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Inspection on 15/04/08 for Courtenay House Nursing & Residential Home

Also see our care home review for Courtenay House Nursing & Residential Home for more information

This inspection was carried out on 15th April 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

The recent refurbishment means that the residents have accommodation which is attractive, homely and comfortable. Once the work has been completed in the bathrooms this will further enhance the accommodation provided. Some of the residents and relatives said that the staff are kind and that the care provided is of a high standard. Comments were made such as: `the residents physical needs are addressed` `the staff are kind....they look after people well` `we are very happy with the care and attention afforded to our relative by all staff` Relatives said that the staff are good at keeping them informed about issues affecting their relative and that they are able to visit whenever they like. An additional comment was made in one of the relatives surveys: `staff have been very helpful in assisting our relative to keep in touch with relatives abroad` The management team carry out appropriate recruitment checks to ensure that staff are safe to work with the vulnerable residents. This was confirmed by all of the staff surveys returned to us. The health and safety of residents and staff is taken seriously and there are systems in place to ensure that regular servicing and maintenance of equipment takes place and that action is taken if problems arise.

What has improved since the last inspection?

Major refurbishment of the communal areas has taken place in the last year and this provides residents with much more comfortable and attractive accommodation. Although there have been some problems recently at the Home the staff, relatives and residents said that there have been many improvements within the last few months. These include improved staffing levels and training so that staff now spend more time with residents on an individual basis, improved management at the Home so that there is now clear leadership providing good support to the staff, residents and relatives. Residents and relatives are now more confident about raising concerns as they know that they will be listened to and action taken. Staff said that the senior management of the organisation provided good support to them whilst the manager was on sick leave. A deputy manager was appointed in January 2008 and a peripatetic manager is in post until the new Manager starts in June 2008. A relative said: `thanks to the dynamic manager and her staff the Home is well run`.

What the care home could do better:

We have been notified of several complaints from relatives and social care professionals since the last Inspection. This was mainly due to the lack of confidence that the people concerned had in the management of the Home to effectively deal with their complaints/concerns. The areas of concern were mainly around the following areas: - staff not spending time with individual residents - not enough meaningful activities - residents having to wait too long for staff assistance. These areas of concern have been dealt with by the Area Manager in an appropriate way and the management team have formed an action plan for improvements. Residents, staff and relatives said that there have been improvements in the standard of care provided recently. Some of the commodes and toilet frames are in need of replacing as part of the current bathroom refurbishment so as to ensure that the equipment that residents use is safe and comfortable. The care plans need to contain more detailed information about the individual residents needs so that staff have clear guidance about how to meet these needs in a consistent way. Responses from staff were mixed with some staff feeling that they have good information about meeting residents needs and good communication systems in place and others feeling that this can be improved.

CARE HOMES FOR OLDER PEOPLE Courtenay House Nursing & Residential Home Fakenham Road Tittleshall Norfolk PE32 2PF Lead Inspector Lella Hudson Unannounced Inspection 15th April 2008 08:45 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 Courtenay House Nursing & Residential Home DS0000015629.V362565.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. Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Courtenay House Nursing & Residential Home Address Fakenham Road Tittleshall Norfolk PE32 2PF 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) 01328 700646 01328 701320 courtenay.house@fshc.co.uk None provided County Healthcare Ltd, a wholly owned subsidiary of Four Seasons Health Care Ltd Position vacant Care Home 51 Category(ies) of Dementia (51), Old age, not falling within any registration, with number other category (51) of places Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Fifty-one (51) older people may be accommodated. Fifty-one (51) older people with dementia may be accommodated. The total number of services users not to exceed fifty-one (51). Date of last inspection 18th April 2007 Brief Description of the Service: Courtenay House is a large detached property in the village of Tittleshall. There has recently been refurbishment of the Home with a reduction in rooms. There are now 42 single bedrooms, none of which are ensuite. The organisation are aware of the need to submit an application for a variation of their registration to reflect this reduction in numbers. The home has a variety of communal rooms for the use of residents. There are gardens with a car park to the rear of the property. Fees are currently between £385 - £537 per week. A copy of the Statement of Purpose for the Home and a copy of the latest Inspection report by CSCI can be obtained from the Manager. Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.