Inspection on 12/09/07 for Collingwood Court Nursing Home

This inspection was carried out on 12th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Collingwood Court Nursing Home 19/11/08

Collingwood Court Nursing Home 14/12/06

Collingwood Court Nursing Home 27/02/06

Collingwood Court Nursing Home 16/06/05

Collingwood Court Nursing Home 06/01/05

Collingwood Court Nursing Home 03/08/04

Collingwood Court Nursing Home 12/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Collingwood Court Nursing Home Collingwood Court Rear Of 1-95 Nelson`s Row Clapham London SW4 7JR Lead Inspector Mary Magee & Rosemary Blenkinsopp Unannounced Inspection 12th September 2007 07:45 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 Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 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. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Collingwood Court Nursing Home Address Collingwood Court Rear Of 1-95 Nelson`s Row Clapham London SW4 7JR 020 7627 1400 020 7720 1998 askent@bupa.com 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) ANS Homes Limited Pamela Mauchaza Care Home 80 Category(ies) of Dementia (52), Mental disorder, excluding registration, with number learning disability or dementia (52), Old age, of places not falling within any other category (28) Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE (maximum number of places: 52 Mental Disorder, excluding learning disability or dementia - Code MD (maximum number of places: 52) Old Age, not falling within any other category - Code OP (maximum number of places: 28) The maximum number of service users who can be accommodated is: 80 14th December 2006 2. Date of last inspection Brief Description of the Service: Collingwood Court is a care home owned and managed by a care provider called ANS, which became a subsidiary of BUPA in August 2005. The home provides nursing care for up to 80 service users in a purpose built two-storey unit. It is set in its own grounds on a quiet street. The location is convenient for public transport and the local shopping area of Clapham. It has a back garden and limited parking facilities are available at the front. The home has three separate units, two of which are on the ground floor. The third unit is located on the first floor. Two of the units provide nursing care for people with mental health problems or dementia. The third unit is for frail older people and people with a physical disability who require nursing care. Each unit has a lounge and dining room. The main kitchen and laundry facilities are located in the basement. A hairdressing room and an activities resource room are available on the first floor. A passenger lift is provided for access to the first floor and the basement, and the home is accessible to those in wheelchairs. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 5 Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this unannounced key inspection. The inspection team spent a full day in the home during this key inspection, meeting with both day and night staff. Throughout the inspection residents, visitors and staff members were spoken to. Written comments were received from ten residents, nine care staff and two placement authorities. The inspectors toured the premises, observed care practices, and examined documentation in relation to residents’ care needs, also examined were the personnel files for seven care staff. The inspection was well facilitated by both the operations manager and the registered manager, care staff and numerous residents were also helpful and assisted with the visit. What the service does well: Staff morale among staff is good, they enjoy sharing the same goal of working together in achieving the best outcome for residents. The home has driven improvements, it has responded positively in addressing shortfalls previously experienced in the service. Communication is good in all areas. Records are clear and maintained consistently; staff handovers are thorough with full and essential details on each resident’s progress provided. Staffing levels are consistently good and ensure that appropriate assistance is always readily available for residents. The attitude and care practices within the staff team are good. Ongoing training and development as well as direct observation of working practices as part of supervision has resulted in improved standards of care and the promotion of good care practices. Two of the nursing staff spoke of how they have achieve improvements, they said “ We find that due to increased staffing levels we are able to give more one to one service to residents that requires it”. Care is individualised and delivered in a flexible and personable manner that suits individual needs. Routines are flexible with residents choosing to rise later in the morning and have breakfast in their rooms. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 7 A report received from a placement-monitoring officer includes the following comments, “Recently the outcome of statutory reviews conducted for residents placed at the home is good and continuing to improve, care is good and more individualised”. What has improved since the last inspection? What they could do better: The home needs to make sure that it build on and sustains the improvements made in the past nine months. Although medication procedures are safe there are minimal shortfalls that need to be addressed. Requirements are made. BUPA has introduced new contracts for all residents that are not self funding. All residents will need to have a contract with the home that sets out the terms and conditions of their residency. Newly recruited staff are vetted thoroughly but for staff employed for some time some essential information is absent in relation to references. The home has a good training and development programme, however it needs to make sure that staff are trained and knowledgeable in conditions and illnesses that affect residents. The home provides a wide range of social activities that residents enjoy and find stimulating. As the service provides care and support for residents with a variety of needs that include dementia and mental health the home should Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 8 consider how it can develop these services further to meet the specialist needs. 