Random inspection report
Care homes for older people
Name: Address: Altham Court Nursing Home Altham Terrace Lincoln LN6 7SP one star adequate service 24/06/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Dawn Podmore Date: 0 1 1 0 2 0 0 9 Information about the care home
Name of care home: Address: Altham Court Nursing Home Altham Terrace Lincoln LN6 7SP 01522511373 01522511471 burrowsl@bupa.com www.bupa.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : BUPA Care Homes (CFC Homes) Ltd care home 48 Number of places (if applicable): Under 65 Over 65 48 0 old age, not falling within any other category physical disability Conditions of registration: Date of last inspection Brief description of the care home 0 10 2 4 0 6 2 0 0 9 Altham Court is situated in a quiet lane within walking distance of the City Centre. It is purpose built with all services situated on ground floor level. Accommodation is provided in two shared and forty-four single bedrooms, which benefit from having ensuite facilities. Altham Court is registered for forty-eight service users, 10 of which could have a physical disability, and provides both personal care and nursing care for older people. There are extensive, well-maintained gardens, which have garden furniture for the comfort of the residents and their visitors. Car parking is available at the front of the building and there is a bus service close by. Information provided at the last key inspection indicated that weekly fees ranged from
Care Homes for Older People Page 2 of 10 Brief description of the care home £360 - £610.82 depending on peoples individual assessed needs. Additional charges are made for services such as chiropody, hairdressing and newspapers. Information about these costs as well as the day-to-day operation of the home, including a copy of the last inspection report, can be found in the Statement of Purpose which is available in the reception area. Care Homes for Older People Page 3 of 10 What we found:
This visit was part of an unannounced random inspection. This type of inspection can take place between key inspections for various reasons, such as to check that requirements have been addressed or to look at areas of concern. On this occasion we wanted to assess what progress had been made to meet the requirements made at the last Key Inspection on June 24th 2009. A new acting manager, Mrs Linda Burrows, has been appointed since the last inspection and she was present throughout the visit. We took a partial tour of the building during which we spoke with some residents, relatives and staff. We also looked at various documentation including, care plans, risk assessments, medication audits and staffing rotas. We assessed how people had been consulted about the running of the home and the quality of the service being provided. We also sent out surveys to residents and staff to ask their opinion of how the home was operating. Sixteen people returned these and their opinions are included in this report. The main findings of the visit are set out below under the standard headings we looked at. Choice of Home The home provides various information to tell people about what type of service it intends to provide and how it operates, this includes The Statement of Purpose and a Service Users Guide. Both of these documents had been updated to include the new management arrangements at the home. As there had been no new admissions to the home since our last visit we were unable to evaluate the quality of initial assessments to assess if the home was making sure that they could meet peoples needs before their admission. However the care plans we looked at contained evidence of peoples continuing needs being reassessed and care records being updated. Two people told us that they had not received a copy of the terms and conditions of living at the home. We discussed this with the manager who confirmed that new terms and conditions were currently being given to all residents. Health and Personal Care At the last inspection the care plans we looked at contained good information about peoples needs and clear guidance for staff about their role in caring and supporting individual people. Although people told us that their social needs were being met plans did not clearly outline how staff would meet these needs. The files we looked at during this visit had some good information about peoples past interests and hobbies, but comprehensive care plans were still not in place. The manager said that files were currently being updated and so work was still in progress regarding this shortfall. We looked at one file to assess how their wound care had been monitored and recorded. The file contained detailed information including body maps and comprehensive
Care Homes for Older People Page 4 of 10 monitoring records. The plan had been regularly updated and amended as necessary. We asked people what they thought about the level of support they were receiving. They told us their needs on the whole were being met and that things had improved since the new manager had come to the home. One person said. its a very good nursing home, it pays good attention to looking after its residents. A relative told us, mums welfare and needs are very well looked after and she is treated with the up-most respect and kindness by all. We looked at the audit system introduced to make sure that medications were being handled safely. It showed that systems were in place to highlight any areas of the system that needed improving and the actions to be taken to address any identified shortfalls. The company has also introduced new medication training which involves staff completing workbooks and their competency being assessed. This is aimed at increasing staffs knowledge and competency to suit their job role. Complaints and Protection People told that they knew how to raise any complaints and were aware of the homes procedure. They said that they felt able to discuss any concerns they might have with the manager and staff. Records had been maintained at the home detailing concerns raised and what had been done to address them. The home has procedures concerning the protection of vulnerable adults. Over the last 6 months some areas of concern have been raised with us and the Lincoln County Council Safeguarding Team. Two of these have been concluded with some shortfalls identified and therefore an action plan has been put in place