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 ONE STAR. This means that the people who use this service experience ADEQUATE quality outcomes. This report contains information gathered about the Home since the last Inspection in April 2007. It includes information provided by the management team, such as the completed Annual Quality Assurance Assessment and through notifications. It also includes information gathered during an unannounced visit to the Home which was carried out on 15th April 2008 between 8.40am and 5.45pm. During the visit we looked around the accommodation, inspected records, spoke to staff, residents and relatives, observed staff supporting residents and spoke to the area manager and the temporary Manager of the Home. Completed surveys were received from residents (1), staff (6) and relatives (15). The results of these are incorporated within this report. The registered Manager has recently left the Home and had been on sick leave for several months prior to this. A new deputy manager was appointed in January 2008 and has been managing the Home with the support of other managers within the organisation who manager other Homes in Norfolk, as well as the support of the area manager. The organisation has recently appointed one of their peripatetic managers, Bonita Witt, to manage the Home until the newly appointed Manager takes up her post in June 2008. The Home is currently undergoing major refurbishment. Work to the communal areas and corridors has been completed, as has several of the bedrooms. The bathrooms are still in the process of being upgraded and redecorated. The number of bedrooms has been reduced and so the Home can now provide accommodation for up to 42 older people. The organisation will be applying to the Commission for a variation to reflect this reduction in numbers. On the day of the visit to the Home there were 27 residents. What the service does well: The recent refurbishment means that the residents have accommodation which is attractive, homely and comfortable. Once the work has been completed in the bathrooms this will further enhance the accommodation provided. Some of the residents and relatives said that the staff are kind and that the care provided is of a high standard. Comments were made such as: Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 6 ‘the residents physical needs are addressed’ ‘the staff are kind….they look after people well’ ‘we are very happy with the care and attention afforded to our relative by all staff’ Relatives said that the staff are good at keeping them informed about issues affecting their relative and that they are able to visit whenever they like. An additional comment was made in one of the relatives surveys: ‘staff have been very helpful in assisting our relative to keep in touch with relatives abroad’ The management team carry out appropriate recruitment checks to ensure that staff are safe to work with the vulnerable residents. This was confirmed by all of the staff surveys returned to us. The health and safety of residents and staff is taken seriously and there are systems in place to ensure that regular servicing and maintenance of equipment takes place and that action is taken if problems arise. What has improved since the last inspection? What they could do better: Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 7 We have been notified of several complaints from relatives and social care professionals since the last Inspection. This was mainly due to the lack of confidence that the people concerned had in the management of the Home to effectively deal with their complaints/concerns. The areas of concern were mainly around the following areas: - staff not spending time with individual residents - not enough meaningful activities - residents having to wait too long for staff assistance. These areas of concern have been dealt with by the Area Manager in an appropriate way and the management team have formed an action plan for improvements. Residents, staff and relatives said that there have been improvements in the standard of care provided recently. Some of the commodes and toilet frames are in need of replacing as part of the current bathroom refurbishment so as to ensure that the equipment that residents use is safe and comfortable. The care plans need to contain more detailed information about the individual residents needs so that staff have clear guidance about how to meet these needs in a consistent way. Responses from staff were mixed with some staff feeling that they have good information about meeting residents needs and good communication systems in place and others feeling that this can be improved. 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. Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The pre admission assessments provide basic information for staff about how to meet residents needs when they first move into the Home. EVIDENCE: We looked at three of the care plans, which include the initial assessment which was undertaken prior to the residents moving to the Home. This provides basic information for staff about how to meet the residents needs and forms the basis for the care plan which is further developed over time. A resident who had recently moved into the Home said that he and his family had received enough information about the Home and that an assessment of his needs had been carried out prior to moving in. The Home does not provide Intermediate Care Courtenay House Nursing & Residential Home DS0000015629.V362565.