CARE HOMES FOR OLDER PEOPLE
Catherine Court Nursing Home Cressex Road Booker High Wycombe Bucks, HP12 4QF Lead Inspector
Guy Horwood Unannounced 27 April 2005 10:00 a.m. 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. Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Catherine Court Nursing Home Address Cressex Road, Booker, High Wycombe, Bucks, HP12 4QF 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) 01494 524850 Community Health Services Limited Care Home 60 Category(ies) of Dementia (30), Old age, not falling within any registration, with number other category (31) of places Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1 Elderly Physically Frail Including Respite 2 Elderly Mentally Impaired Including Respite 3 Admission of a specific Service User: This variation applies to a specific Service User, whose admission the home advised the Commission of. This variation will cease when the Service User leaves or is discharged and the home will notify the Commission accordingly. 4 That from the 19th of May 2004 the home`s registration is varied to enable the admission of a 64-year-old Service user. This variation will cease when the Service User leaves or is discharged and the home will notify the Commission accordingly. Date of last inspection 07 December 2004 Brief Description of the Service: Catherine Court Nursing Home is situated a short distance from the town centre of High Wycombe, in a residential area of the town. The town possesses a variety of shops and local amenities, and provides access to local and national transport networks. The home is owned by Care UK Ltd, and was purpose built for the provision of care. The home provides care with nursing, and can accommodate up to 60 residents, 30 of whom may be provided with care suitable for those with mental health or dementia type illnesses. 52 Service Users can be accommodated in single bedrooms, and 8 in the 4 shared rooms. All rooms have en-suite facilities, and a further 4 bathrooms and 4 shower rooms are provided. A qualified nurse is present within each unit of the home 24 hours a day, and is supported by a team of carers, housekeeping, catering and maintenance staff. Access to healthcare professionals is through direct contact, or by referral through the Service Users General Practitioner. Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection of Catherine Court took place on the 27th April 2005, between 11.40am and 3.30pm. The lead inspector was Mr Guy Horwood, who was accompanied by Mrs Caroline Roberts, (Inspector). The inspectors were met by one of the homes support team. The inspection consisted of meeting with Residents, visitors and staff, witnessing the serving of lunch, and viewing records relating to the running of the home and provision of care. The inspectors received the permission of residents to view some of their bedrooms, and viewed others from the doorway. The inspectors would like to thank the staff team for their co-operation and assistance during the inspection, and particularly the residents for allowing the inspectors into their home. What the service does well: What has improved since the last inspection?
The quality of food provided has improved following the return to work of the homes permanent cook.
Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 Page 6 The homes recruitment procedure and documentation has improved significantly since the serving of an enforcement notice following the last announced inspection. 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. Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 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 Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 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 The admissions procedure allows the home to make an informed decision as to whether they can meet a residents needs, as a consequence residents appeared to be placed appropriately. EVIDENCE: The home has an admissions procedure, which includes meeting with potential residents and/or their representative prior to admission. The records for the most recent admission were viewed and appeared complete and contained relevant information. Pre-admission visits are conducted by a senior nurse. Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 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) Not inspected during this inspection EVIDENCE: Not inspected during this inspection. Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 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) 12 & 15 One to one activities take place within the home, therefore residents receive stimulation and individual interaction with staff. The home’s catering standards have improved, making mealtimes more enjoyable for residents. EVIDENCE: The home has two activities organisers, one for each of the units. One of these activities organisers commenced in post three days prior to this inspection. The activities organiser on the elderly frail unit was noted to be engaged in one to one activities, with the residents relative also involved. The activities organiser was spoken with and stated that she would be liaising with an activities organiser from another of the organisation’s homes with a view to updating her knowledge. The home’s regular cook has returned from maternity leave, and a relative expressed that this has led to an improvement in the quality of food provided. The inspector was present during lunch, this appeared well presented and offered choice. Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 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) EVIDENCE: These standards were not assessed at this inspection. Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 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) 19,20,21,24,26 The home is in need of extensive redecoration and refurbishment to provide the residents with a safe and comfortable environment. In places there were odours, which made the environment unpleasant for residents. EVIDENCE: The majority of the bedrooms are single occupancy, and all have en-suite facilities. The room sizes meet with National Minimum Standards. Suitable furnishings are provided in bedrooms, however, it was evident that a large amount of these furnishings are in need of replacement due to general wear and tear through age and continuous use. Communal areas had peeling wallpaper, stained carpets and worn furnishings. The kitchenettes in both dining areas have missing draws, poorly hung doors and chipped work surfaces. These are required to be refurbished. In some showers and bathrooms, loose tiles, damaged flooring and unpleasant odours were noted. Through discussion with the organisation’s regional manager following the inspection, it was ascertained that an extensive programme of refurbishment is planned within the home.
Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 Page 13 The courtyard was pleasant and well maintained, and provided seating for residents in the better weather. On the day of inspection unpleasant odours were present throughout a large part of the home. Cleaners employed by the home were noted to be attempting to address this issue. Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 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 &29 The home does not have enough contracted staff to provided continuity of care for residents. The vetting and recruitment practices of the home appear adequate ensuring the safety of residents. EVIDENCE: Staffing rotas were viewed and the senior nurse on duty was spoken with. From this it was ascertained that one trained nurse and six carers are to be on duty on each unit throughout the waking day. During the night staffing levels are set at one trained and two care staff on each unit. From analysing the rotas it was evident that the home does not have enough contracted staff to meet the staffing obligations as detailed above. Through discussion with staff and relatives and supporting documentation it is evident that the home is dependent on the use of large numbers of agency staff and the homes contracted staff working excessive hours. The rota is not an accurate record of staff working within the home. Recruitment records for the most recently employed staff were viewed, and these were found to be complete, well maintained and to contain the required information. Recruitment records have improved significantly since the previous inspection. Evidence of ongoing recruitment was seen. Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 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) 32 & 38 Currently there is no clear sense of direction or leadership within the home, this could potentially place residents at risk. The home is not being pro-active in ensuring that potentially harmful items are stored appropriately, which potentially places residents at risk of significant harm. EVIDENCE: The manager is currently on extended leave. The Organisation have placed a team of support staff within the home to cover the managers absence and address ongoing issues. The support team consisted of a nurse, carer, administrator and manager. At the time of the inspection three members of the support team were present within the home, who stated that they were due to remain at the home until July 2005.
Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 Page 16 Through discussions with staff and visitors it was ascertained that staff morale is low, due to the continued uncertantey about the management structure within the home. Through discussion with staff it was ascertained that individual supervision is not taking place. The home had recently been visited by the Health & Safety executive. This had lead to the home being required to take action to address hot water temperatures running at above 45 degrees celcius. During the tour of the premises, prescription creams and latex gloves were noted in bathrooms and en-suites. Due to the catergory of residents accommodated by the home, it is not safe for these items to be on display. Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 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 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 1 1 1 x x 2 x 2 STAFFING Standard No Score 27 2 28 x 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 x x 1 x x x x x 2 Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 Page 18 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. 2. 3. Standard 26 38 19 Regulation 16(2)(k) 13(4)(a) and (c) 23(2) Requirement The premises are to be kept clean, hygienic and free from offensive odours throughout. Prescription creams, lotions and latex gloves must be stored appropriately. The organisation is to forward a detailed action plan pertaining to the planned refurbishment, decoration and repair within the home. The home is to forward an action plan of how they will address the issues identified during the Health and Safety Executives visit. The rota needs to reflect accurately staff employed at the home. Timescale for action 01/06/05 27/04/05 01/06/05 4. 38 10(1) and 13(4) 01/06/05 5. 27 18(1)(a) 01/06/05 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.
Catherine Court Nursing Home H53_H02_S19188_Catherine Court_V222073_UI_270405_Stage 3_GH_ces.doc Version 1.30 Page 19 Refer to Standard Good Practice Recommendations Commission for Social Care Inspection Cambridge House, 8 Bell Business Park, Smeaton Close, Aylesbury, Bucks, HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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