CARE HOMES FOR OLDER PEOPLE
Courtfield Lodge Nursing & Residential Home 81a Marians Drive Ormskirk Lancashire L39 1LG Lead Inspector
Vivienne Morris Unannounced Inspection 19th June 2006 9:30 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 Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Courtfield Lodge Nursing & Residential Home Address 81a Marians Drive Ormskirk Lancashire L39 1LG 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) 01695 570581 Flightcare Limited Miss Maria Deegan Care Home 70 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (70) of places Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 70 service users to include: Up to 70 service users in the category OP (Old age, not falling within any other Category). 1 named service user in the category LD (Learning Disability). The registered provider should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 15th November 2005 2. 3. Date of last inspection Brief Description of the Service: Courtfield Lodge is a purpose built home situated in a residential area close to the town centre of Ormskirk. It provides nursing and personal care for up to 70 older people. The accommodation is on two floors. The upstairs floor is accessed by both stairs and a passenger lift. There is a lounge on each floor and a dining room on the ground floor. The rooms are predominantly single but facilities are available if service users choose to share, either at the time of admission or following admission. The rooms all benefit from the provision of en-suite facilities. Service users had personalised their rooms with ornaments, photos and pictures. The menu provideed a variety of food, although alternatives were available if desired. Specialised diets were catered for if required. The service users’ guide, which contains relevant information about the service, including the most recent inspection report, is given to people who are thinking about living at the home, so that they are able to make an informed choice about where to live. The scale of charges as at 19th June 2006 ranged from £386.00 to £471.00. Additional charges were being incurred for hairdressing, newspapers/magazines, toiletries, private transport and private chiropody. Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over one day during June 2006 by two regulatory inspectors from the Commission for Social Care Inspection. The inspection process focused on the outcomes for people living at the home. The home was found to be clean, tidy, well presented and maintained to a high standard. Record-keeping in general was found to be of a good standard and, the amount of training provided for staff was satisfactory. All the requirements from the previous inspection had been appropriately addressed, which is commendable. Those living at the home who were spoken to were happy with the service provided and the care received. They felt that the management and administration of the home was good. The Commission for Social Care Inspection had received one complaint about this service since the previous inspection. The issues raised were found to be not upheld. A range of evidence has been gathered to formulate this report. During the course of the inspection service users, relatives and staff were spoken to, relevant records and documentation were examined and a tour of the premises took place, when all private accommodation, communal areas and service areas were seen. What the service does well:
Detailed information is gathered prior to admission, which collectively provides a clear picture of individuals so that the home is confident that assessed needs can be adequately met by the staff team. Care Management assessments are obtained and the assessments conducted by the home are very thorough providing staff with detailed information about the needs of individuals before they move into Courtfield Lodge. The plans of care are very well-written documents providing clear guidance for staff as to how individual needs are to be met. Detailed information is obtained in relation to the past history of those living at the home so that staff are able to develop a good relationship with individuals. The general routines of the home are flexible and people are respected to ensure that their privacy and dignity is protected at all times and they are supported to make individual choices so that they are able to make decisions about their preferred life style. Residents are able to manage their own finances if they choose to do so with appropriate support as is required. Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 6 Residents are encouraged to maintain contact with their family and friends and visitors are made welcome to the home in order to promote a friendly atmosphere for those living at Courtfield Lodge. Arrangements are made for people to be supported by the local advocacy service so that an independent person can act upon their behalf, should residents so wish. Residents are provided with a choice of menu and alternatives are available if required to allow people to exercise personal preferences. Food is attractively presented in order to maintain appetite and nutrition. Specialised diets are catered for to ensure that people’s nutritional needs are met and residents are able to eat in the main dining areas or within the privacy of their own rooms, should they so wish. Complaints are well managed so that thorough investigations are conducted and complainants are kept informed of the progress and outcome of the investigation. Robust policies, procedures and practices are adopted so that people living at the home are protected from abusive situations and so that their belongings and valuables are safeguarded. The home is fit for purpose and is maintained to a good standard. It is tastefully decorated, well presented, clean and tidy, providing a pleasant environment for people to live in. Good quality furnishings are provided and people are able to adorn their bedrooms with personal possessions to create a homely environment. The ratio of care staff to residents is calculated in accordance with the dependency levels of those living in the home to ensure that sufficient numbers of staff are deployed to meet the assessed needs of residents. The system utilised is reviewed on a monthly basis or as the occupancy of the home changes so that the care staffing levels can be adjusted accordingly. Detailed induction programmes for new staff are in place to ensure that all staff employed receive sufficient information about the home and the needs of residents before they work alone. A variety of training courses are provided for all staff to ensure that the work force is sufficiently trained to deal with emergency situations and to provide a good standard of care for those living at the home. The home is managed efficiently and effectively by a person who is suitably qualified and experienced to run the service and who is focused on good outcomes for those living at the home. The policies, procedures and systems adopted by the home thoroughly safeguarded residents’ finances. What has improved since the last inspection?
