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Inspection on 25/10/05 for Admiral Court Nursing Home

Also see our care home review for Admiral Court Nursing Home for more information

This inspection was carried out on 25th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a range of activities for residents, which include; shopping, games, cinema and pub outings, bingo, foot massage and visits to the hairdresser.

What has improved since the last inspection?

The contract has been updated; this tells residents what is included within their fees. Medication sheets are now being recorded properly this is a record, which tells people what medication has been given. Some staff had been trained in adult protection; this helps to protect residents from harm. Some areas of the home have been decorated, and most of the bedrooms have new carpets.

What the care home could do better:

The home needs a registered manager to ensure the safe and efficient running of the home. There have been some improvements to the interior of the home since the last inspection. Although some of the bedrooms have been decorated, carpets had been laid prior to the removal of vanity units leaving exposed flooring under sinks. Furniture is in a poor state of repair and must be replaced. The wallpaper in the Cedar Lounge is peeling off near the window and chairs and carpets in the lounge need cleaning or replacement. The smoking lounge looks sparse and should be made more welcoming. Some of the bedrooms viewed looked neglected and many areas of the home were unclean. The company must ensure that the home is decorated and furnished to a reasonable standard. Each service user should be provided with a lockablespace within their room. Many of the nurse call systems did not have pull cords for residents to contact staff these must be replaced. Evidence of service user/supporters input within care plans should be documented, where this is refused this should also be recorded. The policies on complaints and adult protection need to be updated to protect residents and staff must be inducted so that they can do their jobs properly. Staff must be given training in fire evacuation; this must take place so that residents and staff know what to do in the event of a fire.