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. The summary of this inspection report can be made available in other formats on request. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 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 Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. All new residents receive a full comprehensive needs assessment before admission. Assessments by staff are carried out with skill and sensitivity. The service is highly efficient in obtaining a summary of any assessment undertaken through the care management arrangements or via healthcare professionals. EVIDENCE: The service user’s guide has been revised. Copies of the guide as well as information on complaints procedure are supplied to residents; copies were seen in residents’ rooms that inspectors visited. Case tracking was used to evaluate the quality of care delivered and the process from time of referral to admission to the home. Case tracking confirmed good practice in the admissions process. Experienced senior nurses complete needs assessments for all new referrals. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 11 Two residents recently admitted to the Diana unit were included in the group of seven individuals case tracked. For both of the new residents a senior member of staff completed a comprehensive pre admission assessment. Copies of these as well as care management assessments were held on residents’ files, information from these and from needs assessment help formulate and agree care plans. The pre admission assessments undertaken by staff are good and give a clear indication of need and detail all areas where individuals, including lifestyle choices, need to be supported. Both nurses on duty as well as two carers spoken to demonstrated that they are familiar with the needs of the new residents. Additional information shared by staff indicate that they have taken the time to get to know the residents since admission and link with family members too. A resident said, “all the staff know my first name, that is how I like to be addressed and is important to me”. For one of the new residents palliative care is needed. As well as pre admission needs assessments there are also medical reports from health professionals giving information on diagnosis and the medical and nursing treatment prescribed, this also includes pain control measures. Records of communication with the palliative care team prior to admission and since were seen. It is evident that this team does regular monitoring visits to palliative care residents. A palliative care nurse from the hospital was present to see the resident and discuss progress with staff as the inspection took place. Another resident recently admitted told the inspector of her experiences. She had lived with family but due to chronic pulmonary disease she became frailer and needed twenty-four hour care following a hospital admission. Her family had supported her with making her choice and she was adapting well to her new surroundings. “I am very comfortable here and staff have been very kind,” she said. Observations made of practice confirm that staff have made every effort to enable the individual settle in. Care staff addressed her by her preferred name; the care worker had opened the bedroom window early as preferred by resident. The home had made good preparations for the admission of both residents and had made sure that all the necessary equipment and supplies were in place first. As their needs had been fully assessed it was identified that particular equipment was required for both, this was secured in good time. There were copies of records present of requests for oxygen supplies, pressure-relieving equipment. Contracts are provided to residents that are self-funding. BUPA has recently developed a contract format for residents funded by local authorities or care trusts, not yet in operation for residents at the home. A requirement was stated at the previous inspection in regard to supplying contracts to residents funding by various funding bodies. An extension to the timescale has been given to allow for this to be completed. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 11Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Staff actively promote the residents’ right of access to the health and remedial services that they need, both within the home and in the community. Regular appointments are seen as important and there are systems in place to make sure residents are reminded and appointments are not missed. Records show that the home arranges for health professionals to visit residents in the home and provides staff that carry out prescribed treatment and follow recommendations made by professionals. Staff keep a regular check on health aids, making sure they are working effectively and that each resident has the necessary aids to improve their quality of life. Medication procedures are safe but attention is needed in some areas. EVIDENCE: The majority of residents were in bed when the inspectors arrived. It was good to see that the service is flexible, personalised and not task driven. According to lifestyle reviews recorded individuals preference to have hot drinks early Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 13 morning or snacks at night, times preferred for getting up and retiring were also logged. Staff were following these requests. On the ground floor a few residents were in the lounge having a cup of tea and chatting. On the Hazel unit a couple of male residents were enjoying a smoke in the smoking lounge. Both gentlemen spoke of mental health issues they experience and appreciate that a smoking area is set aside for them. The care arrangements for supporting seven residents were case tracked, two in Diana unit, two in Hazel, and three in Rose unit. For residents that have lived at the home for some time information on needs assessment has been transferred from the old to new the formats now in use. Care plans, daily records and progress notes provide evidence that care is being delivered