CARE HOMES FOR OLDER PEOPLE
Church Court Care Centre Church Street Stroud Glos GL5 1JL Lead Inspector
Ruth Wilcox Announced 12 September 2005 09.00 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. Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Church Court Care Centre Address Church Street Stroud Glos GL5 1JL 01453 762293 01453 753161 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) Mrs Sally Robert & Mr Jeremy Walsh Mrs Rita Poole Care Home 18 Category(ies) of Old Age not falling within any other category registration, with number (18) of places Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 11 February 2005 Brief Description of the Service: Church Court is a Grade II listed building dating back to the 17th Century. It is situated next to the parish church in the centre of Stroud and is within easy reach of the shops and local amenities. The home is part of the Blanchworth Care Group. Church Court is registered to provide personal care for eighteen people over the age of 65 years. Care is offered on a long or short-term basis, and nursing care is accessed from community sources if needed. The accommodation is arranged on three floors, all of which can be accessed by a shaft lift. The communal areas consist of two lounge areas and a dining area in the conservatory. There are three double bedrooms all of which are en-suite. There are also twelve single bedrooms, nine of which are en-suite. There is a well tended, attractive garden which is easily accessible to the residents. Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector undertook this announced inspection over five hours on one day in September. The home manager was not available for the inspection, and the deputy manager and the director of care for the company were present throughout, providing assistance where required. The home appeared organised, was welcoming, relaxed and homely. Care records, medication management, the standard of meals, and the opportunities for residents to pursue independence and choices were inspected, including how those requiring assistance with the safekeeping of their valuables or monies are protected. The systems for allocating staff, their recruitment, training and supervision were looked at, as were the arrangements for addressing complaints and monitoring the quality of the service. A partial tour of the premises took place, and the arrangements for ensuring the health and safety of all living and working at the home was inspected. Staff were observed going about their duties whilst interacting with the residents. The care of three residents in particular was closely looked at. Thirteen residents were spoken to directly to obtain their view of the care and services they receive in the home. There was direct contact with five staff, all of whom were very welcoming and helpful, and were open to the inspection process. What the service does well:
Church Court provides a character filled older style environment for the residents, homely in style, with a very attractive garden, which residents thoroughly enjoy in the summer months. There is a continuous programme of maintenance, and the building and fixtures, fittings and equipment are maintained in a safe condition. Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 Page 6 Each resident has a full assessment of their needs before going into the home, and comprehensive and informative care plans are devised on that basis. The home engages with external health care providers to ensure that residents’ health needs can be fully met. Residents are able to manage their own medications if they want, and are able to, though there are safe systems for managing medications on behalf of residents. There is also a safe and accurately maintained system for looking after residents’ monies and valuables, for those choosing to use this service. Residents seem to enjoy a good standard of meals here, with residents themselves confirming that they have a good choice, quality and quantity of food. There is a stable staff group at Church Court, and as such there appears to be good familiar relationships between the residents and staff, with residents’ satisfaction levels regarding their care quite high. Residents indicate that staff are respectful of their privacy, and that they are able to pursue their personal choices, within any limits of their ability. There are established procedures for addressing any areas of concern or complaint, and residents’ views and opinions about the home are sought formally as part of the home’s commitment to monitoring its performance and service. Residents themselves indicated that they felt the staff would be receptive to their concerns, and had confidence in the staff to deal with any concerns that might arise. There are good training opportunities for staff to develop the skills necessary for their role, and a significant percentage of the staff have achieved their NVQ level 2 award. What has improved since the last inspection?
