Inspection on 13/06/05 for Court House Nursing Home

This inspection was carried out on 13th June 2005.

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

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

Other inspections for this house

Court House Nursing Home 22/06/09

Court House Nursing Home 04/06/08

Court House Nursing Home 30/11/06

Court House Nursing Home 18/10/05

Court House Nursing Home 11/10/04

Court House Nursing Home 07/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE COURT HOUSE Barnards Green Malvern Worcestershire WR14 3BS Lead Inspector Nick Richards Unannounced 13 June 2005 7.15am 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 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 and Care Homes for Adults 18 – 65*. 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. COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Court House Address Barnards Green Malvern Worcestershire WR14 3BS 01684 561276 01684 577949 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes Limited CRH(N) 79 Category(ies) of Dementia - over 65 years of age (19), registration, with number Old age, not falling within any other category of places (41), Physical disability (19), Physical disability over 65 years of age (41) COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11 October 2004 Brief Description of the Service: Court House is situated close to the shops and commanding views of the Malvern Hills. Court House provides care in four individual houses for the elderly frail, elderly mentally infirm and young physically disabled. Some bedrooms have an ensuite facility, and all are single occupancy. Most bedrooms are located on the ground floor, while the two units with accommodation on the first floor level possess a central passenger lift. COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over a period of 4 days, and was carried out to assess how the home was addressing the many requirements from the previous inspection, and to establish how effective care was during the early morning, afternoon and evening periods. A tour of the premises took place and staff and care records were inspected. Nine staff on duty and eight of the residents were spoken to. What the service does well: What has improved since the last inspection? What they could do better: Further attention needs to be given to the development of care plans for people with memory loss and challenging behaviours. While significant investment has been placed within the homes environment, there remains COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 6 several areas that would still benefit from environmental investment and development. 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. COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. 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. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 and 5 Good progress had been made to improve the admission procedure to ensure that there is a proper assessment prior to people moving into the home. This helps to ensure that care needs can be met. EVIDENCE: The admission procedure was satisfactory to guide staff on the actions to be taken to ensure that new residents’ needs are properly assessed and planned for. Individual records are kept for each of the residents, and inspection of the records for twelve residents had full assessment information recorded. Staff members on duty were spoken to, and knew about the care needs of the twelve residents. Residents who were interviewed all said that they felt that the home was effectively meeting care needs. COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 9 The homes Statement of Purpose and Service User Guide are satisfactory – providing residents and prospective residents with details of the services the home provides, enabling an informed decision about admission to be made. Some residents said that they were so content with the standard of service provided by the home that they were not interested in either the Statement of Purpose or the Service User Guide. Residents who were able to express an opinion confirmed that either they or their representative had visited the home prior to making a decision to move in – thereby helping to develop an opinion about the suitability of the home prior to any decision being made to take up residence. All residents were provided with an initial “settling-in (or trial) period”. The home does not contract to provide intermediate care. COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10. Significant progress has been made on improving arrangements to ensure that the health care needs of residents are identified and met. These improvements help to safeguard the health care needs of residents. EVIDENCE: Individual plans of care are available, and progress has been made to ensure that all aspects of health, personal and social care needs are identified and planned for. Most plans were detailed, up to date and had been regularly COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 11 reviewed. However, some plans for people with memory loss problems required further development to make sure that care needs (for example “verbal and challenging behaviour”) are met correctly and consistently. Plans relating to people with diabetes were examined, and had been developed significantly since the time of the previous inspection thereby helping to promote a consistent approach to care. Significant events in the home had been recorded, daily entries into case records had been made and entries available gave an indication of the actual care given. Residents spoken to were happy to confirm that their care needs were being met by staff within the home in a dignified and respectful way. Staff were seen providing care sensitively and discretely to residents, and discussions with staff confirmed that they were aware of residents’ care needs, and how the care was to be provided. Nursing staff were observed administering medication to residents. Medication was administered safely and sensitively to ensure that the right medication was administered to the right person, at the right time and in the right dose – thereby promoting the safety and well-being of residents. COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets residents’ tastes and choices. Social, recreational and leisure activities are being provided to enhance residents’ quality of life, and residents are able to maintain contact with family and friends. EVIDENCE: A number of people living in the home were spoken to and everyone who commented on the food said how good it was and that they welcomed the daily choices offered. Menus were inspected and found to be balanced and interesting and meal time arrangements are also flexible enough to accommodate individual preferences. Care staff demonstrated a detailed knowledge and understanding of individual residents’ dietary preferences and requirements. COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 13 Care staff were seen providing direct assistance to people with their lunch in a sensitive and relaxed manner. During the inspection, some relatives were seen visiting people, and staff greeted visitors politely. Residents spoken to said that they could receive visitors at any time of the day, thereby maintaining links with family members. Residents confirmed that there were “no restrictions” on visiting. There have been significant developments in the provision of social, recreational and leisure activities. One activities co-ordinator has been recruited specifically for younger adults within the home, and has developed a good rapport with the younger-aged residents – who confirmed their appreciation of their activities co-ordinator. Two other activity co-ordinators are employed