to address them. Other issues are still being investigated by the team. However the company have taken action to address any areas highlighted to them during the investigations. Staff have received additional training to make sure that they know how to recognise potential abusive situations and their responsibilities in reporting them. Staffing At the last inspection people had raised concerns about the number of staff available, especially for people with nursing needs. During this inspection people told us that things had improved. One person said, there has been a noticeable improvement in staffing since the appointment of the new manager. The staffing arrangements have been reviewed and some changes have been made. This includes the home returning to the practice of having two nurses on duty in the morning. The manager said that additional staff were to be recruited to allow for staff holidays and sickness leave. In the meantime the home is using agency staff to fill the gaps. People told us that although this was better than being short staffed it was not ideal. One resident commented, we need more staff and less agency. The manager said that she was undertaking a full audit of staff training and supervision to make sure that they had all received appropriate training and support. Staff induction was being reiterated for all staff who had come to work at the home recently to make sure that they had covered all the essential subjects. On the day of our visit a training
Care Homes for Older People Page 5 of 10 session about diabetes was taking place. We were told that in the near future staff would be provided with training about the Mental Capacity Act and Deprivation of Liberties. This legislation is aimed at protecting people rights and choices. People told us that they staff provided a good level of care and support. Their comments included, overall the home provides a good level of care, but occasional lapses are generally due to the lack of staff, particularly at weekends and very good, dedicated and caring staff. Staff said that on the whole there were usually enough staff on duty and that they received the training they needed. Management and Administration The home does not currently have a registered manager. Since the last visit the acting manager has left and Mrs Linda Burrows, who was formally the registered manager at the home, has returned. She has told us that she intends to apply to be the registered manager again shortly. People said that the home had improved and issues previously identified had, or were being, addressed. They told us that the home was a happy place to live and work, and that peoples needed were being met. People said, we are happy we picked Altham Court for mum to come to, its perfect for me, I am very happy, its much better since Linda came back and its a very good nursing home, it pays a lot of attention to looking after its residents. When asked what the home did well people commented, the food is very good with plenty of choice, its well furnished with pleasant surroundings and they are always willing to listen and help. Staff also commented favorably about the new manager, They said, good support from the manager, a new strong management so the emphasis is on meeting all the care needs of the residents to a high standard and treating everyone as individuals, over the last month moral in the home has improved and the home has improved 100 . When asked how the home could improve comments included, call bells could be answered in a reasonable time, bedding (sheets) with tears could be replaced and beds could be made better and a bit more for residents to do in the afternoons. Staff also highlighted areas for further improvement. These included communication between staff, more outings for residents, more staff, so there was more time to spend with the residents and building a stronger team after the recent problems. At the last visit staff were not receiving regular supervision and appraisal sessions, but a system was being introduced to address this. The manager told us that this has been delayed due to the change in management but she has established a named nurse/key worker system to facilitate this. Staff confirmed that they felt well supported. Our records show that we have been told about any incidents at the home, such as staff shortages and accidents. They have also been holding meetings to tell people about the change in management and ask them about things that they would like to see change. The manager said that the company also intend to send out surveys to all residents and relatives in the near future so that they can obtain a fuller picture about how the home is operating.
Care Homes for Older People Page 6 of 10 What the care home does well: 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 set out on page 2. Care Homes for Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 15 Each person must have a 07/12/2009 plan that outlines their social and recreational needs. This will enable staff to understand what each person likes to do and their role in supporting them. This requirement has not been fully met due to the change in management, however progress has been made and peoples needs are being met. 2 30 18 (1) Training must be provided in 30/11/2009 subjects such as physical disabilities, dementia awareness and illnesses affecting older people. So that staff have the skills and knowledge to understand these conditions and fully meet peoples needs. This requirement has not been fully met, but progress has been made. The new timescale set at the last Key inspection has not yet expired. Care Homes for Older People Page 8 of 10 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 Care plans should include reference to the Mental Capacity Act, 2007 and the effects it has on resident lives. This is to help to make sure that their rights and choices are protected. Peoples individual dependency levels should be monitored and formally recorded so that the home can demonstrate that there is enough staff on duty to meet people needs. Staff should receive regular supervision and appraisal sessions which are planned and recorded. This will help to make sure that they receive the right level of support to carry out their job. 2 27 3 36 Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Older People Page 10 of 10 - 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!
