Inspection on 20/04/06 for Forrester Court

This inspection was carried out on 20th April 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 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

Forrester Court 14/09/09

Forrester Court 27/10/08

Forrester Court 09/06/08

Forrester Court 21/06/07

Forrester Court 11/01/06

Forrester Court 12/05/05

Forrester Court 11/11/04

Forrester Court 17/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Forrester Court Cirencester Street London W2 5SR Lead Inspector Wynne Price-Rees Unannounced Inspection 20th April 2006 10:00 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 Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 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. Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Forrester Court Address Cirencester Street London W2 5SR 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) 020 7266 3174 020 7286 1068 manager.burroughs@careuk.com Care UK Community Partnerships Limited Mrs Hansa Menon Care Home 110 Category(ies) of Dementia (60), Old age, not falling within any registration, with number other category (50) of places Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nursing beds on Richmond unit not to exceed 20 DE(E) male and female. Nursing beds on St James unit not to exceed 20 OP male and female. (This unit cannot admit service users with a primary diagnosis of dementia). Nursing bed on Hyde Park unit not to exceed 20 OP male and female. (This unit cannot admit service users with a primary diagnosis of dementia). Victoria unit not to exceed 20 DE(E) male and female Regents Park unit not to excede 10 OP and 10 DE(E) male and female. A Total of 20. Kensington unit not to exceed 10 DE from 45 years to 70 years male and female. Only one resident, Jerimiah (Jerry) O`Sullivan, to stay in unit past age of restriction as he has lived there since 1979. 11th January 2006 2. Date of last inspection Brief Description of the Service: Forrester Court is located in the Royal Oak area with good access to local shops and transport links. It is registered to provide care including nursing for up to one hundred and ten residents of either gender and recently it has been registered for up to sixty beds for people with dementia and fifty for older people. The building opened approximately five years ago and was purpose built. It is owned and run by the Care UK organisation. There is a current occupancy of one hundred. Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over three days, during which all key standards were inspected, a total of fifteen care files spread over each unit were case tracked and twenty residents and two relatives spoken with. Six questionnaires were also returned.Activities and care practices were observed and a sample of records checked including all medication administration records. The method of monthly unannounced proprietor’s visits was also discussed with the responsible person. The requirements from the previous inspection were followed up and found to be met. What the service does well: What has improved since the last inspection? What they could do better: Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 Page 6 There are concerns regarding the efficiency of the assessment and reassessment system in place in respect of residents being appropriately placed on units according to the care categories they have been identified as falling under. 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. Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 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 Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 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 and 6. The residents are assessed before entering the home although the assessment and re-assessment procedures require improvement. The home does not provide intermediate care. Quality in the outcome area for standard 3 was adequate. EVIDENCE: The home has a written assessment policy and procedure that is carried out prior to admission and the information was contained in files sampled. Assessment information is forwarded by the placing authority and the home also carries out an assessment visit. Problems have arisen regarding the accuracy of the assessment information as needs displayed and behavioural patterns within the home environment may not correspond to those when admitted to residential care. This has meant that the initial six weekly and subsiquent care reviews have become critical and it is essential that they are carried out on time and if different needs are identified that steps are taken, by the placing officers, to find appropriate alternative placements. In some instances extra one to one care has been provided rather than alternative Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 Page 9 placements and some residents have continued to reside on units that are not appropriate to meet their needs. The Inspector saw a recent referral to the elderly frail unit that stated the multidisciplinary team recommended 24 hour care within an EMI unit. No beds were available within the EMI unit. There were five residents who were receiving extra one to one care above the normal service provided that would indicate either their needs had changed requiring a higher level or different service or that they had initially been wrongly assessed. There were also issues regarding the speed with which reassessments were carried out once requested. One resident entered the home in January 2006 and has not received their personal allowance, that is included within the overall allowance package part of which goes towards their fee payment. This is despite payment cheques being received as there is some confusion regarding the accuracy of payment levels and therefore they have been told not to cash the cheques. This has been brought to the attention of the placing officer and was discussed at a review meeting that took place a month ago. The meeting minutes have not been forwarded to the home and therefore it is not possible to identify what action has been taken. A friend of the resident arranged for a visit from an officer from the department with responsibility for pensions that took place the day prior