CARE HOMES FOR OLDER PEOPLE
Courtlands Rosudgeon Penzance Cornwall TR20 9PN Lead Inspector
Lowenna Harty Announced Inspection 13th October 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 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. Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Courtlands Address Rosudgeon Penzance Cornwall TR20 9PN 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) 01736 710476 01736 71141 Mr Mark Fairhurst Mrs Gillian Fairhurst Mrs Julie Hocking Care Home 37 Category(ies) of Dementia - over 65 years of age (12), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (12), Old age, not falling within any other category (37) Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include one named person only under the age of 65 Date of last inspection 26th April 2005 Brief Description of the Service: Courtlands is a care home providing accommodation and personal care for up to 37 older people, up to 12 of whom may have dementia and a further 12 may have mental illness. One room is reserved for service users who require shortterm/ respite accommodation. Most of the bedrooms provide single accommodation and several have en suite facilities. There are three double bedrooms, all of which have en suite facilities. The home is privately owned and the registered providers are closely involved in the day-to-day management and administration. The home also has a manager registered with the Commission. A team of care staff; ancillary staff, administrator and maintenance manager is employed to assist them. The home is situated in the village of Rosudgeon, between the towns of Penzance and Helston. It is a large, detached property set in its own grounds. The home has two floors, the upper floor being accessible by a lift. There is suitable access for people with disabilities from the outside of the building. There are two downstairs lounges and a separate dining room for the use of service users. There is an additional lounge on the upper floor. There are ample, very well maintained and safe grounds for service users. The home has suitable office space and space for staff to store their personal belongings. Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on 13 October 2005 and was announced. It started in the morning, after breakfast and lasted for approximately six hours. The purpose of the inspection was to ensure that residents’ needs are appropriately met in the home, with particular regard for ensuring good outcomes for them. This involved looking at documents written for them and about them, and examination of the home’s written policies and procedures and records kept to ensure the welfare and protection of residents living there. It involved an inspection of the home’s premises, interviews with residents and observation of the daily life of the home. Time was spent discussing the management of the home with the registered provider and registered manager. The registered provider had submitted a pre-inspection self-assessment to provide additional information to assist the inspection process. The principle method used was case tracking. This involves examining the care notes and documents for a select number of residents and following this through with interviews with them or their relatives and staff working with them. This provides a useful, in-depth insight as to how residents’ needs are being met in the home. At this inspection, four residents were case tracked. Overall the home is meeting the needs of residents well, in a calm, restful, homely environment. What the service does well:
Residents are encouraged to participate in all decision making in the home, including their assessment for admission. There is clear information on the admission procedures in the home’s statement of purpose and they are asked to complete a form to tell the home about their needs and interests before they are formally assessed to see if the home is suitable for them. Their religious and cultural needs are considered in both their assessments and subsequent care plans that are developed with them once they are admitted to the home. The home does not specialise in rehabilitative care, but there are some facilities for residents to be admitted to the home for shorter periods, including for recovery following an admission to hospital, depending on their assessed needs. When this happens, they are helped to return to their own homes, if this is their wish. The registered manager has training in rehabilitation and there was a physiotherapist in the home at the time of the inspection, visiting a resident to assist them to return to their home, when they have fully recovered.
Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 6 The home has good links with local NHS healthcare providers. Residents’ initial assessments and individual care plans consider their healthcare needs so that they can be properly met in the home. Where necessary, residents are helped to access healthcare providers from outside of the home, such as community nurses, chiropodists, dentists and doctors. Residents are able to retain and manage their own medication if they wish and there are suitable facilities in their rooms for them to store their medicines safely. If they prefer, staff will assist them with their medicines and there are suitable systems in place to ensure they are protected from medication errors, for example, only senior staff are responsible for medication, on the basis that they have attended safe handling of medicines training. Residents are provided with a choice of home prepared meals, at regular intervals. Most of those interviewed at the time of the inspection stated that they are satisfied with the food provided to them, which looked wholesome and appetising. Meals are served in one of the lounges, the dining room or residents’ own bedrooms, depending on their needs and personal preferences. The home is comfortable, well furnished and tastefully decorated throughout. Residents have a choice of communal spaces in addition to their own rooms and the home is set in very attractive and safe grounds. It was clean and tidy throughout at the time of the inspection. There are systems in place to protect residents from the risk of infection. The home’s staff are recruited and selected in fair, safe and effective ways to ensure that they are suitable to work with vulnerable older people. They are well trained and encouraged to develop their knowledge and skills so that they can work more effectively with them. Most residents manage their own personal finances, or do so with the assistance of their residents. The home’s administrator may assist them, with their written permission, if they wish it. There are full records to ensure that they can be confident their money is kept safely, when this happens. The home is run to ensure that residents’ health, safety and welfare are well protected, with particular reference to ensuring they are protected from the risk of fire and other hazards, such as infection, falls and accidents. What has improved since the last inspection?
Residents are provided with professional assessments prior to their admission, in every case, to ensure that the home is suitable to meet their needs. Local Community nurses have recently introduced regular clinics, where they come into the home and senior carers work alongside them to develop their knowledge and skills and ensure continuity of care for residents. Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 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 Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 New service users are admitted on the basis of an assessment of their needs although this needs improvement so that they and their representatives can be fully confident that the home is suitable for them. Service users admitted for intermediate care are assisted to return to their own homes if this is what they wish to do. EVIDENCE: The home’s statement of purpose provides clear information on the admission procedure, which is on the basis of an assessment of a prospective service user’s needs, to ensure they can be met. There was assessment information on the files of the four service users whose cases were tracked during the inspection. Prospective service users and/or their representatives are invited to contribute to the assessment process through a separate questionnaire, which they are asked to complete. This covers information on their personal history and preferences. The home’s assessment format covers all aspects of a prospective service user’s health and social care needs, and is completed with them, wherever possible, but it is set in a mainly tick-box format. There was a lack of detail recorded in relation to the number and nature of falls, where a history of falls was indicated on two service users’ assessments and a lack of detail on history of mental illness, for one. Two of the service user’s assessments lacked evidence of a consideration of risks.
Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 10 The home does not specialise in intermediate care provision and does not have separate facilities for this. There are facilities for some short-term respite care and interim care for service users who intend to return to their own homes following an admission to hospital, on the basis of their initial assessment and information provided by other professionals working with them. Service users in these situations are assisted to access the professional services and support they need to help them to return to their own homes. The home’s manager has undertaken training in rehabilitative care and a visiting physiotherapist was at the home at the time of the inspection. Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 11 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 Service users have written care plans to inform them and staff of most of their care needs although there should be more detailed consideration of their mental health. Apart from this, their health care needs are met. Service users who are not able to manage their own medicines are well protected from medication errors. EVIDENCE: All the service users whose cases were tracked had written care plans, which addressed their personal, social and health care needs, including their religious and cultural needs and personal preferences. These are usually reviewed at least monthly. Service users or their representatives had signed up to them as evidence of their participation and agreement. The care planning process includes consideration of the specific aims of a service user’s placement in the home. Whilst information for most of them appeared to be sufficiently comprehensive, there was a lack of information on the mental health of one service user whose case was tracked, where it should have been more fully written up. The home has established good links with local NHS healthcare professionals and service users’ care plans include consideration of most of their healthcare needs. Community nurses visit the home at least twice weekly and have
Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 12 introduced clinics, which they undertake with the senior carers, to improve communication. They undertake additional visits to individual service users as necessary. Service users are assisted to access a range of healthcare professionals according to their individual needs and wishes. There are detailed written procedures to guide staff who manage service users’ medication and service users are asked to provide their written consent when they do this. Only senior carers, who have undergone training in the safe handling of medicines deal with service users’ medication. There are clear records of medicines administered to service users. One service user currently retains and manages their medicine for themselves. They have suitable locked facilities in their room for this. Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Service users’ nutritional needs and dietary preferences are properly taken into account to ensure that they are well fed. EVIDENCE: The registered manager included copies of the menu with the pre-inspection information sent directly to the Commission. Meals are cooked on the premises and served either in the dining room, the lounge or in service users’ own rooms, if they prefer, at regular intervals. Service users interviewed at the time of the inspection indicated that they are satisfied with the food provided to them. Their dietary needs and personal preferences are considered in both their initial assessments and their written care plans. Food served at the time of the inspection looked wholesome and appetising. Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 There are systems in place to protect service users from abuse. EVIDENCE: Staff recruitment records show that they are employed on the basis of their fitness and suitability to work with vulnerable adults. There are detailed written procedures to guide them on how to recognise when abuse is taking place and what to do when this happens. They have access to the local multi-agency guidelines and are provided with in-house training. The registered provider and registered manager have both attended local multi-agency training on the protection of vulnerable adults from abuse and have passed their knowledge on to staff. There have not been any allegations of abuse in the home. Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 15 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 & 26 Service users benefit from a safe, comfortable, homely environment, which is clean and hygienic although it would benefit from the addition of a sluice. EVIDENCE: The home was warm, well furnished and tastefully decorated throughout at the time of the inspection. The registered provider employs a maintenance manager, who ensures that necessary repairs are completed and safety checks are carried out on a regular basis. There are records of environmental risk assessments and fire safety risk assessments and the home is kept secure. Service users interviewed at the time of the inspection said that they feel safe there. The home was clean and tidy throughout at the time of the inspection. There is extensive information and written procedures to guide staff on the control of infection and they are provided with training in this respect. They are provided with suitable equipment to ensure that infections are not spread in the home. Hygiene would be improved further it the home were provided with a sluice
Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 16 and this is an outstanding recommendation, to be met as part of the home’s future development and improvement. Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 17 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): 29 & 30 Staff are employed on the basis of fair, safe and effective recruitment policies and practices to ensure that they are suitable to work with service users. They are well trained to ensure that service users benefit from good care practices. EVIDENCE: There is a clear, written recruitment policy and recruitment documents provide evidence that this is adhered to in practice. There is a comprehensive policy to ensure that staff are recruited on the basis of equal opportunities. Interview records are retained and there is evidence that staff have undergone necessary checks to determine their suitability to work with vulnerable older people. There is a staff training plan for the home, which was submitted to the Commission prior to the inspection. Records of staff attendance at training courses are maintained on their files. All new staff undergo detailed induction training. Courses are conducted in house and through local colleges and independent training providers. A staff member interviewed at the time of the inspection reported that they are provided with good access and support to undertake training to develop their knowledge and skills for the benefit of service users. Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 18 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): 35 & 38 Service users’ financial interests are well managed and their rights protected. The home is mainly safe for service users and staff although there needs to be a specific improvement in this. EVIDENCE: Most service users manage their own financial affairs, or do so with the assistance of their relatives. Where they are not able to do so, the home’s administrator assists them and retains full records, which were available for inspection. All service users have individual personal accounts and provide their written authority for the home to act on their behalf, should they wish this to happen. The home’s manager and maintenance manager work together to ensure that the environment is kept safe for service users and staff. There are records of fire alarm and equipment tests and checks on a regular basis, and fire
Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 19 evacuations. The home’s fire safety risk assessment is complete. There are clear records of staff training in all aspects of health and safety, including fire safety. There is a detailed general environmental health and safety assessment, covering every aspect of work and life in the home, including the use of cot sides on beds, when this is necessary, although individual risk assessments need to be completed in every case, to ensure that the particular equipment used for an individual is safe. Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 20 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 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 21 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. Standard Regulation Requirement Timescale for action 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 OP3 Good Practice Recommendations Consideration should be given to revising the home’s tick box assessment format to ensure that there is sufficient detail recorded, with particular reference to prospective service users’ history of falls and mental state. Service users’ mental health care needs should be fully considered in their written care plans. There should be improved evidence that service users with particular mental health needs have these needs properly recognised and met. The registered provider should install a sluice, when resources permit. Risk assessments for the use of cot sides should be individual for each service user. 2. 3. 4. 5. O5.P7 OP8 OP26 OP38 Courtlands DS0000009010.V256727.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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