CARE HOMES FOR OLDER PEOPLE Admiral Court Nursing Home Cleveland Road Hartlepool TS24 0SY Lead Inspector Mrs Tanya Newton Unannounced Inspection 25th October 2005 09:30 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.V259600.R01.S.doc Version 5.0 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.V259600.R01.S.doc Version 5.0 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 866893 Alliance Care (Woodside) Ltd 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.V259600.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age category for individuals with a mental disorder is aged 45 Date of last inspection 17th May 2005 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 accesible by car and is on major bus routes. The home provides a number of lounges and dining space 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 access to both floors and a small patio area to the rear of the property. Toilet and bathing facilites are provided throughout the home with some assisted aids to provide support to those service users who are less mobile. Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 25th October 2005, between the hours of 9.30am and 4.30 pm. Tanya Newton and Susan Lowther carried out the inspection of the home, some time was spent talking to service users, staff and relatives. Records were examined and a tour of the building took place. The requirements in the previous inspection report were also looked at as part of this inspection. In line with current CSCI policy on Proportionality, the inspection focused upon a number of key standard outcomes for service users. The key standard outcomes not inspected on this occasion will be raised during the next inspection of the home. What the service does well: What has improved since the last inspection? What they could do better: The home needs a registered manager to ensure the safe and efficient running of the home. There have been some improvements to the interior of the home since the last inspection. Although some of the bedrooms have been decorated, carpets had been laid prior to the removal of vanity units leaving exposed flooring under sinks. Furniture is in a poor state of repair and must be replaced. The wallpaper in the Cedar Lounge is peeling off near the window and chairs and carpets in the lounge need cleaning or replacement. The smoking lounge looks sparse and should be made more welcoming. Some of the bedrooms viewed looked neglected and many areas of the home were unclean. The company must ensure that the home is decorated and furnished to a reasonable standard. Each service user should be provided with a lockable Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 Page 6 space within their room. Many of the nurse call systems did not have pull cords for residents to contact staff these must be replaced. Evidence of service user/supporters input within care plans should be documented, where this is refused this should also be recorded. The policies on complaints and adult protection need to be updated to protect residents and staff must be inducted so that they can do their jobs properly. Staff must be given training in fire evacuation; this must take place so that residents and staff know what to do in the event of a fire. 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. Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 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.V259600.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 The assessment process could be further improved to demonstrate how the home will meet the individual needs of the service users placed. There is no contract on resident’s files to tell service users what the home is providing within the fees paid. EVIDENCE: The assessments viewed during the inspection were not up to date and there were lots of gaps in the recording of information despite the recommendation made in the previous inspection report of the home. Assessments form the basis from which the individual plan of care will be written and demonstrate how the home will meet an individuals needs. The information provided within assessments must cover all areas of physical, social, emotional and psychological needs. Where possible service users and/or their relatives should be involved in the assessment process. Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 Page 9 Each service user should be provided with a statement of terms and conditions, which details what the home is providing and the cost. Contracts have been recently reviewed and updated by Four Seasons; the home confirmed that these would be issued to service users. Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 Limited progress has been made on improving arrangements to ensure that the health care needs of service users are identified and met. EVIDENCE: Although some work has been done to improve the care plans they still do not contain all of the information to ensure that all aspects of health, personal and social care needs are identified and planned for. Five care plans were audited; care plans detail how the home will meet individual service users needs, there is some evidence to demonstrate that some of these care plans are being reviewed regularly, not all of them had been reviewed over recent months. The home said that it is trying to involve service users/relatives within the care planning process; this should be evidenced within care plans. There is some evidence that service users health needs are being met; district nurses visit the home where it is required. Records kept by the home need to improve to evidence this further. Most residents spoken to said they were well looked after. The acting manager confirmed that MAR sheets (medication sheets) were now being recorded properly; this provides an audit trail of medication given to residents. Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Social activities are provided which provide stimulation and interest for people living at the home. Visitors are made welcome to the home and can visit at any time. Feedback should be regularly sought regarding menus and service users should always be offered a choice. EVIDENCE: The home has an activity co-ordinator who provides a range of activities to residents, a weekly activity plan was viewed which included; shopping, games, cinema and pub outings, foot massage and hairdresser visits. Visitors were observed coming in and out of the home, visitors spoken with confirmed that they could visit at any time and contact with relatives is encouraged by the home. The home also supports residents in writing letters to relatives who live further away. Comments about the menus were mixed; in the main residents get offered a choice, there are some occasions when this is not possible for example when the kitchen is running short of staff. The cook confirmed that she tries to provide residents with meals of their choice; she will prepare individual items where someone has made a specific Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 Page 12 request. Further discussion needs to take place with residents to see what they would like to be included in the menus. Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Policies on complaints and adult protection should be updated to ensure the protection of service users. EVIDENCE: The home has a complaints policy dated march 2003, which needs minor amendment as it makes reference to NCSC and not CSCI. It should also detail what to do in the event of a complaint being made which is also an adult protection issue, there has been a previous complaint, which should have been referred under adult protection but was dealt with as a complaint. The adult protection policy was viewed during the inspection; it requires further updating to reflect the referral procedure to Social Services in the event of an allegation being made. The home does have a copy of Hartlepool’s inter agency policy on adult protection; the homes own policy should link with this guidance. Training in adult protection has been provided for some of the staff. Two complaints have been made to the home since the last inspection; both were dealt with under the adult protection route. One of the complaints was substantiated and one was not. Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The standards within the environment need to improve substantially so that service users are provided with a clean, safe and homely place to live. EVIDENCE: The previous requirement relating to the environment has not been fully addressed by the home. The home were required to take immediate action and an official letter was left at the home to tell the owner and manager designate that this must be put right or enforcement action would be taken. New carpets had been put down in the majority of the bedrooms and redecoration was taking place throughout the home. Due to vanity units being removed following the laying of carpets there were gaps under most sinks with no carpet, this requires address. A number of rooms required new windowpanes as these were damaged. A number of rooms had no headboards. New flooring is still required in the laundry and the corridor leading to the laundry. The sluices were very dirty and require redecoration and new flooring. The majority of bedrooms still require new furniture as the Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 Page 15 current furniture is of a poor standard and quality for service users. Some of the bedrooms had strong odours. The smoking room is unwelcoming and needs domestic lighting and redecoration. The nurse call cords were missing in the majority of bedrooms. The maintenance manager met with inspectors and agreed timescales in which all-outstanding redecoration/maintenance work required in the previous inspection report of the home would be completed. A further site visit to confirm this will take place. Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Staffing levels must be maintained to ensure that the needs of residents can be consistently met. Recruitment procedures do not fully protect residents. Staff training must be provided so that the home can meet the assessed needs of the residents living within Admiral court. EVIDENCE: Staffing levels are not sufficient to meet the needs and numbers of the service users placed. The Commission has received complaints regarding the staffing numbers. Induction packs for staff were not up to date; this was a requirement in the previous inspection, an immediate requirement notice was issued regarding this. Some staff felt that staffing levels must be improved; staffing numbers were regularly falling below the numbers agreed within the rota due to sickness. The home must take action to address this. One staff file did not have a CRB; the home stated that this had been carried out. A record of all CRB checks should be held on the premises. Staff files must be audited to ensure that they all contain all of the required information. One staff member stated “Much happier now, I’ve worked here years, I’ve no real training or supervision recently”. Another staff member commented; “I had a two day induction but no training in fire or manual handling”. Four Seasons must ensure that staff receive training which is relevant to the job Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 Page 17 they are doing and which will support and safeguard service users living at the home. Training must include manual handling, first aid, food hygiene, fire and health and safety. Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 38. There is no registered manager in post to provide clear, consistent leadership throughout the home. Health and Safety practices in the home may potentially place service users at risk. EVIDENCE: There is no registered manager in post at Admiral Court and this has been the case since January. There is an acting manager in post. The company must ensure that there is a full time registered manager within the home to ensure that standards improve and requirements are met. An application to register a manager must be submitted to the Commission. One of the staff commented “work seems to have stopped here, I feel that the acting manager is working hard and support him as much as possible”. During the inspection some significant Health and Safety concerns were raised with the home; fire training had not been provided since Jan/Feb 2004, and Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 Page 19 fire doors were still being wedged open. An immediate requirement notice was issued, which is an official letter telling the home that improvements must be made. Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 Page 20 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 X 2 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 10 11 1 X X X X X X 2 STAFFING Standard No Score 27 28 29 30 3 X X 1 1 2 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X X X 1 Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP2 Regulation 5(1)b Requirement Each service user must be provided with a statement of terms and conditions (a contract) on admission to the home. Previous timescale of 30/08/05 not met. No service user moves into the home without having his/her needs assessed and been assured that these will be met. Each service user must have a plan of care which details how all aspects of health, personal and social care needs are identified and planned for, service users should be given the opportunity to be involved with this process. The adult protection policy requires further updating to reflect the referral procedure to Social Services in the event of an allegation being made. Training in adult protection should be made available to all staff. The standards within the environment must be substantially improved; all of the previous requirements from the last inspection report must be DS0000000138.V259600.R01.S.doc Timescale for action 30/11/05 2 OP3 14(1)&(2) 30/11/05 3 OP7OP8 15(1)&(2) 30/12/05 4 OP18 13(6) 30/12/05 5 OP19OP26 23 14/11/05 Admiral Court Nursing Home Version 5.0 Page 22 6 OP19 23 7 8 OP19 OP27 23 18(1) a actioned which include new carpets, making good around sink areas where vanity units have been removed. Sluices, wheelchairs and hoists must be cleaned reguarly and standards of cleanliness generally throughout the home must be improved. Previous requirement of 30/08/05 not met. Nurse call pull cords to be replaced where missing. Smoking room to be decorated with domestic lighting installed Furniture must be replaced in bedrooms. New flooring is required in the corridor and sluice, some of the toilets and the laundry. Previous requirement of the 30/08/05 not met. New window panes are required in some rooms, (31/03/06 Staffing numbers must be sufficient to meet the assessed needs of the service users, the home must take action to address this. Previous timescale of 30/08/05 not met. Induction must be provided for All staff and should be based on TOPSS guidance. (previous timescale of 30/08/05 not met). Training relevant to the job must be provided in order that staff are able to meet the assessed needs of service users. Management arrangements within the home require urgent address; the home must make arrangements for a full time manager to be registered within the home.(Previous timescale of 30/08/05 not met). Fire training must be provided and fire doors must not be wedged open. DS0000000138.V259600.R01.S.doc 14/12/05 31/03/06 30/11/05 9 OP28OP29 OP30 18 30/12/05 10 OP31 8&9 30/11/05 11 OP38 23(4) c 07/11/05 Admiral Court Nursing Home Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP15 OP16 OP19 OP33 Good Practice Recommendations The views of service users should be sought regarding the menus and meals provided. The complaints procedure should be updated to reflect the move from NCSC to CSCI. Some rooms should have new pillows/headboards/bedding Effective quality assurance systems, which seek the views of residents, should be further developed. Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 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 Admiral Court Nursing Home DS0000000138.V259600.R01.S.doc Version 5.0 Page 25 - 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. 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