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 care plans are not adequate to ensure that the staff have clear information about how to meet individual residents needs Medication is well managed which means that residents receive their medication in a safe and timely way Residents feel that they are treated with respect EVIDENCE: The care plans have been recently reviewed and updated and the management team are aware that there are further improvements needed to ensure that these are effective working documents. The care plans that we saw contain a lot of information about the individual persons needs and there is evidence of monthly reviews of the information. The care plans contain assessments of a variety of needs such as continence, mobility and pressure care. Although the Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 11 initial assessment includes information about nutritional needs the formal nutritional assessment is not completed, despite the Homes policy about nutritional needs indicating that this will be used. The care plans that are completed following the initial assessments would benefit from being more detailed so as to provide better information for staff about how to meet individual’s needs. For example, one of the care plans states that staff should “offer help to minimise breathlessness” but with no details about how this should be done. One states that staff should “encourage good fluid intake” with no details about what this might be for the individual resident. The care plans relating to continence needs are not detailed enough to provide clear information for staff to ensure that that they provide care which is consistent and meets individuals needs. The daily notes are variable in content and detail and need to be more consistent. We have been notified of five concerns raised by relatives/social care professionals within the last year which relate to the personal care provided to residents which was not meeting their needs. Some of the comments included within the relatives surveys are as follows: ‘the commodes can be dirty’ ‘the call bell and drinks are not always left where residents can reach them’ ‘residents wait too long for staff to assist them to go to the toilet’ The management team of the Home are aware of the concerns and have made efforts to improve the service provided. The surveys did also contain positive comments about the care such as: ‘residents physical needs are addressed’ ‘…they look after people well’ Night time care plans have been written and these provide some good, personalised details about the nursing and personal care needs of residents during the night and also includes details such as whether someone likes to have the door open or shut and other small details which are so important to people. The residents are registered with the local GP practice and have access to other health services as required, such as chiropodist, dentist and opticians. The GP visits the Home routinely once a week and will attend at other times as requested. Medication is managed by the nursing staff. The deputy manager explained the system which is in use. Medication is stored appropriately and records are kept as required. The deputy manager has recently introduced improved communication systems for the nurses with regard to changes in medication. We have been notified of one medication error since the last Inspection. Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 12 The staff who spoke to us were very clear about the importance of spending time with individual residents to encourage them to maintain their independence and to provide support when they need it. Staff were consistent in their views that there have been real improvements in the care provided over the last couple of months. There are currently far fewer residents living at the Home than in the past and although the staffing levels have been adjusted accordingly the staff do still have more time to spend with individuals. The concerns/complaints that we received were with regard to lack of staff time with individuals as well as a lack of attention to privacy and dignity when staff are providing care to the residents. Staff who spoke to us were all aware of the importance of respecting the privacy and dignity of the residents and gave examples of how this is done throughout their work. Staff were observed speaking to and supporting the residents in a kind and caring way. The management team acknowledged that there have been concerns in the past about the standard of care but gave examples of action that has been taken to address these concerns and of further improvements that are needed. The surveys received from staff and relatives were received over a three month period from February to April 2008. The responses are almost equally mixed about the quality of the care provided with some feeling that care is of a high standard and others that there are areas that need improvement. Additional comments made are equally mixed, for example: ‘staff are kind’ ‘the care is of a high standard’ ‘they look after people well’ ‘staff need to spend more time with individuals’ ‘there are not enough staff to give individual care’ The residents and relatives who spoke to us during the visit to the Home all spoke positively about the recent improvements to the care provided and said that staff are kind and that they have time to spend with people individually. The manager said that she is planning to hold a residents meeting within the next few weeks and that it is hoped that this will develop as a forum for residents to discuss issues affecting them within the Home and to be able to raise any concerns/suggestions for improvement. Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents are not supported to take part in meaningful activities on a regular basis Residents are supported to maintain contact with family and friends Residents are helped to exercise choice and control in a limited range of issues affecting their lives Residents receive an appealing, balanced diet EVIDENCE: The surveys from staff, resident and relatives are all consistent in their view that the Home does not provide enough stimulation or activities for residents. The management team are very aware of the lack of meaningful activities which are available to the residents and have taken action to address this. Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 14 An activities organiser has been employed and is due to take up her new role next month. She is currently working nights at the Home and so the residents know her well. We spoke to her and she is extremely enthusiastic about her role and has some very good ideas about how to provide activities which are meaningful for individual residents and cover a wide range of interests from cooking to physical exercise. One of her new responsibilities will be to develop the social history and interests sections of the care plans. The Manager expects that all of the staff will take opportunities as they arise to spend time individually with residents and the management team are working with staff to further their understanding of the importance of having a better understanding of residents previous history and lifestyle. There were several visitors in the Home on the day of the visit. The visitor that we spoke to was very positive about the care provided to her relative and of the support provided to her, as a relative. The views within the relatives surveys were mixed with regard to the welcome that relatives receive at the Home with some making additional comments about the good welcome that they have whilst others commented that they are not always made to feel welcome. The manager has already discussed this issue with staff and it is the subject of forthcoming training for all staff. One of the relatives surveys commented particularly about how good the staff are in assisting their relative to keep in contact with family who are not able to visit them. The residents currently have little opportunities for making choices about their lifestyle except for in minor ways such as choosing what to have from the menu, what to drink or which room they wish to spend time in. The management team are aware of this deficit and are currently covering this within staff supervision and training sessions. Staff who spoke to us were positive that recent changes and improvements will mean that they are able to provide increased opportunities for residents to have a say about their lifestyle within the Home and about issues affecting them within the Home. The Home has two lounge/diners and so residents are able to have meals in smaller groups in the dining room or in their rooms on a tray. Residents who spoke to us said that they enjoy the meals and that they have a choice about what they have although sometimes the menu does not reflect what is actually available. Some residents have particular needs with regard to nutrition and require assistance with eating. We sat with residents at lunch time and observed staff supporting residents in a respectful and appropriate manner. Currently all Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 15 residents are provided with the same plastic glasses and the aprons used are plastic. There are two staff working in the kitchen for the majority of the day and so care staff are only responsible for giving out meals and assisting residents and do not do any cooking or clearing up in the kitchen. We spoke to one of the kitchen staff and he had a good understanding of the individual needs of residents and of personal food/drink preferences. The management team have plans for further improvements to make dining a more pleasurable experience for the residents and to aid them in making choices about what they would like to eat/drink. Pictorial menus are one idea that they plan to implement. Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents and relatives are now more confident that their complaints are listened to and acted upon Inadequate training puts residents at risk from abuse EVIDENCE: As previously mentioned in this report we have received concerns and complaints about the Home from relatives and social care professionals since the last Inspection. These were passed to us as the complainants were not confident enough in the management of the Home to raise them directly with them. We passed these to the organisation to investigate and they have been investigated to a satisfactory level. Some aspects of these concerns/complaints were upheld and others were not. The manager is aware of the need to keep a record of complaints and has implemented this as this was not previously being kept. The manager said that there have not been any concerns/complaints raised with the Home except for those referred by the Commission. The management team are aware of the need to have a more open culture to encourage relatives and residents to raise any concerns/complaints that they may have. Specific Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 17 arrangements have already been put in place to meet with the representatives of one of the residents on a regular basis to discuss issues. The responses within the relatives surveys state that nine know how to make a complaint, four do not and one can not remember. The one survey received from a resident states that they are aware of the complaints procedure and that staff listen and act if issues are raised with them. During our visit to the Home we saw that the manager immediately addressed questions that were asked by a relative and a resident. Both the relative and resident were satisfied with the outcome of their enquiry. The Home has a complaints procedure but the manager is aware of the need to provide this in alternative formats to assist some residents with understanding this. The manager hopes that the residents meetings will enable residents to feel more confident about raising any issues that they may wish to discuss. All of the completed staff surveys state that the staff know what to do if a relative/residents makes a complaint. Staff who spoke to us were clear about the standards of care that should be provided and had a good understanding of what constitutes abuse. They were all confident that the management team would deal appropriately with any allegations that may be made. All five of the staff surveys state that the staff know what to do if relatives or residents with to make a complaint. Discussions with the management team show that they are aware of the appropriate procedure to follow with regard to any allegations of abuse. Some staff have received training with regard to Safeguarding Adults and further training is planned to ensure that all staff have received appropriate training with regard to this issue. Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 18 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 & 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Recent refurbishment means that the residents live in a homely, attractive environment The inadequate commodes do not provide safety and comfort for the residents EVIDENCE: We were shown around the accommodation. Extensive refurbishment is taking place and the lounge/dining room and the corridors are attractive and homely. There are ornaments and pictures to brighten up the areas and there are alcoves with seating in the longer corridors. The Home has two lounge/dining rooms which provide a choice for residents about where to spend their time. The refurbishment has provided a small, quiet lounge which residents said they have used for meeting with relatives and friends. A dedicated hairdressing Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 19 salon has also been provided which the hairdresser and residents are very proud of. Additional office space has also been provided. The organisation are going to apply for a variation in the number of residents which the Home is registered for as they have reduced the number of bedrooms to 42 single rooms. None of the rooms are ensuite and so residents have commodes in their bedrooms. Some of the rooms have been redecorated to a very high standard but are still waiting for locks to be provided on the doors. We only saw a few of the residents bedrooms and these showed that residents are encouraged to personalise their rooms with photographs, pictures, ornaments and their own furniture if they wish to. The bathrooms are still in the process of being refurbished and so there are currently a reduced number of bathrooms available for residents to use. The maintenance member of staff said that this work should be completed within the next month and will then provide a choice for residents of using assisted baths or a level access shower. Some of the relatives surveys mentioned the poor condition of some of the commodes and this was also the subject of a complaint. During our walk around the Home it was noted that some of the commodes and the frames around the toilets are in poor condition. The Home has a full time member of staff responsible for maintenance and there is also a gardener. Domestic staff are provided seven days per week. During the walk around the Home it was noted that the Home was clean and free from offensive odours. On the first floor there is office accommodation and a room which staff use for their breaks and some training. The door at the bottom of the stairs to this area is very noisy when it closes. Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 20 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. Residents basic needs are met by the numbers and skill mix of staff Residents are protected by the robust recruitment practices Insufficient training puts residents at risk of not having their needs met EVIDENCE: We looked at a selection of recruitment files and these contain the records required by regulation. Staff surveys state that appropriate checks were carried out as part of the recruitment procedure. The surveys contained mixed views about training with equal numbers feeling that they receive training which is up to date and relevant as those who feel that this is not the case. Staff who spoke to us said that they had received training with regard to meeting residents basic needs but that they would like more specific training such as dementia, pressure care, diabetes and communication. The management team have plans in place to provide additional training and are aware of the need to provide training which enables staff to better meet individual needs of residents. The organisation has its own training department and also uses trainers from external companies. It also provides Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 21 training for nurses to provide training to other staff, such as moving and handling. Currently the staffing levels are reduced due to the fact that there are only 27 residents living at the Home. The management team have plans to increase the staffing levels as the number of residents increase. Recruitment is ongoing and the manager said that new staff are due to start as soon as their recruitment checks have been received. The manager said that the staffing levels currently being provided are an increase on what was provided a few months ago and feels that this has been a factor in the improvements in standards of care. However, she also feels that additional training and better organisation of the staff team has also been a big factor in the improvements. Several of the relatives and residents surveys state that the staffing levels are not adequate to meet the needs of the residents whilst others state that they are. Additional comments made in the surveys are equally mixed with regard to the effectiveness of the staffing levels. For example: ‘we are very happy with the care and attention afforded to our relative by all staff’ ‘we are very satisfied with the care provided’ ‘they give good care’ ‘there are staff shortages’ ‘there is a lack