in accordance with agreed plans. There is also evidence of good practice and of plans being reviewed at least every month. From speaking to nursing and care staff both on Diana and rose unit the inspectors found that staff are responsive and fully aware of changes to individual needs. Care arrangements for two residents in Diana unit were examined. Two newly admitted residents on Diana unit have written care plans in place that make provision for all areas of support and healthcare, lifestyle. Waterlow and other assessments including nutrition, continence are done within six hours of admission. Risk management strategies are agreed following risk assessments. Attention is given to assessing the need for use of cot sides and agreements are signed to indicate consent by either residents or relatives/ representatives. Continence assessments are completed for residents on admission and regularly reviewed thereafter. The use of continence aids is promoted. A fluid chart was observed for a resident that has a catheter in situ. Records are maintained of how this is functioning in daily records and the plans that staff must follow to manage this effectively and safely. One resident has a pressure sore that was present on admission. Photographs are held of status on admission with wound chart. There is evidence that the tissue viability nurse is consulted on wound care and that necessary recommendations are followed. According to daily records maintained all dressings are done in accordance with those prescribed. Oxygen is provided to the resident and available as required. The resident is comfortable and has a pressure-relieving mattress in place to help promote skin viability. Consultation has taken place with local GP and records are held of this visit. A record is maintained of all healthcare professionals that visit and either examine or provide a service; these include chiropody, optical, and dental appointment. A full list is held of all prescribed medicine. A resident newly admitted finds that she is receiving her medication a prescribed and at the times she requires it. For another resident on Diana unit her condition has been maintained comfortably since admission. She was admitted for palliative care. She is frequently turned and attention is given to creaming her skin in according with Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 14 her cultural preferences. Her appetite is poor, but nutritional drinks supplement her diet. Records of fluid/food intake are present. Pain relieving medication is given at frequencies prescribed. The resident was comfortable and sleeping for short periods during the day. The inspector observed from care records that end of life plans were under discussion and are under development. Staff are sensitive to her need and are awaiting a response from the next of kin overseas. A palliative care nurse from the hospital visits the resident regularly every week to monitor her condition and the response to pain relieving medication. Records are held on the MAR sheet of all medicines administered. Two nurses were observed following medication procedures and signing for controlled drugs. The inspectors selected two care plans on Hazel unit and three from Rose unit. Those residents selected for case tracking were chosen as issues had been identified in event history of the home. The care plans for all five were well laid out and information easy to extract. Those residents who were selected for case tracking met the inspector, and where possible spoke with the inspector. In the first care plan the resident had sat with the inspector during breakfast he demonstrated good signs of well being. He was interacting with other residents and staff . His care plan contained a clear photograph. Individual assessment information was recorded including details of the next of kin, Care Manager GP etc. The information had been transferred onto BUPA headed standard forms of those residents who were already in the home when the change of provider occurred. In all of those care plans inspected this was the case. BUPA assessments for activities of daily living includes standard statements, which have a number rating. Included within this documentation are mandatory care plans for nutrition, falls and manual handling. In those files inspected these were completed. Supporting records for fluid intake were found to be well completed with adequate intake recorded except on one occasion. Ten residents on Hazel unit required fluid intake monitoring. The care plans contained good information in the intervention section; this would provide staff with a good foundation to how to give the care required. Those care plans inspected had recent reviews The care plans were relevant to current areas of identified need and included supporting documentation such as risk assessments. Issues such as sleeping and end of life were covered in the documentation. Manual handling Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 15 assessments, weight records and pressure sore risks were all updated and kept under review. It was identified that some of the waterlow scores were in the very high risk band; these should be kept under more frequent review. A recommendation is made. There was a statement relating to the resident’s ability to use the call bell and a record of actions to be taken if they could not. In another care plan, risk assessments relating to absconding were in place, whilst in another one relating to smoking in her bedroom. In some of the risk assessments terms such as “ constant supervision” were used. These terms should be avoided, as it is not possible unless residents have one to one care to ensure residents have 24 hour supervision. Within the other care plans inspected the information was of a similar standard. The records relating to health care indicated input from the GP and the multidisciplinary team. Those care plans case tracked included a large number of entries from aromatherapy sessions, and a physiotherapy assessment. These are recorded on a professional visits sheet. It is recommended that there is an easier method to establish if regular input from professionals, such as the optician and