CARE HOMES FOR OLDER PEOPLE
Connaught Court Nursing & Residential Home St Oswald`s Road Fulford York North Yorkshire YO10 4FA Lead Inspector
Anne Prankitt Unannounced Inspection 7th March 2006 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 Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 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 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) arichards@rmbi.org.uk Royal Masonic Benevolent Institution Mrs Nancy Gray 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.V283410.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 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. 23rd August 2005 Date of last inspection Brief Description of the Service: Connaught Court is a care home owned by the Royal Masonic Benevolent Institution. A maximum of 90 service users can be cared for at any one time. The home has 4 residential areas for up to 65 service users, known as Ebor, Yorvik, Knavesmire and Fairfax. One of these is for service users with high dependency needs. A nursing area called Viking is provided for up to 15 service users. There is a self contained area for up to 10 service users with dementia needs called Fred Crosland House. The home is situated in Fulford on the outskirts of York. Local amenities are accessible to service users. The home has its own grounds which are accessible to service users. Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection lasted for seven and a half hours, and was conducted by three inspectors. Three hours preparation took place prior to the inspection. The registered manager, Nancy Gray, deputy manager, Margaret Cade, and catering and training manager, Derek Greenfield, assisted at various points of the inspection. Both Nancy Gray and Margaret Cade were available for feedback at the close. During the course of the inspection, some care plans were looked at, some service users and staff were spoken with, and the general activity within the home was observed. A tour of the communal areas was undertaken, and a sample of private bedrooms seen. The systems in place for the safe handling of residents’ monies were looked at, and quality assurance discussed. What the service does well: What has improved since the last inspection?
Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 6 Risk assessments have been included in the care plan where seating is used to improve the safety of a small minority of service users, but which may restrict their movement, to ensure that the chairs are suitable. Arrangements upon death and dying are now better recorded in the care plans, so that staff better understand the individual needs and wishes of residents. New medication fridges have been provided on two of the units, so that medication which needs to be kept cold can be stored appropriately. A number of specialist beds and new commodes have been purchased. On the day of the inspection the number of staff available at the lunchtime meal in the main dining area ensured that the staff member who administered medication was not distracted, so that there was less chance of errors occurring. 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. Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 EVIDENCE: It was confirmed by staff that intermediate care is not provide at the home. This standard therefore is not applicable. Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8 The staff have a good understanding of the service users’ support needs. However, better review of care plans and additional risk assessment would ensure that the written information provided about the needs of service users is up to date and reflects their needs. The systems in place to monitor and supervise the safe administration of medication are not sufficiently robust to protect service users from unnecessary risk. EVIDENCE: A random selection of care plans was looked at from each area of the home. The hard work that staff have put into the majority of those plans seen is noted, and staff demonstrated a good understanding of service users’ needs. Overall good holistic working care plans, which evidenced that the support of outside professionals is sought where required, have been developed. Continence needs are assessed by an appropriate person and continence aids provided. Risk assessments are completed where risk has been identified. A summary of past life and interests helps staff to understand the social interests of service users. Short term care plans were also in place. This is good
Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 10 practice. Daily records are kept for each service user, and staff receive a handover before each shift commences. The following matters were discussed: Whilst action was being taken to address issues of weight loss, the documentation used did not include a trigger for staff where referral should be made for advice. It is recommended that this be introduced. The review of some care plans and risk assessments had fallen behind. It is recommended that both the care plans and risks be reviewed on a monthly basis. Risk assessments for bed rails had not been completed in all cases, and some seen were not properly fitted. Risk assessments where service users are not able to use call bells should be introduced, which should refer to the systems put into place to address this. Knavesmire, Ebor and Yorvik In the case of one service user who suffered from occasional aggressive behaviour, the staff member explained appropriately and in detail how they manage the situation. It is recommended that this be included in the care plan so that it can be ensured that the approach adopted is consistent. Fairfax The approach observed by one member of staff confirmed that they understood how the service user’s needs relating to their arthritis, confusion and short term memory loss were best met. However, these needs were not reflected within the care plan, which required a general update to reflect current needs and abilities. Viking In the case of service users who have become very frail, and who are cared for in bed, it is recommended that documentation which is no longer appropriate be removed from that care plan, to be replaced with information which is more specific to current needs. The care plan in place for the management of pressure sores was not specific, provided insufficient information, and required improvement. Service users appeared very comfortable and well cared for. Staff had taken time to assist those who are more dependent in maintaining their dignity, and to ensure that they were smartly dressed, to include items of jewellery where this was their choice. Service users thought that there were sufficient staff to meet their care needs appropriately. Comments included: ‘I am very satisfied with my care’, ‘My needs are met’. Another service users stated that staff do ‘a Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 11 thoroughly good job’. One isolated comment made was that ‘care staff are on the thin side’. A pharmacy inspection took place at the home in October 2005, following notification by the home to the commission of medication errors which had been made by staff. Since the pharmacy inspection, which resulted in requirements and recommendations being made, there have been a further three reported errors. This is of concern to the commission. It is imperative that the responsible person looks at further ways in which the system can be made safer, including additional supervision by the management of the home for staff where errors occur. In addition, it is expected that additional auditing of systems will take place during regulation 26 visits to the home, with feedback provided to the commission with regard to relevant findings and subsequent action taken following incidents of error. Three staff supervision records provided at the time of the inspection were looked at. The issues regarding medication errors were not discussed within the records. The registered manager has explained subsequently that records relating to action taken following administration error are recorded in a separate file. This will be looked at again at the next inspection. Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 14 The range of social opportunities available at the home assists in meeting the social and recreational needs of service users, who benefit from a relaxed routine where their rights to make choices and to maintain contacts with friends and family is respected and upheld. EVIDENCE: There is a dedicated activities person employed at the home Monday to Friday, who provides a variety of activities to suit a range of interests, including quizzes, knit and chat afternoons, visiting shop and bingo. There is also a library available to service users. Activities are advertised around the home. On the day of the inspection, some service users had volunteered to join an exercise class, and there was a film planned for the afternoon. For those service users who are not able to attend group activity sessions, staff attempt to facilitate one to one time when providing personal care wherever possible. This is more problematic on Viking and Fairfax units, where the dependency needs of service users demand more staff time. However the possibility of extra staff provision is being looked in to. This will assist service users who are more isolated. The activities organiser stated that some service users are taken out individually. The spiritual needs of service users are discussed within the care plans, and a service takes place in the home’s chapel on a weekly basis. Service users explained that there are no visiting restrictions. Visitors on
Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 13 the day were enjoying a meal with their relative. Details about Age Concern befriending services are posted for information. Service users were satisfied that they are able to make choices in their lives, and that they are not restricted by an onerous routine. Staff try to keep the routine flexible at all times to accommodate the individual wishes of service users. One service user stated ‘I am happy here and settled. I enjoy the company of other residents’. Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of the standards were assessed at this inspection. Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of the standards were assessed at this inspection. Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 Appropriate recruitment checks are carried out which helps protect service users from unnecessary risk. EVIDENCE: Two staff recruitment files were looked at. One staff member had been deployed following return of a satisfactory POVAFirst check. It was confirmed that their work was being supervised until such time that a satisfactory Criminal Records Bureau check was returned. Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, and 38 The systems for consultation are good, and service users are listened to. Service users can be assured that their monies are handled safely. Additional attention to the bed rails equipment, and ensuring that sluice rooms remain locked, will assist in protecting service users from unnecessary risk. EVIDENCE: The registered manager is suitably qualified for the role in which she is employed. She holds NVQ Level 5 in management, and attends training to update her skills in management. Staff and service users stated that she and her deputies provided an effective management team. Staff stated that the team was supportive. Comments from service users included that Connaught Court was a ‘well managed home’. Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 18 The home has developed an effective quality assurance system. There are regular resident committee meetings, with one due the week of the inspection. Residents’ satisfaction surveys are sent out annually, and an action plan is provided in response. Additional surveys are sent out. For instance, service users have recently been asked for their views about the choice of bathrooms. The home can safe keep service users’ monies. Both paper and computerised records were kept of incomings and outgoings, and receipts are maintained where transactions are made on their behalf. Lockable facilities are provided in service users’ rooms for those who wish to keep their own monies, and some service users choose to handle their own affairs. Some of the sluice rooms were not kept locked. The sluice room on Fairfax unit was unlocked, and the cupboard in which chemicals were stored would not lock. This was brought to the attention of the maintenance man, and feedback was received that it was repaired. The recording of bed rails is not sufficiently robust, and steps are being put into place for this to be improved upon. Despite these being checked monthly, there were some seen which were not positioned correctly, and the records checked did not evidence which rails had been checked. A policy for the use of bed rails may assist staff in understanding how these are to be fitted safely. There were a number of care staff who have completed First Aid training. Staff spoken with were satisfied that there was sufficient support available should first aid assistance be required. Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 19 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12,13,15 Requirement A risk assessment must be completed for all service users who have bed rails fitted to their beds. Clear records must be maintained as evidence that each bed rail has been checked on a regular basis to ensure that they are safe for use. Where service users suffer from pressure sores, their treatment and outcome must be clearly recorded, and reviewed on a continuing basis. (Timescale of 30/09/05 not met) The responsible individual must further develop effective ways of auditing and monitoring staff management of the medication system, and develop ways in which the system can be made safer. Progress must be reported to the commission within regulation 26 reports. Sluice rooms must be kept locked when not in use. Bed rails must be checked before next being used to ensure they
Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 21 Timescale for action 14/03/06 2 OP8 17(1a) S3(p) 15(2b) 31/03/06 3 OP9 13,26 31/03/06 4 OP38 13 07/03/06 are safe and properly fitted. 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 A policy on the use of bed rails should be developed. With regard to the care plans, it is recommended that: The plans and associated risk assessments are reviewed on a monthly basis. • Further detail about how staff can best manage challenging behaviour is included within the care plan. • All aspects of current care needs, and how they are to be met, is included in the plan. • A risk assessment is completed for service users who are unable to use their call bells whilst in bed. It is recommended that the registered manager consider the current nutritional risk assessments in place, to include triggers for referral to the appropriate professional. • 2. OP8 Connaught Court Nursing & Residential Home DS0000027959.V283410.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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