Inspection on 11/09/07 for Connaught Court Nursing & Residential Home

This inspection was carried out on 11th 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Connaught Court Nursing &... 29/08/08

Connaught Court Nursing &... 19/09/06

Connaught Court Nursing &... 07/03/06

Connaught Court Nursing &... 23/08/05

Connaught Court Nursing &... 19/01/05

Connaught Court Nursing &... 06/07/04

Connaught Court Nursing &... 15/03/04

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

CARE HOMES FOR OLDER PEOPLE Connaught Court Nursing & Residential Home St Oswald`s Road Fulford York North Yorkshire YO10 4FA Lead Inspector Ann Stoner Key Unannounced Inspection 09:30 11 & 12 September 2007 th th 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 Connaught Court Nursing & Residential Home DS0000027959.V351721.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. Connaught Court Nursing & Residential Home DS0000027959.V351721.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Connaught Court Nursing & Residential Home Address St Oswald`s Road Fulford York North Yorkshire YO10 4FA 01904 626238 01904 611741 mcade@rmbi.org.uk www.rmbi.org.uk Royal Masonic Benevolent Institution 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) Mrs Margaret Cade Care Home 90 Category(ies) of Dementia - over 65 years of age (90), Old age, registration, with number not falling within any other category (90) of places Connaught Court Nursing & Residential Home DS0000027959.V351721.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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(E) and Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 90 Service users to include up to 90 (OP) and up to 90 (DE(E)), no more than 15 of whom may require nursing care, up to a maximum of 90 Service users. 19th September 2006 2. 3. Date of last inspection Brief Description of the Service: Connaught Court is a care home owned by the Royal Masonic Benevolent Institution and provides residential and nursing care to men and women who are Freemasons or their dependants. The home has 4 residential areas for people receiving residential care without nursing, Ebor, Yorvik, Knavesmire and Fairfax; one of these is for people with high dependency needs. A separate area, called Viking, provides nursing care for up to 15 people. In addition, Fred Crosland House is a self-contained unit providing care for up to 10 people who have dementia. The home is situated in Fulford on the outskirts of York, and is within easy reach of major road networks, York city centre and local bus routes. There are extensive and attractive grounds surrounding the home that are accessible to people and there is good parking space. The fees at the time of this report ranged from £452 - £711 per week. More up to date information can be obtained from the home. Copies of previous inspection reports are available in the home. Connaught Court Nursing & Residential Home DS0000027959.V351721.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was unannounced and was carried out by one inspector who was at the home from 9.30am to 6.00pm on the 11 and 12th September 2007. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people living there. Before the inspection evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the visit. Survey forms were sent out to people living at the home, their relatives and health care professionals. Information from returned survey forms is reflected in this report. An AQAA (Annual Quality Assurance Assessment) was completed by the home before the visit to provide additional information. During the visit a number of documents were looked at and all areas of the home used by the people living there were visited. A good proportion of time was spent talking with the people who live at the home and their relatives, as well as with the manager and staff. Feedback at the end of the visit was given to the manager, deputy manager and the assistant manager. I would like to thank everyone who contributed to the inspection process and to the home for the hospitality throughout the two days. What the service does well: The home is very spacious with wide corridors, making access easy for people who use a wheelchair. There are communal rooms such as a lounge with a stage for visiting entertainers, a library, a chapel for people of all religions, and plenty of smaller seating areas where people can have peace and quiet to read a book or a newspaper. The grounds and gardens are extensive and attractive with plenty of outdoor seating areas. A relative described the home as being “spacious and like a first class hotel.” Staff from the organisation visit people who are thinking about moving in and invite them to look round the home to make sure that they know what the home has to offer and that their needs can be met there. On admission people are given an information pack with useful leaflets including how to make a complaint, the home’s policy on people giving gifts to staff and the terms and conditions of their stay. Connaught Court Nursing & Residential Home DS0000027959.V351721.R01.S.doc Version 5.2 Page 6 People can furnish their rooms to their own taste and if they are able, and want to do so, they can use a small laundry area to launder their own clothes. Alternatively staff will launder clothes. A relative said that her mother’s clothes were “beautifully laundered and couldn’t be better if they were drycleaned”. A GP (General Practitioner) who returned a survey form said, “I think the staff are very caring.” A relative said, “I have nothing but praise for