Inspection on 29/08/08 for Connaught Court Nursing & Residential Home

This inspection was carried out on 29th August 2008.

CSCI found this care home to be providing an Adequate service.

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 &... 11/09/07

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 20/03/2009.

CARE HOMES FOR OLDER PEOPLE Connaught Court Nursing & Residential Home St Oswald`s Road Fulford York North Yorkshire YO10 4FA Lead Inspector Denise Rouse Key Unannounced Inspection 29th August 2008 9:00 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 Connaught Court Nursing & Residential Home DS0000027959.V371280.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. Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.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 (90), Old age, not falling within any registration, with number other category (90) of places Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.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 and Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 90 11th September 2007 2. Date of last inspection Brief Description of the Service: Connaught Court is a care home owned by the Royal Masonic Benevolent Institution (R.M.B.I.) 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 areas 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 charged on the day of the site visit ranged from £475 - £757 per week. More up to date information can be obtained from the home. Information is available to people about what services the home has to offer and the inspection reports are made available to people. Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The accumulated evidence used in this report has included: • A review of the information held on the home’s file since its last key inspection. • Information submitted by the registered provider in the Annual Quality Assurance Assessment. • Surveys received from nine people living at the home, three staff, and two health care professionals. • An unannounced visit to the home, which lasted one day, and was undertaken by two inspectors and a pharmacy inspector. This included a full tour of the premises. • Evidence was gained by direct observation during the site visit; which involved talking with people living at the home, the management team, other members of staff and relatives who were visiting the home. Inspection of records, including care profiles, medication administration records, staff files, personal allowance accounts and some of the home’s policies and procedures. • We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: Thorough assessments of people’s needs are undertaken and include details of risks, to ensure people’s needs can be met. People say they receive care in a way that respects their privacy and dignity. “ It is a very happy home”. Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 6 “ My daughter and I visited several other homes during one quest, but this one left no doubt in our minds that we had chosen wisely”. One relative spoken with on the site visit said “ We feel privileged to have Mum here, communication is good, staff are observant, they have a nice way about them and I always feel welcome”. A complaint’s procedure is in place to ensure that any concerns raised are investigated and dealt with. The home have 70 of their care staff who hold a National Vocational Qualification at level two or three. Training is provided for staff in mandatory subjects as well as other areas to ensure that care staff have detailed knowledge, which helps them to give good quality care to people in the home. Refurbishment and maintenance is carried out to all areas of the home to ensure that it remains a pleasant place for people to live. What has improved since the last inspection? What they could do better: Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 7 Care plans for new admissions should be completed as soon as possible so that staff have all relevant information available to them to ensure people’s needs are met. Care plans for pressure sores should have all the information contained in them about signs of infection and special equipment to be used, to make sure that people’s health and well being is protected. Parts of the medication systems, in some areas of the home are still not thorough enough to protect people. People on the residential unit do not have the opportunity to have breakfast in their bedrooms unless they are unwell, management should consider how this may be made possible to give people choice. The complaints procedure should be updated to give people the correct details for contacting the Commission for Social Care Inspection. A lockable cupboard should be provided for washing chemicals in the residential laundry to ensure people’s health and safety is protected. Reassessment of staffing numbers should be undertaken on the residential unit to make sure people can receive timely care. Management should keep up to date with information provided on the Commission for Social Care Inspection website which will to help them manage the home. The Operations co-ordinator should consider documenting all the monitoring undertaken of his departments, to make sure that there is evidence available. Audits undertaken to look at care planning and medication must be detailed enough to find any shortfalls and these issues must be addressed to make sure people’s health and safety is protected. Hot water temperatures in people’s bedrooms should continue to be monitored and corrective action should continue to be taken where temperatures are increasing, to protect people’s health and safety. 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.V371280.R02.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.V371280.R02.