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Inspection on 12/10/07 for Court House Retirement Home

Also see our care home review for Court House Retirement Home for more information

This inspection was carried out on 12th October 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All service users spoken to stated that they had been able to visit the home before making any decision to more in. The first four weeks of a stay is considered a trial period for both the service user and the home. This is to ensure that the home is able to meet the needs of the new service user and that it meets their expectations. Service users were happy with the activities arranged by the home. As well as formal activities the home encourages people to socialise, for example sherry is served in the lounge before lunch each day and people living at the home are encouraged to eat their main meal in the dining room with other people. Many service users stated that the company was one of the reasons they liked the home. People continue to be in control of their day to day lives and are able to decide how they spend their time. Everyone stated that they are free to have visitors at any time. Everyone asks said that they would be comfortable to approach a member of the management team if they had any worries or concerns. Service users particularly praised the food in the home saying that there was always a good variety of well cooked meals.

What has improved since the last inspection?

Since the last inspection the home has introduced a visitors book to ensure that they always know who is in the building. There has been improvements in staff training. All staff have now had opportunities to undertake mandatory training and many more people have registered and begun National Vocational Qualifications in care. A new twelve week induction programme has been introduced which new staff found helpful and interesting. The home continues to maintain the buildings to a high standard with all vacant rooms redecorated before a new person moves in.

What the care home could do better:

Service users who were asked stated that they could not think of anything that the home could do better. There is currently no registered manager at the home and has not been for over a year. The home must have a manager registered with the Commission for Social Care Inspection. There have been improvements to care plans since the last inspection but these continue to require further development to ensure that they are fully reflective of current needs and abilities and that service users are involved in their creation and review. Risk assessments need to be completed with service users who administer their own medication and this needs to be regularly reviewed. The home has a robust policy for the recruitment of new staff but this is not always being followed.

