Inspection on 06/04/05 for Fives Court

This inspection was carried out on 6th April 2005.

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 12/05/06

Fives Court 27/09/05

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 Unannounced 6 April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fives Court Version 1.10 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 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 Only 31 Category(ies) of DE(E) Dementia - over 65 (11) registration, with number OP Old Age (31) of places Fives Court Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 31 service users with old age at any one time. 2. No more than 11 service users with Dementia, over 65 years of age at any one time. Date of last inspection 12 January 2005 Brief Description of the Service: Fives Court Care Home is registered to provide personal care only for 31 older people age 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 accommodation is located on the ground floor. The home has a large patio area to the rear of the building and surrounding gardens. Fives Court Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced at 9.15am and was completed at 1.35pm. The purpose of the inspection was to ensure that current staffing levels were sufficient to meet the needs of those users who have dementia care needs. The home had also been experiencing a high amount of serious falls, which has now reduced. The inspector was freely able to tour the premises and visit with many Service Users. Several members of staff were spoken to during the tour. Care records were inspected, as were medication records. What the service does well: What has improved since the last inspection? The home is now operating to the registered category of care in relation to providing care for 11 Service Users with Dementia. This leads to staffing levels now being more appropriate to meeting the needs of the Service Users. Fives Court Version 1.10 Page 6 An activities programme is now in place, this has improved the social quality of life for the Service Users who appear more stimulated. The home until recently had suffered a high incidents of falls, all Service Users now have a falls risk assessment in place and staff are more available to monitor and assist Service Users with daily activities. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fives Court Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Fives Court Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,4 and 5 A clear admission procedure is in place and needs are fully assessed. The pre admission assessment presents as a complex document and may not readily be understood by Service Users. The home is able to manage the care needs of 11 Service Users with mild Dementia with the current staffing levels available. EVIDENCE: All Service Users are assessed by the Registered Manager of the home prior to admission, ensuring through the assessment process that the home can meet the personal needs and social needs of the Service User. The assessment document currently used is the initial part of the long term care plan which could be considered as inappropriate to use during the assessment process, as often Service Users at this time are in stressful situation and do not wish to participate in a long term care planning process. The home is currently providing care for 11 Service Users with mild Dementia, who were observed as relaxed and being supported by the care staff with daily activities. The care staff have recently received training on Dementia care as required. The number of Service Users the home is caring for has reduced from the previous inspection and the home is now operating within the registered category. Fives Court Version 1.10 Page 9 Where possible Service Users are encouraged and invited to visit the home prior to admission, to meet with staff and other Service Users and view the home. Fives Court Version 1.10 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 standard(s) 7,8.9 and 10. Health care needs of Service Users are monitored and appropriate action taken when health care needs change. The care plans do not fully address all aspects of care. Medication procedures are safe and the Staff have a good understanding of the responsibility they have when administering medication. EVIDENCE: Individual care plans are in place and some improvement has been made to the care records, however the standard of recorded information in the care records is variable as are reviews. All records now have a falls risk assessment in place. The number of falls the home is now experiencing has recently reduced. Further details of long term care needs is required to ensure the staff are fully informed of each individual Service Users’ needs and wishes. The home operates a Key worker system but the key worker information was limited in the care records. Again this document should be used to gain further insight to the Service Users needs and expectations of personal care and social care. Some care records provided a manual handling assessment whilst others did not, this could result in staff not being fully informed of the Service Users’ mobility level causing risk to the Service User. Fives Court Version 1.10 Page 11 All Service Users are registered with a local GP. The home is not registered to provide nursing care, therefore nursing needs are attended to by the Community Nursing Team who was seen visiting the home. Service Users reported they could see the doctor anytime which the staff would arrange. The team leader was observed contacting the GP to request a visit for a Service User whose needs had changed during the night. Care staff are responsible for administering medication. The method of administration was safe, apart from hand written orders to the medication sheet. All medication was stored correctly. Medications used were limited, providing evidence of medications reviews taking place by the attending GP. Fives Court Version 1.10 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 Social activities have much improved and Service Users appeared more stimulated and the home was generally calmer. Meals are of a good standard with a varied menu and a daily choice. EVIDENCE: Activities are now provided most days by an allocated activities person from the care team. Several Service Users commented about the more interesting and varied activities now available. Service Users who do not wish to attend activities reported they can do what they like and that the staff respect this. Two staff members commented how much difference the daily activities programme has made to the Service Users. The main hot meal of the day was observed, which was well presented and Service Users reported the food as always good. Service Users were seen using the dining room or if they wish having their meal in their bedroom. The menu was displayed clearly on the dining room wall, with a choice available. A member of the kitchen staff was heard after lunch talking to Service Users about the