CARE HOMES FOR OLDER PEOPLE
Carders Court Nursing Home 23 Ivor Street Castleton Rochdale Lancashire OL11 3JA Lead Inspector
Bernard Tracey Unannounced Inspection 28th November 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 Carders Court Nursing Home DS0000017322.V254325.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. Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Carders Court Nursing Home Address 23 Ivor Street Castleton Rochdale Lancashire OL11 3JA 01706 712377 01706 869391 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) BUPA Care Homes (CFH Care) Limited No. 2741070 Care Home 150 Category(ies) of Past or present alcohol dependence (1), registration, with number Dementia (1), Dementia - over 65 years of age of places (60), Old age, not falling within any other category (90), Physical disability (2) Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 150 service users to include:Linden House - up to 30 service users in the category of DE(E) (Dementia over 65 years), for nursing care; and up to 1 Adult with Dementia (DE). Rakewood House - up to 30 service users in the category of OP (Old People over 65 years), for nursing care; to include up to 2 service users in the category of PD (Physical disability under 65 years), but to be aged between 50 and 65. Brookfield House - up to 30 service users in the category of DE(E) (Dementia over 65 years). Arkwright House - up to 30 service users in the category of OP (Older People over 65 years). Garfield House - up to 30 service users in the category of OP (Older People over 65 years); to include up to 1 named service user in the category of A (past alcohol dependence - the registration should revert back when this person leaves or becomes 65 years of age. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 25th January 2005 2. Date of last inspection Brief Description of the Service: Carders Court Care Home is situated on the outskirts of Castleton town centre close to shops and other amenities and is near to the main bus route. Carders Court consists of five separate units each providing care to meet the differing needs of the service users. Two units provide care for residents with a dementia (Linden and Brookfield House), two provide personal general care (Arkwright and Garfield) and one unit (Rakewood) provides general nursing care. Each unit has 30 beds, and all personal accommodation is provided in single rooms that are on the ground floor. The communal areas on each unit comprise a lounge, dining area, conservatory and a smoking area. Garden and patio areas surround each unit. There is a central administrative block that contains the main office, kitchen and laundry areas and a hairdressing salon. Ample parking areas are provided for visitors and staff.
Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 5 Carders Court provides care for 150 people, male or female, generally over the age of 65 years. Care can be provided for an agreed number of young adults, who are aged between 50 and 65 years of age, who have physical disabilities. The registered provider is Care First Health Care Ltd. owned by BUPA. Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over two days beginning on Monday the 28th November 2005. The inspection involved looking at records, talking to management, eleven staff, ten residents and four visitors. Resident’s care records were examined and a tour of the home was undertaken. At the time of the visit the manager was not registered with the Commission for Social Care Inspection. An application was being processed. There were one hundred and thirty people living in the home on the day of the visit. The home was inspected as a whole and any concerns regarding individual units were discussed with the unit manager and the general manager. What the service does well:
This is a care home where residents are well looked after. The staff team work well together and show a good understanding of the needs of the people living at the home. The home provided appropriate training for staff to ensure they were able to meet the needs of the people who lived in the home. Staff awareness regarding privacy, choice and dignity had a positive impact on the lives of residents. Residents said they were treated with respect. One resident said staff treated her ‘kindly’ another said she ‘felt safe’. The home was good at making relatives feel comfortable and welcomed into the home. Visitors said they were kept informed about important matters and consulted about the care of their relatives. Generally the standard of care planning was good and showed how residents needs would be met by staff. Residents were only admitted once the home could confirm that they would be able to meet the resident’s needs. Care plans are reviewed regularly. The home provids a varied activity programme to meet resident’s choices, expectations and needs. Residents said they were able to join in or spend time in their rooms. The home offers a varied and nutritious diet that residents enjoyed. A choice
Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 7 of meal was always available and there was also an ‘alternative menu’ for those who did not like any of the choices offered. One resident said the ‘food is good’ another said ‘there is always something nice to choose from the menu’. Residents and relatives were aware of whom to raise any concerns or complaints with and were confident they would be listened to and staff would try to resolve the problem. The standard of environment, both internally and externally, was good, providing residents with a bright, clean, comfortable and safe place to live. Relatives commented positively about the cleanliness of the home. One resident said ‘I have my own room and I enjoy it’. Residents said they could bring in their own items to ‘try to make it more like home’. The gardens were safe and accessible for residents and their visitors. One resident said the ‘gardens were beautiful’. Staff were enthusiastic and positive; this improved the quality of life for the residents. One visitor said her relative was ‘very contented, looks well and is very peaceful’. Others said their relative ‘was really looked after’. What has improved since the last inspection? What they could do better:
The care plans did not show that residents or their representatives had been involved in the development or reviews. The manager was aware of this and was taking steps to address the problem. The home needs to arrange a contract with a firm that is registered to dispose of unwanted medication. A system needs to be put in place to check that all resident weighing scales are working properly and weighing accurately.
Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 8 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. Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 9 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 Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 10 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): 3. Standard 6 does not apply to this home. Assessment of individual need is made before each resident moves into the home to ensure that the home can provide the care needed by the individual. EVIDENCE: Further progress has been made with developing the Statement of Purpose and the Service User’s Guide to ensure that residents and their relatives are provided with accurate and up to date information concerning the facilities offered at the home. Brookfield House now provides residential care following an application by the Registered Person for a variation in registration to change from nursing care to residential dementia care. The records of ten residents were examined and were found to contain full assessment information that had been obtained prior to admission, therefore ensuring that the home could meet these needs. Some residents were able to confirm that they had been involved in their assessment and were happy that their needs were being met by the home.
Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 11 The staff spoken to were well aware of the care needs of the individual residents and this was confirmed during the inspection through observations of the care practices being carried out. Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 12 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 Resident’s welfare is closely monitored and health needs were met. The home is not consistently good at involving residents or their representative in the development or review of care plans. The ordering and administration of medication was well managed but the disposal of unused medication on two units was not. Staff awareness regarding privacy, choice and dignity had a positive impact on the lives of residents. EVIDENCE: Individual records are kept for each resident and contain comprehensive information relating to all aspects of health, personal and social care needs of the residents. From this information an individual plan of care is drawn up. Significant events had been recorded and daily entries made setting out the care given.
Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 13 The records of ten residents were looked at in detail and these clearly described the healthcare needs of the residents. Evidence was seen of the monthly reviews carried out to ensure that the care plans continue to meet individual needs. Not all units provided written evidence of residents or their representatives being involved in the drawing up and review of individual care plans. Residents spoken to confirmed that they were happy with their care and that the staff were very good and anything they wanted they only had to ask for. A relative spoken to during the inspection also confirmed that She was kept informed of anything that affected the care and that the staff were very supportive and caring. Risk assessments were in place and covered such areas as moving and handling, nutrition, pressure sores, the use of bed rails and falls. The residents were weighed at least on a monthly basis and the weight recorded on a chart kept in their care plan. However one record seen on the Nursing unit indicated a marked fluctuation in the weight of one individual but no evidence of an intervention by the staff to investigate the cause. A discussion with the unit manager suggested that the scales needed re-calibrating and an undertaking was made to ensure that this was done without delay. A discussion with the residents identified that they had access to other health care professionals, such as dentists, opticians, chiropodists and district nurses. Evidence of these visits was kept in the residents’ individual files. The medications system was safe. Medications were securely stored; the prescription administration sheets were filled in accurately and there was an accurate record of medicines received into the home but arrangements have not been made for the disposal of unused medicines from the two nursing units. Designated and appropriately trained staff administered medicines. All members of staff receive instruction and training in preserving the privacy and dignity of service users on induction, and a signed form indicates acceptance that the training has been given and received during the induction process. Medical examination and personal treatment is provided in the privacy of the service users own room. Relatives and friends are encouraged to visit as often as possible and the home operates an open visiting policy, which is referred to in the Statement of Purpose and confirmed in discussion with residents’ relatives at the inspection. A discussion with the residents identified that they feel their privacy is respected and that they are treated with kindness. Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 14 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 and meals are both well managed, creative and provide daily variation and interest for people living in the home. Visiting arrangements at the home are informal and family and friends of residents are encouraged to maintain contact therefore maintaining and promoting personal relationships. EVIDENCE: There was information on the notice boards about a range of activities and entertainments available both inside and outside the home. Three residents said they could either join in or spend time in their rooms ‘reading or watching television’. Residents and staff said the routines of the home were flexible to suit people’s needs and they were offered choices about many aspects. One resident said ‘I can do what I like’. Another said ‘I like it here’ and ‘I can help out now and again’. Visitors said staff and management made them feel welcome and they were able to visit in private. A resident said his visitors could visit at any time. Residents were encouraged to maintain links with their families, friends and community groups. One resident was being visited by his daughter who told the inspector that she had “nothing but praise” for the staff. Residents confirmed they received a varied and nutritious diet which they
Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 15 enjoyed. A choice of meal was available and there was also an ‘alternative menu’ for those who did not like any of the choices offered. The cook visited each unit and had worked very hard to meet the choices and preferences of residents. There is also a catering quality group attended by the cook, manager and selected residents where comments suggestions and complaints can be addressed. The next meeting of this group was due to be held at a local hotel the following week. The food was served hot and was nicely presented. One resident said the ‘food is good’ another said ‘there is always something nice to choose from the menu’. The home provides a suitably portioned plate for residents who require a pureed diet so that all elements of the meal are separated. Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 16 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 The complaints process in this home was good and residents and their relatives were confident any concerns would be dealt with. EVIDENCE: Arrangements for complaints are handled well and taken seriously ensuring people feel listened to. Procedures for dealing with and reporting abuse were satisfactory ensuring people are adequately protected. Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 17 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 20 22 24 26 The home has a planned maintenance and renewal programme for the redecoration and refurbishment of the home to ensure residents live in a comfortable, homely and safe environment. EVIDENCE: The home was bright, clean, safe and well maintained. Relatives commented positively about the cleanliness of the home. There is a programme of routine maintenance and renewal. Those units that had not received new furniture were due to be refurbished within the near future. Grounds were accessible and safe. Seating and patio areas were available. Some resident’s enjoyed access to the gardens and patio areas directly from their rooms. Bird tables and attractive planters had been placed near to windows. One resident said the ‘gardens were beautiful’.
Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 18 Bedrooms were generally clean and odour free. Residents said they could bring in their own items to ‘try to make it more like home’. Some residents had keys to their rooms and had chosen to lock the doors. Lockable storage was supplied in all rooms. One resident said ‘I have my own room and I enjoy it’. Aids are provided around the home to assist the staff with caring for the resident and also to encourage independence where ever possible. Radiators throughout the home have a guaranteed low temperature surface to protect residents from the risk of burning. Hot water temperatures throughout the home are checked and delivered at a safe temperature in line with health and safety guidelines. Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 19 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 30 Staff are well trained to ensure they have the competencies to meet residents needs. The deployment of staff throughout the day is sufficient to meet the needs of residents. EVIDENCE: The Inspector examined the rotas and found that the staffing levels were sufficient on each unit for the number of residents, to meet their needs. Residents said ‘ staff do their very best but are busy’. Other comments included staff are very ‘kind’ and ‘nice’. One visitor said her relative was ‘very contented, looks well and is very peaceful’. Training is very high on the agenda and comprehensive records are kept of the training undertaken by staff. Staff spoken to informed the Inspector of the training that they had undertaken. They stated that they are encouraged to attend courses and given the time and support to do this. Staff spoken to said that they were clear about their role and work well as a team to ensure the individual and collective needs of the residents are met. Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 20 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): None of the key standards were fully assessed on this inspection EVIDENCE: Mrs Susan Haigh has recently been employed to manage the home. An application to register her with the Commission for Social Care Inspection is being processed. The key standards were not inspected on this occasion. They will be assessed at the next inspection. Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered person must ensure residents or their representative are involved in the review and development of the plan of care. The Registered Person must ensure that an accurate record of residents’ weights is maintained through the correct calibration of the weighing scales. The Registered Person must ensure that medicines are disposed of in accordance with the relevant legislation. Timescale for action 30/01/06 2 OP8 14 30/01/06 3 OP9 17 01/01/06 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 Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 23 Carders Court Nursing Home DS0000017322.V254325.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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