CARE HOMES FOR OLDER PEOPLE
Admiral Court Nursing Home Cleveland Road Hartlepool TS24 0SY Lead Inspector
John Trainor Unannounced Inspection 1:00 10th July 2007 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 Admiral Court Nursing Home DS0000000138.V339930.R02.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. Admiral Court Nursing Home DS0000000138.V339930.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Admiral Court Nursing Home Address Cleveland Road Hartlepool TS24 0SY 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) 01429 866893 01429 267776 admiral.court@fshc.co.uk Alliance Care (Woodside) Ltd (wholly owned subsidiary of Four Seasons Health Care Limited) Tracey Daley Care Home 50 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number disorder, excluding learning disability or of places dementia (30) Admiral Court Nursing Home DS0000000138.V339930.R02.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: Dementia - Code DE, maximum number of places: 20 Mental Disorder, excluding learning disability or dementia - Code MD, maximum number of places: 30 The maximum number of service users who can be accommodated is: 50 7th June 2006 2. Date of last inspection Brief Description of the Service: Admiral Court is a purpose built home, which was built in 1991. The first floor provides nursing and personal care to service users with a mental illness. The ground floor provides nursing care for service users with dementia. The home is situated close to Hartlepool and the Historic Quay. It is easily accessible by car and is on major bus routes. The home provides a number of lounges and dining areas for service users. There is a small kitchen on the first floor for service users and/or their relatives to make drinks and snacks. There is lift and stair access to both floors and a small patio area to the rear of the property. Toilet and bathing facilities are provided throughout the home with some assisted aids to support those service users who are less mobile. Fees at the time of inspection ranged from £358.00 t0 £475.00 and there were extra charges for hairdressing, chiropody, newspapers and toiletries and personal effects. Admiral Court Nursing Home DS0000000138.V339930.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. On 22nd March 2007 the Commission for Social Care Inspection completed a random inspection at the home to look at the specific issue of requirements made at the previous inspection. All of these requirements had been met. The report of that inspection can be made available upon request and the outcomes have served to help form opinion on this key inspection. One requirement was made as a result of the random inspection and this has been reviewed at this key inspection. For this key inspection the home provided information to the Commission for Social Care Inspection before an unannounced site visit, lasting 9 hours. We used this information to give a guide as to what care would be like in the home and tell us what areas we needed to look at to get further evidence. During the site visit we inspected records including health and safety records, care plans and recording. We watched how people were looked after to see what life was like for them and spoke to staff, management and people living in the home. What the service does well: What has improved since the last inspection?
The home had replaced the windows in the home following requirement by the Commission to do so. People had been issued with contracts and assessments and care plans were in place. The company was introducing a new care planning and recording system. New furniture had been purchased for many of the rooms as well as the lounge. There had been some new carpets and some areas had been redecorated. Staffing had been increased. The manager had applied and had been registered with the Commission for Social Care Inspection. All rooms had nurse pull cords available for people.
Admiral Court Nursing Home DS0000000138.V339930.R02.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Admiral Court Nursing Home DS0000000138.V339930.R02.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 Admiral Court Nursing Home DS0000000138.V339930.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People had enough information to make a choice to move into the home and the home had enough information to let them decide they could meet people’s needs. EVIDENCE: All files inspected showed evidence of pre admission assessment. The home did not confirm in writing it could meet people’s needs after completing the preadmission assessment. The home does not provide intermediate care. Admiral Court Nursing Home DS0000000138.V339930.R02.S.doc Version 5.2 Page 9 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were treated with dignity and respect and had their health and personal care needs met in a well planned way. EVIDENCE: All files inspected had a care plan. Medication was stored, administered and recorded safely. The district nurse was in visiting during the site visit. Records showed involvement of other professionals including doctor and specialist nurses for tissue viability and continence advice. Staff were seen interacting with people politely and assisting them kindly. People said the staff were good. One person said, “I’d give them a good reference.” Another said, “Aye it’s a good place, they’ve got all the facilities haven’t they.” Admiral Court Nursing Home DS0000000138.V339930.R02.S.doc Version 5.2 Page 10 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People had social stimulation and activities and a varied and wholesome diet of good quality. EVIDENCE: Activities were taking place in the home and there was a full time activities coordinator, with plans to employ a second. Activities were planned based on what people said they wanted. There were events and entertainers. A physiotherapist attended the home to facilitate gentle exercise. One person who lived in the home said there was, “nice entertainment, music. They come in to see us. A man did line dancing dressed as a cowboy and sang country and western. We had one last week it was very enjoyable.” Another said, “We are taken out now and again. I had a diet coke.” A third said, “I go to the day centre once a week. I enjoy that.” Visitors could come when they wished Admiral Court Nursing Home DS0000000138.V339930.R02.S.doc Version 5.2 Page 11 People said the food was good and that they had a choice of menu and could have a cooked breakfast if they wanted it. “There’s porridge and cereal and if you want a fried breakfast you get it. We are very pleased with it.” Admiral Court Nursing Home DS0000000138.V339930.R02.S.doc Version 5.2 Page 12 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People could be assured their concerns were taken seriously and acted upon and that measures were in place to protect them from abuse. EVIDENCE: The home had a complaints policy and procedure and maintained records of any complaints received. There was a policy and procedure for handling any adult protection issues. Staff were familiar with the procedure to be followed and could demonstrate how they should act when interviewed during inspection. Admiral Court Nursing Home DS0000000138.V339930.R02.S.doc Version 5.2 Page 13 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 and 26. Quality in this outcome area poor. This judgement has been made using available evidence including a visit to this service. People did not live in a safe clean and comfortable environment and improvement was needed. EVIDENCE: Health and safety checks were taking place. The electrical hard wiring certificate was current and valid. The home had a good quality audit system. Environmental health and fire officer had been into the home and the home had responded to things they had been asked to do. Efforts had been made to improve the home. Windows had been replaced as had been required by the Commission. People spoken to said they were happy with their rooms.
