CARE HOMES FOR OLDER PEOPLE
Admiral Court Nursing Home Cleveland Road Hartlepool TS24 0SY Lead Inspector
Mrs Tanya Newton Unannounced Inspection 11:45 7th June 2006 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.V294140.R01.S.doc Version 5.1 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.V294140.R01.S.doc Version 5.1 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) 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.V294140.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Age category for individuals with a mental disorder is aged 45 NAMED INDIVIDUAL: The home may accommodate a named individual as set out in a letter to the registered person dated 9 March 2006, which establishes the basis on which the individual’s needs will be met by the home. Where necessary the homes statement of purpose shall reflect any changes in service provision required for this arrangement. This condition may not apply to anyone else, other than the named individual, who falls outside the registered category. 25th October 2005 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. Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection of Admiral Court Care Home took place on the 7th June between the hours of 11:45 and 5:00pm. Two inspectors carried out the visit. Service users, visitors, relatives and staff were spoken to as part of the inspection and feedback from these people is included throughout this report. Questionnaires were also sent out to ten service users to gain feedback on the care being provided. None were retuned although two comment cards were received from relatives. Information from these surveys is reflected within this report. The inspection focused upon all of the key standard outcomes for service users. What the service does well: What has improved since the last inspection?
Each service user now has an assessment and care plan, which provides staff with information about how their needs should be met. Standards of care and support to residents continue to improve and records are now being maintained. This helps staff to monitor changes in resident’s health. Service users say that privacy is maintained and that staff respect them. Service users are given more choices and are encouraged to be as selfmanaging as possible. Comments about the food and menus were positive and residents are now being consulted about their likes and dislikes.
Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 Page 6 The standards within the environment continue to improve. Staff induction and training is being carried out and staff recruitment practices now help to protect service users. Staff made positive comments about the morale within the home and feel that they have pulled together as a team. Although the home has no registered manager, the acting manager has provided staff with clear direction and has helped to improve standards throughout the home. The home has developed a questionnaire to seek feedback from relatives and other professionals. 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. Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 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.V294140.R01.S.doc Version 5.1 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 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident is provided with a contract, which should provide residents with information about their fees and the terms and conditions of residence. Not all of the contracts were up to date. A basic assessment is provided before admission. Assessments demonstrate how the home can meet a residents needs. The home does not provide intermediate care. EVIDENCE: Each service user is provided with a contract. The contract should tell them what is included within the fees and what may be additionally charged for. Three contracts were viewed. One did not contain any information about the level of fees and none were signed by service users. Where service users are unable to sign their contract a relative, care manager or advocate should be
Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 Page 9 involved. The contract reflects the role and responsbility of the provider and the rights and obligations of the resident. The home carries out its own assessments before admission, meeting people either in hospital, their own homes or at Admiral Court. Service users are able to visit the home prior to admission. One relative said, “My mum looked around before she moved in”. The home requests a copy of the care management assessment for service users funded by the local authority. The assessments viewed contained basic information and not all of the assessments viewed during the inspection were up to date. The home does not admit residents for intermediate care. Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 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 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each service user has a care plan, which reflects their changing needs. Some areas of the care plans were incomplete and need to be updated so that the staff are provided with the information they need to meet all aspects of a residents care. Progress continues to be made to ensure that the personal and health care needs of the service users accommodated are being met. The systems for auditing medication should be improved and treatment rooms require updating and they are in poor condition. Privacy is maintained and service users are respected. EVIDENCE: Each resident has a care plan, which provides staff with information about how service users needs should be met. Care plans have been updated and they now provide staff with more detailed information. Some of the assessments
Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 Page 11 within care plans for more recently admitted residents had not yet been completed. These included pressure care and nutritional assessments. These assessments help provide staff with information to identify changes in health and must be completed. Reviews are carried out reguarly on care plans, this helps staff to monitor changes in a resident’s health. Residents have access to GPs, dentists, community nurses and opticians. A record of these visits is maintained. Service users made the following comments regarding their care “I think we are well looked after here”, “the care and support here is not outstanding but it is not bad” and “its alright in here, we are well looked after”. One of the staff members said “standards of care within the home have improved”, another commented “the standard of care is very good”. A relative said “ I am happy with the care being provided, the home keep us up to date with any changes in my mum’s helath”. Medication systems were looked at during the inspection. The home uses the monitored dosage system (MDS). There are no residents who are able to self administer their own medication at this time. Some concerns were identified, the oramorph had not been dated on opening and some medication was difficult to audit as staff were not following the day order in the blister packs. The treatment room floors and cuboards need replacing as they are in a poor condition. A visiting professional confirmed that staff contact G.Ps where necessary and said that the home has clear strategies in place for managing challenging behaviours. The home makes sure that particular attention is given to supporting resident’s privacy and dignity when delivering personal care. Privacy and dignity is included within induction training for new staff. Residents confirmed this in discussion, making the following comments; “Most of the staff are kind” and “we are treated well here”. Residents said that they are happy with the way in which most people deliver their care. Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activities being provided are varied and provide stimulation and interest for most people living at the home. Family and friends feel welcome and can visit the home at any time. The staff should support service users in making individual choices, which may include taking risks. Menus are varied and service users are given a choice. EVIDENCE: The home has an activity co-ordinator who provides a range of activities to residents. These include shopping, games, trips to the cinema, pub outings, bingo, quizzes, outings, theatre trips, exercises and holidays. Comments from residents were mixed about the activities being provided and included “There’s not much going on, a singer comes in on a night. I go out on my own locally, I would like to go further but I don’t know if I am allowed” and “I find it frustrating that there are few people to converse with. I go out occasionally with another resident”. Staff said that the activities co-ordinator spends time
Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 Page 13 with residents on a one to one basis as well as providing group activities. Some of the residents had been away on holiday to Blackpool, which they said they had enjoyed. The home has open visiting arrangements and residents know that they can entertain their visitors in their own room. If they prefer they can use community areas of the home to talk to visitors. The home also supports residents in writing letters to relatives who live further away. Relatives said, “We can visit at any time, the staff here are approachable and friendly”. A group of residents were asked if they felt that they could make choices and their responses included “I choose to go out to the pub on my own” and “I get up when I feel like it” and “I would like to be able to make a drink when I wanted without asking staff to do this for me”. Most residents said that the food was good. The home has a 4-week menu plan. Lunch is a main cooked meal and service users are given a choice. Tea tends to be lighter with items such as sandwiches, soup or lighter hot meals being provided. Comments from residents include “the food is alright, there is nothing wrong with it” and “I like the food here”. Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are dealt with appropriately and systems to protect people from abuse are in place. EVIDENCE: The home has a complaints procedure, which has recently been updated. Service users and relatives confirmed that they would feel confident in raising any concerns. One complaint has been made to CSCI since the last inspection regarding the food. A visit was made to the service to discuss these concerns and the complaint was partially upheld. The policies and procedures regarding protection of residents are regularly reviewed and updated. The adult protection policy was viewed during the inspection. Training in adult protection has been provided for almost all of the staff. There have been three adult protection referrals since the last inspection, which the home has dealt with appropriately. Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 Page 15 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standards within the environment continue to improve so that service users are provided with a clean, safe and homely place to live. EVIDENCE: Improvements continue to be made to the home and most bedrooms have now been decorated and had new carpets fitted. New furniture has been purchased for some of the bedrooms and the home is planning to purchase more for the remainder of rooms. New windows are going to be fitted throughout the building and work is due to start on this within the next four weeks. Some of the dining and lounge areas need to be decorated and re-carpeted. New flooring is still required in the laundry and the corridor leading to the laundry area. Beds are changed frequently, many daily and there is a programme of daily cleaning throughout the home, which includes carpet cleaning.
Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 Page 16 The home has specialist equipment and aids to support those service users who are less mobile. All rooms are for single occupancy. There is a selection of communal areas on each floor so that residents can choose to sit quietly, meet with visitors or socialise with other residents. The home also has a patio area outside for residents to sit outside in the warmer weather. Service users and relatives said that the T.V aerials in service users bedrooms did not work this should be addressed. Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff confirmed that in the main the staffing hours meet the needs of the residents accommodated, although not when people attended appointments. Recruitment practices are robust and protect service users. There is an annual training plan for the home and records of staff training are maintained. EVIDENCE: The staff rotas were examined during the inspection. The home has the following number of staff on duty; a nurse is on duty on each floor throughout the day and night. There are five carers on duty in the home throughout the day and three during the night. Staff spoken with during the inspection said that the home was running well and made comments such as “its much better here, we are all working together, morale is better and residents are happier” and “it’s a nice staff team”. Staff did say that staffing numbers needed to be increased when service users attended appointments to maintain safe staffing levels at all times. Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 Page 18 Service users and relatives were in the main very positive about the staff working within Admiral Court and made comments such as “the staff are ok” “staffing numbers are ok, sometimes there could be more” and “The staff here are approachable and helpful”. Four staff recruitment files were audited. All contained the required information to protect service users. This included two references, an enhanced criminal record bureau check (CRB), medical declaration and induction and training records. The majority of staff training was up to date and the acting manager confirmed that a number of training courses were booked. Out of the nineteen care staff employed six had gained an NVQ level 2 or above. Two staff are working towards this and the home has plans for the remaining staff to commence this. Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not have a registered manager to provide guidance and support to staff and service users within the home. The home has policies in place to safely manage service users finances. Quality assurance systems are being developed to make improvements to the service being provided. The home has basic health and safety systems in place to protect service users and staff. Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 Page 20 EVIDENCE: There is no registered manager in post at Admiral Court and this has been the case since January 2005. 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. The acting manager has provided staff with clear direction and support enabling them to improve the service. Resident’s finances were not audited during this inspection. However the manager confirmed that the company audits them on a monthly basis to ensure that residents were protected. Quality assurance systems are in place and include Regulation 26 visits from the provider and meetings for staff and service users. Informal feedback is gained through day-to-day contact with service users and their relatives. Questionnaires have been developed to seek feedback from service users and relatives. The acting manager confirmed that the home was carrying out regular Health and Safety checks on the premises and the inspector checked some of these records. All records viewed were up to date. Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 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 X 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 Page 22 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 completed statement of terms and conditions (a contract) on admission to the home. Assessments need to be completed fully for all service users. This is an outstanding requirement, which has been partially 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. This is an outstanding requirement, which is partially met. Medication systems need to be improved so that that stock can be properly audited. Items such as oramorph should be dated on opening. Service users must be supported in making decisions and choices in respect of the care they receive.
DS0000000138.V294140.R01.S.doc Timescale for action 30/07/06 2. OP3 14(1)&(2) 30/07/06 3. OP7 15(1)&(2) 30/07/06 4. OP9 13(2) 30/07/06 5. OP14 12(2) 30/07/06 Admiral Court Nursing Home Version 5.1 Page 23 6. OP19 23 7. 8. OP19 OP27 23 18(1) a 9. OP28 19(5) b 10. OP31 8&9 The standards within the environment must continue to be improved. Furniture must continue to be replaced in bedrooms. Decoration and new carpets need to be replaced in those bedrooms, which have not yet been done. The small lounge next to the ground floor dining area needs to be decorated and the carpet replaced. The treatment rooms need to be refurnished and new flooring put down. New flooring is required in the corridor and sluice. T.V aerials in bedrooms must be fixed. Some of these issues are outstanding from previous inspection reports, which have been actioned in part. New windowpanes are required in some rooms. Previous timescale of 31/03/06 not met. Staffing numbers must be sufficient to meet the assessed needs of the service users at all times. This must include times where service users attend appointments. Previous timescale of 30/08/05 not fully met. The number of staff with an NVQ 2 or equivalent needs to increase so that the home meet the target of at least 50 of staff having this award. 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. 30/08/06 31/07/06 31/07/06 30/12/06 30/08/06 Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 Page 24 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 Admiral Court Nursing Home DS0000000138.V294140.R01.S.doc Version 5.1 Page 25 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.V294140.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
