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Inspection on 04/05/05 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 4th May 2005.

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

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

Staff carry out their duties in a calm and effective manner. The plans of care are held in the bedroom of the service user and updated as and when the needs change giving ownership of the records to the person they belong to.

What has improved since the last inspection?

The home has started to add locks to some doors for people to hold a key for their own bedroom. Many of the walls have been painted making areas look cleaner and brighter. The home has introduced a new system that allows medication to be administered more safely.

What the care home could do better:

The home needs to buy new carpets and curtains. Activities to meet the needs of individual people need to be established.

CARE HOMES FOR OLDER PEOPLE Courtenay House. Fakenham Road Tittleshall Norfolk PE32 2PF Lead Inspector Ruth Hannent Unannounced 04 May 2005 9.30 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. 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. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Courtenay House Address Fakenham Road, Tittleshall, Norfolk, PE32 2PF 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) 01328 700646 01328 701320 County Health Care Ltd Vacancy Care Home 51 Category(ies) of Dementia 51, Old age 51 registration, with number of places Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Fifty one (51) older people may be accommodated. Fifty one (51) older people with dementia may be accommodated Date of last inspection 23rd November 2004 Brief Description of the Service: Countenay House is a large detached property in the village of Tittleshall. Bedrooms are on the ground and first floors and consist of six double and thirty-nine single bedrooms, some of which have en suite facility. The home has a variety of communal rooms for the use of service users There are gardens with car park to the rear of the property. Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The majority of the inspection was spent walking around the building and talking to the people who live or work there and observing the care being delivered. The Acting Manager has only been in this position for two weeks and although unable to find some paperwork, spent time showing the Inspector around the building. The Pharmacy Inspector was also present for part of the day and spent time looked at all issues raised in a recent complaint regarding medication records, following a complaint with care practice. Eight people were spoken to in depth, two senior staff were interviewed, two kitchen staff were spoken to and five visitors had a brief conversation on their opinion of the home. What the service does well: What has improved since the last inspection? What they could do better: The home needs to buy new carpets and curtains. Activities to meet the needs of individual people need to be established. Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 6 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. Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The Home assures that the needs of the people requiring a place at the home can be met, by a comprehensive assessment prior to admission. EVIDENCE: Two people who have recently been admitted to the home have a full assessment written. A visit to one persons home was carried out by the Acting Manager and Head of Care and the visit to Courtenay House by the other person gave time for the assessment to be completed. The information gathered gave a clear picture of the needs of health and care requirements. Records seen included medicines to be administered, the pattern of care required throughout the day and medical details to assist the nursing and care staff. These people are now living in Courtenay House and the care plans have started to be developed from the information written on the assessment form. These 2 new people were spoken to during the inspection and one gave a full account of her needs which corresponded with the assessment. Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8, and 9 The service users health and personal care needs are clear but plans are lacking in respect of social care needs. Through records seen and on talking to staff the health care needs of service users are met. The pharmacist inspectors overall judgement of medication practice at the home is that there continues to be shortfalls in the safe handling and administration of medicines at the home that could impinge on the health and welfare of service users. EVIDENCE: For each resident who lives in the home there is a file that is held within their bedrooms that contains the full care plan. Some information is available to guide the staff in the care delivery. This includes the pattern of the day and required times, the type of personal care support they require and food they enjoy. More in depth details to ensure the care plans are tailored to each person would ensure that the support given is person centred. (Requirement) Some family involvement in the writing of these care plans were seen but not all information was clear and not signed by the person or their representative. Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 10 Records were looked at of people who may not be receiving the appropriate care. The care plans, daily records and accident records, regarding a recent complaint did not have any information logged that could substantiate this complaint. Two staff members who were interviewed could not offer any information regarding any practice that was incorrect and the Manager could not recall any incident that could relate to the complaint. A full inspection of Standard 9 relating to medication was simultaneously carried out by specialist pharmacist inspector Mark Andrews. The detailed findings of his inspection have been provided in a separate Pharmacy Inspection Report sent alongside this report. Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 15 Service Users lifestyle expectations are may not always be met due to the lack of information on records Families and friends are involved with the people who live at Courtenay House. Meals are not always offered with choice in the most appropriate way to suit the ability and understanding of the people who live at Courtenay House. EVIDENCE: The home has a programme of activities planned, but on discussing with the Acting Manager, the programme offered to people in Courtenay House does not always happen. It is also not clear that these activities are suited to the individual people as the social care needs of the assessment of care have not been completed. Many of the people were seen sitting in armchairs in the lounge areas and bedrooms for long periods of time with nothing to occupy them. The television was on with some people sitting in the room in a position that would not enable them to see the screen and those who could see were interacting with a family visitor about the cooking programme. When this visitor left these people became silent and were not interacting in any way. (Requirement) Throughout the day of the inspection visitors were seen coming and going. Two people were spoken to on different occasions. They both were pleased Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 12 with the care offered. One person had stayed for lunch with her mother and had enjoyed the time spent. Another gentleman was enjoying a television programme in the bedroom with his mother. The lunchtime meal was seen and although choice was on the menu not everything stated was available. None of the meals for the day were seen on either a display board or menu and on asking 5 people no one could say what they were having for lunch. (Requirement) The meal was carried out in a calm manner with people enjoying what they were eating with some happy to sit at the dining table and some remaining in the armchairs with a table pulled up to the chair. (A concern arises over how long people remain in the armchairs). Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 17 EVIDENCE: Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20 and24 On the day of inspection not all areas within Coutenay House were seen as safe. The residents do not have comfortable indoor communal facilities. The residents do not have suitable or comfortable bathrooms in all areas. EVIDENCE: The corridor by the kitchen had a supermarket trolley parked in front of a fire exit blocking the exit and making it unsafe. (Requirement) There are areas in the home that have been painted and appear clean but need carpets replaced especially in the main lounge with curtains or blinds placed at the windows to give a comfortable area for people to sit in. Curtains in some rooms had fixing that had broken and curtains were falling down. (Requirement) Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 15 The hairdresser has to use a bathroom that is also a wheelchair store and then sit people in the corridor to dry their hair that is a main thoroughfare used by all visitors and residents offering no privacy to the people having their hair dried. (Requirement) The bedrooms are adequately furnished but many rooms are in need of new or repaired furniture. There are still, as mentioned in the last inspection, some people who require nursing care sleeping on a divan bed and not an adjustable nursing bed for suitable/safe care management. (Requirement) Many bathrooms had no coverings at the windows and were in need of refurbishment especially in the older part of Courtenay House. (Requirement) All the bedrooms have a glass panel in the door that is not suitable for offering full privacy for the person living in the home. Although the rooms had curtains across the glass anyone walking by could see into the room where the curtain was slightly drawn. (Requirement) Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 Staff appeared competent to carry out their role but were not trained to the required standard. EVIDENCE: A training return sheet was seen, that is required by Four Seasons to be completed monthly, showing that at the end of April many of the staff were behind with the mandatory training. This included Moving and Handling, Health and Safety, Infection Control, Death and Dying and the Protection of Vulnerable Adults. Records also showed that only 25 of staff were trained at NVQ2 level. (Requirement) Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were looked at during this inspection. EVIDENCE: Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 1 1 x x x 2 x x STAFFING Standard No Score 27 x 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x x x x x x x x x Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 19 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 9 Regulation 13.2 Timescale for action The registered person must As make arrangements for the recorded recording, handling, safekeeping, on safe administration and disposal attached of medicines. SEE SEPARATE pharmacy PHARMACY INSPECTORS report REPORT FOR THE FULL LIST OF REQUIREMENTS AND RECOMMENDATIONS. The registered person must take As steps to ensure the nonrecorded on availability of medicines is attached avoided thereby ensuring the continuation of prescribed pharmacy treatments and protecting the report. health and welfare of service users. SEE SEPARATE PHARMACY REPORT FOR THE FULL LIST OF REQUIREMENTS AND RECOMMENDATIONS The registered person must 30th June ensure that the service users 2005 have a detailed care plan to include all aspects of their health and welfare. The registered person must 30th June ensure that a programme of 2005 activities is provided once consultation with residents and their families have taken place The registered person must 30th June Version 1.30 Page 20 Requirement 2. 9 12.1 3. 7 15 4. 12 16.2 (m) (n) 5. 15 16.2 (i) Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc 6. 19 13.4 (a) 7. 20 16 &.23 8. 24 23(n) 9. 24 12.4 (a) 10. 30 18.1 (a) ensure that the choice of meals is made available and clear consultation takes place with menus available for service users to see. The registered person must have systems in place to ensure all fire exits are kept clear of any obstacles. The registered person must ensure that the carpets and curtains are replaced in the main lounge and some bedrooms and bathrooms with curtains to be re hung where fixings are broken. The registered person must ensure that the appropriate nursing beds that adjust to heights that meet the needs of the care are provided for people who reuire nursing care. REQUIREMENT FROM PAST INSPECTION The registered person must box in the glass panels in bedroom doors to ensure privacy at all times. The registered person must ensure that the staff have the up to date mandatory training and record the dates the training has taken place. 2005 Immediate and ongoing 30th June 2005 ongoing 31st July 2005 31st July 2005 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 Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 21 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF 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. Extracts may not be used or reproduced without the express permission of CSCI Courtenay House. RMUI55s15629CourtenayHouseV225717040505 Stage4.doc Version 1.30 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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