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Inspection on 05/09/05 for Altham Court Nursing Home

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

This inspection was carried out on 5th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 is very well organised and managed, with well trained staff who are well supported and have a good knowledge of residents needs. Residents have detailed comprehensive care plans, which are reviewed regularly. Comments from residents included" The staff are brilliant"" Its just like having my own flat" The staff encourage service user to maintain activities that they enjoy at home and offer access to a wide range of local community activities. There are regular meetings with service users, which ensures that they are able to express their views 50% of the staff team have an N.V.Q. qualification.

What has improved since the last inspection?

What the care home could do better:

This was a positive inspection with only one requirement for the completion of risk assessments and management plans for all residents experiencing frequent falls. One resident who had experienced a number of falls, did not have a risk assessment / management plan in place to address this.Two good practice recommendations were made in relation to food temperatures being checked, to ensure food served is hot and the time taken for staff to respond to call bells. Both of these had already been identified by the home from residents meetings and were being acted upon.

CARE HOMES FOR OLDER PEOPLE Altham Court Nursing Home Altham Terrace Lincoln Lincs LN6 7SP Lead Inspector Wilma Crawford Unannounced 05 September 2005 09:30 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 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. Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Altham Court Nursing Home Address Altham Terrace Lincoln Lincs LN6 7SP 01522 511373 01522 511471 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes Limited Mrs Linda Carol Burrows Care home with nursing 48 Category(ies) of OP Old age - 48 registration, with number PD Physical disability - 6 of places Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 11 July 2005 Brief Description of the Service: The home is owned and run by the BUPA organisation and employs a care manager and social care manager (deputy manager). This home is situated in a quiet lane within walking distance from the City Centre. The home has extensive and well-kept gardens, which have garden furniture for the comfort of service users. Altham Court is registered for forty-eight service users, 6 of whom have a physical disability, and provides both personal care and nursing care for older people. This is a purpose built home with all services situated on ground floor level, with two double-shared bedrooms and forty-four single rooms with en-suite facilities giving total number of beds of forty eight. Car parking is to the front of the building and there is a bus service close by, which relatives can use to visit this home. The homes statement of purpose states that its aim is to ‘provide our customers with the highest quality service. We will use our health and care knowledge, specialist skills and values to deliver an individual service to our customers.’ Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two visits of 4 hours. A tour of part of the premises was conducted with the manager. The main method of inspection used was called case tracking which involved selecting three residents and tracking the care they receive through the checking of their records, discussion with them, two care staff and observation of care practices. What the service does well: What has improved since the last inspection? What they could do better: This was a positive inspection with only one requirement for the completion of risk assessments and management plans for all residents experiencing frequent falls. One resident who had experienced a number of falls, did not have a risk assessment / management plan in place to address this. Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 Page 6 Two good practice recommendations were made in relation to food temperatures being checked, to ensure food served is hot and the time taken for staff to respond to call bells. Both of these had already been identified by the home from residents meetings and were being acted upon. 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. Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 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 standard(s) 3 &5; Standard 6 does not apply as the home does not provide an intermediate care service. Residents are admitted into the home only after a full needs assessment has been carried out either by the home or health care or social care agencies. Written confirmation that the home can meet a prospective residents needs is provided by the home. Residents are able to visit the home before moving into the home. EVIDENCE: The home has a detailed admission procedure, which identifies the needs of residents coming into the home. One resident said that she was visited prior to admission by someone from the home. The second resident had an assessment undertaken by the Social Services Department. Files seen showed that residents had been written to confirming that the home could meet their needs. Two care workers spoken to knew about the care needs of residents and were aware of the homes pre-admission assessment procedures. Both residents confirmed that they were able to visit the home prior to making a decision to moving in. Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11 Residents wishes concerning terminal care and arrangements after death are recorded and acted upon. EVIDENCE: The home has a policy and procedure in regard to death and dying. The lead nurse manager confirmed that in such situations additional staffing is made available to sit with the resident and their family. Staff explained that they have received training in relation to bereavement and this subject is also covered in the homes induction training. This includes relatives and friends of residents who are dying being able to stay with them for as long as they wish, and residents’ wishes being respected as recorded in their care plans. Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 15 Relatives and friends of residents are made welcome in this home. Meals are well managed with choices available to residents. EVIDENCE: Residents confirmed that they have visitors in their rooms and that they are made welcome by care staff. An area is provided by the home for visitors to make hot drinks, they are also able to join their relative for a meal if they wish. One resident commented, “My family can visit at any time, there are no restrictions”. Residents said that they have a choice of meals and their individual tastes are catered for. One resident said that ‘there are too many carrots and the food is sometimes served cold’. Other residents spoken with all said that the food was good and that there was plenty. The meals are served in the dining room or on trays in bedrooms if preferred. The chef also organises theme nights where residents are given the opportunity to try different foods. An Italian lunch had been planned for later in the week and a menu displayed. Residents’ likes and dislikes or special diets are recorded. Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 Page 11 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 standard(s) 16, 18 The home takes the issue of protecting residents from harm very seriously and has a comprehensive adult protection policy. EVIDENCE: The home has both a comprehensive complaints and ‘Whistle Blowing’ policy. Staff members receive Adult Protection training, and records of this are found in the staff training file. Staff spoke knowledgeably about abusive practices and what action they would take if this came to their attention. The home has a copy of the local authorities updated adult protection procedures. The three residents spoken to confirmed that they felt safe in the home. One resident said “If there ever was a problem (which there never has been.) Linda, Maggie or the staff would sort it out.” They also said that they would feel confident about approaching either. The home’s complaint log was seen, one complaint had been received since the last inspection and had been resolved to the complainants satisfaction. Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 Page 12 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 standard(s) 20, 24, 25 The home provides a comfortable and homely environment, and is flexible enough to meet a range of needs. The service users benefit from a range of specialist equipment designed to meet individual needs. The staff maintain a high standard of cleanliness and encourage service users to personalise their bedrooms. The facilities within the home ensure that service users are able to participate in domestic activity if they wish. EVIDENCE: There are several lounge/sitting areas, a courtyard and extensive private gardens, which are all accessible to residents. One resident said “I have my own garden which the handyman helped me with and it has a water feature”. The décor and furniture is of a domestic style and is in good order. Flooring is well maintained. Bedrooms contain furniture as required within the National Minimum Standards (NMS) and have en suite facilities. Residents have the opportunity to bring their own belongings into the home if they wish. There is adequate space in bedrooms and bathrooms for specialist equipment such as hoists, wheelchairs and specialist beds. Residents’ comments were positive about their bedrooms and each room viewed was individually Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 Page 13 decorated and furnished and contained personal items reflecting individual interests and tastes. Residents’ confirmed that they are consulted as to choice of decor and bed linen/curtains. There is an on-going programme of redecoration and refurbishment. Staff support residents if they wish to participate in light domestic tasks around the home and the cleaning of their rooms. In addition the home employs housekeepers. Bathrooms and toilets were clean and are lockable. The home has recently had a sum of money made available to replace and update the existing sluice facility. Communal areas meet space requirements cited in the NMS and are able to accommodate specialist furniture required by the service users. Environmental risk assessments are in place and are reviewed at lest annually Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 The staff group are an established team and staffing levels are sufficient to meet the current needs of residents. Staff are provided with training to ensure their competency and have the skills and experience needed to carry out their roles and are committed to the work they do. There is a satisfactory recruitment process in operation. EVIDENCE: All residents spoken to were complimentary about the care staff provide. A key worker system is in operation giving staff specific responsibilities for specific residents. All residents spoken to were aware of who their key worker was and all felt able to raise any problems with them should they arise. Discussion and records demonstrated that staffing levels set by the Care Standards Commission are adhered to. On the day of the inspection two nurses, and nine care staff were on duty on the morning shift, two nurses and seven care staff on the afternoon shift and one night nurse and five carers during the night. . All staff members spoken to felt that the current staffing levels were adequate. The home also employs an activities coordinator, handyman, administrator, housekeepers, chefs, and kitchen staff. Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 34, 35, 37, 38 The home is being led by a trained and committed manager. The environment of the home is generally safe, however an issue was identified, which could put a resident at potential risk, which needs addressing. There are suitable systems in place to safeguard residents financial interests. EVIDENCE: The manager and the assistant manager are competent through their experience and qualifications to run the home and they work closely as a team. The manager has 22 years experience in delivering care to older people. She has been the manager of the home for 3.5 years and has completed N.V.Q level Residents knew who was in charge and one commented that they would go straight to the manager if they had a concern. Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 Page 16 There are satisfactory policies and procedures including regular audits of the monies held in safe keeping by the home of residents who need this support. Residents have a family representative or solicitor as appointees, to manage their financial affairs if they are unable to do this for themselves. Assessments are documented in relation to health and safety issues that may arise from the environment of the home. Maintenance records are also kept. In relation to one resident who has recently experienced a large number of falls, could not be demonstrated that a risk assessment had been completed in relation to the possibility of further falls occurring and this is required. It is however acknowledged that other residents experiencing falls did have risk assessments in place to manage this risk. Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x 3 x x x 3 3 x STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x 3 x 2 2 Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 Page 18 No Are there any outstanding requirements from the last inspection? 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, OP37, OP38 Regulation 13 (4) (c) Requirement The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. Trends in relation to falls needs to be identified and acted upon sooner. Risk assessments/ management plans should be in place for all service users experiencing falls. Timescale for action October 31st 2005 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 33 Good Practice Recommendations As part of the homes quality assurance audit, it is recommended that an audit is completed by the home to identify the time taken to respond to call bells, and the temperature at which food is served. An appropriate action plan should be developed to ensure that call bells are answered within a maximum of five minutes and food being served to residents is hot. Altham Court Nursing Home C53-C04 S2528 AlthamCourt V248260 050905 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection Unity House, The Point Weaver Road Off Whisby Road Lincoln, LN6 3QN 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. 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