Inspection on 26/05/09 for Dove Court Nursing Home

This inspection was carried out on 26th May 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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 21/04/05

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 06/08/2009.

Key inspection report Care homes for older people Name: Address: Dove Court Nursing Home Albert Street Kettering Northants NN16 0EB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rajshree Mistry     Date: 2 6 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 38 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Dove Court Nursing Home Albert Street Kettering Northants NN16 0EB 01536484411 01536484410 dove.court@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons Homes (No 4) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) care home 58 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: Dove Court Nursing Home is registered to provide personal care with nursing for male and female service users whose primary care needs fall within the following categories:- Old age, not falling within any other category (OP) 58 Physical disability over the age of 35 years (PD) 10 Physical disability over the age of 65 years (PD)(E) 10 Dementia over the age of 65 years (DE)(E) 28 No persons falling within the categories of PD or PD(EO are to be accommodated at Dove Court Nursing Home when there are 10 persons faling within these categories residing at the home No persons falling within the category of Dementia DE(E) are to be accommodated at Dove Court Nursing Home when there are already 28 persons falling within this Care Homes for Older People Page 4 of 38 Over 65 28 1 58 10 0 0 0 10 category residing at the home Persons with dementia should only be accommodated on the ground floor at Dove Court Nursing Home The maximum number of persons to be accommodated at Dove Court Nursing Home is 58 To accommodate the person named in application reference number V34452 under the category MD(E) Date of last inspection Brief description of the care home Dove Court Nursing Home is a large modern, purpose built home situated close to Kettering town centre. It is registered to provide both nursing and residential care. There is car parking to the front of the home. Accommodation is over two floors. Access to the upper floor is via a passenger lift. All the bedrooms are single with en-suite facilities and there are additional assisted bathing and toilet facilities. There are several lounges and dining areas and an enclosed garden and patio area, which is accessible to people who use wheelchairs. There is a qualified nurse on duty at all times. The Acting Manager provided us with the range of fees, which are £355.12 to £627.00 per week. There are additional charges for personal expenditure such as hairdressing and personal toiletries. People considering using Dove Court Nursing Home should contact the Acting Manager or the home directly to discuss individual needs and requirements. Full details for Dove Court Nursing Home and any specific requirements can be obtained in the form of a Statement of Purpose and a Service User Guide. The latest inspection report from the Care Quality Commission is available at the home or accessible via our website: www.cqc.org.uk 1 0 1 1 2 0 0 8 Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for Dove Court Nursing Home is 2 star. This means the people who use this service experience good quality outcomes. We as it appears throughout this Inspection Report refers to the Care Quality Commission (CQC). Any reference to the Commission for Social Care Inspection (CSCI) should be taken as CQC, who now hold the legal responsibilities previously held by the CSCI, as of 1st April 2009. This key inspection started with the review of the last key inspection report dated 27th May 2008. We looked at the information we had about the management of Dove Court Nursing Home and the events that affects the well-being of the people using the service, which includes complaints. We received from the Acting Manager the completed Annual Quality Assurance Care Homes for Older People Page 6 of 38 Assessment (AQAA) document, which is the homes self-assessment of the standards within the home. We sent out 44 surveys to the people using the service and their relatives. We received 9 surveys from the people using the service and 9 from relatives. The responses and comments received indicated people were satisfied with the quality and standard of care, services and facilities provided. The responses also indicated that people were supported to continue living their choice of lifestyle, including participating in social events and maintain their independence as far as practicable. The comments received included improvements made to the management and the quality of care people received, which are reflected throughout this inspection report to support our findings. We sent out 45 surveys to the staff, of which 8 were returned. The majority of the responses received indicated peoples needs are met by trained staff. Some of the comments received reflected the changes in management, staffing and improvements made at Dove Court Nursing Home. These comments are included throughout this inspection report. We sent out 3 surveys to General Practitioner Surgeries, of which, none were returned. We visited Dove Court Nursing Home on 26th May 2009 at 9.45am and finished at 6pm. The Acting Manager assisted us during the site visit to the home. The main method of inspecting we used was case tracking. This means looking at the range of nursing and personal care people receive that is met by the staff who ensure peoples rights, dignity, choice and independence is promoted. We selected five people to case track, all of whom had differing needs, abilities and included a person that was new to the home. We spoke with those people and other people using the service. We spoke with the Link Resident, who is a person that wishes to assist us by collating surveys, views and experiences of people using the service that want to speak with them. We read the care files containing information about people health and personal care needs, lifestyle, and how these are met. We made observations of people, how they are treated by the staff with regards to meeting their needs and promoting their well-being. We spoke with visiting relatives and the General Practitioner to gather their views about the quality of the care people receive, their observations and experiences. We looked at the accommodation offered to people using the service. This included communal areas, bathrooms and individual bedrooms, with permission. We spoke with the staff at all levels on the day to ascertain the recruitment process, training and skills to meet the needs of the people using the service. We looked at the staff files that demonstrated the staff recruitment, training and skill-mix. We read the information people received about Dove Court Nursing Home. We looked at the policies, procedures and specific records to demonstrate the day-to-day management of the service. The Care Quality Commission has a focus on Equality and Diversity and issues relating to these are included throughout the main body of this inspection report. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? Since the last inspection of Dove Court Nursing Home, an Acting Manager has been appointed and is in the process of submitting an application to CQC to be the Care Homes for Older People Page 8 of 38 registered manager for the service. The requirements made at the last inspection have been addressed satisfactorily. There have been significant improvements made at Dove Court Nursing Home. These included improvement to the management, staffing and clarity of roles and responsibilities. Staff have regular staff meetings, supervisions and training to maintain their knowledge and skills in line with current best practice. New staff have been recruited such as care staff, an Activities Organiser and an Administrator. There has been improvement made with regards to quality of care, with the introduction of new assessment and care planning formats to ensure peoples needs and lifestyle choices are promoted. There has been improvements made to the home environment with the re-decoration of the communal areas, bedrooms and re-carpeting in some rooms. The residential unit has been moved to the ground floor, which has significantly improved the quality of lifestyle and care people receive. The comments we received from people using the service, relatives, visiting GP and staff with regards to how the service has improved, included; When I completed this questionnaire last year, I expressed major concerns about this home. But I am pleased to say many of these concerns have now been effectively addressed. Since the appointment of a new manager, I feel that Dove Court is on the up, despite a few members of the old guard still being in place. I am delighted with the progress we are making Improving consistently over the last few months Since we have been under new management, things have greatly improved ... (manager) is approachable and interested New manager is pro-active and caring .... There is better leadership with ... now being in charge Food, still not as good but improving. There is room for improvement Home is refurbished, new curtains, new beds, new paintings, new home People are involved in the home. We have regular residents and relatives meetings now, previously communication was poor Excellent care, there has been significant improvements with regards to having the same carers/staff working when we visit I have no criticism about the home or the care now but if you had asked me a year Care Homes for Older People Page 9 of 38 ago it would have been different What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 38 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive good information about the service, are involved in the assessment process to make sure their health and personal care needs are met. Evidence: We wanted to find out what information people receive about Dove Court Nursing Home. The information gathered from the self-assessment tool completed by the Acting Manager stated people receive a brochure for the home and described the admission process that included the opportunity for people to have a short stay known as a trial visit. We read the information people receive about the home or who are considering using the home for themselves or their relative or friend, known as Service User Guide. This was comprehensive and recently updated. It outlined the type of care services people can expect to receive, the accommodation and facilities available to them should they choose to move to the home. The aims and objectives of the home are set Care Homes for Older People Page 12 of 38 Evidence: out in the form of the Statement of Purpose and includes the key policies and procedures such as the admission process, the complaints procedure and the skills and qualifications of the staff and management team. The surveys we received from the people using the service and their relatives confirmed that they or their relatives had received information about the service. Some people we spoke with said they had the opportunity to visit the home before choosing to move in. Other people living at the home said they moved to the home directly from home or hospital and that their relatives had visited the home first. We wanted to find out whether people considering using Dove Court Nursing Home were involved in the process to say what help they need on a daily basis. This process is known as the assessment of needs, which considers if the persons health and care needs can be met by the home. The information we gathered from the selfassessment tool completed by the Acting Manager stated encourage pre-admission visits and ensure through the pre-admission assessment the clients are placed appropriately. We spoke with three people that we case tracked with regards to the process of moving into the home. They confirmed that a social worker and staff from the home asked about their health and personal care needs. This showed that trained staff from the home carry out their own assessment of needs to ensure people needs would be met at Dove Court Nursing Home. Comments received included; They did the assessment in hospital. The social worker arranged this place for me We looked at the care files for the people we case tracked. All had a copy of the homes assessment of needs. The assessments were comprehensive and showed a range of information gathered about the person, which included their health and personal details, medical history, illness, cognitive impairment, mental and physical needs and well-being, dietary needs, medication, cultural and diversity needs and also their daily routines, wishes and interests. It also included the contact details of significant people that are important to them such as family, next of kin and the General Practitioner. The assessments reflected peoples views and wishes indicating they or their relatives were involved to personalise their care. This showed that the assessment process was robust to ensure peoples needs would be met by the staff at the home. The home