Admiral Court Nursing Home DS0000000138.V339930.R02.S.doc Version 5.2 Page 14 Some decorating had been done and some of it was to an acceptable standard. In communal areas decorating was better. In individual rooms new decorating was poor and substandard. Holes had been poorly filled and then just painted over. The dining room had ingrained dirt around the floor edges and there was an underlying odour in the lounge area outside the dining room. Toilets were filthy and ingrained with scale and dirt. One toilet upstairs had the boarding underneath the sink coming away and the floor needed repair. Cistern tops in several toilet areas did not fit correctly. The upstairs kitchen was dirty. Cupboards needed to be cleaned and cups had ingrained dirt marks in them. The fire escape at the end of the building was bare in terms of flooring on the stairs and poorly decorated. Upstairs one end of the corridor had a severe unpleasant odour. One smoking room was poorly decorated and did not have a fan though there were plans to fit one. Some grab rails in corridors were loose and moved from the wall when touched. Admiral Court Nursing Home DS0000000138.V339930.R02.S.doc Version 5.2 Page 15 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People had their needs met by staff deployed in sufficient number and with sufficient skill to do the job. EVIDENCE: Staff were recruited safely with all relevant checks in place as required by regulation. Staff got regular training to enable them to do their jobs. Staff got regular supervision and were deployed in sufficient number to meet the needs of the people in the home. When interviewed, staff were knowledgeable about their clients and about the care people needed. They were open and honest about shortfalls in the home and demonstrated good values. Staff were seen to treat people politely with respect for their personal dignity. Admiral Court Nursing Home DS0000000138.V339930.R02.S.doc Version 5.2 Page 16 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): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People lived in a well managed home though the poor state of repair to the home suggested quality checking in this area did not put right things that were wrong. EVIDENCE: The manager was not a qualified nurse though there was a clinical lead in the home to manage nursing issues. The manager needed to complete the NVQ level 4 in care. The company reviewed policies and procedures on a rolling basis. Health and safety checks had taken place. Fire equipment was tested in June 2007 with alarms maintained in March 2007. The electrical hard wiring certificate was current and demonstrated the safety of the installation.
Admiral Court Nursing Home DS0000000138.V339930.R02.S.doc Version 5.2 Page 17 Improvements had been made in the last year of the manager being in post and this should be recognised and commended. Service user individual money records were kept electronically. Receipts were kept, spending was double signed and records were audited. Money was kept in a communal bank account which did not earn interest and allocated out of a pooled cash tin. There was a comprehensive quality assurance system in place. Environmental issues were of concern in that internal quality assurance had not remedied them when there was a potential risk. Admiral Court Nursing Home DS0000000138.V339930.R02.S.doc Version 5.2 Page 18 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 Admiral Court Nursing Home DS0000000138.V339930.R02.S.doc Version 5.2 Page 19 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 1 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 3 3 Admiral Court Nursing Home DS0000000138.V339930.R02.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement People must not be admitted to the home without the home confirming in writing the ability to meet the person’s assessed needs. Grab rails to assist mobility around the home must be audited and repaired where needed to maintain the safety of people in the home. A programme of repair must be produced and implemented to raise the environmental standards in the home. The home must be deep cleaned and maintained free from offensive odours. Timescale for action 16/08/07 2 OP19 13(4) 17/08/07 3 OP19 23(2(b, d,)) 16(2(k), 23 (2(d)) 16/06/08 4 OP26 16/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP31 Good Practice Recommendations The manager should achieve NVQ level 4 in Care.
DS0000000138.V339930.R02.S.doc Version 5.2 Page 21 Admiral Court Nursing Home Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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
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