of staff to spend with individual residents’ Staff who spoke to us said that the staffing levels have increased and that also the shifts are now better organised with staff being clear about their roles and responsibilities. Staff said that handovers are now more effective and that this provides a good forum for information for staff coming on duty. We were told that a fifteen minute handover takes place at the beginning of each shift and staff have to come in fifteen minutes early for their shift but are not paid for this time. The manager said that additional staff are on duty when particular activities are taking place. On the day of the visit an additional carer was on duty as the chiropodist, hairdresser and GP were due to visit. Although the staffing levels appear to be adequate it must be noted that staff take breaks throughout their shifts which are not accounted for on the staff rota. As well as nurses and care staff the Home employs an administrator, domestic, catering and maintenance staff. Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 22 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): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The residents are benefiting from the clear leadership from the recently appointed management team The lack of consultation with residents does not ensure that their views are taken into account Comprehensive recording and policies ensure that the residents finances are safe guarded Good health and safety policies and awareness of staff ensures that residents are protected Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 23 EVIDENCE: The previous registered manager of the Home has recently left, following a long period of being on sick leave. The Home did not have a deputy manager either at that time. A new deputy manager was appointed in January 2008 and since then he has been managing the Home with the support of other Managers within the organisation and the Area Manager, Craig Prior. An interim manager was appointed a few weeks ago and will manage the Home until the newly appointed manager starts work at the Home in June 2008. The interim manager will remain in post to provide induction for the new manager. Staff, relatives and residents told us that many improvements have been made since the new management team have been in place and that they have confidence in their ability to continue to make improvements and provide effective management for the Home. A comment was made in one of the relatives surveys: ‘thanks to the new dynamic manager and her staff the home is well run’ and within a staff survey: “we have had good support from the organisation’ Although there have been problems within the Home recently the organisation have recognised these and have taken steps to address them. Many improvements have been made and there are plans in place to further improve the standard of care provided to the residents. Quality assurance processes have not been fully in place but the manager has plans to obtain the views of residents and relatives on a regular basis, through the use of questionnaires, regular meetings and through an open style of management. We were shown the system in place for looking after residents money. The administrator is responsible for this system. The organisation encourages residents to look after their own money or for a representative to do this for them. However, they do look after small amounts of money and there are appropriate systems in place for this. We were shown the new financial care plan which will form part of the admissions assessment and will provide very clear information to staff about the arrangements in place for looking after residents money. Staff confirmed the managers information that supervisions have taken place for all staff recently and that there is an ongoing plan for regular supervision to Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 24 take place for all staff. The nurses will receive training from the manager so as to be able to provide supervision for the care staff. The supervision sessions have been used to clarify with each staff member their roles and responsibilities and the proposed changes to take place over the next few months. Health and safety is taken seriously by the management team and the staff with the maintenance member of staff is responsible for ensuring that regular maintenance and servicing of equipment takes place. A sample of records were seen and these show that this does take place. A fire risk assessment has been carried out and we were told that the actions arising from the last assessment have been completed. Electrical testing was taking place on the day of our visit to the Home. Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 25 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 3 X 3 Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1) Requirement The care plans must contain detailed information about individuals care needs to ensure that residents needs are met All staff must receive training about Safeguarding Vulnerable Adults to ensure the residents are protected from abuse Some of the commodes and toilet frames must be replaced to ensure that residents have safe and comfortable equipment to use Staff must receive training in subjects relevant to the needs of the residents to ensure that staff are able to meet the residents needs An effective quality assurance system must be in place to ensure that the views of the residents are taken into consideration Timescale for action 30/06/08 2 OP18 13 (6) 31/07/08 3 OP22 23 (2)(c) 30/06/08 4 OP30 18 (c)(i) 30/09/08 5 OP33 24 30/10/08 Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Courtenay House Nursing & Residential Home DS0000015629.V362565.R01.S.doc Version 5.2 Page 29 - 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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