to the inspection. The resident’s sister resides on another unit and similar problems have been experienced over a greater period of time. When interviewed the resident said this has led to great anxiety as they fear they may be ejected from the home or have to pay back any monies wrongly apportioned to them. A serious incident occurred regarding a resident self-harming during the inspection and urgent re-assessment requests were made by the home and GP. The re-assessment was carried out promptly by the placing officer and the psychiatric team made an appointment to re-assess within five days that was unfortunately cancelled. This is being re-arranged. A referral to the adult protection team was also made and a strategy meeting is being arranged. In the interim extra one to one cover was agreed and put in place. Staff stated that difficulties have previously arisen regarding the arrangement of prompt re-assessments with care package managers carrying out their reassessments only after those of the psychiatric team which have taken up to three months. The home now carries out an assessment prior to residents being re-admitted from hospital. The home does not provide intermediate care. Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 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 and 10. All files sampled held care plans. Generally health needs were met although a few health monitoring records required updating within the care plans. Personal and social needs were generally met with a high level of activities provided. The majority of daily progress notes corresponded to goals set. The residents’ rights to privacy and dignity were observed. Medication was properly stored, administered and recorded. There were file records of the wishes of residents’ in the event of death. Quality for all of the above standards outcomes was good except standard seven that was adequate. EVIDENCE: All the case files sampled contained care plans that identified goals, needs and how they were to be achieved and met. These were in the main identified within the daily progress notes, by number, fed the in-house reviews and were underpinned by regularly updated risk assessments. There are some staff who are experiencing difficulty using the numbering system when recording daily Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 Page 11 notes but this is isoated and being addressed within training and supervision. The goal planning system was clearly recorded. The records showed that residents health needs were satisfactorily met and this was reflected in the conversations held with residents. There were two instances where nutritional, Barthel index and Waterlow charts had not been updated for January and March although the reviews had been carried out as evidenced by notes available. The residents are all registered with visiting GPs and can retain their own if practicable. They also have full access to community based health services such as local hospitals, district nurses, chiropodist, dentist and opticians. Arrangements are made for these services to be made available in the home or residents access them within the local community. The medication administration sheets were checked for all residents and found to be accurately recorded. The home has a policy and procedure regarding dignity and privacy that staff confirmed they have received training in and residents stated are observed. Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 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 & 15. The residents’ lifestyles match their expectations; preferences and they are encouraged to maintain contact with family and friends. They are facilitated to exercise choice and control over their lives. A wholesome and appealing balanced diet is provided. Quality for all of the above standards outcomes was good. EVIDENCE: The residents generally felt satisfied with the level and type of activities provided that are both person focused and promote group participation. Many different activities were observed that catered for all residents and promoted and stimulated them. One resident said they would like more activities adding they will be taking this up with one of the activities co-ordinators themselves. A lot of staff training has been provided surrounding provision of activities for people with dementia and this has been reflected in the increased participation levels of residents. These activities are designed to prompt and stimulate residents using remeniscence, appropriate era music and written materials. The residents spoken with said they participate as much or as little as they wish. Each care plan had a specific goal that detailed interests, hobbies and this fed the activities provided and their timing. Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 Page 13 The residents said that they can receive visitors at any time they wish providing it does not inconvenience others. They also stated that they are encouraged to make their own decisions and this was reflected in the care practices observed. They are able to bring personal possessions to the home providing this is practicable. The meals observed were hot, well presented and plentiful food was available with choice provided. The residents spoken with said they found the meals very good. One resident said they had informed staff that they do not like liver or kidneys and they were always given alternatives when these were on the menu. Nutrition and weight monitoring is included as part of the care planning process. Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 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): 16 & 18. There is a complaints procedure that most residents and relatives are aware of. Records showed complaints are fully investigated. Residents are protected from abuse. The quality of outcomes for both standards were good. EVIDENCE: There is a written complaints procedure in place that residents have access to. The majority of residents asked if they knew whom to complain to identified staff that they had most contact with rather than using the formal process although they were aware of the procedure. Of the six complaints identified, since the last inspection, all had been fully investigated and recorded with varying outcomes depending on nature and findings. Complaints are included as part of the quality assurance monitoring system. The residents spoken with said they currently have no complaints. All staff have received adult protection training as part of induction and the rolling training programme. Adult protection is also included as part of the section leader and unit meetings. All staff are CRB checked prior to commencing in post. There is currently one referral to POVA. There is also a policy regarding aggression by residents and how to address this. The handling of residents’ finances is fully documented and most are subject to appointeeship or receiver by Westminster City Council. See previous standards. Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 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 & 26. The home’s layout and location is suitable for it’s stated purpose, safe, accessible and well maintained. It was clean, pleasant and hygienic. The quality of outcomes for both standards was good. EVIDENCE: A tour of the premises showed the home to be suitable for it’s stated purpose with care and support carried out in a safe, comfortable environment. The previous infestation problems appear to have been addressed and regular monitoring takes place by an outside company contracted to do so. Any holes in the exterior walls have been cemented, the rubbish area sealed and brushes fitted to exterior doors. The home was found to be clean tidy and odour free. The home is embarking on a refurbishment programme with all curtains being replaced, corridor carpets and lino replacement on Victoria unit scheduled and the kitchen has been fumigated. Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 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 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 & 30. There is a suitable staff skill mix with required numbers and residents are in safe hands.The recruitment procedure protects residents and staff are well trained and competent to carry out their duties. The quality outcomes for the above standards was good. EVIDENCE: The staff rota showed there are suitable numbers on duty to perform their duties competently and this was born out by the care practices observed and variety of activities provided over the three inspection days. There are currently no staff vacancies. All staff receive induction training as required by the standard that is complimented by a comprehensive rolling training programme that includes specialist training in dementia care provided by medically qualified trainers. The induction is based on the TOPPs induction and foundation course. Some staff spoken with showed the Inspecter the training certificates they have been awarded. Monthly training is posted on unit noticeboards. Of 100 staff, 68 hold NVQ level 2 or equivalent qualifications and a further 20 are currently undertaking the award. The home also has access to training provided by Westminster City Council. The organisation operates a comprehensive and thorough recruitment policy and procedure that meets the standard requirements and adheres to equal opportunities legislation. Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 Page 17 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 & 38. The home is well-run, in the residents best interests, by a manager that is fit, competent and qualified to do so. Their financial interests, health, safety and welfare promoted and protected. The quality outcomes for the above standards was good with the exception of standard 33 that was adequate. EVIDENCE: The home is well run by a Care Manager with extensive experience in the field including previously in the post of Deputy Manager. They are an RGN and hold an NVQ level 4 management award. The management practices inspected demonstrate they are competent to fulfil the role of the post. There are clear lines of accountability and an appropriate management structure in place. There is a comprehensive quality assurance system that includes unannounced proprietor compliance visits, self audits, and clinical governance manager annual audits based on the CSCI standards. These contain measurable Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 Page 18 performance indicators. Quarterly monitoring reports include type, nature and amount of accidents and incidents. The only concern regarding the QA system is surrounding the identification of assessment and re-assessment issues and initiating action when identified. The arrangements for safeguarding residents’ financial interests have been and any concerns have been stated elsewhere in the report. All transactions are recorded and a monthly audit and balance carried out by the administrator. The safe working practices of standard thirty-eight were met. There is an inhouse maintenance team responsible for carrying out routine checks, maintenance and record keeping. Maintenance report books are kept in each unit. Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 Page 19 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 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 3 14 3 15 3 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 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? NO 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 OP3 Regulation 14 & 24 Requirement Timescale for action 20/04/06 2 3 4 OP3 OP7 OP33 14 12 14 Residents financial situation must be incorporated into the assessment and re-assessmet processes and addressed within acceptable timescales. Re-assessments must be 20/04/06 promptly carried out when requested by the home. All health charts must be kept up 20/04/06 to date. The assessment information 20/04/06 must reflect the needs of residents once they have moved into the home in order to ensure they can be met and the reassessments must reflect the current situation with appropriate new placements being made as required. This must be more thoroughly pursued as part of the quality assurance monitoring. Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Forrester Court DS0000026014.V288205.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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