within the home and provide social, recreational and leisure activities for older people who are resident in Beacon House, Bredon House and Midsummer. Staff have been creative and imaginative in their organisation and provision of recreational activities - even arranging animals such as Shetland ponies to visit residents within the home, who reportedly enjoyed the experience. COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Complaints are handled objectively and residents are confident that their concerns will be listened to, taken seriously and acted upon. A vulnerable adults procedure is available to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a simple and clear complaints procedure. A copy of the complaints procedure was available to all residents, visitors and relatives. Residents spoken to were confident that concerns could be raised with the home. A procedure for responding to allegations of abuse is available, and the management culture within the home aims to protect residents from abuse or potential abuse. Since the present manager has been appointed to the home, the numbers of complaints received by the Commission about the home has decreased significantly. COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) 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. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26. Investment within the homes physical environment has been undertaken helping to enhance the appearance of Beacon and Hollybush House. The environmental standards within Midsummer House are in need of improvement and development to create a more comfortable and pleasing homely environment. EVIDENCE: COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 16 Many bedrooms seen had been furnished with residents’ personal possessions, thereby generating ownership and a sense of autonomy for individuals, and several residents confirmed that they appreciated the physical environment. However, there were some areas within the home (predominantly Midsummer House) where bedrooms could be enhanced through redecoration and the provision of better quality furnishings – which were, in several bedrooms, looking worn. It was also noted that many bedroom doors failed to possess approved locking devices which would enable residents to lock their doors for privacy purposes and open their doors when they are within their room using just one movement. Although the environmental layout of Midsummer is generally suitable for residents, it was noted that corridors were narrow and one resident who was mobility impaired was experiencing difficulties in making his way around the corridor. Hollybush House had benefited significantly from refurbishment and redecoration since the time of the previous inspection, and residents were very appreciative of the environmental standards within the unit. The enhanced environmental standards on this unit serves to emphasise the need for environmental investment on Midsummer. Hot water temperatures have been risk assessed and had been regulated to prevent people being accidentally scalded when they have a bath, and radiators had been guarded and restricted to prevent people being accidentally burnt through intentional or unintentional contact. All the windows located above first floor level had been restricted to prevent people from being injured through falling out of the windows (accidentally or deliberately). Most areas within the home were clean and tidy, with the exception of several bedrooms on Bredon House, which were odorous due to the behaviours of some people who possess memory loss problems. Opportunity was taken to discuss the use of impervious floor coverings to address the problem of odours. COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30. Staffing levels and competencies are suitable to ensure that residents’ needs are identified and effectively met. EVIDENCE: There were suitable nursing and care staff on duty to provide care and support for the residents. In addition to nursing and care staff, there were also ancillary staff on duty to support service provision. During the visit, call bells were activated, and staff responded speedily to them. The duty rotas confirmed that the staffing levels were stable, with little evidence of staff being absent through short-term sickness. Training has been provided to staff, and includes infection control, medication management, care planning and moving and handling. Training was identified in response to the needs of residents, to ensure that care delivered was appropriate to and in response to the needs of residents. COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 18 Residents said that staff were “very good, they look after us well”, “very kind” and were “very attentive”. Residents generally believed that there were sufficient staff available to meet their needs. The home manager has, quite rightly, focused a large amount of time and effort on staff development and training. This has helped to improve service delivery and is also contributing to greater staffing stability within the home. COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. 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 a well run home and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 34. There is clear leadership, guidance and direction to staff to ensure residents receive consistent care, resulting in practices that promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: There is a manager-designate who has confirmed that she will be making application for registration to the Commission. She is competent and appropriately qualified and experienced to manage the service. Once the application is approved, the manager-designate will become the registered COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 20 manager for the home. Staff and residents spoke very highly of her, and commendable diligence and action has been undertaken to improve the quality of the service provided by the home since the time of the previous inspection. Residents clearly expressed their opinion that the home was being run in their best interests. COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 21 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 3 2 3 3 3 4 3 5 3 6 N/A HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 3 3 3 2 3 3 3 2 Score Standard No 7 8 9 10 11 Score 2 3 3 3 x Standard No 27 28 29 30 3 3 x 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 3 33 3 34 3 35 x 36 x 37 x 38 x COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 15 Requirement Care plans for people with memory loss problems must be developed and implemented to ensure that associated behaviours can be effectively managed and treated in a consistent manner. All fatigued items of bedroom furniture must be replaced. The use of non-slip, impervious floor coverings must be considered for use in bedrooms where residents have memory loss, behavioural and continence problems to stop unpleasant odours. The doors of residents’ private accommodation must be fitted with a lock suited to the residents capabilities and accessible to staff in emergencies. Midsummer’s corridors must be reviewed, and appropriate action taken to ensure that accessibility for mobility-restricted service users is promoted and facilitated. Timescale for action 31/08/05 2. 3. 22 26 16 16 30/11/05 30/09/05 4. 26 13, 16 31/12/05 5. 22 23 31/12/05 COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 23 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 Good Practice Recommendations COURT HOUSE E52 S4106 Court House V231209 130605.doc Version 1.30 Page 24 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 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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