has introduced a new assessment of needs format known as Care and Health Assessment Profile (CHAP). We saw this had been used for the newest person Care Homes for Older People Page 13 of 38 Evidence: living at the home and showed more information was gathered with regards to the persons health and care needs, preferences, interests and lifestyle. We spoke with the Registered Nurse and the Head of Residential Care, who are trained to assess peoples needs. They said the new CHAP format allows for more information to be gathered that would be used to assess risk, ensure specialist equipment was available and to develop individual plans of care. We wanted to find out what information staff receive about a new person that moves to the home. Staff we spoke with confirmed that by the time the person moves to the home, there is a care file containing a plan of care and information is also shared through the staff handover over meetings. This supported all the responses and comments received in the staff and relatives surveys, which included: We have been shown his care package and there is information in his room for us to read We have good communication systems The people we case tracked that were financially supported by either the local authority or the Primary Care Trusts had assessments of needs completed by a social worker and a contractual agreement in place for their stay. The Acting Manager confirmed contracts are in place for privately funded people, which includes the terms and conditions of stay. Dove Court Nursing Home does not provide intermediate care services. Care Homes for Older People Page 14 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and care needs are met through improved care planning and staff that understands and promotes health, well-being and independence. Evidence: We wanted to find out how peoples health and personal care needs are met. The information we gathered from the self-assessment tool completed by the Acting Manager provided a summary of evidence and practice within the home. It stated that care planning has improved and involved people to ensure that their health needs, personal care needs and choice of lifestyle are reflected. We received a number surveys from people using the service and their relatives. All the responses and comments received indicated that people had their care and health needs met by staff that also respected their privacy and dignity. Some of the comments received included: When I completed this questionnaire last year, I expressed major concerns about this home. But I am very pleased to say many of theses concerns have now been Care Homes for Older People Page 15 of 38 Evidence: effectively addressed. Since the appointment of a new manager, I feel that Dove Court is really on the up, despite a few members of the old guard still being in place. I am delighted with the progress we are making The staff and carers are cheerful in their dealing with the residents and do appear to help them achieve their potential Dove Court provides a secure caring environment. The staff are cheerful and supportive to my mothers needs My mother feels at home and considers that she receives good care My mother ... can be very stubborn and independent. The staff are very patient and understanding The atmosphere in the home was relaxed. People within each of the living areas choose to relax either in the lounge or stay in their bedroom. We spoke with several people including the people we chose to case track, which included the newest person that had moved to the home. People spoke positively about the nurses and care staff that assisted them with their health and personal care needs. One lady said having expressed a preference of having female staff assist her with her personal care needs this has always happened. Two people told us that they had been involved in agreeing their plan of care to ensure their preferences and wishes were respected. Some of the comments we received from people using the service with regards to the staff meeting their health and personal care needs and from the staff included; The staff are very good I need help with most things, I have a catheter now and need help due to being in a wheelchair and mobility problems Provide good support and care On the nursing floor, even though our floor is very physical and mentally going, our residents are always looked after 100 People told us that they were involved in developing their plan of care to make sure they way the care is provided suited them. We read the care plans for the people we case tracked. The care plans have significantly improved, providing good information as to the persons health and personal care needs and with consideration how their Care Homes for Older People Page 16 of 38 Evidence: illness or disability affects them. There are care plans for the day and night, which showed consideration had been made to people needs and lifestyle. The nursing plans reflected the monitoring in place to prevent people from developing pressure sores, which included regular drinks and turning for people being nursed in bed. The care files contained appropriate risk assessments and the care plans included the safety measures in place to promote peoples health, safety and wellbeing. These included falls managements, nutrition, moving and handling and for people who required bed-rails to ensure that they were appropriate for their care and safety. The daily records completed by the staff demonstrated health and care needs were met as per the care plan. In addition, any concerns regarding the persons health and wellbeing were recorded, for example a request for the GP to visit. The Head of Residential Care oversees the care of people receiving personal care. They recently qualified in dementia care mapping, which is programme used to support people with dementia. They demonstrated how care planning takes into account peoples history, lifestyle and interests, with the help of members of their family. Staff we spoke with and their training records viewed showed they had received training to care for people using the service, that included dementia awareness. In addition, the Deputy Manager, who is a trained nurse also holds regular training and study days for staff to ensure their knowledge and skills are in line with current best practice. This showed peoples lifestyle and routines are promoted by trained staff. We wanted to find out how peoples privacy and dignity is maintained and their independence is promoted. The care plans we read reflective peoples preferences and how they wish to be cared for. Throughout the day we observed