CARE HOMES FOR OLDER PEOPLE
Courtlands Rosudgeon Penzance Cornwall TR20 9PN
Lead Inspector Lowenna Harty Unannounced 26th April 2005 10:00 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. Courtlands Version 1.10 Page 3 SERVICE INFORMATION
Name of service Courtlands Address Rosudgeon Penzance Cornwall TR20 9PN 01736 710476 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) Mr Mark Fairhurst Mrs Gillian Fairhurst Mrs Julie Hocking Care Home 37 Category(ies) of Dementia - over 65 years of age (12) registration, with number Mental Disorder, excluding learning disability or of places dementia - over 65 years of age (12) Old age, not falling within any other category (37) Courtlands Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Service users to include one named person only under the age of 65 years Date of last inspection 21 February 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 Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection as part of the home’s annual inspection programme on 29 April 2005 starting at 10.30 am. The inspector was at the home for five hours and undertook the following activities whilst at the home 1. Inspection of records, including assessment information and care plans 2. Discussion with the manager of the home on how it operates on a day-today basis 3. Inspection of the building 4. Interview with a member of staff 5. Interviews, held in private, with seven service users and a relative of a service user who was visiting the home 6. Observation of the daily life of the home. What the service does well:
All of the service users interviewed and the visiting relatives seen by the inspector stated that they are satisfied with the care and services provided t6 them at Courtlands. The staff member interviewed stated that they like working at the home because there is a good team spirit among the staff, the management team is supportive and staff are provided with good access to training. The home is comfortable, homely, well maintained and safe. Service users’ health and social care needs are well met and they have access to a range of external healthcare providers who were seen coming and going from the home at the time of the inspection. There are plenty of visitors to the home and service users are able to join in a range of activities or spend time in their own rooms or quiet lounges if they prefer. The home has very spacious grounds that are well tended and safe. Service users’ views on how they want the home to be run are sought. There are sufficient staff on duty to enable them to spend time with service users and give them they care they need. Courtlands Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Courtlands Version 1.10 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 Courtlands Version 1.10 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 Service users are assessed prior to their admission to the home, although full information was not available on all those whose cases were tracked at the inspection. The home does not provide intermediate care so this standard was not assessed. EVIDENCE: The home’s assessment format provides for full and detailed assessment information to be provided on behalf of service users entering the home. It is sent to service users and/or their representatives for self-completion, which provides good evidence of their participation in the process. Information was also provided in the form of professional assessments conducted by referring agencies in situations where they were referred by health or social services. The inspector noted that assessment information was not completed in full for some of the service users, sometimes because they were referred from areas outside of Cornwall and in some cases there is an over-reliance on the selfassessment, although all service users are provided with written care plans. Assessment information should be completed in full and where this is not possible prior to admission, it should be completed shortly afterwards, prior to the care planning process.
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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 & 10 Service users are provided with written care plans that they are invited to sign, which are reviewed on a monthly basis. Their health care needs are well met and fully considered in the care planning process. There are measures in place to ensure that service users’ privacy and dignity is respected. EVIDENCE: All of the service users whose cases were tracked at the time of the inspection had written care plans that, in most cases, they had signed their agreement to. This includes written risk assessments and consideration of any history of falls. Care plans are reviewed at least monthly and a system for checking that this happens has recently been introduced to the home. Care records indicate that service users’ health care needs are well met and they are provided with access to a full range of NHS health care providers depending on their needs. Service users interviewed stated that they are satisfied with the care and services provided to them at the home and all stated that their privacy is respected. There is a rolling programme to provide them with locks to their bedroom doors and they are available on request to those who express a wish to be provided with lockable bedroom doors. Several rooms have en-suite bathrooms. Service users only share rooms where they have made a positive
Courtlands Version 1.10 Page 11 choice to do so. All shared rooms have en-suite bathrooms and privacy curtains. Courtlands Version 1.10 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 14 Service users are provided with activities and a lifestyle in accordance with the home’s statement of purpose and their individual needs and preferences. They are able to maintain contact with family and friends and there are systems in place to ensure that they are regularly consulted on matters that affect them. EVIDENCE: The home’s statement of purpose provides information on the activities that the home provides and the home is well laid out, with three separate lounges and a dining room to ensure that service users can choose whether or not to participate. Their hobbies and interests are considered as part of the assessment and care planning processes. The home employs two activities organisers and information on forthcoming activities is published on the home’s notice board. All of the service users stated that they are satisfied with the activities provided to them in the home. Staff are provided with access to training in caring for people with dementia in order that care and services are appropriate to meet their particular needs. There are plenty of visitors to the home and service users come and go as they wish, depending on their individual risk assessments. The home has systems in place to consult with service users, including quality assurance questionnaires and regular residents’ meetings with minutes kept as well as a key worker system in operation so that service users’ individual wishes can be considered as part of the care planning and review process.