dentist, has occurred other than going through the entries. Other information in the care plans included a placement review conducted 11 /4/07. A recommendation is made. Reports received from two local authorities indicate that improvements are felt at the home. One placement monitoring officer reported favourably on the outcome of recent statutory reviews. This she reported was in marked contrast to issues that arose in statutory reviews undertaken in previously in 2005/2006. A family member also reported back on the improvements, his comments stated that he now felt confident in the home, “he knew that his relative was now well cared for”. The practice of administering medications was observed during the morning period. The practice was safe. In the front of the medication file was the NMC guidelines on medications and the BUPA policy. A staff signatures list was also available. On the Medication Administration Records (MAR) charts, there were clear photographs of the residents and their allergies recorded. The charts were completed and no gaps evident. Records of medications received in to the home were in place. Those medications, which are disposed of, had two signatures confirming their disposal. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 16 Medications to be administered “as required “had some instructions in place although some were without the maximum dose or the reason for the administration of the medication. However staff have worked on this and consulted with the GP to rectify this shortfall. Confirmation was received that this area has been addressed. Although medication procedures are safe an error has taken place since the inspection. Handovers are thorough controlled medication counted by two staff at each handover. An error was found when a check was done in a recent handover. Appropriate notification was made as this related to drug. A requirement is stated in relation to this error. On Rose unit there are residents present with either mental health conditions or dementia. One resident case tracked has a condition that can be quite challenging. The risks and how to manage these are recorded in the care plans. There is evidence that some issues have arisen in recent months, a review was requested with local authority. Examples were seen of how staff have tailored the care plan to respond more appropriately to need. The resident can on occasions become challenging and having restless nights. He has a preference if this occurs for rising at five am, having a snack and going to bed for the morning. This preference is respected. There also behaviour charts held recording incidents and frequencies and any triggers identified. Examples were seen too of consultation with a doctor when it was identified that he was unwell. Following consultation with the GP antibiotics were prescribed. The MAR sheet demonstrated that the course was completed, progress notes too showed that the response was good to treatment and that the condition is improving. Staff spoken to during the inspection demonstrated that they are knowledgeable on individuals’ conditions, are quick to recognise when a resident presents with changes and seek professional advice. Another resident whose care was case tracked has appropriate arrangements in place to address his needs. He receives mainly bed care. He has a long standing pressure sore. This is dressed frequently and reviewed by the tissue viability nurse, his position is turned frequently evidenced by turning charts. Staff have skills and ability to support and encourage residents to be involved in the ongoing development of their plan. Appointed key workers are allocated to individual residents, they build up special relationships with residents. This is effective, a resident recently admitted finds that having a key worker has worked well and helped feel more secure in her new surroundings. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The food in the home is of good quality, well presented and meets the dietary needs of residents. Individual preferences dietary needs are considered when planning and preparing menus. Staff are trained to help those residents who need help when eating and are sensitive in their approach. Residents are able to choose to eat in their own room if they wish. Regular drinks and snacks are available. Although medication procedures are safe there are some shortfalls in medication procedures. EVIDENCE: Over the day residents and visitors were spoken to. Visitors feel welcome at the home, also when they phone to check on progress staff are responsive. Residents are actively encouraged to keep in contact with family and friends living in the community. One resident has a next of kin living abroad. Records on the resident’s file confirmed that staff have made every effort to inform her of the resident’s condition. Visitors are welcome at any time and facilities are available for them to have a drink with the resident. Residents can choose to entertain visitors in their own rooms or use a lounge or the garden areas. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 18 The attitude of staff is good; over the day there was a real emphasis on enabling and supporting residents in a pleasant and friendly manner. Residents and relatives spoken too find that staff approach is good. A number remarked that they have found tangible improvements in staff attitude and practice. Training delivered to staff on the essence of care and good practice is demonstrated throughout the home. Routines are flexible in the home with personal preferences and routines always taken into account. The majority of residents had not risen when the inspectors arrived. Some were sleeping; others relaxed in their bed rooms and indicated a preference for rising later in the morning. They had warm drinks and were assisted with personal care and dressing at times they prefer. Privacy and dignity is promoted, doors were kept closed in bathrooms and bedrooms as staff attended to personal care and support issues. Personal appearances are considered, nail care and personal grooming are promoted to boost self esteem and self worth. Some residents said they had chosen to go to the lounges and