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 3 (6 not applicable) People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are fully assessed before they are offered a place in the home; this ensures their needs can be met. EVIDENCE: People who are considering moving into the home have a pre admission assessment undertaken by people who are competent to assess their people’s needs. They are also visited by the company’s care advice visitor where necessary and the home tries to ensure the same people deal with the enquiry. The assessment’s we looked at were detailed and included information about people’s physical and special needs and where necessary information about people’s communication skills and memory. Additional information from care managers and discharging hospitals is also gained to ensure people’s full needs are known and can be met. Admissions are not made to the home if staff cannot meet their needs. Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 10 Prospective residents are able to visit the home to look around with their chosen representative. They can stay for a meal or for a trial period to help them get a feel for the home. The manager and staff spend time with people to answer their questions and help them decide if this is the right home for them. People receive literature about the Royal Masonic Benevolent Institution in their “ Meeting the needs of older Freemasons and their dependants” information pack. We saw that it did not include the summery from the last Inspection. The manager said the last inspection report was available to people at reception and many copies of the report had been taken from the reception area. The manager told us that the homes brochure was currently being re designed and was not available in the home. However there was enough detailed information available to help people make an informed choice about if the home was the right place for them. The recommendation that this information should be made available in different formats to help people who may have different communication needs, has not yet been implemented and this is still being considered by head office, therefore information is only available in normal print at this time. Seven people indicated in their surveys they were happy with the information they received about what the care home had to offer them. One said “ I received information by post, and carried out personal inspection with their son” another said “ My daughter and I visited several other homes during one quest, but this one left no doubt in our minds that we had chosen wisely”. Intermediate care is not provided. Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.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 10 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s health care needs are being met, however there are some shortfalls to be addressed relating to care documentation and medications, which may place some people at risk. EVIDENCE: A lot of work has been undertaken since the last site visit to ensure that people’s care plans are individual and reflect people’s care needs. Care plans were reassessed monthly or as a person’s needs changed. Some people had signed their care documentation, which clarified that they had taken part in their review and was in agreement with the care to be given. We looked at four peoples care in depth. Most had thorough person centred care plans and, where necessary risk assessments were in place. However one person’s care plans from the dementia unit were not completed, signed, or dated. Although staff appeared to meet this person’s needs care plans must be completed as soon as possible so that staff have information about how to look after people Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 12 to meet their needs. Another person on the nursing unit had a care plan for a pressure sore, however this was discussed with the manager as there was no detail recorded about what type of pressure mattress the person was being nursed on and what signs staff should look out for in the way of infection. And what action should be undertaken if this occurred. This detail was added at the time of the site visit by the manager. A key worker system is in place, which allows people to build up trust and gain support from their allocated member of staff; this helps to enhance the care they receive. We saw that specialist equipment is available to ensure that people’s individual and special health care needs are met. This includes profiling beds and hoists. Help and advice is sought from health care professionals in relation to people’s health and special needs to ensure their needs are met. People are escorted to appointments or health care professionals attend the home as required. Staff addressed people by their preferred names. They could lock their bedroom doors if they wished. People spoken with said that when staff attended to them to help them wash they covered them with towels to help to maintain their privacy and dignity. Staff helped and support people who had issues remembering things in a sensitive and supportive way. People are able to follow their own chosen routines with support and guidance as required from the staff to ensure people’s individuality and independence is protected. Staff were seen to spend time with people on the dementia and nursing units. A CSCI pharmacist inspector again attended on this visit and conducted a pharmacy inspection of the systems in place for managing medications in all the units at the home. The pharmacist inspector found evidence of good practice on the Fred Crosland unit but some areas of concern on the other units. Improvements have been made to the availability of medication and the quality of handwritten administration charts. However accurate administration and recording of medication administration is not consistently done. This means people are at risk of not getting their medication as prescribed, which may effect how their condition responds. The current month’s Medication Administration Record (MAR) charts were looked at on all units. There were a number of MAR charts that had no records of administration. This was of particular concern for medication such as creams and ointments. The charts for these medicines indicated that they are applied by the care staff but the MAR chart is not always completed. To demonstrate that people are getting the medication as prescribed the MAR chart should record each administration. Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 13 The administration for one person prescribed a Fentanyl patch to provide continuous pain relief was poor. The records in the controlled drug register and on the MAR chart showed that the patch had been applied 3 days later than the due date. This means that the amount of drug being released would not be consistent so the person may not be getting continual pain relief. It is important that medication is given as prescribed to make sure that the symptoms the person is experiencing such as pain are well controlled. One person has their medication crushed because they have swallowing difficulties. A letter from the GP dated 11 February 2002 authorising all their medication to be crushed was kept in the folder. However there was a letter dated 28 August 2008 from the supplying pharmacist stating that one of the tablets should not be crushed. Authority from the pharmacist as well as the GP must be taken before medication is crushed. This is to make sure that crushing will not alter the action of the medication or have a harmful affect on the person. Crushing medication should only be considered after alternative forms of medication such as liquids have been considered or a review of the prescribed medicines has been done. Creams requiring storage in a fridge were found in the medicine cupboards. Other medication was found that had a limited use once opened but had no date of opening. It is important that the instructions on storage are checked and followed to make sure medicines are safe to use. Air conditioning units have been put into all medication rooms. This is good practice as it helps to keep the temperatures of the rooms at the level recommended by the manufacturers. The recording in the controlled drugs register in the nursing unit of controlled drugs sent from other units for disposal is now accurately done. This means there is now a clear account of these drugs in the home. A number of people self administer some of their medication. Risk assessments have been done and reviewed. This is good practice as it will help to make sure people are happy to continue self administering their medication and are safe to do so. Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 14 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 15 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a variety of activities available which they can take part in if they wish. People receive a varied and nutritious diet. EVIDENCE: People told us that they could get up and go to bed when they wanted. However this should be reassessed by management in the residential unit. People’s preferred activities and hobbies are recorded on their pre admission assessment. The activities co-ordinator tries to provide one to one and group activities to fulfil people’s needs. Activities are advertised in a “ Newsletter and Programme” produced monthly. Activities available in August included concerts by a male singer to provide classical music with a range of well-known songs. A film afternoon entitled “ A visit to Switzerland and the “ Welcome return of the Daytone barbers Shop Singers”. As well as an outing to Burnby Hall Gardens. The client group is diverse across the home and therefore the activities programme available perhaps did not meet those people who were more fit and active. One gentleman told us that he had commenced a Gentlemen’s Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 15 Evening, which was held in the lounge, and this was very popular and well attended. Clothes parties, skittles, general knowledge quizzes, exercise classes and a social afternoon with bingo was provided. Some people attend the local church events as well as attending the religious services held in the chapel at the home. People told us they could choose to take part in activities if they wished. Others preferred not to take part and preferred their own company. On the day of the site visit the activities co-ordinator took someone out to the bank and then after lunch sat with a group of ladies in the lounge and helped people to knit. The home has a mini bus and car, which have been provided by charitable donations, and this helps people to get out and about. A library is available with large and standard print books. There are three hairdressers and a barber who attend the home so that people can have a choice of whom they would like to attend. People spoken with said they chose to follow their own routines. Those people on the nursing unit who required more help and assistance were seen to be making decisions about how they wished to spend their day and were assisted to be as independent as possible by patient and supportive staff. People in the dementia unit gain social stimulation from staff and some were talking to each other or choosing to go for a walk by themselves. They are encouraged to remain as independent as possible. People with similar abilities continue to be grouped together so that they can help each other. Staff have received dementia training and this helps them to be able to meet people’s needs. The kitchen was inspected. Food prepared looked appetising. Systems are in operation to promote food health and safety. Breakfast is not being served on the residential unit, to people in their bedrooms. The manager said they just would not have the staff or the systems in place to accommodate this. If people were unwell then they would be given a tray in their bedroom. This