the staff who do a wonderful job.” Visitors are made welcome, are offered cups of tea and coffee and may stay and eat with their relatives in the main dining room or in private. Staff are kind, discreet and patient when assisting and supporting people. A person living at the home said, “We are very well looked after, we want for nothing. It is a very good place to live when you are old.” The home makes sure that special events in people’s lives are celebrated. The home recently hosted a 100th birthday party for one person and arranged a private dinner for a couple celebrating their 62nd wedding anniversary. What has improved since the last inspection? What they could do better: The manager needs to make sure that care plans are detailed. Everyone who lives at the home has a care plan, but because the instructions for staff are not clear and precise there is a risk that people’s needs may be overlooked. Not all staff have received training in infection control, moving and handling, fire safety and food hygiene. Qualified nurses do not have refresher training in medication as often as they should. The manager must make sure that everyone has this training. This will make sure that staff have the necessary skills to care for people properly and that risks to people living at the home are minimised. Connaught Court Nursing & Residential Home DS0000027959.V351721.R01.S.doc Version 5.2 Page 7 The home should consider using larger print, colour and pictures in all written information about the home. This will make sure that information is suitable for everyone at the home and that people have information that they can read and understand. The home should change the way it orders repeat prescriptions and amend records when people handle their own medication. This will make sure that the home follows safe practice and guidelines. Some people who rely on staff for support and assistance have their choices restricted. The manager should review all routines and practices in the home to make sure that they are in the best interests of people living there. This will give people more choice in their daily life. Although activities are provided, some people living at the home felt there is not always enough stimulation. A range of activities should be available that are suitable to people’s needs and abilities and that are based on past and/or current interests. This will prevent people from feeling bored. The manager should make effective team working a priority. This will help to reduce the barriers between staff and management in the home. A full list of requirements and recommendations made at this inspection can be found at the end of this report. 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. Connaught Court Nursing & Residential Home DS0000027959.V351721.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 Connaught Court Nursing & Residential Home DS0000027959.V351721.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): Standards 1, 2, 3 and 5. Standard 6 does not apply to this home. People who use the service experience good quality outcomes in this area. People thinking about moving into the home and their family or friends have the information needed to choose a home, which will meet their needs. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The manager said that before any decisions about admission are made, people are invited to visit the home. A relative confirmed this by saying that she visited on behalf of her mother. She initially felt that it was the right place and said that it had been a good choice. The Statement of Purpose and Service User Guide, which gives people information about the home, is available in the entrance. To make sure that this is suitable for everyone living at the home, consideration should be given to using a larger font size, visual prompts such as colour and pictures. On admission staff use a checklist to make sure that people are given a copy of an Connaught Court Nursing & Residential Home DS0000027959.V351721.R01.S.doc Version 5.2 Page 10 agreement of their stay, the service user guide, the complaints policy, confidentiality policy, privacy and dignity policy and gifts and gratuities policy. A person living at the home said she had been given lots of information about the home. The organisation has a team of care advice visitors who carry out preadmission assessments nationwide in the person’s current setting, which could be their home, another care home or hospital. This is carried out before any decisions about admission are made, so that the home is sure it can meet the person’s needs. The pre-admission assessments of three people were sampled. There was good information about the people involved in the assessment process and evidence of pre-admission visits to the home. The format for the assessment suggests that people fall within a score of 1 – 4 in different headings. For example, the assessment for ‘Personal Care’ is as follows: • Score 1 No help needed • Score 2 Manages with minimal help • Score 3 Greater supervision/intervention required • Score 4 Totally dependent This means that unless a good deal of additional information is recorded, there is nothing about the precise level of support and assistance the person needs. All of the pre-admission assessments sampled lacked specific information about people’s precise needs. Connaught Court Nursing & Residential Home DS0000027959.V351721.