CARE HOMES FOR OLDER PEOPLE Court House Retirement Home Church Street Cheddar Somerset BS27 3RA Lead Inspector Jane Poole Unannounced Inspection 12th October 2007 09:30 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 Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Court House Retirement Home Address Church Street Cheddar Somerset BS27 3RA 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) 01934 742131 01934 742054 Mr Brian Dando MRS PEARL DANDO Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd October 2006. Brief Description of the Service: Court House Retirement home is a large Georgian House situated in the heart of the town of Cheddar in Somerset. Accommodation is arranged in three buildings. The main house, which can accommodate 12 service users, The Courtyard is made up of 6 rooms and The Cottage which accommodates 8 service users. The Courtyard and the Cottage are situated in the grounds of the main house. The home is registered with the Commission for Social Care Inspection to provide personal care for up to 29 service users over the age of 65 years. The home is not registered to provide nursing care. The registered providers are Mr B. & Mrs P.Dando. The current fee range is £420.00 to £520.00 per week. Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. The inspection was carried out over a 6 hour period by one inspector. The inspector was given unrestricted access to all areas of the home, was able to speak with staff and service users, observe care practices and tour the buildings. All records requested were made available. Prior to the inspection the manager completed an Annual Quality Assurance Audit (AQAA) setting out what the home had achieved in the last 12 months and their plans for the future. What the service does well: All service users spoken to stated that they had been able to visit the home before making any decision to more in. The first four weeks of a stay is considered a trial period for both the service user and the home. This is to ensure that the home is able to meet the needs of the new service user and that it meets their expectations. Service users were happy with the activities arranged by the home. As well as formal activities the home encourages people to socialise, for example sherry is served in the lounge before lunch each day and people living at the home are encouraged to eat their main meal in the dining room with other people. Many service users stated that the company was one of the reasons they liked the home. People continue to be in control of their day to day lives and are able to decide how they spend their time. Everyone stated that they are free to have visitors at any time. Everyone asks said that they would be comfortable to approach a member of the management team if they had any worries or concerns. Service users particularly praised the food in the home saying that there was always a good variety of well cooked meals. Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 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 Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are able to visit the Court House before making a decision to make it their home. Intermediate care is not provided. EVIDENCE: All prospective service users are assessed to ensure that the home is able to meet their needs. Service users spoken to on the day of the inspection stated that they had been able to visit the home before making any decision about moving in. Most people stated that they had been able to have a meal at the home, which was an opportunity to meet with staff and other service users. Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 9 The manager explained that once service users moved in they are not expected to sign a contract for four weeks and this period is treated as a trial for the new service user and the home. Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality of care plans is variable and some would benefit from further development in consultation with service users. Service users have access to healthcare professionals in line with their individual needs. Medication procedures need to be improved to ensure that they reflect good practice recommendations. EVIDENCE: The management in the home is working to upgrade the quality of the service users care plans. The inspector viewed three care plans. Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 11 One was very comprehensive and covered all aspects of care. There was evidence that the care plan had been up dated with all changes of need. Other care plans seen were not so comprehensive and needed further development to ensure that they covered all aspects of care. All care plans seen had been signed by the service users, although people spoken to were not totally clear about the reason for the care plan. Staff stated that they used the care plans to inform their day to day practices in the home. All appointments with medical practitioners are recorded and service users stated that they had access to healthcare professionals according to their individual need. Service users stated that staff assisted them to attend appointments outside the home. Service users stated that staff were sensitive to their needs and always assisted with personal care in a way that respected their privacy and dignity. All service users stated that they were able to see personal and professional visitors in private and all have the option of having a telephone installed in their bedroom. The home uses a Monitored Dosage System (MDS) for medication. There is secure storage but the manager explained that storage systems are being changed and in the future all medication will be kept in locked cabinets in individual rooms. The inspector viewed the Medication Administration Records (MARs) and noted that these were correctly signed when administered or refused. Records relating to controlled drugs correlated to stocks held in the sample checked by the inspector. Hand written entries on the MARs had not been signed and witnessed in line with good practice recommendations. Some service users living at the home self-administer their own medication. The inspector viewed the care plan of one person who self-administers part of their prescription. There was no risk assessment in respect of medication in the care plan. Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users continue to make decisions about their day-to-day lives. Service users are able to choose from a wide variety of good quality meals. EVIDENCE: The inspector spent much of the day talking with service users both in their private rooms and in communal areas. People stated that felt that they continued to be in control of their day to day lives and were able to make decisions about what they did each day. One person said “You continue to be in charge of day to day life but there is someone around to fall back on.” There are some organised activities in the home but many people said that they simply enjoyed the companionship of other service users. On the evening of the inspection there was an old time musical evening planned that some people were looking forward to. People said that staff often asked them if they Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 13 would like to go into the town to do shopping and some trips further afield are organised. Service users are able to have visitors at any time and many go out with family and friends. Many service users have telephones in their rooms and one person has a computer, which they use to keep in touch with friends and family by e-mail. There is a dining room in the main house and another in the cottage, people are also able to eat in their rooms if they wish to. All service users spoken to stated that they were very happy with the food in the home and said there was always a good choice. A member of the management team visits all service users on a weekly basis to discuss menu options and many service users stated that they are also able to request a meal that is not on the set menu. The inspector observed lunchtime in the main house. Many people met in the lounge before lunch for a glass of sherry and a chat. The food was very well presented and it was evidenced that people had made different choices. Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users feel comfortable to raise concerns with the management team. Staff would benefit from further training in the protection of vulnerable adults and the awareness of local policies and procedures to be followed. EVIDENCE: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. Service users spoken to said that they would be comfortable to raise any concerns with a member of the management team, although people stated clearly that they had no reason to complain about any aspect of their care. Staff were aware of the ability to take serious concerns outside the home. Service users were seen to move freely around the home and had unlimited access to their personal rooms and all communal areas. Staff receive training on the protection of vulnerable adults during their induction and as part of their National Vocational Qualification (NVQ) training. It is recommended that further training is made available for more long Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 15 standing staff who are not undertaking the NVQ award to ensure that they are aware of procedures to be followed. The inspector viewed the recruitment files of three recently appointed members of staff. All had been checked against the Protection Of Vulnerable Adults (POVA) register and had undergone an enhanced Criminal Records Bureau (CRB) check. There was only one written reference for one member of staff rather than the required two. Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and provides a comfortable environment for service users. Service users are able to personalise their rooms which gives them an individual homely feel. EVIDENCE: The home is made up of three separate accommodation areas. The main house is able to accommodate up to 12 people over two floors, the cottage which can accommodate 8 people and 6 rooms set around a courtyard area. All areas are fitted with a fire detection and call bell system. The grounds around the home are attractive and well maintained with ample seating areas for service users. Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 17 The home is ideally situated to enable service users to access the amenities available in the town of Cheddar. All areas seen by the inspector were pleasantly furnished and well maintained. Service users are able to bring their own furniture with them to the home, which gives personal rooms an individual feel. All bedrooms have en suite facilities and there are toilets close to communal areas. There is an ongoing programme of redecoration and each room is decorated and re carpeted when it becomes vacant. All areas seen by the inspector were clean and fresh and more than one service user commented on how clean the home is always kept. There is a laundry, which is appropriate to the needs of the home, and all personal laundry is washed individually. One service user explained that each person has a day when laundry is collected and it is returned washed and ironed the following day. Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities for staff training have improved since the last inspection. The home need to ensure that the staff recruitment procedure is always followed to minimise the risks of abuse to service users. EVIDENCE: The home employs 20 care staff, 2 of whom have a National Vocational Qualification (NVQ) at level 2 or above. A further 12 people are currently working towards this award (figures taken from Annual Quality Assurance Assessment. AQAA) There are also 8 ancillary staff employed at the home. The AQAA states that since the last inspection the home have implemented a comprehensive training package for all staff. This was evidenced at the inspection. A new 12 week induction programme has been introduced and all staff have had opportunities to undertake statutory training. Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 19 One new member of staff stated that they had felt well supported when they began work at the home and were finding the induction programme interesting and useful. Staff and service users spoken to felt that there were sufficient staff on duty at all times. People said that staff always responded very quickly if they rang their bell for assistance. As previously stated the inspector viewed the recruitment files of the 3 most recently appointed members of staff. With the exception of one file, which only contained one written reference, all required documentation was present. Staff were observed to interact with service users in a friendly respectful manner. Service users stated that they were assisted with personal care in a way that respected their privacy and dignity. Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 20 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): 32, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is currently no manager registered with the Commission for Social Care Inspection. The home seeks the views of service users to ensure that they are happy with the quality of care provided. EVIDENCE: There is currently no manager registered with the Commission for Social Care Inspection. However the person who was the registered manager is now back Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 21 at the home after over a year away. The manager is supported by a deputy, who takes charge of the home in their absence. The manager does not have a professional qualification in care or management but has many years experience of working with older people. All service users spoke very highly of the management team describing them as very approachable and always willing to listen. There are regular staff and service user meetings and action plans are drawn up after each meeting to ensure that the home is responding to comments and suggestions made. Service users spoken to stated that the management and other staff regularly check out with them that the home is meeting their needs in their preferred way. A survey has been sent to all service users to seek their views on the home. The home does not act as a financial appointee or power of attorney for anyone living at the home. All service users manage their own finances some with the assistance of friends and family. The home has taken reasonable steps to ensure the health and safety of service users. The fire alarms are tested on a weekly basis and emergency lighting is tested monthly. All staff receive training in fire safety and there are clear procedures to be followed during the day and at night. The Annual Quality Assurance Assessment completed by the home prior to the inspection gives evidence that all equipment in the home is regularly serviced. All parts of the home and the grounds are well maintained. Appropriate insurance is in place. Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 22 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 x x x 3 x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 3 x 3 x x 3 Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 23 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 OP9 Regulation 13 (2) Requirement Risk assessments must be completed with all service users who administer their own medication. Staff must only be employed in the home once two written references have been obtained. The home must register a manager with the Commission for Social Care Inspection. Timescale for action 31/10/07 2 3 OP18 OP29 OP31 19 (1) [b] 18 (1) [a] 31/10/07 30/11/07 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 2 Refer to Standard OP9 OP18 Good Practice Recommendations All hand written entries on Medication Administration Records should be signed and witnessed. All staff should undertake training in the protection of vulnerable adults and be made aware of local policies and procedures. Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. Extracts may not be used or reproduced without the express permission of CSCI Court House Retirement Home DS0000016113.V350772.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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