Inspection on 08/11/05 for Glastonbury Court

This inspection was carried out on 8th November 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 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

Glastonbury Court 30/07/07

Glastonbury Court 31/07/06

Glastonbury Court 01/03/06

Glastonbury Court 29/03/05

Glastonbury Court 01/12/04

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

CARE HOMES FOR OLDER PEOPLE Glastonbury Court Glastonbury Court Glastonbury Road Bury St Edmunds Suffolk IP33 2EX Lead Inspector Mary Jeffries Unannounced Inspection 8th November 2005 12:30 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 Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 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. Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Glastonbury Court Address Glastonbury Court Glastonbury Road Bury St Edmunds Suffolk IP33 2EX 01284352650 01284352645 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) Suffolk County Council Mrs Moira Elizabeth Clare Care Home 48 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (16) of places Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th March 2005 Brief Description of the Service: Glastonbury Court is situated in a pleasant residential area of Bury St Edmunds. It is registered for the care of 16 older people and 32 older people with dementia. It is a modern two-storey building that was designed for its current use. All rooms are for single occupation and all have en-suite facilities. The rooms are grouped into units of 8, each with its own lounge, kitchen and dining area. Willow, Cherry and Elm, on the ground floor, are the individual units which make up the nurse led unit at Glastonbury Court. Two nurses work on the ground floor between 10 am and 6pm, one nurse at other times. The nurses manage the care on the units, supported by a team leader. These units provide care for older people with dementia. Beech, Cedar, and Maple do not provide nursing care, and are on the first floor of the home. Beech unit has recently been converted to provide care for older people with dementia. The Home is owned and managed by Suffolk County Council. Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place during one afternoon and early evening in November. The Registered Manager and Senior Team Leader helped facilitate the inspection, 4 carers, including one who had been recently recruited, two nurses, and the cook participated. All staff were helpful and participated fully. Forty-three of the forty eight places at the home were full at the time of the inspection; there was one vacancy on Maple, and four on Beech, the recently converted dementia unit which was being gradually filled. The inspector sat in a staff handover on Beech Unit. The Inspector spent time with all of the four service users on the recently opened dementia unit, tracked three of these service users, and met with two relatives of one of them. The inspector also met two service users on the nursing unit, who were also tracked, and inspected one other file. The home had previously been in contact with the CSCI regarding one of these service users, concerning an identified need to use restraint routinely. A group of four service users were spoken with on one of the older people units. What the service does well: What has improved since the last inspection? All requirements from the previous inspection had been met. Criminal Records Bureau checks are now in place for all staff including nursing staff and visiting professionals. A Service Users Guide that meets the regulations had been produced. Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 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 Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 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): 1,2,3,5, 6 Service users entering the home can expect to have a single assessment in place, and to be assessed by the home. EVIDENCE: A revised Statement of Purpose, including details of the change of use of Beech had been forwarded shortly before the inspection. The Service User Guide, containing all required information had been produced in an A5 booklet. This had been enlarged to A4, to make it more accessible to service users, and the home is planning to develop this further with photographs. A service user spoken to said that they had not had a copy of the Service User Guide, and the senior team leader confirmed that the guide had yet to be distributed. A copy of the home’s contract with service users was inspected. The terms and conditions in the contract applied to permanent placement, and although the home does offer respite care there was no separate contract for this. Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 9 The files for 3 of the four people recently admitted to the newly opened dementia unit all had single assessments (Compass) and the home’s own (STARS) assessments completed by the home. One of the compass assessments had not been dated. Two service users files on the nursing unit were both seen to have STARS Assessments. One service user who had been moved to the new dementia unit from an older people’s unit had a full review on file, although it was noted that this was entitled Review for EMI unit. A staff member spoken with thought that the wrong form had been used, although two nurses spoken with said that they thought that the new unit was an EMI (Elderly Mental Illness) unit. All of the service users in the home were over 65. At least one of them, currently aged 66, and who had been on the dementia unit for approximately 