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): Standards 7, 8, 9, and 10. People who use the service experience adequate quality outcomes in this area. The care needs of people living at the home may be overlooked as care plans do not give staff clear and precise instructions to follow. People’s health care needs are met and their privacy and dignity is respected. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: Those care plans sampled did not reflect the actual care that was being delivered. One person’s personal hygiene plan said, ‘most days assistance is needed with washing and dressing’. This does not give staff the precise information they need. A care worker said that this person could sometimes wash her own hands and face and could help to dress by putting her arms in sleeves. She preferred a bath to a shower. None of this was in the care plan. A continence care plan said ‘wears pads day and night’, but there was no information about the type of pads or how often they should be changed. Other plans were similar giving information such as, ‘needs assistance with Connaught Court Nursing & Residential Home DS0000027959.V351721.R01.S.doc Version 5.2 Page 12 toileting and going to bed’. One person’s continence plan said, ‘ incontinent of urine and faeces’ but there was no information about how this should be managed, the action that staff should take to promote continence, or any continence aids being used. Some plans were confusing because the actions for staff were within the monthly evaluation rather than the main body of the care plan. In a returned survey form one GP (General Practitioner) said, “I think the staff are very caring.” This survey also showed that staff always seek advice and act upon it to manage and improve people’s health. A relative said, in a returned survey form, “Connaught Court provides support to my mother. I consider she is extremely well cared for and I have nothing but praise for the staff who do a wonderful job.” The deputy manager said that the home has a good relationship with other health care professionals such as the specialist Parkinson’s disease nurse. Medication was given out properly and good records were made. A person who held their own medication had a risk assessment in place, but this did not show what the home should do to make sure that they managed this properly and it was not signed by their GP. The home’s system for ordering medication does not follow guidelines issued by The Royal Pharmaceutical Society of Great Britain. Repeat prescriptions are sent by the GP direct to the pharmacist. This means that the home does not see, check or sign the original prescription, which is poor practice. Training records show that not all qualified staff have medication training updates as required. Care workers described the different ways that they protect people’s privacy and dignity. Throughout the two day visit people locked their bedroom doors and staff asked permission before entering. Connaught Court Nursing & Residential Home DS0000027959.V351721.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): Standards 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. Some staff routines restrict the choices of some people living at the home. Social and recreational activities do not always meet the expectations and needs of everyone living at the home. This means that some people have little stimulation. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: From discussions with staff and some people living at the home it is clear that people’s choices are to a certain extent determined by staff routines and the level and support required from staff. For example, a care worker in one part of the home said that most people have difficulty leaning over a sink to have their hair washed by the hairdresser. As a result, care workers wash people’s hair while they are assisting people to bathe. Because the hairdresser visits each Wednesday, most people have a bath Monday or Tuesday so that their hair has been washed when the hairdresser visits. One member of staff said people are assisted to get up in the morning at 7.00am and if people are asleep she will wake them. Similarly, she described a routine where people Connaught Court Nursing & Residential Home DS0000027959.V351721.R01.S.doc Version 5.2 Page 14 are assisted to bed at 7.00pm, starting with staff assisting those people who need the support of two carers first. These routines restrict peoples’ choices. One person living at the home said that she gets undressed after her evening meal, which is not her choice but is a time when staff are available to assist her. She said that she would like a bath each evening, but has a bath at a time that suits the staff. People who were more independent spoke about making choices from the menu, flexible times for going to bed and getting up in the morning, furnishing their rooms and doing their own laundry. There was a constant stream of visitors to the home during the two days and all were made welcome. One person said that she visits her mother every week and stays to eat lunch with her. She described meals as being, “a social occasion.” Other people entertained visitors in their rooms and all were offered tea or coffee. There is a chapel on site where a multi-denomination service is held once a week. A service took place during this inspection visit and was very well attended by people living at the home. The manager said that if someone wanted an alternative or special service this would be arranged. People’s views about the level of social activities were mixed. The AQAA (Annual Quality Assurance Assessment) shows that the home employs a full time Activities Co-ordinator who organises a full and varied entertainment programme