staff treating people using the service with respect at all times. People we spoke with described how staff ensure their dignity and privacy is respected, which was consistent with the practice described by the staff that we spoke with. We concluded that the systems, practices, staff skills and their conduct benefits and provides people with a better quality of life. Some of the comments we received from the people using the service and staff, included; They do respect my privacy and dignity and will keep half of me covered up at all times I dont have a problems talking with the staff, they understand me and I understand them Care Homes for Older People Page 17 of 38 Evidence: Maintains safety, sustain dignity, sustain an optimal mental health and wellbeing, promotes recovery We spoke with the link resident at the home. This is a person who has been identified to assist us with the distribution and collation of surveys, and to share views of their experiences of using the service. The link resident said the the improvements were made with the Acting Manager introducing better systems, staffing, management that changed the quality of the service people received. They said the biggest change was with the residential unit moving to the ground floor; There was a distinct lack of time and attention given to people in the residential unit. However, since .... moved the residential unit to the ground floor, its the best thing that ever happened, otherwise, I would not be here now The move was done sensitively and significantly improved the personal care and attention - you feel valued The staff told us that they receive information about peoples individual needs through the handover meetings and the care plans, which are in place before the person moves to the home. Dove Court Nursing Home uses a key-working system whereby named staff are responsible for the well-being of named people using the service. Staff demonstrated a good understanding of peoples needs and risks. Staff showed a good awareness of how dementia affects people and gave examples of how they approach and encourage people with dementia to maintain as much independence and making decisions, as practicable. This supported the responses we received in the staff surveys and the information gathered from the self-assessment tool. The Head of Residential Care told us they have set up a support group for dementia, with the help from the General Practitioner (GP) and Alzheimers Society to benefit the people using the service. This showed the service works with other agencies to support individuals and their relatives. People told us that they have good health care support from visiting GP and specialist nurses. The care files we read detailed visits from the GP and District Nurses and the treatment or advice given. One lady said they have call the doctor out when I needed one. Although we did not receive a survey back from the GP, we did speak with the visiting GP. They gave us very positive feedback about the care provided to the people using the service and the competence of the staff to care for the people living at the home. They told us they are involved in the dementia care support group recently set up at Care Homes for Older People Page 18 of 38 Evidence: the home, to benefit people using the service, staff and relatives. The comments received from the GP included; Excellent care, there has been significant improvements with regards to having the same carers and staff when we visit Carers are good, they show an understanding of residents, they will say shes not normally like that, and good at following instructions Staff genuinely care for the patients I have no criticism about the home or the care now but if you had asked me a year ago, it would have been different I am confident that they call genuinely, they will ask you to see another resident if they have any concerns when you visit It has helped having one surgery involved, gives us a change to get to know patients and staff People said they receive their medicines on time. The trained nurses are responsible for giving people their medicine in the nursing unit and the Head of Residential Care and senior carers are trained to give people their medicine in the other part of the home. Medication is kept in a locked trolley and stored securely in the medical room, along with the controlled drugs (strong medicines) and medication stored in the fridge. We observed people having their medicines given to them after lunch by the Head of Residential Care, checking the records against the medication. Trained nurses give medicines to people receiving nursing care. We concluded having spoken with staff that the management of medicines, ordering, storage and disposal procedures was robust. We checked the management, storage and recording systems for controlled medications. This was robust and managed in line with current best practice. Care Homes for Older People Page 19 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a lifestyle that encourages social contact and interests, and offers good choice of meals that promotes their well-being. Evidence: We wanted to find out how people spend their day and what opportunities and activities are available for people using the service. The self-assessment tool completed by the Registered Manager stated there is a varied and enjoyable activities programme for all the residents, external agencies such as entertainers, other local groups and set up our own dementia care support group helped by the Alzheimers Society and our own GP. It also stated that the Activities Organiser has a robust programme of events. The information in the Service User Guide detailed the range of social and leisure opportunities available to people using the service. The survey responses received from the people using the service and their relatives indicated that people knew about the activities arranged by the home. We shared the comments received in the surveys with the Acting Manager, which were acknowledged. These included: A happy and cheerful environment. A new manager has made a marked improvement Care Homes for Older People Page 20 of 38 Evidence: on every aspect of the home Although activities are held most day of the week, there is nothing or very little for residents to see, do or experience at the weekends. This can make Saturday and Sundays very dull for residents especially in dark weather An outside shelter or porch for wheelchair dependants to get into the fresh air During our visit to the home, we saw people each of the units within the home, either sitting in the lounges, dining room, seating in the