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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 The home actively listens to comments and complaints made by service users and their representatives and takes action where necessary. EVIDENCE: The home has a detailed written complaints procedure that is readily available to service users and their representatives. They are made aware of their right to contact the Commission directly if they prefer to do so. There are full records of complaints and compliments maintained in the home. Service users’ individual views are sought through the assessment and care planning process and there are regular service users’ meetings, with minutes kept. The home has a quality assurance programme in place to ensure that the views of service users and other stakeholders are routinely sought and analysed. Courtlands Version 1.10 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 standard(s) 19 & 26 The home is comfortable and safe and there is a programme of routine maintenance for the upkeep and gradual improvement of the building. It was clean and tidy throughout at the unannounced inspection. EVIDENCE: The home is well decorated and tastefully furnished. There is a dedicated maintenance manager to ensure the upkeep of the house and grounds The home was warm and appeared clean and tidy throughout at the time of the unannounced inspection. There is a rolling programme to provide all the service users with lockable doors to their private accommodation and a sluice should be provided in accordance with the home’s long-term business planning. The home’s records with regard to fire safety, including risk assessments, staff training, fire drills, maintenance checks and equipment checks are clearly maintained and up-to-date. Staff are provided with routine in-house training on infection control and the home has written policies and procedures and suitable equipment for them in this respect. Some staff have completed external training in infection control and others are booked onto the external training course, to commence shortly.
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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) 27, 29 & 30 The home employs an effective staff team in sufficient numbers to meet the needs of service users and has a clear commitment to staff training. Recruitment policy and practices are fair, safe and based on equal opportunities. EVIDENCE: There is a relatively stable staff team working in the home. Existing staff tend to cover vacant posts with only occasional input by bank or agency staff. There are sufficient numbers of domestic, administrative and maintenance staff to ensure that staff providing direct care can spend time with the service users. Staff files checked at the inspection contained all the information required by regulation, including appropriate references, checks, interview records and full employment histories. Nearly half the staff are qualified to NVQ level 2 or above and more are due to achieve qualification to this level shortly. There is a clear commitment to staff training and the registered manager has recently drawn up a new staff training plan format, which she is in the process of completing, to ensure improved prioritisation and ensure that all staff have the essential skills they need to carry out their jobs effectively. Courtlands Version 1.10 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 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) 33 & 38 The home has a well developed quality assurance programme and service users are encouraged to make their views known to ensure the home is managed in their best interests. There are measures in place to ensure the health, safety and welfare of service users, staff and visitors to the home. EVIDENCE: Service users’ views and the views of external stakeholders are routinely sought through the home’s formal quality assurance programme. There is a clear and accessible complaints procedure and records of service users’ compliments and complaints. Service users hold meetings on a regular basis, with records kept, and are provided with individual care plans, which are regularly reviewed. The home’s fire safety and environmental risk assessments are completed and subject to regular review. There are records of safety and equipment checks, including fire safety. Service users are provided with individual safety risk assessments as part of the care planning process. There are written policies and procedures to guide staff and they have access to
Courtlands Version 1.10 Page 19 training courses in all aspects of health and safety. Key aspects are addressed as part of the induction programme for all new staff upon commencing employment in the home. Courtlands Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x x x x 3 Courtlands Version 1.10 Page 21 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 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 3 Good Practice Recommendations Service users written assessments should be completed and where, self-assessments have been done, checked by trained staff prior to commencing the care planning process. The home should obtain a sluicing facility when resoureces permit. 2. 26 Courtlands Version 1.10 Page 22 Commission for Social Care Inspection 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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