Staff now ensure that residents’ care records are no longer inappropriately left in accessible places, so that the security and confidentiality of such records can be properly maintained. The lounge and dining room have been newly carpeted, and remedial maintenance works continue to an area of wall in the lounge. The work top sealant in the kitchen has been renewed in the interests of hygiene. Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 Page 7 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. Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 Page 8 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 Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 Page 9 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. All residents are admitted to the home on the basis of a full assessment of their needs, ensuring that they can receive the care that they require. EVIDENCE: Pre-admission assessments for prospective residents have been performed by the home’s staff in hospital or in the person’s own home, as appropriate. The pre-admission assessments for three residents who were part of the case tracking exercise were seen to be adequately comprehensive. Where applicable, records contained evidence of information gathering with other health care professionals or Social Services who had previously been involved in the care of the individual. Church Court does not provide intermediate care. Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 & 10. There is a consistent care planning system in place, which adequately provides staff with the information they need to satisfactorily meet residents’ health and personal needs. The systems for the administration of medications are good, with clear arrangements in place to ensure residents’ medication needs are met. Care and support is offered in such a way as to promote the privacy and dignity of the individual. EVIDENCE: Each resident has an individual plan of care, which is based on an assessment of all their needs, including risk assessments. Three were selected as part of the case tracking exercise. In the main care plans are well written, are done so in consultation with the resident concerned, and are regularly reviewed. Each plan that formed the case tracking exercise contained clear instructions as to how each individual’s health needs are to be met, with visual evidence confirming that this is carried out.
Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 Page 11 Records contained evidence of appropriate medical interventions and access to health care services for residents, with good multi disciplinary working being carried out in order to meet all health needs. The system for handling residents’ medications is safe and well managed. With one exception staff have received accredited medication training. All medications are stored appropriately, with clearly printed Medication Administration Records from the supplying pharmacist. These records are thoroughly recorded by the staff, and are well maintained. Although there is evidence to confirm that residents are able to self-medicate if they wish and are able to on the basis of a documented risk assessment, there is no one currently doing this. Care plans are written in a sensitive way, and show due regard for the privacy and dignity of the individual. Residents spoken to were satisfied with the care they receive, confirming that staff are respectful of their needs and choices. One person confirmed that staff knock on her door before entering, and are ‘very good, gentle and respectful’. Two residents were reluctant to speak to the inspector, saying that they had nothing to grumble about and that they were ‘OK’. Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 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 standard(s) 14 & 15. Respect is shown to residents’ personal choices, in order that they are enabled to maintain some control over their lives wherever possible. Dietary needs of residents are well catered for, with a balanced and varied selection of food available that meets their tastes and choices. EVIDENCE: One resident said that he enjoyed a good degree of independence and was able to exercise his personal choices, of which staff were respectful. Others were evidently spending their time, where and how they chose. Some were less able, and as such were more reliant on the staff to help them pursue certain choices; one such person said that he was able to express his choices under these circumstances, with staff attentive to this. Advocacy information is made available to residents and their families, which may be of interest to some. Residents are able to source community services, such as their own dentist and optician if they do not wish to use services sourced by the home. One resident was not happy to be living in a home at all, and as such required a lot of reassurances from the staff and her family. Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 Page 13 Menus show a range of varied and nutritious meals available for residents, and from conversations and observation of the lunch it was clear that they are also offered choice with their meals. Despite this, one person said that she ‘eats what’s put in front of her’. The meal looked wholesome and appetising, and residents confirmed their enjoyment of it, with the exception of one person who was clearly not enjoying her main course. The vast majority of residents spoke positively about the quality and quantity of food provided for them. Special diets and adapted eating aids can be provided. Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 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 standard(s) 16. The home has a satisfactory complaints system, with evidence that residents feel that any concerns they may have are listened to and acted upon. EVIDENCE: Information on how to make a complaint is contained in the complaints procedure displayed on the public notice board. Residents confirmed that staff were always attentive to them, and said that they feel confident that staff would be receptive to any concerns they might have, and would address them. There were no formal complaints recorded in the register to inspect. Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 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 standard(s) 19 & 25. The standard of the environment in this home is satisfactory, with appropriate attention to safety aspects, to ensure the safety and comfort of the residents. EVIDENCE: Since the last inspection the lounge, dining room and a ground floor bedroom have been recarpeted, and additional repairs have been carried out to a large wall crack in the lounge. Remedial work has been carried out in the kitchen to repair some sealant around the work surfaces; it is reported that a kitchen refurbishment is planned, the timescale for which is not known at this time. The building is very old, and is generally well maintained and decorated. The garden to the rear of the property is very attractive and well maintained, and as such is a source of great enjoyment for the residents. There is a range of cyclical maintenance that is carried out at designated times, and records of this are kept. These records include evidence of regular monitoring and recording of hot water temperatures, in order to ensure safe temperatures for the residents. Radiators are fitted with a protective guard for the safety of residents, and
Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 Page 16 upstairs windows are fitted with discreet chains to ensure a safe opening width. Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 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 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 & 30. Staffing provision is adequate to meet the needs of the residents currently living in the home. The failure to adhere to the recruitment procedure, and carry out full preemployment checks thoroughly in every case could place residents at risk. The arrangements for the induction and training of staff are good, with staff able to have a clear understanding of their roles. EVIDENCE: Staff rotas demonstrate the provision of care and ancillary staff. It is the routine for three care staff to be on duty during all day time hours, though there is a variation to this during the afternoon and evening at the weekend, when there are only two staff on duty. Although this poses a degree of concern about how two staff safely meet the needs of the residents, there appears to be no problem achieving this at the current time, given the dependency levels of the residents currently accommodated. The director of care confirmed that this arrangement is kept under review regarding its continued suitability. Two waking night staff provide care overnight. Ancillary support is provided from a cook, a domestic assistant and maintenance person. Staff were observed as they carried out their duties, and from conversations with residents appeared to be meeting their needs in a timely way. There has been no recent recruitment to the home, with a quite stable staff group in place; however, the records for three care staff were inspected.
Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 Page 18 Each of these showed that in the main appropriately robust recruitment procedures and pre-employment checks are carried out. In one of these cases an omission to adhere to this procedure in full had resulted in a CRB and POVA disclosure being received after employment had commenced, with no POVA First disclosure sought. There are good training opportunities for staff in the home, with training records showing that a structured induction training programme is given to new staff, with an additional in-house training programme implemented as well. One newer member of staff is currently undergoing additional training to the foundation standard. Other records showed a wide range of training undertaken, all of which was entirely relevant to the staff’s role. The home has made very good progress with the NVQ training programme, with at least 75 of them having achieved a level 2 NVQ. Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 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 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) 33, 35, 36 & 38. The systems for resident consultation in this home are satisfactory, with evidence that residents’ views are both sought and acted upon. Good management systems are in place to ensure that the health, safety and welfare of the residents is safeguarded. EVIDENCE: Periodic residents’ meetings are held, which offer the residents the opportunity for any discussion they might choose. Their views are sought formally with the use of satisfaction surveys, the most recent one being in March 2005. The results of such surveys are published, with action plans drawn up to address any areas of concern. The home routinely uses a satisfaction survey for any respite service user at the end of their stay. Comments and Suggestions cards are displayed in the home for anyone to complete if they wish.
Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 Page 20 Some residents have placed personal money and valuables with the home for safekeeping. Thorough records for each person, which include transaction details, running totals, and receipts, are kept. Residents or their representative can sign to acknowledge transactions, but where this is not possible in the majority of cases, two staff members sign the record to witness on behalf of the resident. A random check on the arrangements for two residents proved to be accurate. A formally recorded staff supervision programme has been successfully implemented; an audit tool shows that most staff will be receiving the recommended minimum number of six sessions during the current twelvemonth period. There was evidence that health and safety issues are addressed satisfactorily in this home, with written policies, procedures and risk assessments, provision of necessary equipment and staff training. Four staff are currently qualified to provide First Aid. All necessary safety checks and maintenance of equipment is undertaken in a timely fashion. Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 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 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x 3 x STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x 3 3 x 3 Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 Page 22 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 29 Regulation 19(1.b.i) Requirement The Registered Person must ensure that in extreme cases where it has been deemed necessary to employ a worker pursuant to the receipt of a CRB disclosure, a POVA check has been received in the first instance. Timescale for action 31/10/05 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. Refer to Standard Good Practice Recommendations Church Court Care Centre d51_d03_s16409_Church Court_V189273_120905_Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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