corridors, in the garden or in their bedrooms. We saw staff sitting with people talking and spending quality time with them as they were being nursed in bed. We saw some ladies waiting outside the salon and said to us, Im just waiting here to have my hair done. This showed people were not restricted. We saw one gentleman, asking a member of staff for their cigarette and together went into the garden to smoke his cigarette. We saw people receiving visitors throughout the day, which showed visiting times were not restricted. People told us they regularly have family that visit and are made to feel very welcome. Two people told us they enjoy playing carpet bowls in the upstairs lounge and some people felt quite happy sitting watching television programmes especially in the mornings. Some of the comments received from people using the service and relatives included: Family visits take place 3 times a week on average I visit 4 times a week. If my mother needs to contact me the carers will help her call me As we are infrequent visitors, it would be nice if one of the carers had a brief word with us about our .... We saw throughout the home, notices and displays of events planned such as the Residents and Relatives meetings, visits from the local minister and the Veterans Day on 26th June 2009. We spoke with the Activities Organiser to find out how peoples interests and activities are made known. They told us they receive information from the senior staff or the nurses and read the information gathered in the assessment with regards to the persons interests and hobbies. The Activities Organiser showed us the record kept of events and activities that have taken place and planned such as the sing-a-long, film shows, Remembrance Day, birthday celebrations and Veterans Day planned. They told us were liaising with staff to do activities at the weekends, which Care Homes for Older People Page 21 of 38 Evidence: has been raised as an issue. This showed that the comment we received in the surveys was already known and was being addressed by the home. One person told us that there are regular residents meetings held. They told us that they discuss lots of things that includes social events, meals and complaints. The Acting Manager said the last meeting took place in March 2009 but the minutes of the meeting were not available as yet. We wanted to find out what information staff receive about peoples interests and choice of lifestyle. Staff told us the care plans provides them with information as to peoples interests. Staff told us activities information and events are also shared through the handover meetings and by the Activities Organiser who also attends some meetings. A member of staff told us that one gentleman often goes out, which is what they had done since moving to the home. We also received a comment in the staff survey that we shared with the Acting Manager, stated I feel the company needs a minibus. This showed peoples lifestyle and routines is being promoted. The care files we read for the people we case tracked showed peoples interests and hobbies were identified at the initial assessment using the new assessment forms. Thus, showing the benefits of the new assessment forms introduced. Our own observations, information read and received indicated peoples lifestyle, routines and opportunity to participate in activities is encouraged by the staff that promotes their well-being. We wanted to find out what the meals were like. The responses received in the surveys indicated they all liked the meals provided. People using the service that we spoke with were also positive about the choice of meals provided and felt there was still some room for improvement. Some of the comments received included; I dont mind English food, dont want ... food, I dont want to brother them The only area that my mother is not always satisfied with is the catering. She finds at times a little of the food is difficult to eat and it can be sometimes unappetising Food, still not as good but improving. We are raising this on Tuesdays meeting with the new procedure, There is room for improvement He does say that he enjoys the lunches We saw that the meals were served individually, well presented, appetising and Care Homes for Older People Page 22 of 38 Evidence: nutritious. People appeared to enjoy their meals at the dining table and whilst others preferred to eat their meals in the privacy of their bedrooms. We saw staff assisting people individually and in a discreet and sensitive manner. This showed peoples dignity was respected. We saw people were encouraged to have regular drinks as it was a warm day. Staff were seen going to the bedrooms where people were being nursed in bed to ensure their were comfortable and had regular drinks. This showed staff were aware not only those people that were in the lounge but also those people being nursed in bed, which ensures health and well-being is promoted. The care files read contained peoples dietary needs and requirements. We observed staff offering the choice of meals for lunch. The Head of Residential Care told us they had improved the way the choice of meals is offered to people with dementia. This is now done by providing them with the choice of the two main choice of meals to encourage them to choose the meal they wish to eat. This showed people were encouraged to make decisions for themselves, which promotes their well-being. We spoke with the chef and the kitchen assistant providing meals to suit dietary needs and requirements. They confirmed they are made aware of people needs and currently provide puree meals and sugar free meals to some people using the service. They also told us that all the kitchen staff have completed all their training with regards to food and hygiene. We did receive a comment from a relative with regards to use of plastic crockery, which we shared with the Acting Manager. They assured us that this was not the practice within the home and our observations, discussion with the people using the service and the staff, supported this. Care Homes for Older People Page 23 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident to complain and protected by staff recruitment processes and training to ensure people are safe from harm and abuse. Evidence: We wanted to find out if people were aware of how to make a complaint, confident to complain and felt safe and protected at Dove Court Nursing Home. The information gathered from the self-assessment tool completed by the Acting Manager stated complaints are managed well within the homes policy and encourage residents and relatives to raise any points of