Inspection on 27/10/08 for Forrester Court

This inspection was carried out on 27th October 2008.

CSCI 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

Forrester Court 14/09/09

Forrester Court 09/06/08

Forrester Court 21/06/07

Forrester Court 20/04/06

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 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Forrester Court Cirencester Street London W2 5SR Lead Inspector Ffion Simmons, Sheila Lycholit & Jane Shaw Key Unannounced Inspection 10:00 27 & 28th October 2008 th 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.V372774.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. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 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.forrestercourt@careuk.com manager.burroughs@careuk.com Care UK Community Partnerships Ltd Mrs Hansa Menon Care Home 110 Category(ies) of Dementia (110), Old age, not falling within any registration, with number other category (110) of places Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia Code DE 2. Old Age, not falling within any other category Code OP The maximum number of service users who can be accommodated is: 110 9th June 2008 Date of last inspection Brief Description of the Service: Forrester Court is located off the Harrow Road, with good access to local shops and services and close to Royal Oak tube station. 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 nine years ago and is purpose built. It is owned and run by Care UK and places are commissioned by Westminster Council and the PCT. The Royal Borough of Kensington and Chelsea commission some places in Kensington, the unit for people with early onset dementia. The weekly fees for the service ranges between £340 and £750. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The unannounced key inspection took place over two days on the 27th and 28th of October 2008 and lasted a total of 14 ½ hrs. This was the home’s second key inspection for this year. Three inspectors were involved in this inspection. During the inspection, we spoke with residents and staff and observed care practices. We tracked the care of eight residents, and in doing so we checked their personal records. A number of other records and documentation were checked during the inspection, including the computerised care plans and risk assessment, staff files, health and safety documentation, the home’s computerised complaint records and incident records and quality assurance documentation. A full audit of medication was carried out by a specialist Pharmacist Inspector to assess the home’s management of medication. Questionnaires were sent to residents, professionals and staff to comment on the service. We have used the information within these questionnaires to contribute to the content of the report. What the service does well: The home uses a comprehensive on-line computerised system for care planning, recording staff training, complaints and accidents, which can be monitored remotely by Senior Managers and Care UK’s clinical governance team. The home’s activities programme is varied and meets the needs, abilities and interests of the residents. Visitors are welcomed into the home and residents are supported to maintain important personal and family relationships. A wide choice of meals is available, with food freshly prepared on the premises. Individual likes and dislikes regarding food are met and the catering service is able to meet the cultural and ethnic needs of residents. The home is accessible and meets the specific needs of the people who live there. Residents live in a clean and well-maintained home, which is homely, and comfortable. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home’s contract and service user’s guide should be amended to clearly state Care UK’s policy on smoking, which does not permit any smoking within the building. This is important so that residents are aware of this policy prior to moving into the home, Records kept in relation to wound care management, such as turning charts, must be improved to provide evidence that care is being provided as per residents’ care plan. Action must be taken by the home to work with the pharmacist and GP to ensure that supplies of medicines for all residents are available for the start of a new medication cycle. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 7 Two written references must be obtained for all new staff before they are appointed, at least one of which should be from the most recent employer. This is to ensure that residents are protected and staff employed are suitable to work with vulnerable adults. While steps have been taken to implement regular supervision for staff, further action is needed to ensure that supervision contracts are in place and that all supervisors have received training. 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. The summary of this inspection report can be made available in other formats on request. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 6. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Personalised assessments are undertaken prior to a resident moving into the home to ensure that residents’ needs are known prior to admission. Clarity on the home’s policy on smoking within the home’s documentation is needed to ensure residents can make an informed choice about moving into the home. EVIDENCE: Each of the eight residents’ files looked at contained a copy of a contract setting out the term and conditions. The home implemented a new policy on smoking in 2007 whereby there is no smoking allowed in the building, including in residents’ rooms. Residents who smoke are supported by staff to smoke outside. The Manager said that in wet or cold weather or at night, residents on Kensington can use a designated room to smoke, though staff on the unit were unaware of this. The home’s smoking policy should be clearly stated in the contract and in the service user’s guide, so that prospective residents are aware of the policy before deciding to accept a place. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 10 The home’s admissions policy requires a pre-admission assessment to be carried out before residents are admitted to the home, which is in addition to the needs assessment, which is supplied by the funding authority. The individual files of four recently admitted residents were seen, which showed that an assessment had been undertaken by staff at the home. Each of the residents had been visited in hospital or at home and one resident had visited Kensington unit with his family before accepting a place. The home does not provide intermediate care. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8. 9 & 10. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans are comprehensive and are reviewed regularly, and outline residents’ health, personal and social care needs. The home’s management of medication has been improved with regular auditing. EVIDENCE: Care plans seen on the Saturn system were more detailed than at the previous inspection and included information about residents’ social history and religious and cultural background. Risk assessments covered all areas of concern and were regularly reviewed. The care plan of one resident who had been displaying aggressive behaviour towards staff and other residents showed that referrals had been made to members of the multi professional team for advice, including the GP, dietician and physiotherapist. One to one staffing for this resident had greatly reduced the number of incidents. Guidance for staff in anticipating and managing this resident’s behaviour needed to be more detailed, with strategies in place. The advice of a Psychologist is likely to been beneficial. Discrepancies in monitoring eating and drinking plans are discussed under standard 15. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 12 Good interactions were observed on Kensington where staff responded positively to residents and explained when they were not able to support them straightaway. Neither of the care plans of younger people looked at on Kensington unit referred to any rehabilitation activities, for example to support cooking and self-care skills, though this reflected the lack of clarity about the placements given by the placing authorities. During the inspection, we tracked the care of residents who had pressure ulcers to assess the standards of pressure area care. The risk of residents developing a pressure ulcer had been assessed using the Waterlow score, and a care plan relating to pressure area care and wound care was in place for each resident. We found evidence that referrals are made to the Tissue Viability Nurse for specialist advice on wound management. We found that the advice given by the Tissue Viability Nurse had been incorporated into the resident’s care plan and followed by staff. The home uses “turning charts” to document when they assist residents to change position in order to relive pressure. We noted gaps in the recording on the turning charts. The charts showed that there had been a number of occasions where staff had not recorded that they had turned residents for a number of hours for example on one occasion the records showed that a resident had not been turned between 06:00 until 22:00 that evening. This potentially puts residents at risk of further tissue breakdown. Care must also be taken to ensure that the frequency of the “turns” are as per the care plan, as we found that there were some discrepancies in the care plans seen. We inspected the recording of receipts, administration and disposal of medication in all six units in the home to see if medicines were being handled safely. We also randomly checked quantities of stocks of medicines to determine whether recording was accurate, and tracked four residents who were prescribed complex medication regimens. We were pleased to note that with the exception of one unit there were no omissions in the recording of receipts and administration. When random samples of stocks were counted all dosages could be reconciled with the endorsements on the Medication Administration Records (MAR). In one of the residential units there was a gap noted for calcium tablets. The home was carrying out its own audits daily, weekly and monthly and had identified this and found that it had not been given. On this same unit it was noticed that for one resident there were no medicines in stock for the first day of the current medicines cycle. We noticed that several residents were able to self medicate their own inhalers or apply their own creams. There were risk assessments in place to monitor compliance. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 13 There was evidence of review of medication by the GP. Several residents had had medication discontinued or doses reduced and we were able to track these changes to the care plans. It was particularly pleasing to note that a resident previously prescribed large doses of a pain killer was now controlled on a much lower dose of a less potent medicine. There was also evidence of review of residents with diabetes. Nurses and care workers had good clear records of blood glucose monitoring and the GP provided target levels for what these should be and when to request further medical intervention. The home had introduced pain charts and were monitoring those residents who were prescribed analgesics for long term relief to see if the pain killers were effective. One resident was finding it difficult to take his medicine and it was clearly documented in his care plan that the medicines must be offered one at a time to aid him. For another resident there was a consent form, which had been agreed by the multidisciplinary team to allow the medicine to be disguised in food. We looked at the recording of warfarin in