taking into account all abilities and preferences. This person was on leave during this inspection visit. A newsletter and activities programme is available for people in large print. This showed a film afternoon, trips to Tapton Hall and Burnby Hall Gardens and two concerts during August, along with regular weekly activities such as a quiz, exercise class and bingo. One person said that there was little stimulation for her. She described activities such as knitting and painting but said she was not interested in these. She said there are occasional outings and entertainers visiting the home, and said that bingo was the highlight of the week, but when the Activities Co-ordinator is away, there is nothing. Some staff said that activities are geared towards the more independent people living at the home. The person in charge of the dementia care unit spoke about mini-bus outings for people, but a member of staff on this unit said the Activities Co-ordinator did not visit the unit and “people just sit in chairs all day.” The person in charge of the dementia care unit described how she is encouraging people to retain as much independence as possible in areas such as dressing and eating by using ‘mirroring’ techniques. She said that this was particularly effective at mealtimes and is achieved by grouping people with similar abilities together so that they can watch and follow other people’s behaviour. Unfortunately, two staff on duty had not had any training in Connaught Court Nursing & Residential Home DS0000027959.V351721.R01.S.doc Version 5.2 Page 15 dementia care, and one in particular, had little understanding about good practice in dementia care. The lunchtime meal in the main dining room was relaxed and some people were seen enjoying a glass of wine with their lunch. Returned survey forms completed by people living at the home show that people usually like the meals provided. One person described meals as being ‘tasty’ and another person said, ‘If you don’t like what is on offer staff will find you something else.” One person described the food as being plain and well balanced, another said that meals are OK but she missed food such as fresh salmon. A relative said that the meals were basic but acceptable. The home’s food budget is £3. 06p per person per day. Some staff said that portion sizes are small and a comment in a returned survey form completed by a member of staff said, “It is all about money now not the diet of residents.” One member of staff assisted a person to eat a blended meal but did not know what food she was offering, therefore gave no explanations to the person about her meal. Connaught Court Nursing & Residential Home DS0000027959.V351721.R01.S.doc Version 5.2 Page 16 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): Standards 16 and18. People who use the service experience good quality outcomes in this area. Complaints are dealt with properly and people are protected from abuse. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: People are given information about how to complain when they are admitted to the home, and all of those spoken to said that they knew how to complain and would do so if necessary. Like other written information for people, consideration should be given to making information about complaints easier to read and understand, by using large print, visual prompts such as colour and pictures. This will make sure that it meets the needs of everyone at the home. The home keeps a clear record of all complaints and details of how the home has dealt with them. A relative who completed a survey form said that they knew how to make a complaint. Care staff knew the different types of abuse and how to report a safeguarding (abuse) issue. All staff have had training on POVA (Protection of Vulnerable Adults), senior staff have attended safeguarding training, and have used local procedures to alert a potential safeguarding issue. Connaught Court Nursing & Residential Home DS0000027959.V351721.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): Standards 19 and 26. People who use the service experience excellent quality outcomes in this area. The layout and design of the home supports people to live in a safe, well maintained home that encourages people to retain as much independence as possible. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The home is spacious with plenty of sitting areas and wide corridors giving easy access to all parts of the home, particularly to people who use a wheelchair. Communal areas include a library, spacious lounge with a stage for entertainment and a chapel where multi-denominational services take place. Staff have tried to make some bathrooms more ‘homely’ by using seaside prints and plants. The manager described on-going plans to refurbish, update and renew decorations and furnishings. Bedrooms are personalised Connaught Court Nursing & Residential Home DS0000027959.V351721.R01.S.doc Version 5.2 Page 18 according to individual taste and people were seen entertaining visitors in their rooms, and using a key giving them additional privacy. Call bells are left within easy reach of people. A visitor said that staff respond immediately to call bells and gave an example of how two staff came immediately when her grandchildren accidentally pressed the call bell in her mother’s room. One unit, designed as a small house, provides accommodation for people with dementia. The house is spacious and has some good practice features such as a reminiscence room, pictures on some bedroom doors to remind people of their surroundings and