concerns so that they may be explores and dealt with efficiently. We saw the complaints procedure displayed at the entrance to the home along with the contact details for Advocacy services. We read the service user guide and statement of purpose, which is given to people when they move to the home. Both had details of the homes complaints procedure and who people can contact including the head office for the company and the Care Quality Commission. The surveys responses received from the people using the service and their relatives indicated people know how to complain and who to speak with if they are unhappy about the care they receive. People we spoke with during our visit including the link resident said they were confident to speak with the staff or the Acting Manager if they had a complaint. Some of the comments received included: Care Homes for Older People Page 24 of 38 Evidence: There will always been room for improvement but Dove Court has made good progress in recent months and it would be unfair to pick on anything at this time whilst this continues Its quite nice here, they look after me what more can I ask for The staff we spoke with and the staff surveys we received all indicated that staff were confident to receive concerns and complaints, which would be passed to the senior person on duty. Comments received included, tell the nurse or manager. This showed staff were aware of the homes complaints procedures and confident to deal with the concern in line with the homes procedure. The visiting GP also expressed confidence in the home and acknowledged the improvements made over the recent months. This further supported the comments received from the people we spoke with and the surveys. The information gathered from the self-assessment tool completed by the Acting Manager stated the home received 14 complaints, of which 64 were upheld. It also told us that the numbers of complaints over the last few months had decreased. We looked at the complaints log, which demonstrated the investigations and the remedial actions taken to address the complaints. The Care Quality Commission received 3 complaints about the service since the last inspection. The complaints were referred to the home to investigate using the homes complaints procedure. These were included in the homes complaints log that we viewed. We wanted to find out if the staff knew what safeguarding issues meant and how to deal with any allegations or suspicions with regard to abuse. Safeguarding issues means promoting the well-being of people using the service from harm, risk and abuse. Staff we spoke with ranged from a new care staff, senior carer, Head of Residential Care and registered nurse. All demonstrated a good understanding of safeguarding issues, the type of abuse that could occur and demonstrated their responsibility with regards to following procedures by reporting it to the senior on duty or the manager. The new carer said they had received induction training that included training in safeguarding adults and awareness of the multi-agency policy and procedure. This was consistent with the staff training records viewed, showing that appropriate training is in place. Care Homes for Older People Page 25 of 38 Evidence: Staff showed they were confident to raise concerns with regards to poor practice using the homes whistle-blowing procedures. This was consistent with the responses received in the staff surveys demonstrating peoples well-being and safety is promoted. Staff we spoke with confirmed they started work after pre-employment checks were carried out such as receipt of satisfactory references and criminal records bureau (CRB) checks. This is a check to assess the suitability of the applicant to work with vulnerable people. With regards to registered nurses employed, confirmation of their registration with the Nursing and Midwifery Council is obtained. This demonstrated that staff recruitment procedures are followed to ensure peoples health and safety is protected and promoted. Care Homes for Older People Page 26 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, clean and tidy home that promotes their independence and well-being. Evidence: We wanted to find out what type of accommodation and facilities is offered to the people using the service. The information we gathered from the self-assessment tool completed by the Acting Manager and the service user guide that we read stated the home is purpose built and all bedrooms have en-suite facilities. The self-assessment tool detailed all the environmental improvements made to the home including redecoration to the communal areas, bedrooms re-painted, replacement of some carpets and the purchase of profile beds with integrated bed-rails for the people receiving nursing care. The surveys responses received from people using the service and their relatives all said it was a clean, tidy and fresh home. The comments included in these surveys and those received from the staff included: It very clean Home is refurbished: new curtains new beds, new paintings and new home Care Homes for Older People Page 27 of 38 Evidence: People that we spoke with including the link resident, GP and visiting relatives all commented on the cleanliness of the home. We were told by the link resident that the residential unit was re-located to the ground floor in a sensitive manner. This was a positive move for the people receiving personal care in the residential unit as they said they now felt valued and received help when required. This supported the responses we received in the surveys. On the daily of our visit to the home, we saw people were sat in the lounges on each floor, some sat in the dining room and others preferred to stay in their bedrooms. Access to the upper floor is via a passenger lift or stairs located at the center of the building. People were seen moving around the home freely or were helped by the staff who were vigilant. The ambiance in the home was pleasant and relaxing. There is lots of natural and good lighting throughout the home. We saw a number of bedrooms, which all had en-suite facilities and additional lavatories, bathing and assisting bathing facilities throughout the home. There is a nurse-call bell system throughout the home. There was equipment available for staff to use to assist people with moving and handling. People being nursed in bed were using profile beds and air mattress to promote their well-being. The bedrooms were well decorated and furnished with co-ordinating bedroom furniture and furnishings. People had personalised their bedrooms with pictures and photographs, which made them look