CARE HOMES FOR OLDER PEOPLE
Colonia Court St Andrews Avenue Colchester Essex CO4 3AN Lead Inspector
Carolyn Delaney Unannounced Inspection 25th September 2007 10:00 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 Colonia Court DS0000015331.V345182.R01.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. Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Colonia Court Address St Andrews Avenue Colchester Essex CO4 3AN 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) 01206 791952 01206 794230 www.bupa.com BUPA Care Homes (CFHCare) Limited Harvey Newman Care Home 110 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number disorder, excluding learning disability or of places dementia (20), Mental Disorder, excluding learning disability or dementia - over 65 years of age (4), Physical disability (3), Physical disability over 65 years of age (60) Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. 7. Amber Lodge Persons of either sex, under the age of 65 years, who require nursing care by reason of Huntington’s Disease (not to exceed 20 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of Huntington’s Disease (not to exceed 4 persons) Blomfield House Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 30 persons) Mumford House Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 30 persons) Paxman House Persons of either sex, aged 50 years and over, who require nursing care by reason of a physical disability (not to exceed 3 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 30 persons) The total number of service users accommodated not to exceed 110 persons 11th October 2006 Date of last inspection Brief Description of the Service: Colonia Court is registered to provide nursing and care for up to 110 residents. The site is separated into four houses. Residents are accommodated in single rooms, all with en-suite toilet and basin. Each house has a good range of communal rooms and the accommodation is all on one level. The houses are staffed on an individual basis and the central services include administration, laundry and kitchen. The home has car parking facilities and gardens attached to each house. Colonia Court is set in a residential area and is approximately one mile from Colchester town centre and two miles from the railway station. Buses run along St Andrews Avenue outside the home. Paxman House is registered to provide nursing care for up to 30 residents over the age of 65 and up to 3 residents over the age of 50, who require nursing care because of a physical illness or disability. Amber Lodge is a 20 bedded specialist unit for residents over the age of 18 years with Huntington’s Disease.
Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 5 Mumford House is registered to provide care for up to 30 residents over the age of 65 who have dementia. Blomfield House is registered to provide care for up to 30 residents over the age of 65. The range of fees at Colonia Court in October 2006 were: personal care £590 £630, nursing care £600 - £630, care for Huntington’s Disease £2000 - £2700. The fees were dependent on assessments. The higher range of fees on Amber Lodge for Huntington’s Disease was for 1:1 or 1:2 care. Items such as toiletries, newspapers, hairdressing and private chiropody were charged for separately. The home had a range of information for potential residents and their representatives. Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This was routine key inspection carried out over two days on 25th & 26th September 2007. As part of the inspection process an unannounced visit was made to the home. During this visit residents, relatives and staff were spoken with and a number of records such as care plans, staff records and information about how the home is managed and maintained were assessed. We inspected standards on two of the four houses. A brief tour of the home was carried out and communal areas such as dining rooms and lounge areas were viewed as well as a number of residents’ bedrooms. As part of the inspection process a number of residents and relatives were offered the opportunity to make comment about the home by completing feedback surveys. What the service does well:
Colonia Court provides a safe and comfortable home for its residents. People who live there and their families are happy with how the home is managed and the care and support provided. Some people made very positive comments about the home. Staff ensure that people are only offered a place at the home once a detailed assessment of the person’s needs has been carried out. Each person has a detailed care plan developed as to how his or her assessed needs are to be met. Where risks to a person’s safety or welfare are identified these are well managed. So far as possible residents are supported to live their lives as they would choose. There is a range of activities made available for residents and they are regularly consulted so that the activities provided match their wishes. Complaints are received and dealt with in an appropriate manner and staff are trained so as to minimise the risk of harm to residents. Staff are recruited robustly. There is an ongoing training programme for staff to equip them with the skills they need to be able to care for residents. The home is well managed and staff are supervised regularly. There are regular checks carried out on the environment, equipment and systems within the home so as ensure that they are maintained in safe working order.
Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the home and the assessment process assure residents that the home will be able to meet their needs. EVIDENCE: Colonia Court has detailed information available about the home and the services provided. The majority of residents who completed surveys said that they had received enough information about the home to be able to decide that it was the right place for them. Since the last inspection BUPA have introduced a new format for recording information about residents’ needs. This includes an assessment, which staff complete for prospective residents before they are offered a place at the home
Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 10 Once a person moves into the home the information in the initial assessment is reviewed and amended where there have been any changes. This ensures that there is up to date and accurate information about each person from which to develop a plan of care. The pre-admission assessments for a number of people who had moved into the home since the last inspection were examined. These were completed in detail and had sufficient information recorded about each individual’s needs so that the manager could determine whether staff at the home could support the person. Residents and relatives who were spoken with during the inspection visit said that they were happy with the care and support provided. Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Colonia court are provided with a good level of support and care, which meet their assessed needs. EVIDENCE: Residents who completed surveys said that they receive the care and medical support that they need and in general relatives feel that residents’ needs are met. One resident said ‘if you have to be in a care home there is none better’ Another resident said they ‘would not choose to live anywhere else’. Each individual has a specifically developed plan of care. A number of care plans were assessed during the inspection. Care plans were very well written and there was evidence that wherever possible the resident or their family had been involved in planning the care. Care plans included details of the resident’s capabilities regarding daily activities of living. Care plans also included details of resident’s preferences for how they would wish to receive care such as preferred gender of carer to provide personal care.
Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 12 Care plans were reviewed on a regular basis and residents or their relatives were invited to be part of the review process. A number of care plans included comments made by residents and their relatives, which evidenced that they were happy with the care provided. The majority of relatives who completed surveys felt that they receive enough information so that they can make decisions about the care and treatment provided and most people say that they are kept up to date with any changes or events at the home. Risks to the health and welfare of residents such as risks of developing pressure sores due to immobility, risks of falls or injuries or weight loss are assessed and plans are developed so as to minimise these risks. BUPA have a system for auditing any occurrences of injury to residents so that any trends can be identified and risks can be further minimised. Residents have access to medical treatment in accordance with their needs and plan of care and there were detailed records available regarding treatment provided by resident’s general practitioners and other healthcare professionals. Residents looked well cared for, in particular residents who depend upon staff for ensuring that they are kept clean and comfortable. Staff ensure that residents’ hair, nails and mouth care is well maintained. Where residents require assistance with changing their position in bed, taking food and fluids there was evidence that they are well supported. All residents were wearing suitable clothing and footwear. Records are maintained regarding the medication, which is prescribed for residents. These records were well maintained in line with the proprietor’s policy. Staff were observed to administer medicines in a safe manner. Wherever it is possible residents are supported to retain control of their medicines. Procedures for storing medicines were noted to be safe and appropriate. All of the residents who completed surveys said that staff listen and act on what they say. A number of relatives commented that staff encourage residents to make choices such as asking when they would like to use the toilet, what food they would like and what activities they would like to participate in. Residents and relatives feel that staff provide good care and a number of people said that they were happy living in the home. Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are supported in making decisions about their daily lives so that they can live their lives so far as possible as they would wish. EVIDENCE: Residents who completed surveys said that there are activities arranged which they can participate in. Some people said that did not wish to participate in activities, as they preferred their own company. Residents who were spoken with during the inspection said that there were always some activities available to do in the home. There is a programme of activities for residents and this is made available in advance. Resident’s preferences for how they like to spend their time is recorded in their plan of care and there was evidence that the activities coordinators liaise with people so as to ensure that the activities planned are suited to their needs. One resident had recently written a book, which was published. Activities include a range of games and quizzes, crafts and trips outside of the home. There is a minibus available for residents to use. One of the activities coordinators had put together a resource folder with details of activities and
Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 14 amenities available locally. Residents have the opportunity to access local day centre facilities where this is appropriate. The majority of residents feel that staff listen and act upon what they say and relatives feel that staff can meet the different needs of residents taking into account age, ethnicity, gender and faith. Relatives who were spoken with during the inspection and who completed surveys said that they are made to feel welcomed when they visit. Residents said that they like the meals at the home and a number of people said that the food was ‘good’. There is a planned menu, which is available to residents. There are a variety of meals available. BUPA have introduced a menu master system so as to ensure that meals meet the nutritional needs of residents. A new ‘Night Bite’ menu has been introduced so that food is available 24 hours a day. During the inspection the serving of meals was observed. Residents were offered a choice of meal and had the opportunity to have an alternative choice if they had changed their mind about what they had ordered. For example residents were offered a choice of sandwiches, sausages and chips or cheese or scrambled egg on toast. There were also a variety of cakes, fresh fruit and yoghurts available. Meals were served in an unrushed manner and staff were available to support residents according to their needs. Residents have the opportunity to attend regular meetings where they can voice their opinions about any issues such as meals. Resident’s views are then fed back to the catering department. Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home feel assured that any concerns they have will be addressed. Staff act so as to protect and safeguard residents. EVIDENCE: There is a policy and procedure regarding how complaints will be received and dealt with and this is displayed throughout the home and included within the information provided to residents and relatives. The majority of residents and relatives who completed surveys and who spoke with the inspector said that they knew who to speak with if they were unhappy or if they wished to make a complaint. Where people indicated that they had made complaints they said they were happy with how these were dealt with. Records are maintained in respect of complaints received and these were examined. There had been thirteen formal complaints received since the last inspection. Complaints were made about laundry service, missing items of clothing, odour, noisy residents and one complaint was made about poor care. Records showed that complaints were investigated and responded to within the agreed timescales. The outcomes as to whether the complaints had been upheld or not were recorded. More informal complaints are logged on each unit and dealt with by senior staff. Both residents and visitors to the home who were spoken with during the site visit said that they were happy with how any issues are dealt with.
Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 16 There is an ongoing programme for staff training, which includes training in respect of safeguarding residents and whistle blowing. In addition staff undertake personal best training, which gives staff an insight into what it is like to be a resident in the home. Staff who were spoken with during the inspection could demonstrate that they were aware of the proper action to take if they suspect or witness any ill treatment of residents. Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Colonia Court provides a safe, comfortable and well-maintained home for residents. EVIDENCE: All of the residents and relatives who spoke with the inspector indicated that they were very happy with the accommodation and that the home is generally clean and fresh. During the inspection a brief tour of the premises was carried out. All areas were noted to be clean and there were no unpleasant odours. Resident’s bedrooms, which were seen, were comfortable and personalised. A dedicated team of cleaning staff are employed in the home and the majority of people who completed surveys said that the home is fresh and clean.
Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 18 Residents have access to comfortable communal living spaces, which are furnished and decorated nicely. Since the last inspection work has been commenced to increase the number of bedrooms on two of the houses. As part of this refurbishment residents will have access to an internet café area and a television room with a wide screen television. The home is equipped with lifting equipment which suits the needs of people who live there. Records were available to demonstrate that checks were carried out on all equipment so as to ensure that it was maintained in good working order. Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. 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. People living in the home are supported by staff who are recruited robustly, trained and supervised consistently so as to ensure that resident’s needs are met. EVIDENCE: The majority of residents who completed surveys said that staff are available when needed and relatives generally feel confident that staff have the right skills and experience to look after people properly. Some people commented that staff are ‘friendly and helpful’ or ‘great’. Some comments were made about younger staff perhaps not so skilled in dealing with residents who have dementia. Staff rotas were examined and these evidenced that staffing levels were maintained on each of the units. There was evidence that staffing levels were reviewed as needed. The home uses very little temporary agency staff and there is a low turnover of staff and low absence due to sickness. This helps to promote continuity of care within the home. Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 20 At the time of this inspection 21 of the 150 care staff working at the home (14 ) had undertaken National Vocational Qualification (NVQ) training and a further 11 people had recently commenced this training. There is a robust system for recruiting new staff to work in the home. A sample of people who had been employed at the home since the last inspection were examined. There was evidence that these people had been recruited according to the home’s policy and that all of the checks as required so as to help safeguard residents living in the home. All staff had provided details of previous employment and references had been sought. Staff had been interviewed so as to determine their fitness and suitability to work in the home. Criminal Records Bureau (CRB) disclosures and PoVA First checks had been obtained for staff before they were offered employment at the home. There is an ongoing training programme for staff. This includes training for safe moving and handling, health and safety, fire safety and safeguarding. In addition staff undertake distance learning packages for nutrition and staff access specialist training for meeting the needs of people who have Huntingdon’s disease. The manager has planned for staff to undertake palliative care training. Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 21 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Colonia Court is managed in the interests of the people who live there. EVIDENCE: There was evidence that the home is well managed and that residents and relatives are regularly consulted about how the home is managed and that their views are taken into account when planning changes. Residents and their families have the opportunity to attend regular meetings where they can discuss any issues they may have. One such meeting was held on the day of the inspection visit. Records are maintained in respect of these meetings.
Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 22 BUPA have a continuous system for monitoring and auditing how the home is managed. As part of this system regular checks are carried out to assess staff training, medication, care planning and hospitality etc and where issues are identified these are addressed. The majority of people who were spoken with during the inspection were very complimentary about the home. People living at the home have the opportunity to have their money banked in an interest bearing bank account. Residents who chose to do this do not have an individual account, however the rate of interest applied to their account is calculated in proportion to their account balance. Residents do not have access to money at weekends or evenings. There was evidence that staff working at the home receive regular supervision so as to monitor and maintain quality in staff practice. Staff spoken with confirmed that they receive regular supervision and support. Records and certificates in respect of the maintenance, repair and renewal of systems and equipment in the home were examined. These were organised, up to date and evidenced that all equipment including fire safety, gas and electrical installations were maintained in good working order. Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 23 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 3 3 X X X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 2 3 X 3 Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 OP28 Good Practice Recommendations The registered person should ensure that there are a minimum of 50 care assistants trained to NVQ level 2. The arrangements for resident’s access to monies held for them by the home should be clear and included within the service users guide. 2. OP35 Colonia Court DS0000015331.V345182.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge CB21 5XE 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
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