meet with friends before breakfast. The home had recently had a garden fete that was well attended. The residents in the main looked well presented although some attention to the ladies hair should be addressed. Some residents choose to take breakfast in their rooms. The majority of residents came to the dining rooms after they were assisted to wash and dress. Observations made were that residents enjoyed breakfast; a choice of hot porridge or other cereals was available. Care staff were present to assist those requiring support. The meal was unhurried with some choosing to remain in the dining areas for some time later. A television was on in one lounge; it was not loud and did not distract residents from chatting to each other. Appropriate staffing levels were present, this allowed residents to feel valued and they find that staff work with them at a pace they like. Generally the home is making good provision for the social and recreational interests of residents. Two activities coordinators are employed, although one was on holiday at the time of inspection. A varied programme is available for residents that considers their capacity and conditions. Two of the units have residents with a combination of needs, some experience mental health conditions and some have dementia. Staff demonstrate that they have become more familiar with managing the conditions of residents on the Rose unit. More training would assist with this, referred to in staffing. The residents had varying levels of ability and disability in Rose and hazel units .It was difficult to engage with some residents whilst others provided limited information. There were lifestyles profiles included with care plans which provided some information about the residents past life . These could have been expanded upon to provide fuller information, which could have improved resident’s care. The inspectors found that residents with conditions such as dementia or mental health issues would benefit from a more appropriate social activity programme. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 19 A number withdrew from group participation. It appeared that those that are restless and challenging distract some residents. This environment is not always conducive to achieving the best outcome for individuals. The operations manager spoke of plans to divide lounges so that residents could be less distracted or inconvenienced. A recommendation is stated in relation to providing more appropriate stimulation for those residents with particular needs. Those activities during the inspection taking place included floor skittles, dominoes, and a pampering session. It was noticeable that the TV’s were not on in the lounge areas, which promoted more interaction between staff and residents and residents with one another. In individual bedrooms the TV’s were on at residents’ request. The home had recently had a garden fete that was well attend. Pictures and records provide evidence of many of the social occasions held and enjoyed by residents. Consideration is also given to providing for particular needs and capacities. Throughout the morning residents were occupied by chatting with friends and other residents, also some were having one to one dialogues with staff. Activities were taking place over the day. Cultural and religious needs are considered. A resident on Diana unit is originally from an eastern European country, though fluent in English likes the fact that one of the carers speaks in her native tongue. Another resident recently moved to the home has recorded that she likes to worship and has a particular preference. Contact has been made with local church to enable a visiting priest attend her religious needs. The home’s policies, procedure, guidance ensure that residents are protected from financial abuse. One of the residents case tracked is unable to manage independently. A spreadsheet was supplied by the manager to demonstrate how the resident is supported to manage his money. Records are maintained that shows a clear audit trail of all financial transactions. Food and mealtimes are treated as a social occasion and something to look forward to. The feedback from residents about the quality of food provided was good. Preferences of times to eat are considered, if a resident enjoys additional drinks and snacks, these are recorded on lifestyle format used. Residents find that they have light snacks if they wish. Healthy options are promoted, the inspectors observed portions of fresh fruit being cut up and served to residents over the course of the day. Snack time has been introduced after supper as well for residents that like a light supper before retiring to bed. Meals served during the inspection appeared wholesome and nourishing, this included breakfast and main lunch. Catering staff are familiar with the dietary requirements recorded in residents’ care plans and provides a diet that meets their individual needs. Menu options were seen; these provide a good range of variety and meet cultural needs and preferences. For residents that require Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 20 pureed foods these appeared attractive, residents find that they taste good too. Care staff are sensitive to the needs of those service users who find it difficult to eat and give assistance with feeding. They are aware of the importance of feeding at the pace of the service user, making them feel comfortable and unhurried. Tables were set attractively with the necessary cutlery and aids to help individuals during their meal. Drinks are encouraged with jugs of fruit drinks replenished during the day. Others requiring assistance were supported and encouraged to have refreshments. Residents enjoy the flexibility of meal arrangements and enjoy being able to eat in their own room if they wish. It was observed that staff have an awareness of encouraging a homely spirit and respond to residents that enjoy frequent cups of tea. One elderly resident had risen early and was enjoying a cup of tea in the lounge, she told the inspector how her preferences are considered, “I love my cup of tea, this was my routine before I moved to the home and I still can enjoy it here”. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents are safeguarded from abuse or neglect with staff trained and knowledgeable on safeguarding vulnerable adults procedures. The home responds positively to the views or concerns of residents, families or healthcare professionals. EVIDENCE: The organisation has an effective complaints procedure. Both relatives and residents feel that their complaints are dealt with appropriately. Residents and relative’s home state that they are extremely satisfied with the service provision, feel very safe and well supported. An examination took place of the complaints recorded since the last inspection. A low number have been recorded. Outcomes of complaints are managed very effectively and with sensitivity. There is evidence that the service has learnt and is continuing from the process, and the same issues do not reoccur, also that additional actions are taken to prevent incidents that impact on residents. It was evident that procedures and timescales are adhered to when responding to and investigating complaints. The policies and procedures regarding protection of residents are satisfactory and are reviewed and updated in line with regulations and other external Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 22 guidance. Within the policy it is clear when incidents need external input and who to refer the incident to. Links with external agencies are satisfactory and include notification of any allegations or incidents to CSCI and adult protection teams. Training on safeguarding adults has been provided to staff as a result of recommendations made following an investigation earlier in the year. A number of staff were interviewed. The majority of staff demonstrate a good awareness of safeguarding vulnerable adults protocol, what immediate action to take and when and who to refer any incident on to. Staff need to be aware also of the external avenues for referral of suspected abuse and information on contact points should be on hand. A recommendation is made The outcomes from any referral are satisfactorily managed, with issues resolved. Residents and others associated with the home state that they are satisfied with the service provision, and feel safe and supported. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 26 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. As attention continues to be given to refurbishing the environment the home is becoming an attractive and comfortable place to live. It is a clean pleasant and attractive environment. EVIDENCE: It was evident that the home has undergone a major refurbishment, including replacement carpets, redecoration, replacement beds and soft furnishings. Those areas that had been addressed had considerably improved. Repairs, which had been identified at the last inspection including handles to toilets and bathrooms, had been addressed. Areas were clean and tidy although carpets were being laid. The home was clean and odour free in all communal areas. Clinical waste is properly managed and stored. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 24 Call bells are left within reach of residents and these are responded to promptly. The management monitors the effective function of the system. It was noticed on arrival that several of the bedroom windows were open. Some had asked staff to open them, however staff must ensure that windows if open, are not causing drafts or allowing the bedrooms to become too chilly for residents. It was noticeable in bedroom 21, that the window was open the resident was in bed and the room felt chilly. A recommendation is made. This bedroom also needed a door handle. The bathroom in this area was in need of refurbishment and was used as storage are for equipment, there was an odour present in this bathroom too. Ventilation in some bathrooms is not good. A requirement stated in previous inspection is almost met except for bathrooms and some bedrooms. The requirement is restated with extended timescale for compliance. Resident’s bedrooms that were decorated recently looked very attractive, residents too find them comfortable. Bedrooms (eight) were viewed on all three units. These varied with some residents choosing to display many of their possessions and personalise them. All residents are assessed for their need to have equipment or aids before they move into the home and these are provided to them on admission. There is evidence that the home meets the changing needs of all residents promptly, and especially where they have different cultural and specialist care needs. The home meets the requirements of the Disability Discrimination Act and the layout and design of the home is suitable to meet the specific needs of the people who live there. As individuals with dementia and mental health related issues share communal areas this can pose some challenges to residents. The operations manager spoke of plans to divide lounges on Hazel and Rose units to accommodate smaller groups for activities. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Staff attitude is good, individual members of staff display the essential qualities of kindness and empathy. The staffing levels are good with appropriate numbers of suitably trained staff available at all times. A wide range of training from induction to mandatory training is given; this is reflected in good practice. More consideration to conditions that affect residents should be included in training and development plans. EVIDENCE: The inspector observed that all staff were courteous in their interactions with the inspectors, residents and visitors. They were smiling and pleasant and this is in sharp contrast to previous inspections. On the morning of the site visit on Hazel wing, there were two qualified and five care staff. The home has a number of Polish residents and within the staff team three Polish staff. Similar staffing levels were found on Rose and Diana units. In all staffing levels were found to be appropriate to the numbers and needs of residents. The inspectors interviewed eight staff in all. Four of the staff are qualified nurses, four are care workers. All the care staff interviewed are positive about the improvements made in