homely and comfortable. This supported the information we received in the self-assessment tool. The home employs a house-keeper, laundry person and domestic staff who are responsible for the cleanliness of the home. People we spoke with were satisfied with the laundry arrangements. We saw staff wearing protective clothing such as gloves and aprons when preparing to assist people with any nursing or personal care tasks. Staff spoken with demonstrated a good understanding of infection control practices and the training records viewed showed staff receive regular training and updates. The Deputy Manager who is also a registered nurse told us that there are regular study days, information provided and training for all the staff to ensure knowledge and practice promotes peoples wellbeing. We concluded from the information we received, comments and observations made that the home environment promotes peoples health and well-being. Care Homes for Older People Page 28 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported and protected by robust staff recruitment and training that promotes peoples health and well-being. Evidence: We wanted to find out if the staff recruitment process, the skill-mix and staffing levels met the needs of the people living at Dove Court Nursing Home. The information we gathered from the self-assessment tool completed by the Acting Manager stated there is a robust recruitment procedure, minimal agency staff are used, and staffing levels are set above the national minimum standards. We read the information people receive about the service; Service User Guide with regards to the staffing, which clearly details the staff complement from the manager, qualified nurses, care staff and ancillary staff. This showed the service was open and transparent about the the staff complement and numbers. The surveys we received from the people using the service and their relatives, all indicated that staff were available, listened and acted on requests. People that we spoke with and our observations on the day, showed staffing levels were for each unit and consistent with the staff rota that we viewed. Some of the comments received in the surveys and from the people we spoke with included; Excellent staff and manager Care Homes for Older People Page 29 of 38 Evidence: The staff are cheerful and supportive to my mothers needs The staff are very patient and understanding There is more consistency of staff The majority of the staff surveys received indicated that staff felt their sufficient numbers of staff including qualified nurses on duty to meet peoples needs. The Acting Manager told us that they have increased the numbers of staff recently on the nursing floor to meet the increased needs of people requiring nursing care. There is a qualified nurse on duty at all times on the nursing floor with four carers in the mornings. This demonstrated that the service responds quickly to make sure people using the service have their needs met promptly and safely by the staff on duty. We observed staff interacting with the people using the service in a polite and courteous manner, which showed staff treated people with respect. We concluded from our observations and discussions with the people using the service, the staff and the Acting Manager, that the staffing levels and consistency of staff has improved. People acknowledged the use of agency staff had reduced and staff morale had improved, which benefits the people using the service. We checked five staff files ranging from a registered nurse, Head of Residential Care, senior carer and a carer, which included a new member of staff. All the files contained evidence of pre-employment checks such as satisfactory references and a criminal records bureau (CRB) check. This is a check to assess the suitability of the applicant to work with vulnerable people. We saw the registration for nurses with the Nursing and Midwifery Council. We concluded that the staff recruitment procedure was robust, which protects the people using the service. The newest member of staff described the recruitment process and training their completed. The recruitment process was consistent with our findings. The induction training is in line with the Skills for Care induction programme that includes the homes policies and procedures and the mandatory training. We saw the training undertaken, which was consistent with what staff had told us. Training included manual handling, infection control, safeguarding adults, care planning, first aid, dementia awareness, fire, nutrition and elderly care and continence management to name a few. The Deputy Manager said there are in-house training days for staff to attend, which raises their awareness. The Deputy Manager is a qualified nurse and maintains her skills and knowledge along with the other trained nurses by attending Care Homes for Older People Page 30 of 38 Evidence: regular updates and training. The Head of Residential Care confirmed she has qualified in dementia mapping and will include the knowledge gained into care planning for people with dementia. We concluded that the staff knowledge, skill-mix and expertise is good to safely meet the needs of the people using the service. The staff surveys responses indicated that staff received training relevant to their role, have good communication systems in place and support from the manager. Some of the comments received were shared with the Acting Manager, and included: I think ... manager, ... deputy manager and ... nurse on nursing floor are fantastic and help as much as they can We have good communication systems Was trained one-to-one care Sometimes, things dont get passed on through handover and we carers find out through ourselves We are provided with lots of training The information we gathered from the self-assessment tool completed by the Acting Manager stated only 15 of the care staff had attained National Vocational Qualification (NVQ)level 2 and above in care. The Acting Manager confirmed that a number of staff have commenced the NVQ training and new staff would commence their NVQ training after satisfactorily completing their induction and probationary period. Whilst this showed there is a training programme in place, the numbers of staff with the NVQ qualification should be improved. Care Homes for Older People Page 31 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from the improved management of the home, are involved and consulted about the quality of the service that promotes their health, safety and wellbeing. Evidence: We wanted to find out whether the management of Dove Court Nursing Home protects