Inspection on 21/04/05 for Dove Court Nursing Home

This inspection was carried out on 21st April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Dove Court Nursing Home 26/05/09

Dove Court Nursing Home 10/11/08

Dove Court Nursing Home 27/05/08

Dove Court Nursing Home 04/06/07

Dove Court Nursing Home 28/09/06

Dove Court Nursing Home 19/08/05

Dove Court Nursing Home 09/07/04

Dove Court Nursing Home 04/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Dove Court Nursing Home Albert Street Kettering Northants NN16 0EB Lead Inspector Sarah Smart Unannounced 21 April 2005 10.00 st 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. Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Dove Court Nursing Home Address Albert Street Kettering Northants NN16 0EB 01536 484411 01536 484410 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) Four Seasons Healthcare Limited Vacant Care Home with Nursing 58 Category(ies) of DE(E) Dementia - Over 65 Years (9) registration, with number OP Old Age (58) of places PD Physical Disability (10) TI Terminally Ill (9) Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age range for Physical disability and Terminally ill is from 35 years of age. 2. Of a total of 58 persons requiring personal care 10 of which may have physical disability over 65 years of age. 3. Of a total of 58 persons requiring personal care 9 of which may have dementia over 65 years of age. 4. Of a total of 58 persons requiring personal care 9 may be terminally ill. 5. One named service user falling in the category of learning disability (LD). Date of last inspection 9th July 2005 Brief Description of the Service: Dove Court is a large, purpose built nursing and residential home situated in the back streets close to Kettering town centre. The home offers single rooms with ensuite facilities, over two floors. The home has several lounges and dining areas, and assisted bathrooms. The home has outdoor space which is accessible to the service users. Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was undertaken between the hours of 10.20am and 2.15pm. The pre-inspection questionnaire had been completed and returned to the inspector prior to the inspection. Written feedback in the form of questionnaires was received from 9 service users, and 11 relatives. Some of the feedback received was not positive in the following areas: eight out of nine service users stated that they like living at the home sometimes, 4 out of nine do not feel well cared for, and 5 out of nine do not like the food. Of the 11 relatives, 4 stated that they do not feel welcome at the home, and 6 said that the home could keep them better informed of their relatives change in health. 10 out of 11 stated that there were not enough staff on duty, and 5 said they were dissatisfied overall with the care. With these comments in mind, the inspector focused on these areas when speaking to staff and service users during the inspection, looking at documentation, and observing practice within the home. The primary method of inspection used was ‘case tracking’. This involves selecting a number of service users and tracking their care and experiences through review of their records, discussion with them, the care staff and observation of care practices. The following areas were covered during the inspection: case tracking, medication, sample of policy review, staff rota, staff files, quality assurance, staff supervision, accident records, complaints records, previous requirements made, and staff and service user interviews. Two staff members, plus the acting manager, were interviewed at length, and several others briefly, whilst four service users were spoken to in detail. Two service users were case tracked. What the service does well: The acting manager joined the home after a fairly long period of problems. As a result of this inspection she has demonstrated that she has successfully prioritised the work, which needed to be done, and is gradually improving the quality of the care provided. Assessments of service users were recorded to a high standard. The staff spoken to by the inspector demonstrated a good knowledge of the service users in their care, giving detailed descriptions of their needs. Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 Page 6 The provision of equipment to meet the service users needs is of very high importance to the acting manager. All of the required equipment was in place in the home. Service users choices were respected at all times. What has improved since the last inspection? What they could do better: The company are consistently failing to recognise the requirement to issue service users with contracts of residency. The company assured the inspector that such contracts would be in place by the end of March, however this has not been adhered to. The company is putting both itself and service users at risk by failing to do this. The statement of purpose was not up to date, and was not available to service users. In some instances record keeping was not done in line with the care being given. The temperature of the medication store is above the acceptable level of 25 degrees, which may effect the structure of the medication stored there. This must be addressed. All of the homes policies have not been reviewed timely. Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 Page 7 The wishes of service users in the event of their death are not ascertained or recorded. Accident records for March showed a concerning trend, which the acting manager should monitor. The acting manager has no proof of staff training, as the previously available documents are no longer in the home. The acting manager stated that she will be addressing this in the coming months. Some service users money is stored in a communal bank account. This is not acceptable, and is not in the service users best interests. Staff supervision has not been carried out or recorded in the recent months. 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. Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 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 standard(s) 1,2,3,4,5,6 Service users are not adequately informed by the statement of purpose. They are put at risk by the company repeatedly refusing to issue contract of residency. Service users needs were assessed and met. EVIDENCE: The statement of purpose had been the subject of a previous requirement as it was not up to date. This remains outstanding. The statement of purpose is not made available to service users. Service users are still not issued with contracts of residency despite this being a requirement since 2003. The home have attempted to take action in relation to this, despite the company failing to, by asking service users to sign a letter containing valuable information. The assessments contained valuable information, and contained a needs assessment in relation to personal physical care, and a social history, which advised the reader of past employment, hobbies and family. Staff spoken to by the inspector demonstrated a good knowledge of the service users in their care, and the service users stated that their needs are met. Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 Page 10 Service users are able to visit the home for a half day or a meal before deciding to move in permanently, or they stay initially on a temporary basis. All service users are admitted on a four week trial period after which time a review is held. The home does not provide intermediate care. Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 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 standard(s) 7,8,9,11 Documentation did not indicate that service users health and personal care needs are met, or that their wishes are considered. Medication storage was not acceptable, and other aspects of medication management requires a small amount of attention. EVIDENCE: Care plans were written to an acceptable standard although several further areas of need were identified for which care plans must be written. One of the service users care plans were signed by a relative, however the other were not agreed by the service user or relative. Carers spoken to by the inspector had a good knowledge of the service users and their needs. One service users care plan was slightly out of date, as it stated she was to have fortisip, however the nurse in charge stated that this was not longer needed. It was not prescribed on the medication administration record sheets. Healthcare assessments were generally in place, however one had not been fully completed, and a further score had not been scored correctly. Service users rooms demonstrated that the equipment identified as required was in place e.g. air mattresses for pressure area care, bed rails. A turn chart for one service user had not been completed since the night staff left duty, however the inspector was satisfied that the service user had been turned, but her chart had not been completed. This was addressed at the time of the inspection. One Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 Page 12 service users wound record had not been completed for nine days, despite it being redressed in this period of time. Medication was viewed on both floors of the home. On the 1st floor some medication was not being given as prescribed, and there remained some gaps in the recording. The room where medication is stored on the first floor was extremely hot, the thermometer on the wall reading 27 degrees. The required storage temperature is not higher than 25 degrees. Other aspects of medication management was satisfactory on this floor. On the ground floor the medication room door lock was broken. This was attended to by the acting manager at the time. Medication was managed acceptably on this floor. In one service users file the wishes in the event of their death were recorded. The other had no such record. The policy in the event of death was acceptable, although it had not been reviewed for sometime, and this had been the subject of a previous requirement. Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 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 standard(s) 14, 15 partially Service users choices are encouraged, enabled and respected. The provision of activities in the home is satisfactory. EVIDENCE: Service users spoken to stated that they are encouraged and enabled to choose what time they rise and retire, and when they have a bath. They added that there is a choice of food available. Several service users showed the inspector a structured activities programme, incorporating a variety of hobbies etc. The home have an activities organiser, who had arranged a clothing sale on the day of the inspection. Service users stated that they could choose whether to join in or not. Two of the service users spoken to stated that the food was very good, whilst one said “passable”, and a second said that a variety of homemade puddings would be nice. The lunch on the day of the inspection looked and smelt appealing. Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 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 standard(s) 16,17,18 The management of complaints was satisfactory. Service users were protected and their rights respected. EVIDENCE: The complaints policy was viewed. This contained all of the required information, however as with other policies it had not been reviewed for two years despite a previous requirement. Staff spoken to demonstrated a good knowledge of the complaint handling procedure. The complaint record was viewed. This contained one complaint since January, which appeared not to have been concluded. The acting manager gave an acceptable explanation for this, leading the inspector to recommend that the complaint handling documentation should be completed. Two service users were asked how they were planning to exercise their right to vote in the forthcoming elections. They both stated that they had arranged to receive postal votes. The home have a copy of the Northamptonshire inter-agency policy on abuse, as well as their own policy, which was satisfactory however unreviewed. Staff spoken to by the inspector demonstrated a good knowledge of the abuse policy. Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 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) These standards were not assessed during this inspection. EVIDENCE: These standards were not assessed during this inspection. Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Staffing levels, and continuity, were adequate to meet the existing service users needs. Recruitment procedures were robust, however staff training requires documentary evidence. EVIDENCE: The staff rota was viewed. Staffing is recorded separately for the two floors of the home, however staff provide assistance on either floor if required. The first floor, or nursing floor has one nurse on duty at all times, with 4 carers in the morning, 3 in the afternoon, and two at night. On the ground floor, or residential floor, there is a minimum of one senior carer on each shift with three carers in the morning, two in the afternoon, and one at night. Service users spoken to by the inspector stated that their call bells are answered promptly, and that staff meet their needs. One service user added that staff have time to meet her needs, but do not have time to do the little, important extras. Staff spoken to said that they sometimes work short due to sickness, usually about once per week. In addition there is ancillary and housekeeping staff. The acting manager advised that agency usage has decreased due to the employment of additional staff recently. Accident records demonstrated that all of the accidents which occurred in March occurred where service users were “found on the floor”. This may indicate staff shortage, or poor deployment of staff, and should be monitored. Staff spoken to demonstrated a good knowledge of the service users in their care, and service users stated that their needs are met. Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 Page 17 A sample of staff files were viewed. They contained all of the required information. One staff member advised the inspector that she had worked 44.5 hours during one week, however she had not signed to opt out of the working time directive regulations. During previous inspections the inspector had viewed a training matrix which clearly demonstrated statutory and other training for staff. This document is no longer available to the acting manager, who has been unable to verify staff training in writing since accepting her post. The acting manager advised the inspector that she intends to shortly introduce a rolling programme for statutory and other training. Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 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) 31,33,35,36,37,38 Some areas should be addressed to ensure service user safety. Safe practices are not in place for storage of service users money. EVIDENCE: The acting manager has recently undergone her fit person interview. Registration has been delayed due to awaiting one reference from her previous employer. The acting manager is due to commence her National Vocational Qualification level 4 course shortly. The acting manager distributes quality questionnaires regularly to service users about different aspects of the home. The information gathered is then fed back to staff during regular Head of Department meetings. Service users spending money stored in the home was managed satisfactorily. However, larger sums of money are deposited into a communal account. Staff supervision records were noted in the staff files, although they were not current. The acting manager advised that they are to recommence shortly. Accident records require monitoring and must contain recorded reviews. Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 Page 19 None of the policies viewed had been reviewed for 2 years. The confidentiality policy did not give instruction to staff regarding disclosing information over the telephone, contact with the media, or conversations between staff outside work. Accident records were cross-referenced with the information in the service users files. All accidents were recorded. All of the accidents to service users during the month of March stated “found on the floor” – which raised concerns about staffing levels or deployment. Accidents were not reviewed. One service user was observed to be transported in a wheelchair without footrests in place. Her file was checked, and recorded that she refuses to have footrests in place. Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 1 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 3 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 x 3 x 1 2 2 3 Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15(1) Requirement Previous requirement made 4.5.04, timescale: by 30.8.04. Care plans must contain specific information in relation to the needs of the service users. Previous requirement made 27.5.03, timescale: by 30.8.03. Service users must be issued a contract of residency in order to protect the service user and the home Previous requirement made 29.9.03, timescale 30.10.03. The statement of purpose must include the information outlined in schedule 1, and must be available to existing and prospective service users Previous requirement made 4.5.04, timescale: 30.6.04. Healthcare assessments must be completed fully and accurately reflect the service users needs. Previous requirement made 4.5.04, timescale: by 30.6.04. Signatures, or codes indicating the reason for omittance, must be entered onto the medication administration record sheets. Previous requirement made 4.5.04, timescale: by 30.7.04. Timescale for action By 30.5.05 2. 2 5 By 30.5.05 3. 1 4 By 30.5.05 4. 8 12(1) By 30.5.05 5. 9 13(2) By 30.5.05 6. 37 17 By 30.5.05 Page 22 Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 7. 8. 9. 7,8 9 35 15(1), 12(1) 13(2) 20 Policies and procedures must be reviewed timely. Record keeping must demonstrate the care given. Storage of medication must be maintained below 25 degrees Service users money must not be stored in a communal bank account. By 31.5.05 By 15.5.05 By 31.5.05 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. Refer to Standard 11 16 38 29 36 37 Good Practice Recommendations Service users wishes in the event of their death should be recorded. Complaint recording should be more detailed. The occurance of accidents should be monitored. reviews following accidnts shold be recorded. Staff wokring over 40 hours per week should sign opt out agreements. Staff supervision should be reintroduced, and recorded two monthly. The confidentiality policy should contain additonal information. Dove Court Nursing Home C51 S12611 Dove Court V222965 210405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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