the providers, Morris Care, and this will be used at Isle Court also, to gather information for analysis to ensure that the service continues to improve. Mrs Hallen has undertaken a range of statutory training since being in post. She has also undertaken training in appraisal skills and safeguarding of adults and is currently doing a 12 week dementia course, as are other staff. She stated that she has very good support from the providers, Morris & Company Limited, who have continued to maintain stability and consistency in its management structure for many years. The management finds out what people like by talking to them, involving them in their care and holding resident and relative meetings so that any issues can be discussed. The manager is aware of the importance of making people safe and without unnecessarily restricting their freedom and is introducing the required assessments in order to do this. The manager uses the concept of person centred thinking and including residents to shape the delivery of the service. This is seen in the way care plans are written, the involvement of staff in recording care delivery, surveys and staff supervision. There is regular training on all aspects of health and safety. Risk assessments are carried out both for individuals and for the environment. All equipment and systems are serviced and inspected as per legal requirements. The service employs a maintenance team to ensure that any hazards that arise can be rectified quickly. DS0000073169.V375486.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 X X 4 DS0000073169.V375486.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000073169.V375486.R01.S.doc Version 5.2 Page 23 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: 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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