and promotes the well-being of the people using the service and the staff. The information we gathered from the self-assessment tool completed by the Acting Manager confirmed they, as the Acting Manager, are in post and have many years experience of managing a care home. It also stated staffing has improved with clarity of roles and responsibilities, good communication and regular staff meetings and supervisions. The surveys we received from the people using the service, their relatives and the staff all commented on the new manager in post and the changes brought to the home were mostly welcomed. We also received similar comments from the people we Care Homes for Older People Page 32 of 38 Evidence: spoke with using the service, the link resident, staff and the visiting GP. We shared with the Acting Manager some of the comments received that included: When I completed this questionnaire last year, I expressed major concerns about this home. But I am very pleased to say many of these concerns have now been effectively addressed. Since the appointment of a new manager, I feel that Dove Court is really on the up, despite a few members of the old guard still being in place. I am delighted with the progress we are making Improving consistently over the last few months A new manager has made a marked improvement on every aspect of the home Our new manager is very hands on, if I cant find the nurse, the manager is there, he does help and advise me to the best possible taste New manager is pro-active and caring unlike the old guard There is better leadership with ... now being in charge Now more efficient and structure in the home and the staff Improvement made with the change of management and re-location of the residential unit adjacent to the dementia unit on the ground floor with their own team of staff One staff survey comment indicated the management and staffing levels in the home was unsafe. We shared these specific comments with the Acting Manager who was surprised having improved the service, management and staffing within the home. We found no evidence during our site visit to support the specific comments. The Acting Manager confirmed that they are in the process of submitting an application form to the Care Quality Commission to become the Registered Manager for Dove Court Nursing Home. This will be progressed by us upon receipt of their application. Staff spoken with at all levels confirmed that they have clarity to their roles and responsibilities. Staff indicated there is better leadership and communication has improved with staff now having regular meetings, training and supervisions. We saw the staff supervision schedules displayed in the office for each unit showing staff have Care Homes for Older People Page 33 of 38 Evidence: planned supervision meetings. We read the staff meeting minutes of 23rd March 2009, where discussions took place regarding health and safety, training updates and the security in the home. We concluded that staff are supervised regularly and informed of important issues in the home. Dove Court Nursing Home conducts their own internal monitoring through the monthly visits conducted by a representative for the Responsible Individual. A report is produced following the visits, known as regulation 26 visits detailing the findings and action plan to address any issues identified. This showed the service self-regulates to maintain the standards within the home. We saw displayed notices for the residents and relatives meetings. The link resident said, People are involved in the home. We have regular residents and relatives meetings now, previously communication was poor. There is a questionnaire on food, which we will complete. Some people using the service said they choose to attend these meetings. We were unable to read the minutes of the last residents and relatives meeting, but did read the minutes from a previous meeting. The topics discussed included: staff recruitment, residents committee, catering, transport and chiropodist visits. We concluded that people are involved and consulted about important issues in the home. The Acting Manager informed us that there is a quality assurance system in place managed by the head office for the company. People using the service are surveyed to seek their views about the quality of the service they receive, the facilities and accommodation. We were advised that the surveys were due to be sent out at the end of the month. The Acting Manager advised us that the findings from the quality assurance is shared with the people using the service. We discussed with the Acting Manager that some consideration should be made to measuring the results from the quality assurance against the aims and objectives written in the statement of purpose. This would show if peoples experiences and expectations of the service is consistent and would help to develop new aims and objectives as the service develops. We wanted to find out how people are supported to manage their money. Whilst some people preferred to manage their own money, other people preferred to have some money held in safekeeping by the home. The home has a system in place to manage peoples money safely and records are in place to confirm this. The information we gathered from the self-assessment tool completed by the Acting Manager stated all policies and procedures are review and kept up to date. Staff we Care Homes for Older People Page 34 of 38 Evidence: spoke with confirmed they have access to the policies and procedures and receive regular updates, in line with changes in practice and new legislation. The selfassessment tool also detailed the programme of maintenance, servicing and testing of equipment and checks in place. This supported our observations, findings and information read during our visit to the home. We concluded that the home environment is safe and well maintained for the people living and the staff working at Dove Court Nursing Home. Care Homes for Older People Page 35 of 38 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 36 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 28 There should be at least 50 of the care staff that have attained National Vocational Qualification (NVQ) level 2 or above. The home should consider measuring the results from the quality assurance against the aims and objectives in the statement of purpose to show if the expectations of the service are met, help identify areas of improvement and ensure the statement of purpose evolves as the service develops. 2 33 Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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