Inspection on 12/05/06 for Fives Court

This inspection was carried out on 12th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Fives Court 27/09/05

Fives Court 06/04/05

Fives Court 12/01/05

Fives Court 26/08/04

Fives Court 19/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Fives Court Angel Lane Mere Warminster Wiltshire BA12 6DF Lead Inspector Karen Mandle Key Unannounced Inspection 12th May 2006 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fives Court Address Angel Lane Mere Warminster Wiltshire BA12 6DF 01747 860707 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Orders Of St John Care Trust Mr Richard Dyer Care Home 31 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (31) of places Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No more than 31 service users with Old Age at any one time. No more than 11 service users with Dementia, over 65 years of age at any one time. 17th June 2002 Date of last inspection Brief Description of the Service: Fives Court is registered to provide personal care only for 31 older people aged 65 years and older, 11 of which may be suffering from Dementia. The home is located in the village of Mere within walking distance of the village shops and local facilities. Mere is situated on the A303 London to the west trunk road. Fives Court is a purpose built home offering comfortable single room accommodation but without en-suite facilities. The home offers various communal areas. All bedrooms and communal rooms are located on the ground floor. The home has a large patio area to the rear of the building and surrounding gardens. Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit for this key inspection commenced 12th May 2006 when the inspector toured the building, observed the staff interacting with service users and attending to their personal care needs. Prior to the site visit-taking place the inspector sent five service users surveys to the home to gain written information about the service provided from five service users. The responses were mainly positive apart from two comments made regarding the lack of activities some afternoons. The inspector visited with many of the service users during the site visit to gain their views and opinions of the service that the home provided. The majority of comments received from the service users were very positive and were mainly about the care staff of the home that were reported as caring and supportive. The inspector returned to the home 15th May to complete the site visit. The registered manager Mr Richard Dyer was available both days. The care of five service users was cased tracked through the inspection process. This was inclusive of observing the care provided whilst on site. Reviewing the care records of the five service users and the medications. Following the site visit, written contact was made to five families to gain their views of the service provided by the home and to the local GP practice. The judgements contained in this report have been made form evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Evidence was available of good referrals being made to other health care professionals when the care needs of the service users changed and specialised advice was required to ensure that all health care needs were being met. The medication procedure remains safe and all medication is stored correctly. The food remains of a good quality with a daily choice provided, which is enjoyed by the service users. The home is well maintained with corridors being currently refurbished and plans in place to refurbish the communal areas. Service users were happy with the accommodation provided. Service users were complimentary of the care staff and expressed that they could do as they wished in the home and were provided with choice relating to daily life. Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 A clear admission procedure is in place. The pre admission assessment tool currently used may not be fully understood by the service user. The current format of the pre assessment tool is not suitable to cover all aspects of the pre assessment in order to implement a full care plan. Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager conducts a pre admission assessment for each service user prior to admission. The manager had obtained detailed information of a perspective service user who could not be assessed due to current living location of the prospective service user, from the care manager and the family of the service user. However the home continues to use a long-term care needs assessment document to record the care needs of the service user at the pre admission assessment. It has been recommended at the pervious inspection for the home or the organisation to consider implementing a format that enables the person conducting the assessment to gain detailed information of the service users’ care needs whilst providing a service user Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 9 friendly format. The assessment should cover all aspects of care and used towards implementing a care plan ensuring that all care needs at the time of the admission taking place can be fully met. Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. The care plans provided more detailed information relating to the service user care needs. However pressure area risk assessments are not used. Health care needs of the service users are being met. The medication procedure is safe. Service users confirmed that they are treated with respect and their privacy is upheld. Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each service user is provided with a care plan. The inspector reviewed 5 care plans as part of the case tracking process. A general improvement was observed to the detail recorded relating to the care needs of the service users within the care plans. Good evidence was seen of referrals and visits by other health care professionals ensuring that more complex health care needs of the service users were being met. However a pressure are risk assessment is still not in use ensuring that all pressure area care needs can be fully met against the outcome of the risk. Personal care and support is provided, which service users were generally satisfied with apart from the amount of baths offered per Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 11 week, which is only one. This was also referred to from a relative through a comment card. The home should provide service users with a choice of how frequently they would like to have a bath and ensure that staffing levels are appropriate to meeting the service users wishes. Whilst speaking to the care leader it was evident that the care staff knew the health care needs of the service users well and evidence of appropriate referrals to other health care professionals was seen when significant changes in health care needs had occurred. All service users are registered with a local GP. Service users confirmed that the staff would arrange for them to see a GP if they wished. The home is not registered to provide nursing care therefore all nursing needs are attended to by the community nursing team. Service users expressed that their health care needs were being met. Service users were complimentary of the support provided by the care team. The care staff remain responsible for the administration of medications which was assessed as safe. All medications received into the home are clearly recorded. The medication administration records were complete and up to date. Two service users who self medicate insulin daily had a full selfmedication risk assessments in place which was supported by the community nurse. All personal care and support is provided in the privacy of the service users’ bedroom or the bathroom. Service users were able to confirm this with the inspector. Several service users also confirmed that they were treated with respect and they could do as they wished. Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 Due to the length of time the activities person had been in post the activities programme was not fully up and running. Service users maintain links with family and friends. Where possible service users control their own life. The food provided remains of a good standard with a balanced and varied menu offered. Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An activities person had been recruited the week prior to the inspection-taking place however was not available at the time of the inspection to discuss activity plans. Two service users surveys reported that more activities would be appreciated, as the afternoons can be long. The home has provided outside entertainment to the service user. Service users were observed reading newspapers, listening to music and watching TV. The home provides a large open plan communal space where service users were observed interacting with each other. Service users confirmed that they were supported by the home to retain links with family and friends. Service users also confirmed that they could receive visitors anytime either in the privacy of their bedroom or in one the communal Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 13 rooms. The visitors signing in book also provided evidence of visits taking place. Service users confirmed with the inspector that they were supported to choose how they spent their time by the care team and could do as they wish. Service users who enjoy the privacy of time spent in their bedrooms were able to do so. The food provided continues to be of a good standard. Service users were very complimentary of the food and the variety of the menu. A daily choice is always provided and a member of staff was observed asking service users what they would like to eat for the following day. Dietary needs are monitored and service users are weighed monthly. Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): An organisational complaints procedure is in place and available to all service users. The care leaders are fully informed of the local vulnerable adults procedure. Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: An organisational complaints procedure is in place, a copy of which is situated in the entrance hall to the home. All service users are provided with a copy of the complaints procedure. The home has not recently received any formal complaints. The care leaders are fully informed and have received training in the local vulnerable adults procedure. During discussion with the care leader it was evident that she would feel confident with using the vulnerable adults procedure if any allegations or concerns of abuse were raised. Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Fives Court is a well maintained home providing a safe environment for service users to live in. The home was clean to a good standard throughout. Infection control measures are in place apart from storing some clinical waste in the laundry facility. Quality in this outcome area is judged to be good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The inspector conducted a tour of the home, which was well maintained throughout. The corridors are currently being refurbished, one of which has been completed, which appears homely and fresh. The manager informed the inspector that plans are in place to refurbish the larger communal area. The home provides a large open plan communal area and dining room where the majority of the service users like to spend their day. The furnishings throughout the home are domestic and well maintained. Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 16 The home was clean to a good standard throughout including all communal toilets and bathrooms. Infection control measures are in place, however some clinical waste was being stored in the laundry facility. A designated infection control person is now in place who the inspector discussed the storage of clinical waste with. Hand-washing facilities are well provided through out the home ensuring staff can wash their hands between supporting service users reducing the risk of cross infection to service users. Service users when asked were complimentary of the accommodation provided and several commented about how clean the home was. Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Although staffing levels have increased by 25 hours per week, the amount of care hours do not provide flexibility within the care routine of the day. Service users were very complimentary of the support the care staff provided. Employment procedures were satisfactory ensuring the safety of service users. All mandatory training is provided and the staff confirmed that they are supported with NVQ training. Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Recruitment of new staff has improved from the previous inspection with less agency staff currently being used. Where agency staff was used, the rotas provided evidence of the same agency staff being repeatedly at the home ensuring some of continuity of care to the service users. An additional support worker is now provided for 25 hours per week during the morning period. The staff reported that this additional person is a great help to the care staff during the busy morning period when personal care and supported is being provided. A care leader and two carers are on duty each morning for a maximum of 31 service users. The organisation should continue to consider a staffing level of 1-8 ratio rather than a 1-10 to ensure that all care needs can be fully met. An activities person has been recruited for 20 hours per week. Two domestic cleaners are employed, however a laundry person is not employed therefore the carers continue to do all the laundry duties. Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 18 It was evident through conversation with staff that, the staff knew the care and social needs of the service users well. The service users were very complimentary of the staff and confirmed that the staff was always kind and supportive. The inspector reviewed 4 employment records all of which had evidence of appropriate police checks being completed prior to the commencement of employment. Two references had been obtained along with a contract of employment. However three files did not contain evidence of regular supervision taking place or photographs of the staff members as proof of identification. Evidence was available that the staff had been provided with all mandatory training. The care leader informed the inspector that additional training such a assessing and writing risk assessments had been provided along with dementia training. Carers are also supported with NVQ training. Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38 The manager is competent and has a good understanding of the service users needs. Quality assurance and monitoring systems are in place, which do involve the service users. Service users’ personal money is safeguarded by the homes’ procedures. The home is well maintained and provides a safe environment for service users to live in. Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager Mr Richard Dyer has been in post approximately three years and has a good understanding of the service users needs and the responsibility of his role as manager. Mr Dyer has completed level 4 NVQ in management. Care staff and service users when asked were complimentary of the manager and reported that Mr Dyer was always open and approachable. Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 20 Quality assurance and quality monitoring systems are in place gaining the views of the service users, as to the service that the home provides. The cook is active in conducting surveys and speaking with service users regarding the quality of the food and the choice made available. Safe systems are in place to ensure that service users personal monies are safeguarded with written records of all transactions seen. The home is well maintained throughout with health and safety issues addressed. The fire log indicated that weekly checks of the fire alarm was taking place however the monthly emergency lighting test had not been completed in April. A care leader who has not received full training on fire safety provides the fire training to all staff, therefore the fire training will be provided by a person who is qualified to do so ensuring the safety of service users and staff. Accident records were complete and audited monthly. Completed risk assessments were in place for the premises. Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? yes 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 OP7 Regulation 15 (2,b) Requirement The Registered Manager will ensure all Service Users who have pressure damage or are at risk of pressure damage will have a risk assessment in place which are reviewed monthly. Service users will be given the opportunity to participate in the care planning process and sign in agreement to the care plan. The registered manager will ensure that all clinical waste is stored correctly. The registered manager will ensure that the staffing levels provided can fully meet all care needs of the service users. The registered person will ensure that all staff receives appropriate and regular supervision. The registered person will ensure that the emergency lighting is tested monthly. The registered person will ensure that a person qualified to teach fire training is provided. DS0000028276.V295857.R01.S.doc Timescale for action 01/08/06 2. OP7 15 01/08/06 3. 4. OP26 OP27 13(3) 18(1) 01/08/06 01/08/06 5. OP36 18(2) 01/08/06 OP38 6. 7 OP38 23(4) 23(4) 01/08/06 01/08/06 Fives Court Version 5.2 Page 23 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. Refer to Standard OP3 OP7 Good Practice Recommendations The Registered Manager should consider a more Service User friendly pre assessment tool. The Registered manager should audit the care plans monthly. Fives Court DS0000028276.V295857.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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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