the home citing more training, supportive management, better staffing levels and on going refurbishment as the main Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 26 factors. Written comments were received from ten staff members. The comments suggested that staff feel supported and enjoy their role. Staff spoken to (8) advised the inspectors that they had received training in the mandatory topics and had regular updates in these. Staff had completed NVQ training and were due to start the next level. One of the more senior carers has NVQ level 3. During discussions she demonstrated a good understanding of residents’ needs and subsequent actions needed to respond, she also related well to residents that were challenging. One training session, which had been received very positively by all staff interviewed, was “ personal best”. This is a session conducted by BUPA, which covers the expected conduct by staff working in the home. This included items such as attitude, manners, and approach. It was evident during the site visit this had improved practice. Residents too commented favourably on the approach and attitude of staff employed. A number of visitors remarked that improvements in staff approach and practice were tangible in recent months. Recruitment and training records for seven staff were examined. All staff recruited in the past twelve months have been vetted fully before they commence employment. Enhanced disclosures with POVA checks, previous employment records and references were available for three new staff. There was evidence that an audit had been done of all staff files. Unfortunately it did not highlight that references were absent for one staff member that has worked at the home for over three years. It is possible that these have been mislaid as files have been reorganised. A requirement is stated in relation to this file. A recommendation was made at the previous inspection about requesting references that are stamped to evidence their authenticity. One of the nursing staff engaged in the last twelve months had professional references but a stamp or letterhead was absent. The home had verified that references are authentic. Staff employed before the introduction of POVA checks should have a new CRB disclosure sought, a recommendation is made. The service sees induction and any probationary period as being an extension of recruitment, all new staff complete Induction Training that meets Skills for Care targets. Staff receive a range of mandatory training. A training matrix is displayed in the office demonstrating this; this also includes planned training for 20072008. Staff enjoy the opportunities given for self development. Two of the carers interviewed spoke positively of opportunities, “ Since the change of provider opportunities are very good for training staff, we get plenty of training” In respect of infection control principals all staff had the basic knowledge and were seen to observe good hygiene practices during the day. Apart from the qualified nurses staff are relatively unaware of clostridium dificile and its management. There is a training programme organised by the home that Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 27 covers all areas of infection control. Workbooks used by care staff on infection control programmes were examined. But not all the care workers have attended this training yet according to the manager. It was evident that some of the care staff spoken to are due to attend the next planned session. The requirement stated at previous inspection in relation to infection control training is restated to allow for all care staff to complete this training. Management is recognising that more focus is needed on caring and supporting those with dementia, also those with mental health conditions. Overall staff were observed to manage well situations and have a good understanding of challenging situations. The inspectors would like to see more training on dementia as there are many resident in this home with varying degrees and different types of this condition. In addition there are other mental health conditions which staff need to develop more awareness of in order to provide the best care. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 36 37 38 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The improvements found in the home reflect the efficient leadership and good management. Residents benefit from living in a safe well run home where good working practices are promoted. EVIDENCE: Effective management combined with strong leadership has contributed to the tangible improvements found in this service. The home is well run with the health and welfare of residents and staff promoted. Each member of staff displays a strong sense of accountability and a good attitude. The service also has effective systems in place to recognise and respond to shortfalls in the service. Each unit has a senior sister in place that takes responsibility for auditing residents’ files. From examining the care Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 29 planning and recording it is evident that the audit system is reaping benefits and that records are consistently maintained up to date. The registered manager has registered with CSCI and is responsible for clinical management. She is experienced and is due to complete the RMA in October 2007. The operations manager is responsible for the overall management of the service, she has acquired the RMA. Both managers work well together to seek improvements and to motivate the staff team. Staff find that they are effectively supervised, they have regular team meetings. Staff know the codes of conduct expected. Poor practice or performance are dealt with via training or by disciplinary measures. This has had a motivating effect on staff, two staff spoken to are pleased that working practices are monitored, They said “It is easier to work with staff in an environment where good working practices are promoted”. The home has very efficient systems to ensure effective safeguarding and management of resident’s money including records keeping. A spreadsheet was supplied that demonstrated a clear audit trail of all transactions