should be looked at to allow people to have a choice. Staff informed people what food was available, so that they could choose what they would like to eat. Lunch was well attended and was a social occasion in the main dining area. People are helped and supported to eat by patient staff in an unhurried manner on the nursing and dementia unit. Care staff are sensitive to the needs of people who find it difficult to eat and need help and encouragement with feeding. They have whatever portion size they prefer and can choose at lunchtime what they wished to eat from two hot choices of home cooked food. Menus are available in the main dining area, and food is served by waiters. Some units have kitchen staff to assist at meal times to help ensure meals are served promptly. One person commented in their survey Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 16 “ The various choices of menu mean’s that you can mostly find what you want. If exceptionally nothing suits, you can get something that does”. Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 17 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 18 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that their concerns will be listened to and acted upon and they feel protected. EVIDENCE: The complaints procedure is available to people. One person said, “ If I had any complaints I would feel happy to talk to the staff about them and I’m sure they would be sorted out”. Others said they would feel comfortable about raising any issues. Complaints are investigated and documented, and the complainant is informed of the outcome. However, information about how people can contact the Commission for Social Care Inspection was not up to date and this should be updated and be provided to people. The manager has an open door policy; anyone one can see her to make their views known at any time. Everyone who returned surveys said they knew how make a complaint. One person said “The manager and staff are always so helpful I would not hesitate to approach one of them, should the need arise”. And “ the complaints procedure is both simple and effective, but I must confess that I personally have never had to avail myself of this facility”. A safeguarding policy is in place. Staff spoken with knew what to do if an allegation of abuse occurred. Ongoing training and information relating to the whistle blowing procedure has been given to all staff and issues are brought to management’s attention to be acted upon. This ensures that people are being protected from abuse. There has been one safeguarding incident since the last Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 18 inspection, there was a delay referring this to the local authority due to the manager being unclear about referring an incident between residents. However she is now fully aware of what action to take and this incident was referred and dealt with appropriately. Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 19 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 26 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained home, which is constantly being upgraded to ensure it meets the needs of people living in the home. Infection control measures are in place which help protect people. EVIDENCE: The home is inviting and there are wide corridors, which are airy and light. Handrails are fitted to help people to mobilise throughout the home. There are passenger lifts available to the upstairs floors and automatic doors to some areas of the home help people who may be unsteady on their feet or who use wheelchairs to access all areas of the home and aid their independence. There are a dedicated maintenance team on site to ensure any issues are dealt with promptly. Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 20 The home is maintained and decorated and a programme of refurbishment is taking place in certain areas of the home to enhance the facilities available for people. Improvements made since the last inspection include: New furniture in some areas of the home. The kitchens for people to use in the different wings of the home have been refurbished and modernised. Three assisted baths have been replaced for more modern equipment. New curtains have been hung in the in main dining room, lounge and all bedrooms. New carpets have been fitted in the nursing wing and in Fred Crosland House. A total refurbishment of the communal toilets has occurred with the addition of disabled facilities, these have been completed to a high standard. TV housing has been commissioned and built in main lounge and the addition of a fireplace as a focal point for a seating arrangement. There has also been a new dishwasher fitted into the kitchen on Fairfax. There are communal lounges as well as quiet seating areas spread throughout all areas of the home. There is a stage area in the main lounge for concerts and a separate library. There are two conservatories for people to enjoy sitting in as well as large well-kept gardens with garden furniture. A bowling green is accessible and this adds to the ambiance of the home. Fred Crossland House, which caters for people who have dementia, is particularly attractive; there is signage to help people remember where toilets, bathrooms and their bedrooms are. A room has been decorated and furnished to replicate an old fashioned parlour, this can help people reminisce. The unit has secure access but people can safely walk outside in the fresh air in wellpresented and safe garden, one of which has a summerhouse and there are plans to create a sensory garden in the internal patio area for people to enjoy. There is also a multi denominational chapel on site for people to use and a separate hairdressing salon. The residential unit also has a separate laundry room where people who are able can do their own washing and ironing. Soap powder was available it was suggested this may be safer being stored in a lockable cupboard in the laundry area. The home is clean and there is no malodour. Hand wash facilities are available in all areas of the home. One comment received from a survey was “ I have had some of my visitors comment on the state of cleanliness”. Another said “ I find that Connaught court is to warm for me” and “ This home is in magnificent grounds which are kept Immaculate”. The laundry facilities and systems in operation in the home ensure infection control measures are in place. Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 21 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 30 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Competent well-trained staff look after people living in the home, however the numbers of staff working on the residential unit should be reassessed to make sure timely care can be given. EVIDENCE: Staff spoken with were friendly approachable and positive about the role they played in the home. There has been an increase in permanent staff recruited for night shifts since the last inspection to improve the quality of care being delivered on nights. The inspectors observed staff being sensitive to people’s needs and being supportive of each other. Recruitment policies and procedures are thorough to ensure staff recruited are suitable to work in the care industry. Equality and diversity of staff is respected and male and female staff are available to care for people. An equal opportunities policy is in place. Staff update their training to ensure their health and safety is protected and that of the people living in the home. There is a record kept of staff who have received training, a programme of training has occurred since the last inspection and this has addressed the issues raised at the last inspection, only staff who are on maternity leave have not been updated and this is due to be undertaken on their return. Training for Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 22 staff in mandatory areas is up to date and extra training in areas such as risk assessment, appraisal, hand hygiene, bereavement, palliative care diabetes, equality and diversity telephone manner healthy eating has been provided for some staff. The home have 70 of care staff that hold a NVQ in care at level 2 or 3. This helps to enhance the care that people are receiving. Staff spoken with confirmed that induction training occurred and they said there was always lots of training available to them and this was kept up to date. Staff said they feel well trained; there is a good team spirit. This helps to ensure that staff have up to date skills to deliver good care. One member of staff who completed a survey said “ We have a training officer at the home, who ensures we all attend mandatory training and also offers us a wide range of choice of other training in different formats. If we feel we need training in a certain area, we can discuss this when we have supervision or appraisal and this is then passed on to our trainer. Who does her best to provide the training we need. We all have a training passport and any training we do is documented in there”. Staff said that managers were approachable and staff could see them anytime. Staff meetings are held, general staff meetings occasionally and unit meetings monthly, minutes are taken and these are made available to staff who cannot attend. Staff have supervision and appraisal with their unit managers and the management team. This ensures that any issues can be raised and dealt with appropriately. One relative spoken with on the site visit said “ We feel privileged to have Mum here, communication is good, staff are observant, they have a nice way about them and I always feel welcome”. Some areas of the home have good levels of staffing, on the residential unit at handover staff discussed with the inspector that they felt the higher dependency of people they were looking after, and the layout of the building meant they felt they needed more staff to deliver care, as some people had to wait. This was raised with three of the management team who stated they felt the staffing levels were fair. This has been raised by staff and staffing levels and people’s dependencies should be reviewed by the manager of the home to ensure care can be given timely. People surveyed living in the home were asked “Are the staff available when you need them?” five said “always”, one commented “ I’ve never found otherwise” and three replied “ usually”. One staff survey said “ On early shift we are usually very busy and able to meet individuals physical needs but in the afternoon we can also meet there psychological needs”. It was not clear which unit this person worked on. Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 23 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): Standards 31 33 35 38 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are benefiting from the home being run by a confident manager, however shortfalls relating to the quality of some of the audits undertaken should be addressed to ensure peoples well being is protected. People’s health and safety is protected. EVIDENCE: The manager is experienced and approachable and is supernumerary. There is an extensive management team consisting of the manager, deputy manager, assistant manager operations co-ordinator business co-ordinator and an administration assistant. Also there is a business operations manager who Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 24 attends the home to monitor how the home is operating. The new Chief Executive of the R.M.B.I. was also visiting the home in August so people could speak with him. Staff spoken with throughout the home said that they felt they could raise issues they had. Some said they would raise them with their nurses or heads of department first who would take the issues to management. One gentleman spoken with said that he felt things were improving