The statement of Purpose had been updated since the previous inspection to reflect the current management arrangements so that people were able to make an informed choice about where to live.
Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 7 The management of medications had improved since the previous inspection and policies and procedures had been updated to reflect recent changes in relation to the disposal of medications. The bathing facility which was out of commission at the previous inspection had been replaced with a new parker bath, therefore providing residents with a wider choice of bathing areas. A number of requirements in relation to the environment had been addressed since the last inspection, which was pleasing to see. A new nurse call system had been installed so that a more prompt response could be made by staff. Hand washing facilities had been installed in the sluice area in order to reduce the possibility of cross infection. Residents and representatives had been involved in the pre-admission and care planning processes, allowing them some input into the care being delivered. The plans of care seen had been reviewed and updated at least monthly to reflect any changes in current care needs. The care records identified the preferences of people living at the home, including their leisure and social interests so that staff were aware of individual social care needs. An audit of residents’ belongings had been conducted on admission to the home so that individual possessions were adequately safe guarded and the policies and procedures of the home had been reviewed and updated to reflect any changes in current legislation and good practice guidelines. What they could do better:
Handwritten entries on Medication Administration Records should be signed, checked and countersigned to minimise the possibility of transcription errors. The provision of social activities could be improved so that those living at the home are stimulated and so that their social and leisure interests are fully met. The dining arrangements on the first floor could be improved by ensuring that the dining tables are attractively laid prior to meals being served so that independence is promoted and a homely environment for dining is created. The pipe work in some of the bathrooms was unguarded. This should be covered to protect the safety of those living at the home. The patio area needed to be thoroughly cleaned and freed from wildlife mess so that the possibility of cross infection is minimised. The registered person should be able to demonstrate compliance with the water regulations (fittings) 1998 to ensure residents are fully protected. The home should continue to progress towards achieving a 50 ratio of care staff having achieved a National Vocational Qualification at level 2 or above. Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 8 Robust recruitment procedures must be adopted by the home to ensure that people living there are adequately protected. The mechanism in place for monitoring the quality of service provided should be further developed and extended so that the outcome for residents can be more effectively assessed. 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. Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 9 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 Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The needs of those wishing to live at the home had been thoroughly assessed prior to admission so that the home was confident that the staff team could meet individual needs. EVIDENCE: The care records of four people living at Courtfield Lodge were examined at the time of the inspectors visit to the home. New residents had received a full comprehensive needs assessment before admission to the home and for individuals who were self-funding the manager of the home had carried out the assessment, gaining extremely detailed information to ensure that individual assessed needs could be adequately met by the staff team. The service was highly efficient in obtaining a summary of any assessment undertaken through the Care Management arrangements and insisted on receiving a copy of the care plan so that the staff team were aware of the needs of people before they moved into the home. Residents were provided
Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 11 with written contracts at the time of moving into the home so that they were aware of the terms and conditions of living at the home. Standard 1 of the National Minimum Standards for Care Homes for Older People was not fully assessed on this occasion. However, the requirement from the previous inspection had been appropriately addressed. The statement of purpose had been updated to reflect the current management arrangements so that people were provided with up to date information to enable them to make an informed decision about where to live. Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff were provided with clear instructions to ensure that the assessed needs of those living at the home were being fully met and their rights to privacy and dignity were being upheld. EVIDENCE: The care of four people living at the home was ‘tracked’ during the course of the inspection. The plans of care were found to be very well written documents, providing clear guidance for staff as to how individual assessed needs were to be met. The information recorded had been gathered during the pre-admission process to show that the care plans included all assessed needs of those living at Courtfield Lodge. Recorded evidence demonstrated that advice had been sought from a variety of external professionals to ensure that health care needs were being appropriately met. Social care profiles had been completed, which demonstrated that staff had determined what residents enjoyed doing in relation to leisure interests and
Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 13 hobbies. These profiles provided a clear picture of individual’s past life, which promoted a holistic approach to those living at the home. The care files examined consistently showed that those living at the home had been given the opportunity to be involved in the planning of their care so that they were able to discuss any concerns or preferences which they may have had. The care plans seen had been reviewed at least once every month so that any changes in residents’ assessed needs were clearly reflected. A variety of risk assessments had been conducted to show that strategies had been put in place to minimise or eliminate any identified risk. The management of medications was generally satisfactory in order to safeguard that those living at the home. Policies and procedures describing the handling of medication within the home were available for staff reference so that they were aware of correct procedures to follow. The procedures describing the arrangements for the disposal of unwanted medicines had been updated to reflect the recent changes. Qualified nurses administered medicines to residents receiving nursing care and the inspector was advised that all carers handling medication had completed assessed medication training to ensure safe handling of medications. The pre-printed MARs used throughout the home were generally up-to-date but handwritten entries were not always signed, independently checked and countersigned in order to reduce the risk of transcription error. The plans of care demonstrated that the privacy and dignity of those living at the home was protected at all times. Staff were instructed during induction about how to treat service users with respect and were seen to be knocking on resident’s bedroom doors before entering. Staff were also seen to be talking with residents in a respectful manner demonstrating that service users were treated well. Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those living at the home were supported to exercise autonomy and choice so that they were able make decisions about their preferred life style. Meals and mealtimes were being well managed to ensure that adequate nutrition was being maintained. EVIDENCE: At the time of the inspection the activities co-ordinator was on sick leave and although some activities were being provided by care staff these were limited. An activity profile had been completed for each resident. However, these were not dated and therefore the inspectors were unable to determine how recent they were. Social profiles had been completed providing staff with information about each persons life history so that those working at the home got a clear picture of each individual and were therefore able to adopt a holistic approach to meeting health, personal and social care needs. The care of a visually impaired resident was tracked at the time of the inspection so that the inspectors were able to determine whether the home provided equal opportunities for those with a disability. The care records demonstrated that this person was able to make a variety of choices in relation
Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 15 to the routines of daily life and the home had arranged the provision of specialist equipment so that the residents’ life would be as comfortable and as enjoyable as possible. Feedback from relatives surveys conducted by the home indicated that they would like to see more planned activities, including shows and days out. Residents spoken to said that activities were okay and that they were able to choose whether to participate or not, although they would like to go out more often. However, they also confirmed that the routines of daily living were generally flexible and that they were able to exercise choices about meals, getting up and going to bed. There were no activities seen to be provided on the day of the inspection and staff spoken to stated that the provision of activities was not as good since the activities co-ordinator was on sick leave. The bathing facility which was out of commission at the last inspection had been replaced by the installation of a new parker bath so that those living at the home were able to exercise choice in relation to wider range of bathing facilities. At the time of the inspection there were three service users living at the home who were being supported to manage their own finances, which demonstrated that residents were able to exercise choice about their personal affairs and were supported to maintain control over this area of their lives. Policies and procedures were in place at the home to demonstrate that systems had been implemented to ensure that those living at the home were supported to handle their own finances should they so wish. Staff confirmed that those living at the home were offered the option of a postal vote should they so wish to ensure that their right to vote was respected. Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 16 Policies and procedures were in place at the home to ensure that residents were able to access their own records under the Data Protection act 1998 if they so required. Policies and procedures demonstrated that the home would access an independent body to act on behalf of a resident, should the resident so wish in order to provide some protection and to help them to make decisions about their life. The home had arranged support of the local advocacy for one resident so that an independent person was acting on their behalf. Service users were able to bring personal possessions to the home with them, which individualised their own accommodation. An audit of service users’ belongings had been consistently conducted on admission to the home, in order to protect their personal items. Evidence was available to demonstrate that some links had been established with the local community and policies and procedures were in place in relation to people visiting the home. Visiting times were flexible within reason and relatives spoken to confirmed that visitors were always made welcome to the home being offered beverages. Those spoken to also confirmed that staff encourage residents to maintain contact with their family and friends. Inspectors noted that residents were able to entertain their visitors in private or within the communal areas of the home if they preferred. At the time of the inspection meals were being well managed to ensure adequate nutritional intake. At lunchtime a calm environment prevailed and service users were enjoying the dining experience. The dining room on the ground floor was found to be a pleasant area for residents to eat in. It was bright and airy and the dining tables were attractively laid with cruet sets, condiments, napkins and flower arrangements. Specialised aids and equipment were provided in accordance with residents assessed needs to promote independence. The menu of the day was displayed in the dining room so that people were aware of the choices being served for lunch. Some residents on the first floor were eating their lunch at the dining tables, whilst others remained in the lounge to take their meal. This was discussed with staff who informed the inspectors that the resident’s preferred area to dine was taken into consideration and should the needs of residents change then additional dining tables could be accommodated in the dining room. The dining tables were covered with tablecloths although cutlery, condiments and napkins had not been provided. The inspectors were informed that the tables are laid as meals are served, which did not promote independence or choice. Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 17 Meals were served in service users’ bedrooms if they preferred some privacy whilst dining. Nutritional risk assessments had been conducted, which identified anyone who was at risk of malnutrition, in which case advice was sought from the dietician and nutritional care planning was developed in accordance with individual need to ensure that adequate dietary intake was being maintained. Those living at the home confirmed that they were asked every day what they would like for their meals and that were able to choose from the menu or were able to select an alternative if they so wished. The meals served were recorded and were seen to be attractively presented and of a good nutritious standard. Liquidised diets were served in individual portions, so that food items could be easily identified to promote appetite and to aid in nutrition. Detailed records were available about individual diets and staff were aware of residents’ dietary needs and preferences, which ensured that service users received a nutritious diet in accordance to their needs. Appropriate training had been provided to relevant staff to ensure that food hygiene standards were maintained. Residents confirmed that a snack was provided in the evening and that food and beverages were available at all times, should they wish to have something to eat between meals. Appropriate food was provided for those requiring special diets due to medical conditions to ensure health care needs were being met. A variety of fresh fruit and vegetables was observed in the store room and a plentiful supply of food was evident demonstrating that there was a sufficient quantity of food for the needs of the residents. Staff were seen to be supporting those who required assistance with feeding in a sensitive and discreet manner by sitting with them and chatting to them to encourage dietary intake. However, staff were also seen to be encouraging residents to eat by them selves as far as possible to encourage independence. Meal times were unrushed and those living at the home were allowed to eat at their own pace so that they did not feel uncomfortable and so that adequate dietary intake was promoted. Residents spoken to were very satisfied with the quality and quantity of meals served. Comments made included “there is a good variety of meals”, “we get all fresh food and home baking” and “the food is very good”. Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 18 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were taken seriously and appropriate investigations were conducted. However, information provided in relation to complaints was not consistent or up to date. The policies, procedures and practices of the home protected those living there from potential abusive situations. EVIDENCE: Two different complaints procedures were in place to inform people of the process to take should they wish to make a complaint and which incorporated appropriate timescales for responses to be forwarded to the complainant. One procedure was included in the service users’ guide and the policy and procedure manual and the other was displayed in the reception area of the home, which contained out of date details and therefore did not provide the reader with current information. A record was retained of all complaints made to the home, which showed that detailed investigations had been conducted. Feedback obtained from people who use the service indicated that the management of complaints was good. A written policy was in place at the home in relation to the protection of vulnerable adults, which provided clear guidance on the procedure to be followed in the event of any allegations of abuse being received. A copy of the guidance ‘No Secrets’, produced by the Department of Health was readily available for staff reference to ensure that correct procedures were followed. A whistle blowing policy was also in place so that staff were aware of their
Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 19 responsibilities in relation to the reporting of any concerns which may affect those living at Courtfield Lodge. Policies also demonstrated that service users had access to their own records. Monies retained on service users’ behalf were securely stored and receipts were given for any money or valuables received, which service users wished to the home to retain on their behalf for safekeeping. Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 20 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users lived in a clean and pleasant environment, which was free from offensive odours. Adequate procedures were in place for the control of infection. EVIDENCE: Decoration of residents’ bedrooms and communal areas was on going. A rolling programme of maintenance was evident. The home was found to be generally safe and fit for stated purpose and well presented, providing those living there with a pleasant, hygienic and comfortable environment. Residents and visitors spoken to stated that they liked the accommodation. One comment received was, “it is always clean and tidy and never smells”. The pipe work in some of the bathrooms was not guarded to ensure that the safety of people living at the home was totally protected. The good sized bedrooms were personalised with resident’s belongings and good quality linen and furnishings were provided, which created homely surroundings for people living at the home. Those spoken to were satisfied with their bedrooms and happy that they were able to bring personal possessions to the home with them. The communal
Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 21 areas were light and airy and were found to be tastefully decorated and furnished so that residents were comfortable. The inspectors noted that the pipe work in some of the bathrooms was not guarded so that the safety of those living at the home was not consistently Most of the external areas of the home were generally safe and tidy for use by residents. However, an aviary had been erected to the rear of building, next to the patio and families of ducks lived within the grounds and although residents seemed to enjoy watching the wild life, the patio area could not have been used by residents on the day of the inspection as it was in need of a thorough clean due to the mess the wild life had created. All the environmental requirements from the previous inspection had been appropriately addressed, which is commendable and shows that the registered persons strive to provide a good standard of accommodation for the people living at Courtfield Lodge. Hand washing facilities had been provided in areas where infected linen was being handled to minimise the risk of cross infection. The nurse call system had recently been replaced with a less complicated system so that residents needs could be more promptly attended to. A new parker baths had been installed so that residents were able to choose from a wider range of bathing facilities. At the time of the inspection there was plenty of hot water and those spoken to stated that they can have a bath at any time. Detailed policies and procedures were in place in relation to the control of infection so that staff were aware of measures to take in order to protect those living at the home. Laundry facilities were appropriately sited to reduce the possibility of cross infection. Staff spoken to were fully aware of the measures needed to minimise the risk of infection. Residents spoken to were satisfied with the laundry arrangements in the home. One comment stating, “our clothes are washed, ironed and returned. I have no complaints about the laundry”. The registered person had not obtained confirmation that services and facilities complied with the Water Supply (Water Fittings) Regulations 1999 to ensure the protection of those living at the home. The inspectors provided the registered manager with advice about how to contact the water inspectorate. Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessed needs of those living at the home were adequately met by the numbers and skill mix of staff. Training provided for staff demonstrated that service users were in safe hands at all times. The recruitment process was not thorough enough to ensure that staff employed at the home were suitable to work with vulnerable adults. EVIDENCE: A clear staff rota was in place at the home demonstrating which staff were on duty at any time of the day and night and in what capacity they were employed, demonstrating that the skill mix of staff was appropriate to the needs of those living at the home. A clear procedure was in place for calculating the ratio of care staff to service users, by utilising individual dependency assessments to ensure that adequate care was provided to those living at the home. In addition, extra staff were being deployed to ensure that the needs of those requiring a high level of care intervention were being met. Evidence was available to demonstrate that the system used for calculating the ratio of care staff to service users was reviewed on a monthly basis or when the occupancy of the home changed so that the ratio of care staff to service users could be adjusted accordingly. The use of agency staff was minimal to ensure that continuity of care was maintained. Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 23 At the time of the inspection there were 29 care staff employed, 11 of whom had completed a National Vocational Qualification (NVQ), showing that the home was working towards achieving 50 of care staff being trained to NVQ level 2 or above to ensure that staff were appropriately trained to meet the needs of those living at the home. Evidence was available to demonstrate that none care staff were also given the opportunity to achieve a National Vocational Qualification so that relevant training was provided for the entire workforce. The home’s recruitment procedure needed to be improved, to ensure that all staff employed were suitable to work with vulnerable people. The personnel files of four recent employees were examined, which showed that thorough pre-employment checks had not always been carried out to ensure the protection of those living at the home. The Criminal Records Bureau(CRB) disclosure for one staff member had been brought from their previous place of work, the CRB and POVA first checks for two employees had not been obtained prior to employment and only one reference was available for one employee. These failings in the recruitment procedure did not consistently protect the people living at the home. In depth Induction training had been provided for all staff within the first six weeks of employment, which was recorded in individual work books demonstrating that new staff had been provided with relevant information in relation to the aims and objectives of the home. Staff had been provided with a variety of training courses, including a number of compulsory core training sessions. The plans of care were very well written providing staff with clear guidance as to how individual needs were to be met and staff spoken to were knowledgeable in relation to the needs of those living at the home. Individual training and development programmes were in place so that the manager of the home could determine at what stage staff were at in relation to their training needs and to ensure that those working at the home were competent to do the job expected of them and to ensure that they were able to meet the assessed needs of those living at the home. It is recommended that a training matrix be developed so that an overview of training needs is produced so that training for staff can be easily recognised and planned in accordance with individual needs. Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed, although the quality of service provided could be monitored more effectively. People living at the home and the staff team were adequately protected in relation to health and safety issues and safe working practices and residents financial interests were safe guarded. EVIDENCE: The registered manager of the home is a first level nurse with a number of years managerial experience and at the time of the inspection was in the process of completing a National Vocational Qualification at level 4, showing that she is suitably qualified, experienced and competent to run the home. The manager was working continuously to improve the service, providing a quality of life for residents. She was resident focused, leading a team of staff who put the needs of residents first. The manager was aware of current developments both nationally and by the Commission for Social Care Inspection and planned
Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 25 the service accordingly. Systems were in place to monitor staff adherence to policies and procedures, which were reviewed regularly so that staff had access to current legislation and good practice guidelines. One comment received was “the manager is approachable and supportive.” The manager was highly regarded by other professionals, showing that she liased with them on a regular basis. One external professional provided very positive comments, stating that the home had significantly improved over the last two years. Management processes made sure that staff received feedback about their work so that they were aware of any improvements required. Visitors and residents spoken to were very happy with the service provided and felt that the care was good. There was an organisational annual development plan in place to demonstrate that the organisation had a systemic cycle of planning in place, which reflected the aims and outcomes for the people using the services within the organisation. The registered provider met with the manager of the home every two weeks to discuss any relevant issues so that planned action could be agreed. Recorded minutes of these meetings were retained at the home and monthly reports were prepared which were available for inspection to demonstrate that the registered provider visits the home regularly and identifies any issues requiring attention. Residents and visitor surveys had recently been conducted, which provided positive comments about the management and administration of the home, but suggested that the manager could be more visible so that she could be contacted more easily. The mechanism for obtaining feedback about the service needed to be improved