next day meal and what their preferred choice was going to be. Fives Court Version 1.10 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 There is a complaints policy and procedures in place . A vulnerable adults procedure is also in place and staff are fully aware of the local procedure and how to use it. EVIDENCE: There is an organisational complaints procedure in place, a copy of which is situated in the entrance hall to the home for anyone to see. All Service Users are provided with a copy of the complaints procedure. The home has not recently received any formal complaints. The home has copies of the “No Secrets” document, which was seen available to all staff. Care Leaders have a clear understanding of the local vulnerable adults procedure. An “Abuse” organisational policy and procedure is in place as is a “Whistle Blowing” policy. Fives Court Version 1.10 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 24, and 26 The home is well maintained providing a safe environment for Service Users. Although the home is purpose built and quite large it is homely because of the décor and furnishings. All bedrooms are single, which are personalised and homely. The home is clean to a good standard. EVIDENCE: Fives Court is a purpose built home, which is well furnished with domestic furnishings. The communal rooms are light and spacious, which are popular seating areas with the Service Users. The décor of the home is generally well maintained. All bedrooms are single which are homely with many personal items and furnishings around. The bedrooms do not have en-suite facilities but communal toilets are available throughout the home as are assisted baths. A bathroom, which has been out of action, will shortly be refurbished to provide a shower room for Service Users offering a choice of bathing facilities. The bathrooms are clean to a good standard and quite homely. Fives Court Version 1.10 Page 15 All areas of the home were clean to a good standard of hygiene and cross infection issues were addressed. The care staff were observed using plastic gloves and aprons whist attending to Service Users personal care needs, and using appropriate hand washing methods, avoiding cross infection between Service Users. Fives Court Version 1.10 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The home is able to meet the needs of the current Service User group with the staffing levels in operation and with the additional activities person. Staff training has become more relevant to the needs of the Service Users enabling staff to have improved knowledge when caring for people with Dementia. The home is calmer and staff appeared more relaxed and Service Users were benefiting from the improved atmosphere. EVIDENCE: Concerns have been raised at the previous two inspections relating to staffing levels not being adequate to meet the needs of those Service Users suffering from Dementia. However now the home is operating within the registered category of care and a delegated activities person is available the home was seen to be meeting the needs of all Service Users. The home was calmer and positive interaction was observed between the Service Users and care staff. A stable core team of staff are in place who, have worked at the home for several years providing stability and continuity of care to the Service Users. The staff confirmed that all mandatory training is provided and specialised training in Dementia was provided. Some training has been provided for care staff in relation to conducting effective risk assessments following the amount of falls the home was experiencing and lack of effective falls risk assessments. Many of the staff now have NVQ Level 2 or 3 or are working towards obtaining Fives Court Version 1.10 Page 17 an NVQ. The Staff receive regular supervision. Service Users spoken to were complimentary of the staff and how supportive they were. Fives Court Version 1.10 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38 There is leadership from the manager and the care leaders all of who know the Service Users well. Training for staff and health and safety checks made in the home provide a safe environment for Service Users to live in. EVIDENCE: The Registered Manager has been in post for approximately 18 months and has worked in the care field for many years. The Manager is currently working towards the Registered Manager’s award. The Manager is supported by Care Leaders on each shift and a care leader is always on duty in the absence of the Registered Manager providing continuity of care to the Service Users. Fire records indicated that weekly testing of the fire alarm system was taking place and staff had received fire training. Emergency lighting was tested monthly and all fire exits were accessible. A new call bell system will be in place in May 2005. The accidents records had not been reviewed consistently due to sickness. All accidents are fully recorded and action taken. Fives Court Version 1.10 Page 19 Fives Court Version 1.10 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 3 N/A 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 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x 3 x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x x 3 Fives Court Version 1.10 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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. Comment; This has been addressed in part as all Service Users now have a risk assessment in place but the assessments are not being reviewed monthly. The Registered Manager will ensure more detail is recorded on the long term care needs assessment document. The Registered Manager will ensure that the Key Worker documentation involves the Service User and relates to Service Users needs and welfare. Service Users will be given the opportunity to particpate in the care planning process and sign the care plan when agreed. All Service Users will have a manual handling assessment in place. All medications when hand written onto the medication Version 1.10 Timescale for action By the 1st March 2005 2. OP7 15 By 30th May 2005 By 30th May 2005 3. OP7 15 4. OP7 15 By 30th May 2005 By 30th May2005 By 1st May 2005 Page 22 5. 6. OP7 OP9 15 13 (2) Fives Court sheets will be counter signed by two members of staff. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP4 OP3 OP7 Good Practice Recommendations The Registered Manager should continue to monitor how many Service Users are admitted to the home with Dementia. The Registered Manager should consider a more Service User friendly pre assessment tool. The Registered manager should audit the care plans monthly. Fives Court Version 1.10 Page 23 Commission for Social Care Inspection Suite C, Avonbridge House Bath Road Chippenham Wiltshire, 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. Extracts may not be used or reproduced without the express permission of CSCI Fives Court Version 1.10 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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