now as he and other likeminded people, who spoke out were on the residents committee and he felt things were being addressed more fully. Quality assurance audits are undertaken. A care plan audit for all areas of the home and a medication audit occur. The shift leaders audit other areas of the home. However these audits had failed to highlight and deal with the shortfalls raised in relation to two care plans for the case tracked individuals and the issues which must be addressed relating to medications. The quality and of the audits must be reviewed, to ensure they are thorough enough to pick up such issues which must be dealt with. The manager was informed about Key Lines Of Regulatory Assessment. She was not aware of this document. The management team should look at the Commission for Social Care Inspection web site to help keep them up to date with new guidance, which could help them manage the home. At feedback, when one inspector said on the residential unit staff had said they felt more staff was required to meet people’s needs. This was robustly denied by the management team. It was reinforced by the second inspector that if staff are saying there is an issue, management must look at this and act accordingly to make sure staff feel supported. The manager undertakes regular visits to each area of the home although these are not documented. The Operations co-ordinator observes people in the dining room and observes his departments and asks people about the food. However there is no documented evidence to support this, and this should be considered. In November 2007 a questionnaire was sent to people living in the home and their relatives. There is also a comments book in the main dining room, which appears to be well used by people to give their views. There is a yearly audit completed from an outside source and the results of this are available to people living in the home. A monthly safety audit also occurs. The residents personal allowance account was inspected, it revealed for the people case tracked that there had been a discrepancy between two people with similar names, for one hairdressing service. This mistake had been rectified. Receipts for all transactions were kept. The personal allowance account balance was discussed with the administrator following the site visit Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 25 and the account balanced. People were given statements of their accounts when they asked for them. This ensures that people are protected from financial abuse. People’s health and safety is protected. Evidence of fire drills and fire alarm checks undertaken were inspected. The hot water temperature checks made of the supplies to people’s bedrooms were also checked. Some temperatures were seen to be at 44-45 degrees centigrade, this was discussed, as the preferred temperature is 43. However due to the age of the home and the plumbing systems valves have to be replaced and a plumber is required for this. The maintenance team keep a close eye on this situation. And there are plans for the future to address the plumbing and boiler system in place in the home, which will rectify this issue. It is suggested that the monitoring systems in place continue to help protect people’s health and safety. Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 27 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 OP33 Regulation 10 14 (2) (a) Requirement Care planning and medication audits must be detailed enough to find any shortfalls, and action must be taken to address any issues found. This will make sure that people’s Health and wellbeing is protected. 2 OP9 13 (2) All medication must be administered as prescribed. Accurate records of administration must be kept for all medicines. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. 3 OP9 13 (2) A system must be in place to check the storage requirements for medicines. This will make sure medication is safe to administer. Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 28 Timescale for action 20/10/08 20/10/08 20/10/08 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 Care plans for new admissions should be completed timely, to ensure staff have all relevant information available to them to meet people’s needs. Care plans for pressure sores should contain information about special equipment being used and what signs of infection may occur, to ensure that people’s health and well being is being protected. Consideration should be made as to how breakfast may be served to people in their bedrooms on the residential unit, if they require this, other than when they are unwell. To give people choice. Information in the complaints procedure should be changed to reflect the current contact details for the Commission for Social Care Inspection. Management should reassess staffing and the dependency levels of people on the residential unit, to ensure timely care can be given. Any shortfalls found should be addressed. Management should keep up to date with the Commission for Social Care Inspection web site, and familiarise themselves with the Key Lines of Regulatory Assessment. The operations director should consider documenting all the monitoring undertaken in his departments, to ensure evidence is available. Hot water temperatures in people’s bedrooms should continue to be monitored and corrective action should continue to be taken where temperatures are increasing, to protect people’s health and wellbeing. A lockable cupboard should be provided for washing chemicals in the resident’s laundry to ensure people’s health and safety is protected. 2 OP15 3 4 OP16 OP27 5 OP33 6 OP38 Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 29 Connaught Court Nursing & Residential Home DS0000027959.V371280.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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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