old-fashioned door knockers on each bedroom door. There are spacious and attractive grounds with easy access for people with limited mobility and those who use a wheelchair. Several people were sitting, walking and chatting to each other in the gardens throughout this inspection. A visitor described the home as being, “spacious, spotless and like a first class hotel”. The laundry was clean and tidy and there is a separate area for people who want and are able to do their own laundry. One person said that she makes use of this facility. One person who has her clothes laundered by staff said that her clothes are always “nicely laundered.” A visitor said that her mother’s clothes are beautifully laundered and couldn’t be better if they were drycleaned. Staff had a good understanding of how to prevent the spread of infection in the home. Connaught Court Nursing & Residential Home DS0000027959.V351721.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): Standards 27, 28, 29 and 30. People who use the service experience adequate quality outcomes in this area. Refresher training is not always delivered on time, which means that some staff practices may not be up to date. Staff routines leave some people feeling that their needs are not always met. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: Management and staff had differing views about staffing levels. Most staff who returned survey forms said that staffing levels did not meet the needs of people living at the home. Comments included: • It worries me that we are short staffed and the care workers who do such a good job are being stretched to the limit so that the residents do not always get the top quality service that they should have at their age. There never seems to be time to talk any more to the residents. Could employ more staff in order to provide the level of individual care that some residents need. The home is staffed to the specified levels required. However, due to the ever increasing frailties of the residents it is not always possible to spend quality time that the individuals deserve due to the workload involved. DS0000027959.V351721.R01.S.doc Version 5.2 Page 20 • Connaught Court Nursing & Residential Home • • There is not enough staff, we go short to cover other floors. The management won’t take on new staff even though we struggle and are exhausted and tired. Always work very short staffed. Throughout the inspection staff spoke about being rushed and being short staffed. A person living at the home said that staff are busy and don’t have time to spend with people. She said “There is no continuity of staff, and using agency staff means that you don’t know who is coming to help you.” During the two day visit staff seemed to be relaxed and unhurried and the numbers of staff on duty seemed to be appropriate for the needs of the people living at the home, but through discussions with people it seems that care is delivered in a ‘task orientated’ way rather than ‘person centred’ way. One person living at the home said that some choices she makes are determined by time and by staff numbers. This is something the management team should address. The manager said that a review of staffing levels had been carried out by the organisation and staffing levels did in fact meet people’s needs. The AQAA (Annual Quality Assurance Assessment) shows that plans for the next 12 months include recruitment of additional night staff, which will reduce the need to use agency staff. The AQAA shows that 1/3 of the people living at the home are male but only 1/8 of the staff team are male, however people living at the home said that this was not a problem. Ethnicity seemed to be more of a problem as some people said that they found it difficult to understand some staff. The home has a training officer. This person said that because she has to work some shifts she does not have time to update mandatory training. Some staff have not had mandatory training updates as required. This includes training on infection control, moving and handling, fire safety and food hygiene. There is a spacious training room with relevant books and magazines available for staff. All new staff complete an induction programme based on the Skills for Care common induction standards. More than 50 of the staff team have a National Vocational Qualification (NVQ) at level 2 or above. Overall, comments from staff in returned survey forms show that they think training is relevant to their job role and the needs of people living at the home. The recruitment records of two people were looked at. All the required checks had taken place, but it is recommended that original photographs be held on staff files rather than a photocopy, as facial features are sometimes difficult to distinguish. Connaught Court Nursing & Residential Home DS0000027959.V351721.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): Standards31, 33, 35 and 38. People who use the service experience adequate quality outcomes in this area. Differing views about the management of the home could affect the service that is delivered to people living there and has the potential to cause unrest and tension. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The manager, who is a first level nurse, has worked in the home for 12 years in various management posts, but has only held the post of manager for 6 months. During this time she has completed registration with the Commission for Social Care Inspection. Connaught Court Nursing & Residential Home DS0000027959.V351721.R01.S.doc Version 5.2 Page 22 Once more there were inconsistencies about the way that the home is managed. The management team felt that the new manager was addressing some of the home’s communication difficulties by introducing weekly senior staff meeting, general staff meetings, social evenings for staff, and regular sherry mornings with people there. Minutes of staff meetings were seen. The deputy manager was very positive about the senior staff meetings and said it was a valuable way of ensuring senior staff followed a consistent approach. The manager has also introduced a system where a policy of the month is circulated to all areas of the home. She said that this works well and keeps staff up to date with policies and procedures. Evidence of this was seen in different parts of the home. Views from staff in returned survey forms included comments such as: • There is very bad communication by management. • It seems to be ‘them and us’. • There is no communication from management. • Appraisals and supervision are carried out but these do not supply the support that we sometimes require. • You are not allowed to have an opinion. • Management is ineffective. During the inspection one member of staff said that staff meetings take place, supervision is effective and regular and she felt supported by the management team. Another person said that the management team was ineffective. The manager should make effective team working a priority before the views of some staff start to affect the people living at the home. The Business Co-ordinator deals with any monies handed in for safekeeping by people living at the home. Records of all transactions are kept up to date. Quality assurance surveys are sent out by the organisation and collated centrally. From the analysis the manager forms an action plan for the following 12 months. Meetings take place for people living at the home and minutes are taken and are available in the home. The AQAA (Annual Quality Assurance Assessment) shows that servicing and maintenance of equipment takes place as required, but as shown previously in this report mandatory training updates do not take place as necessary. Connaught Court Nursing & Residential Home DS0000027959.V351721.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 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Connaught Court Nursing & Residential Home DS0000027959.V351721.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. 1. Standard OP7 Regulation 15 (1) Requirement People living at the home must have a detailed care plan that gives staff clear instructions on how to deliver care. Timescale for action 31/12/07 2 OP30 18 (1) This will make sure that people receive care that meets their individual needs. All staff must receive mandatory 31/12/07 training such as infection control, moving and handling, fire safety and food hygiene. Up dates must take place as required. This will make sure that staff have the necessary skills to care for people properly and that risks to people living at the home are minimised. Connaught Court Nursing & Residential Home DS0000027959.V351721.R01.S.doc Version 5.2 Page 25 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 OP1 OP16 Good Practice Recommendations Consideration should be given to using a larger font size, visual prompts such as colour and pictures on all written information such as the Statement of Purpose, Service User Guide and complaints procedure. This will make sure that people have information that they can read and understand. Information recorded in the home’s pre-admission assessment should give details about the precise level of support and assistance the person needs. This will make sure that staff have accurate and up to date information about people needs. The home should check repeat prescriptions against the original request and sign the back of the prescription before sending them to the pharmacist. This will make sure that the home is complying with guidelines from The Royal Pharmaceutical Society of Great Britain. Qualified staff should have medication updates as required. This will make sure that their practice is up to date. Risk assessments for people handling their own medication should be signed by the person’s GP and should show what staff should do to make sure that the person is managing his/her medication properly. This will make sure that people remain safe and able to handle their medication. The manager should review routines and practices to make sure that they are in the best interests of people living at the home. This will make sure people’s choices are respected. Recreational activities, based on people’s past and current interest and abilities, should be provided regardless of people’s medical condition or disability. This will make sure that activities are available to everyone. DS0000027959.V351721.R01.S.doc Version 5.2 Page 26 2. OP3 3. OP9 4. OP12 OP14 OP27 OP12 5. Connaught Court Nursing & Residential Home 6. OP15 7 8 OP29 OP31 When people are assisted and supported to eat they should be given a full explanation of the food offered. This will make sure that people are aware of what they are eating. Photographs on staff files should be originals rather than photocopies. This will make sure that people’s features are recognisable. The manager should make effective team working a priority. This will help to reduce the barriers between staff and management in the home. Connaught Court Nursing & Residential Home DS0000027959.V351721.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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. 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