the home and for all residents the dose being administered was recorded clearly and correlated with the latest blood test result. One resident was discharged from hospital on a regimen involving a reducing dose of an injection and we were able to track the dosage to the discharge letter from hospital. Another had the frequency for taking medicines for Parkinson’s disease increased and this was well managed by the home. We looked at the storage of Controlled Drugs and checked the balances .These were correct and records correlated with the MAR. We looked at the protocol for a resident being fed by tube because of swallowing difficulties and this was clear and well documented. Seizure charts were available for residents who had occasional fits and care workers had clear protocols of what to do if these occurred. Storage of medication was good in the home and temperatures were within the required range. Lancets for taking blood samples were of the professional type to prevent the risk of infection. Overall we were pleased with the improvements in medication management in the home. These need to be sustained by continued auditing and continued vigilance. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home’s activities programme is varied and meets the needs, abilities and interests of the residents. Visitors are welcomed into the home and residents are supported to maintain important personal and family relationships. The meals offered cater for the varying cultural and dietary needs of individuals. EVIDENCE: At the last key inspection, we found that there was a varied and imaginative programme of activities available for residents to meet their needs, abilities and interests. We found this to be the case also at this inspection. We noted that a programme of activities is available within each unit, designed to meet the needs and abilities of the residents. As discussed within the previous section, steps are taken through the assessment and care planning process to identify and respect the culture and religious beliefs of residents living in the home. The majority of residents are of Christian faith and to meet the needs of these residents, a Church of England service takes place in the home on a weekly basis. Catholic Mass is arranged once or twice per month, and residents can be supported if they prefer to attend the Church, which is approximately three minute walk away. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 15 Where residents are assessed under the Mental Capacity Act as not having capacity, staff need to be clear about any restrictions that are in place. Training for RGNs and Senior Carers in the Mental Capacity Act is recommended, so that staff have sufficient knowledge to answer queries from residents and know when to refer issues or concerns to the Care Manager/Care Co-ordinator, Psychiatrist or Independent Mental Capacity Advocate (IMCA). Lunch was briefly observed on two units. Residents at Kensington unit were seen to be eating heartily. One resident who eats a restricted range of foods was eating a meal specially prepared for him. Yam and sweet potatoes were available for the residents of West Indian origin. On St James’ unit, we observed staff sensitively supporting residents to eat their meals. We noted as per the recommendation of the last inspection report, that residents were offered fresh fruit as part of their meals. Fluid and nutrition charts were looked at on Richmond unit. During the previous week one resident’s fluid intake appeared to be very low on three days, though the daily notes indicated that she had eaten and taken fluids quite well. It is recommended that a weekly monitoring chart is completed for each unit so that senior staff can monitor food and fluid intake and check promptly whether any record of low intake is real or an error in recording. Other monitoring charts seen on Richmond indicated that residents, about whom there were concerns, were getting sufficient food and fluid. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home’s complaints procedure is clearly written and most residents understand how to make a complaint. Complaints are listened to and are taken seriously. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Residents are better protected from abuse as staff now have a better understanding of the procedures and their responsibilities in this area. EVIDENCE: At our last key inspection, we found that there had been a number of allegations and incidents of abuse, which had not been reported either to the local safeguarding team or to the Commission for Social Care Inspection (CSCI). An immediate requirement notice was issued to ensure that the safeguarding policies and regulations are followed in the area of protection. At this key inspection, we found that the home had worked well to improve standards in this area. All allegations and incidents which fall under the safeguarding procedures are now reported promptly both to the relevant safeguarding teams and the Commission. The recording of incidents are being monitored more closely by the Manager and the Deputy Manager to ensure that appropriate action is being taken by staff to safeguard residents. Staff have received further training in the protection of vulnerable adults and a copy of the home’s whistle-blowing policy has been given to all units for staff reference. This has resulted in staff having a better understanding of their responsibilities in ensuring that the safeguarding policies and procedures are followed. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 17 The home has a complaints policy, which is accessible to residents within the home’s brochure. The majority of residents commented that they knew how to make a complaint. One resident commented “if anyone trouble me, I make a complaint to the manager”. Another resident commented “as I have not really had any complaints, I have not had cause to find out.” There is a comprehensive computerised system in place for recording complaints and to detail action taken to investigate including the outcome. At the last inspection we found examples where concerns had been raised but these were not investigated under the home’s complaints procedures. At this inspection, we found that complaints were well recorded and investigated, and the outcome of the complaint was clearly recorded. The management team have held meetings with staff to ensure that they are aware of their responsibilities for recording complaints and concerns. It was outlined within the home’s improvement plan that staff will receive training with regards to recording complaints and concerns by a member of Care Uk’s clinical governance team. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is accessible and meets the specific needs of the people who live there. Residents live in a clean and well-maintained home, which is homely, and comfortable. EVIDENCE: Forrester Court is a purpose built Nursing home, registered to provide a service to 110 residents. The home is situated off the Harrow Road with good access to local shops and services and close to Royal Oak tube station. There are six units within the home, three of these units are for residents requiring nursing care. There are two residential units within the home and a 10 bedded unit providing care and support to residents who have early onset dementia. All bedrooms are single with en-suite facilities. During the inspection, we toured the building and found the home to be clean and free from malodours. We asked residents to comment if they felt the Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 19 home was fresh and clean and one residents commented “no doubt about it”. A relative commented, “this is an excellent unit, both in quality of environment – room corridors etc and the staff”. Domestic staff are employed at the home to clean the units. We found the home to be well-maintained and accessible to people with a physical disability. Arrangements are in place for replacing carpets in the home. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service recognises the importance of training, and tries to deliver a programme that meets the needs of residents. The manager is aware that there are some gaps in staff completing the on-line training programme and has plans in place to improve on this. Residents would benefit from improved recruitment practices, which ensures that all necessary pre-employment checks are undertaken. EVIDENCE: The files of eight members of staff were looked at, including four recently appointed care staff. All of the files were well ordered, with a checklist for recruitment checks. Care UK’s policy, in line with the standard is to obtain two written references. However, the files of three of the four newly appointed staff contained only one reference. In the case of two staff who had previously worked at another care home, no reference from the owner or manager of the home had been sought. Following discussion, the Manager undertook to contact the home and obtained references by fax. One of these references needed further clarification, which the Manager planned to seek. Since the inspection in June this year when the appointment of a member of staff, whose CRB check had revealed a previous conviction, was not fully documented, the Manager has undertaken a risk assessment agreed by a senior Care UK Manager. Discussion with head office staff concerning the appointment has also been recorded. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 21 Since the last inspection when more than 50 of staff were on ‘bank’ contracts, the Manager confirmed that 95 of all staff have been transferred to permanent contracts, providing greater consistency of staffing for residents. The Annual Quality Assurance Assessment outlined that 72 percent of the staff team have obtained the National Vocational Qualification at level 2 or above. Staff are offered a range of in-house training and distance learning. At the last key inspection, we found that staff were having difficulty in completing core and refresher training on time. Since then, a training matrix has been put in place and is audited by the Registered Manager on a weekly basis to check staff’s progress in completing the training. We were told that there has been a marked improvement in staff completing their training and staff are reminded during their supervision sessions of the needs to complete the training. Supplementary training in the protection of vulnerable adults from abuse has been carried out to update staff’s knowledge in this area. Staff at the home have also received training in effective communication, which has impacted positively on their interaction with residents. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is managed by a person who has the required experience and qualifications to run the home. The frequency of supervision has improved but there is further work required. The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The home has a Registered Manager in post who holds the SEN general nurse qualification, the Registered Mental Nurse qualification, the Registered Manager’s award and assessors award. There is a Deputy Manager in the home to support the manager. The Deputy Manager is also a Registered General Nurse and Registered Mental Nurse. Since the last key inspection, Care UK has re-created a second Deputy Manager’s post, and have recruited into this post. A senior Support Manager has also been brought in to support the management team to improve standards in the home. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 23 Records show that from the middle of September 2008, senior staff meetings have taken place weekly. Notes kept of meetings are detailed, though it is suggested that they would be further improved by the addition of an action column or action plan. Only two unit meetings have taken place since the new meetings structure was introduced. The Manager explained that Unit Managers are finding it difficult to get all staff together. It is recommended that steps are taken to ensure that unit meetings take place regularly, for example by relief staff covering the unit for the period of the meeting or by holding two meetings at different times. The home’s computerised system is comprehensive and allows Care UK’s clinical governance team to monitor records, as well as providing a range of management information about the service. We noted from checking the home’s quality assurance records that the clinical governance team undertake monthly audits on different aspects of care in the home, including bed rails audit, personal grooming audit and an audit of staff records. Since the last inspection, staff have worked hard to ensure that regular medication audits take place so that any issues are identified and addressed quickly. Since the last inspection, the Manager and Deputy Manager have also been auditing the complaints, accident and incident records on a daily basis to ensure that incidents are reported and any necessary follow-up action is taken promptly. We saw evidence during the inspection that the home has recently sent out satisfaction surveys to residents and their relatives to seek their view on the quality of the service they receive. The home has a suggestions box at the entrance to encourage feedback on the service. The home also offers residents the opportunity to comment on aspects o the running of the home through residents’ forums. We saw evidence that any concerns are acted upon. Regulation 26 visits take place on a monthly basis, and are now forwarded to the Commission as per the requirement of the last inspection. Staff files showed that since the last inspection in June this year, a system of regular staff supervision has been implemented. Supervision notes varied in detail, with some being of a good standard, stating clearly what had been discussed and agreed. The lack of detail and ambivalent recording of some notes indicate that staff carrying out supervision would benefit from training. No supervision contracts were in place. Following discussion the Manager made a contract available, which when put into place will clarify the purpose of supervision and set out the responsibilities of both parties. The contract needs to be amended to confirm that notes will be made available to the supervisee. Steps should be taken to allocate one supervisor to each member of staff to ensure consistency and the development of a professional relationship. The home has a policy for the management of residents’ money. A lockable drawer is provided in the rooms for residents to keep their valuables. Where required, the home’s administrator is responsible for the safe handling of residents’ money. A safe is available to ensure residents’ monies are securely stored. We inspected the financial records of eight residents and found that Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 24 receipts are kept to show the purchases made. The balances of money kept on behalf of the resident were correct. The administrator confirmed that the financial records are regularly audited. The home employs maintenance staff. We checked the health and safety records during the inspection and found that there were no issues or concerns in this area. Daily checks of the building are undertaken to check for any health and safety risks to residents. Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 25 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 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 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 26 No 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 OP2 Regulation 5(1)c Timescale for action Residents’ contracts and the 01/01/09 service user’s guide should clearly state the home’s policy of no smoking in the building, so that prospective residents are aware of this condition before accepting a place. Records kept in relation to 01/12/09 wound care management, such as turning charts, must be improved to provide evidence that care is being provided as per residents’ care plan. Action must be taken by the 01/11/08 home to work with the pharmacist and GP to ensure that supplies of medicines for all residents are available for the start of a new medication cycle. Two written references must be 01/01/09 obtained for all staff before they are appointed. Other than in exceptional circumstances one of these references should be from the most recent employer. Staff providing supervision 01/01/09 should have relevant training. A supervision contract should be agreed with each member of DS0000026014.V372774.R01.S.doc Version 5.2 Page 27 Requirement 2. OP8 17 (1) (a) Schedule 3 (k) & 17 (3) 13(2) 3. OP9 4. OP29 19, Schedule 2 5. OP36 18 Forrester Court 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. Refer to Standard OP7 Good Practice Recommendations Strategies for managing challenging behaviour should be developed, in conjunction with members of the multi professional team. Consideration should be given to providing further training for staff in understanding and managing difficult behaviour in people who have dementia. Staff would benefit from training in the provisions of the Mental Capacity Act, so that they clearly understand any restrictions placed on residents assessed as not having capacity. Ways of ensuring that unit meetings take place regularly and that all staff are able to attend should be explored. The use of a weekly summary sheet for fluid and nutrition intake on each unit, would allow senior staff to monitor this area of care more closely. 2. OP14 3. 4. OP32 OP15 Forrester Court DS0000026014.V372774.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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