by seeking the views of stakeholders in the community as to how the service is achieving outcomes for residents and by holding recorded meetings at regular intervals so that relevant issues may be discussed. Action had been progressed within agreed timescales to implement requirements identified in the previous inspection report. The organisation had achieved an external quality award showing that the organisation was accredited by an external body. Some internal audits had been commenced as part of the quality assurance monitoring process. However, these needed to be extended so that all outcome areas for residents are monitored. The plans of care seen were very well written and incorporated short term and long term goals for service users, which demonstrated a commitment to the development for each service user and promoted their independence. Any discussions with relatives of service users were documented so that a record was retained of any concerns or compliments. Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 26 If they wish and are able to residents are helped to take responsibility for managing their own money. They are provided with facilities to keep their money and valuables safe. Where the home is responsible for residents’ money it works to a safe system, maintains clear records that are kept up to date and can be used to track individual resident’s finances. The service understands the need to meet external requirements where it acts as agent or appointee for residents. The home had a good record of meeting relevant Health and Safety requirements and legislation. Records were of a satisfactory standard and were routinely completed. Residents were aware of safety arrangements and had confidence in safe working practices of staff. The registered person had conducted a variety of risk assessments for safe working practice topics and significant findings of the risk assessment were recorded to ensure that risks were identified and appropriate strategies were put in place to minimise or eliminate the risk factor. All new staff had received induction and foundation training to meet TOPSS specification to ensure that they were fully aware of their responsibilities in relation to safe working practice topics. Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 27 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 Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 28 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 4 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 29 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 OP12 Regulation 16(2)(m)( n) Requirement The registered person shall having regard to the size of the care home and the number and needs of service users:• make arrangements to enable service users to engage in local, social and community activities, and • consult service users about the programme of activities arranged by or on behalf of the care home. The registered person shall not employ a person to work at the care home unless – the person is fit to work at the care home; he has obtained in respect of that person the information and documents specified in Schedule 2 of the Care Homes Regulations, including two written references, a POVA first check and a CRB disclosure (unless in exceptional circumstances), and he is satisfied on reasonable grounds as to the authenticity of the references.
DS0000025553.V292340.R01.S.doc Timescale for action 31/08/06 2. OP29 19(1) 30/06/06 Courtfield Lodge Nursing & Residential Home Version 5.1 Page 30 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. 3. 4. 5. 6. 7. 8. 9. Refer to Standard OP9 OP15 OP16 OP19 OP19 OP26 OP28 OP30 OP31 Good Practice Recommendations Handwritten MAR entries should be signed and countersigned. The dining tables on the first floor should be laid prior to meals being served. The two complaints procedures should be reviewed and amalgamated to ensure that information provided is consistent and up to date. The patio area should be thoroughly cleaned. The unguarded pipe work in some of the bathrooms should be covered. The registered person should be able to demonstrate that services and facilities comply with the Water Supply (Water Fittings) Regulations 1999. It is recommended that the home continue to work towards achieving 50 of care staff being trained to a National Vocational Qualification at Level 2 or above. It is recommended that the registered manager developes a staff training matrix. The registered manager should continue working towards obtaining a National Vocational Award level 4, in accordance with standard 31 of the National Minimum Standards for Older People. The quality assurance monitoring system should include feedback from stakeholders in the community to determine their views on how the home is achieving goals for service users. The process of internally auditing systems within the home should be further developed and extended. The results of service users’ surveys should be published so that prospective and current service users are able to see how the home is achieving it’s goals. Residents, relatives and staff meetings should be held on a regulary basis, with minutes kept. An annual development plan specific to Courtfoeld Lodge should be implemented based on a cycle of planning, action and review.
DS0000025553.V292340.R01.S.doc Version 5.1 Page 31 10. OP33 11. 12. 13. 14. OP33 OP33 OP33 OP33 Courtfield Lodge Nursing & Residential Home Courtfield Lodge Nursing & Residential Home DS0000025553.V292340.R01.S.doc Version 5.1 Page 32 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