for a resident. Residents know that they have access to their records whenever they wish, this information was acquired during discussions with individuals. The service is faultless in its role as agent or appointee and fulfils all requirements in supporting residents manage their personal allowance. Record keeping is good, with all records for residents maintained up to date and well ordered. Accidents and incidents are recorded, also appropriate notifications are made to relevant authorities. The organisation has a number of ways for determine quality assurance, there are self monitoring and self evaluating systems that highlight and identify where areas of improvement are needed. There is evidence that the quality assurance system is effective. The inspectors sampled a number of records relating to health and safety measures and servicing of the equipment. The building is safely maintained with evidence on the AQQA and on the home’s own records of how this is maintained. The gas certificate was dated 30 /10/06 and will be done this month. Portable electrical appliance testing was conducted March 2007.The lift inspection was carried out August 07. The Legionella certificate was dated 31/8/07. In relation to those measures in place for the prevention of fire evidence of regular checks on escape routes, torches, fire door self closures and weekly alarm testing records were all on site. The fire extinguishers and fire alarms had been serviced March 2007. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 30 Staff have fire training including the fire videos 1 & 2, which is signed for by the staff themselves. Fire drills are also carried out frequently with everyone in the building signatures are not obtained for these. Attendance to fire training is compulsory and those staff who do not attend are prevented from attending work the next day. There is a matrix that indicates which staff need updating. In the fire training, should a staff member demonstrate any issues about safety, then this would be passed to the management to follow up in staff supervision sessions, and more training may be required. Hot water is tested weekly and records retained. Any outlet over 43degrees would be adjusted. On those records seen all were within the normal limits below 43 degrees. The employer’s liability insurance certificate was current. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 31 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 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? YES 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 OP2 Regulation 5 Requirement The registered person must ensure that all service users receive a contract between themselves and the home, detailing the applicable terms and conditions and funders. (Timescale of 31/03/07 not met, the organisation has developed a contract for those not self funding, an extension of time is needed to implement this.) The registered person must ensure that medication procedures and checks completed at handovers are through to prevent any errors in medication procedures. The registered person must ensure that the programme of maintenance and renewal for the fabric and decoration of the building includes the refurbishment of bathrooms and bedrooms. Ventilation issues need to be attended to. Redecoration of damaged/ peeling paintwork in some ensuite bathrooms. (Programme is DS0000007015.V343869.R02.S.doc Timescale for action 31/12/07 2 OP9 13 31/10/07 3 OP19 23 30/11/07 Collingwood Court Nursing Home Version 5.2 Page 33 still underway so extension to timescale of 31/03/07 given)) 4 OP29 19Sch 2 The registered person must ensure that appropriate documentation is available for all staff employed. This relates to references absent for a care worker that has been employed for over three years. (An audit was completed of staff files to respond to this and supplied within timescales of 31/03/07, however it did not highlight that references were absent on one staff file.) The registered person must ensure staff receive training appropriate to the work they are to perform, specifically, to raise their understanding of particular physical and/or mental conditions and of managing infections such as clostridium difficile. (Partially met in timescale of 30/03/07, training organised and already delivered to a number of care staff, timescale extended to allow for the staff team to complete the programme) 30/10/07 5 OP30 18 30/12/07 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 OP7 Good Practice Recommendations The registered person should ensure that for residents DS0000007015.V343869.R02.S.doc Version 5.2 Page 34 Collingwood Court Nursing Home OP8 2 3 4. 5 OP8 OP8 OP9 OP12 6 7 OP18 OP24 8 OP29 identified in high-risk category (waterlow scores) that reviews are more frequent. The registered person should ensure that terms recorded such as one to one supervision to residents are avoided unless this is actually provided. The registered person should consider implementing a more accessible format to record visits by healthcare professionals. The registered person should ensure that when a staff member hand-transcribes a medication record there is always evidence that another staff member has checked it. The registered person should endeavour to make more provision for appropriate and suitable social stimulation for those residents with particular needs such as dementia or mental health conditions. Environmental changes should be also considered to assist with this. The registered person should ensure that staff are aware of the external avenues for referral of suspected abuse and information on contact points should be on hand. The registered person should ensure that staff are aware of the of the impact on residents of opening bedroom windows early morning. They should always keep a check on room temperatures. The registered person should ensure that new CRB enhanced disclosures are sought for all staff employed before POVA checks became available. Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Collingwood Court Nursing Home DS0000007015.V343869.R02.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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