CARE HOMES FOR OLDER PEOPLE
Church Court Care Centre Church Street Stroud Glos GL5 1JL Lead Inspector
Mrs Ruth Wilcox Unannounced Inspection 13th March 2006 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 Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 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. Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Church Court Care Centre Address Church Street Stroud Glos GL5 1JL 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) 01453 762293 01453 753161 Mrs Sally Roberts Mr Jeremy Walsh Mrs Rita June 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 DS0000016409.V277357.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th September 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 DS0000016409.V277357.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection on one day in March 2006. The home’s manager was present throughout the inspection, providing assistance and information as requested. The availability of information about the home to assist prospective residents and their families in making their choice about it was looked at. Care records were inspected, and the care of two residents was closely looked at in particular. There was direct contact with ten residents, two visitors and two other staff. Their views regarding the standards of services and care at the home were sought wherever practicable. The opportunities for residents to engage in social activities were looked at, including the arrangements to receive their visitors. The management arrangements, and the policies and procedures for protecting the safety and rights of vulnerable residents were inspected. A tour of the premises took place, with particular attention to the standard of maintenance and cleanliness. The provision and training of staff was inspected, and staff were observed at various times throughout the visit, whilst going about their duties and interacting with the residents. What the service does well:
Prospective residents and their families have access to a good amount of information about Church Court ahead of their admission, in order that they can make an informed choice about moving there. There is a stable staff group here, which is led by a long serving and experienced manager. Each resident’s personal care needs are well met at Church Court, with staff working in partnership with external healthcare professionals in order to meet health needs as well. Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 Page 6 One such visiting health care professional was entirely satisfied with the care her patient was receiving in the home, speaking positively about the staff and the care here. Staff were observed at various times, and on each occasion were courteous and attentive, and were mindful of individuals’ privacy, choices and level of independence. Residents, without exception, were satisfied with the care they received, with life in the home, and with the staff. A social activities programme is available, in which residents can participate or not, according to their choice. Residents are encouraged to pursue their personal interests also. Visitors are welcomed into the life of Church Court, and residents are well supported to maintain their close contacts with family and friends. A visitor was very complimentary about all aspects of the home. Members of staff are provided with the opportunity to attend a variety of training to equip them to care for each person appropriately. What has improved since the last 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.
Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 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 the following standard(s): 1. The pre-admission information ensures that residents have access to adequate information when making their choice about the home. EVIDENCE: A copy of the home’s Statement of Purpose and the Service User Guide is readily available in the entrance hall, for anyone choosing to read them. Copies of the Service User Guide are issued to each prospective resident from the registered provider’s head office. These documents are reviewed and updated as and when needed, the most recent review of information having been carried out in September last year. Church Court does not provide intermediate care. Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 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 the following standard(s): 7, 8 & 10. There is a clear care planning system in place, which in the main provides staff with the information they need to meet residents’ health and personal needs; isolated gaps in this system could pose a degree of risk to residents. The people living here are treated with respect and courtesy. EVIDENCE: Each resident has an individual plan of care, which is based on an assessment of their needs, including a range of risk assessments; two were selected as part of the case tracking exercise. Care plans are regularly reviewed. On the whole, they contain explicit instructions to address any specific requirements. However in one case, although it had been identified that the person concerned was at risk of developing a pressure sore, no care plan had been recorded to address this need; case tracking showed however, that all appropriate care and support equipment was in place to address the need. Plans demonstrated very good collaborative multidisciplinary working with a wide range of health care professionals where applicable. Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 Page 10 In one case, the district nurse was attending regularly to carry out wound dressings; although primarily her responsibility, there was no recorded plan of care for the staff to follow, for any action and care necessary in the home. A visiting health care professional was entirely satisfied with the care her patient was receiving at Church Court, saying that she had confidence in the staff’s good standards of care, that they always called her appropriately, and carried out her instructions fully and properly. Residents themselves were all very complimentary about the staff team, and indicated high levels of satisfaction regarding their care, and the way that staff are consistently mindful and respectful towards their privacy and dignity. Some residents were in the dining room having their hair done by the visiting hairdresser; although this has the potential to compromise dignity, those spoken to were entirely happy about this arrangement. Throughout the day, members of staff were observed and overheard addressing the residents in a respectful and sensitive fashion. All personal care appeared to be given in privacy. Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 Page 11 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. A planned activities and entertainments programme enables residents to have regular and varied opportunities for social activity, with visiting arrangements ensuring that they can keep close contact with their families and friends. EVIDENCE: There is a regular weekly programme of planned social activities for residents, which includes group games, entertainment, gentle exercise and religious services. Residents’ past interests and hobbies are ascertained during the assessment process, and records of activities and of those taking part are maintained. Some residents were pursuing their personal interests such as reading, television and radio, knitting and crossword puzzles. Residents said that the staff are very sociable with them, and that staff always respected individual choices regarding participation in activities. Staff demonstrated their practice of entering into social discourse with residents at all times, including during the delivery of personal care where appropriate. The home provides a relaxed environment for visitors, and does not place any restrictions on them. One visitor was seen, who was happy to confirm that she was always made to feel very welcome when visiting her close friend, saying that the staff had a ‘lovely attitude’, and were ‘very caring and helpful’ to her and her friend.
Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 Page 12 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): 18. The home’s Adult Protection policies help to provide a safe environment for the residents. EVIDENCE: The home has a written policy on abuse, and has a Whistleblowing procedure for staff to follow if they had any concerns, which was easily accessible. Staff have undertaken adult protection training, and those spoken to were able to talk confidently and knowledgeably about the issues, demonstrating a clear understanding of what to do if they had any concerns. Residents themselves confirmed that staff were very respectful to them, and were always mindful of their choices. Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 Page 13 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 & 26. The standard of the environment at Church Court is generally satisfactory, and provides residents with a comfortable and clean place to live. EVIDENCE: The maintenance person was present in the home during this visit. An urgent repair was being carried out, and there is also a range of cyclical maintenance work and safety checks, which are routinely performed and recorded. There are several areas of woodwork, such as painted doors and skirting boards that are very clearly showing signs of wear and tear, and patches of wallpaper in the lounge are stained and marked from wear and tear also. The small garden is well tended, and provides a very pleasant area for residents to enjoy. All areas of the home were cleaned to a fair standard, and were completely odour free. Some areas had not been cleaned at the point of being inspected, but were due to be attended to later in the day. Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 Page 14 Clinical waste is managed safely. The sluice room is clean and secure, although several large containers of chemicals are stored on the floor in here, restricting access to the hand basin. The laundry room was orderly and clean, and contains a washing machine with a sluicing disinfection cycle. Gloves, aprons, liquid soap and paper towels are provided throughout the home. Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 Page 15 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 & 30. Staffing provision is adequate to meet the needs of the residents currently living in the home, with staff having good training opportunities in order that they can fully understand their roles. EVIDENCE: There is a small and stable team of staff at Church Court. A staff rota is maintained, which shows that there are three care staff on duty during the day and evening, with two staff providing night cover. There is a variation to this however, with only two carers on duty in the afternoon and evening at weekends; this arrangement is continually under review, to ensure that it does not compromise the staff’s ability to meet the needs of the residents at those times. An ancillary team of cooks, cleaners and maintenance personnel supports the care team. Residents and visitors all confirmed that the staff are ‘very kind and caring’. The evidently capable and hard working staff who were working on this day were carrying out their caring duties very attentively. The staff training programme demonstrates that there are regular training opportunities for them, with a range of mandatory and optional training relevant to their roles being undertaken, including access to the NVQ programme. Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 Page 16 New staff attend formal and structured induction training of at least three days at a training centre, and also complete an induction programme specific to Church Court. New staff work under supervision during this period. Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 Page 17 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): 31. There is an experienced manager in place here, to ensure that the health and safety of the residents is safeguarded. EVIDENCE: The home’s manager has long experience of caring for people in this setting, and has been at Church Court for seventeen years; this is her fifth year here as the manager. She is registered with the CSCI, has achieved the NVQ level 4 in care, and the Registered Manager’s Award, and has undertaken regular training specific to her role. Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 Page 18 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X X Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 Page 19 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(1) Requirement The Registered Manager must ensure that staff document fully and appropriately detailed plans of care for residents who are • Assessed as being at risk of developing pressure sores • Under the care of the District Nurse regarding the management of a wound and/or dressing The Registered Manager must ensure that the damaged areas of woodwork and wallpaper in a number of areas of the home are prioritised for repair, with an anticipated date for the work identified. Timescale for action 30/04/06 2 OP19 23(2.b) 30/04/06 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 Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 Page 20 1 OP26 The Registered Manager should find alternative storage arrangements for the containers currently on the floor in the sluice room. Church Court Care Centre DS0000016409.V277357.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Gloucester Office Unit 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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