3 years, had been admitted under 65, however, there was no evidence that admissions out side of the age for which the home is registered had been made since a requirement was made by the CSCI in November 2003, that the registered manager must ensure that she has final responsibility for accepting new service users, and that the home can demonstrate its capacity to meet the assessed needs of those referred. From discussion with staff on the nursing unit, it was established however that some of the elderly service users had longstanding enduring mental illnesses. The nurses spoken with advised that all service users on the unit have mental health needs, which may or may not involve dementia, and all are referred by the consultant psychiatrist. The file for one service user who was subject to a 117 order under the Mental Heath Act was seen. This service user had a longstanding bi-polar disorder, and frontal lobe damage, and no diagnosis of dementia. Service users files contained comprehensive assessments including falls risk assessments and skin assessments. On the day of the inspection, one prospective service user was visiting Beech unit with their relatives. One other service user had an appointment to come and see the unit and the home, on the 10th November, and another had a planned admission date for the 10th. The seventh permanent place on the unit had been allocated to a service user who was expected some time after 14th November, leaving one respite place that the unit had started to take bookings for. The relatives of a service user who had moved to this unit from an older people’s unit described how the service user had been brought over several times to see it and to have a walk round before moving over, and how on the last occasion they had done this, the service user had said that they did not want to go back to their previous unit. The manager and deputy team leader confirmed that the home does not provide intermediate care. Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Service users can expect to have a care plan which is regularly reviewed and which addressed all aspects of their care. EVIDENCE: All five service users files inspected had care plans, with specific goals. The care plans for three service users admitted within the last week were in the process of being completed. Service users spoken with understood and recalled the reviews that they and participated in, but were less interested in paper care plans. One said, “ We don’t interfere- they carry on the good work and we are happy to let them.” Care programme reviews were conducted for all service users care plans on the nurse led (ground floor) units, whilst the team leaders conduct reviews of the homes care plan based on the STARS assessment. The two service users nursing files inspected had evidence of regular reviews and both had diagnosis of dementia. Copies of a CPA review for one of these service users which was held in September had not yet been written up. A nurse advised that the current pressures on their time, due to a changed compliment, staff sickness, and staff vacancies was the reason for this. Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 11 Records contained lists of G.P. appointments. The relatives of one service user with dementia volunteered that they thought the home were particularly good at getting medical attention when required, and spoke of two occasions when their relative care staff had noticed that the service users might have an infection and called for a doctor, that they – as regular visitors – hadn’t picked up themselves. This service users records confirmed this. The group of service users on the older people’s unit also, when asked what they thought the home was particularly good at, advised that the home was very good at getting the doctor in when needed, and went on to speak of the other health needs that were met, for example by the visiting chiropodist. Most of these service users wore spectacles, and three of them said they had new spectacles this year. A carer on this unit explained that they gave help choosing the frames, for those who wearing glasses, and one service user contributed that they had always worn them and hadn’t needed assistance. This group of service users also confirmed that their privacy was respected, and that staff knocked on their doors before entering their rooms. One said, “No one bosses me about or nothing, it’s good here, we’re a team on our own”. A service user on Cedar described how they helped choose the colour scheme for their bedroom which had recently been redecorated, and a new carpet laid. All service users had key workers. One of the key workers was spoken with regarding the clothing choice of a person with dementia, who was wearing a dress, and had brought dresses in, but in talking with them they clearly felt more comfortable in trousers. The key worker was very responsive, and had telephoned the relatives to discuss this during the evening, and offered to turn up the service users new trousers which had been too long. The administration of tea time medicines was observed on the first floor, and 12 Medication Administration records (MAR Sheets) were examined, 8 on an older people’s unit and the those of the four service users with dementia, recently admitted to Beech unit. All records were complete, with explanations recorded on the reverse side where appropriate. Records contained service users photographs. On the first floor, creams are kept in service user’s rooms, and locked cupboards have been provided on the new dementia care unit, Beech, for this purpose, however a prescribed cream with active ingredients was not locked away in one service user’s room on Beech. This was locked away immediately once reported. The home had an appropriate controlled drugs cabinet, and returns for controlled drugs and other medication were checked and medicines found to reconcile properly with records. An issue around inappropriate medication administration had recently been dealt with and corrected with a training need identified. On the day of the inspections staff who choose to were having influenza vaccinations. Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 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 Service users can expect to have a good quality of life at Glastonbury Court, with ample opportunity to mix with other residents and members of the local community. EVIDENCE: Relatives spoken with at the inspection said that they could not fault the home in terms of making them feel welcome to visit at any time. Through talking with service users, staff and management, and seeing the photographs of events and posters of events displayed in the home, it was evident that the home provides a very good social activity programme. This included a garden party and a trip to Felixstowe in August, weekly school children’s visits, a bar within the home. A pantomime had been arranged for December. A bi monthly Songs of Praise is held at the home. One of the service user’s on Cedar was doing a jigsaw during the early evening, and another had a corner of materials that they used for hobbies and interests in the lounge. They described bingo sessions, card playing, dominoes and singing on the unit. The food within the home was well appreciated by the service users. The group spoken with on the older people’s unit particularly appreciated that they were Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 13 brought a cup of tea in bed every morning. Service users said that they could have a cooked breakfast every day if they wanted it, or if they preferred, a bacon sandwich. Daily menus were posted. A main dish of the day and a pudding of the day is provided, but also a choice, including fish, “cooked how you like it” most days. The cook was in the process of creating a set of visual menus, photographs of different dishes. This was to help service users know what they were choosing, and also to help stimulate appetite. Most of the cooking is done in the main kitchen, but service users confirmed that they could make toast in the kitchens on the units. The main dish on the day of the inspection was beef and potato pie. One service spoken to said that they had had a salad instead. At suppertime, service users said that they were offered a milky drink, and could have biscuits. The service users said that special teas were prepared when it was someone’s birthday. Two of the service users in the home were diabetics, but diet controlled, and the measures taken to provide for this were discussed with the cook. A carer advised that when the additional activities time that has been allocated is on line, that they are hoping to involve service users with baking on the units. Daily activities logs on service users files showed what service users had been involved in. On Beech, there were fumble baskets with nostalgic contents. One service user, with dementia, asked for this when they had had enough of talking to the inspector. There were also photographic coffee table books on life in the 1920’s and 1930’s, and dolls. The furnishings included fluffy modern cushions for sensory stimulation. A service user on the nursing unit who had a diagnosis of dementia volunteered, “ I’ve been here seven years, it’s a lovely place.” Another service user on this unit was seen enjoying crawling on the floor. The service user was is a very positive mood, and enjoying interaction with the staff. A nurse advised that this service user, who is not able to walk, enjoys the opportunity to stretch out and move for themself. Two service users on this unit were seen and heard to be in some distress; and staff were responding appropriately, monitoring the situation but giving the service users the personal space they needed. Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 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): 16,17,18 A number of mechanisms are in place to ensure that service users interests and quality of life are protected, including recruitment practices, the complaints procedure and Dementia mapping. EVIDENCE: A complaints log had been set up, and one complaint was entered. A note stated that the complainant were satisfied with the result of this complaint, which had been dealt with at Stage 1 of the complaints procedure, but did not indicate whether it had been upheld or not. The group of service users spoken with knew that they could complain to the manager or Senior Team Leader, but expressed the view that they thought it very unlikely that they would need to. They said that they had had a meeting of residents on their unit the previous night, and had discussed very similar things to the matters being considered in the inspection, including anything they thought could be improved. These service users confirmed that they had all been able to vote, and staff had offered to take them to the (very) local polling station. The home had established an arrangement for Social Care services to fund obtaining CRBs for Nursing staff who work in the home, and these were seen to be present with the exception of three, who were on long term sickness absence. CRBs had been obtained for visiting professionals, including the hairdresser and pat dog worker, and for all new staff. Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 15 Restraint was seen being used to provide personal care for one service user on the nursing unit. Records of this were in place; the current records most recent being on the care notes, and previous were filed with the nursing notes. A risk assessment signed by the doctor and relative was in place. Dementia mapping exercises which measure the quality of life for service users with dementia had been undertaken by an external mapper in May 2005, The results of this for six service users were seen and ranged from 1.00 to 2.1; the scale ranges from –5 to 5, and scores over 0 are positive. Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 16 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): 19,20,21,23,24,25,26 The home provides a clean attractive environment that is well suited to the needs of service users. EVIDENCE: Service users with dementia on Beech require support to access the whole building, but are able to freely access a small secure sensory garden which leads directly from the unit, the home being built on a slope. They also have large amounts of varied communal space and very good aspects over the gardens and surroundings. One of the recently admitted service user’s showed the planters that they had potted up in the sensory garden. This is not yet fully developed, but which the home plans to complete in November. There is a small lip on the ground as these doors go out onto the patio/sensory garden, which is a potential tripping hazard. The home advised that property services are aware of this and are unable to change it as it prevents ingress of water, and that a risk assessment was in place. Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 17 A service user who had been recently admitted to Beech said “ I could sing, it’s so nice in this home”. When what they liked, the service user replied, “ for one thing, the views, and the bedrooms, they are so nice, I’m delighted with it.” A new laundry had been provided since the last inspection, which was to a good standard and included machines with sluice cycles. Laundry had been sent to another home during the development of this provision: the group of service users spoken to said that the system was now working smoothly, that very little if anything got lost, and whilst they occasionally had to wait to get something back they really “ couldn’t grumble” about it. Service users said that they had clean sheet routinely, every week, and a clean towel every day. The home was clean, bright and free from odour, and a thorough control of infection policy was in place. There was a towel in the bathroom on Beech, which was supposed to be “for show “, that is to make the bathroom appear as normal as possible. It was on a high shelf, but was not neatly folded and appeared to have been used. It was removed immediately once attention was drawn to this. Service users reported that they did not like the hoist seat in the bathroom on Cedar unit, which sometimes got stuck as they were being moved by a carer, which unnerved them. This was inspected, and staff explained that the hoist was somewhat stiff, and sometimes they were unable to make the adjustment for it to turn smoothly first time. Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 18 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 Sound recruitment measures, good supervision and comprehensive training programmes support staff who demonstrated high levels of motivation and commitment to their work with service users. EVIDENCE: Service users on Cedar thought that there were not always enough staff. In particular, one said that they used to get taken out in a wheelchair occasionally, and although they are taken down to the garden sometimes they do not get taken out like they used to. The residents also were aware that sometimes they stipulated the time they wanted to go to bed, and staffing meant that they had to wait for a carer. The other way in which pressures manifested was when they wanted to go to the toilet or get off the toilet and had to wait for assistance. A carer acknowledged that they did sometimes get the “ring of confidence”, a faint imprint of the toilet seat on these occasions. The carer also said that sometimes a service user wanted to go to bed at a stipulated time that it was not possible to meet, as they were attending to another service user. One of the service users, who was very frail and did not converse easily or without effort, however, was keen to add to this discussion, “ They are really nice people, you couldn’t ask for better, I mean it.” The manager advised that there had been some staffing pressures, and that a recently recruited member of staff had decided not to stay as they had to work Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 19 across the home, rather than on just the new unit. There had also been some pressures on the nursing staff, including a reduction in nursing staff provided and sickness. There was no Nurse Team leader post at the time of the inspection. Further interviews for care staff were scheduled to take place. The home was adequately staffed on the day of the inspection. There was one agency staff on duty on the afternoon of the inspection, and had been using dedicated agency staff to provide support to the nursing compliment. Although the new dementia unit was not full, it had the full staffing compliment. Induction and foundation training is delivered to all new staff who do not hold an NVQ. Evidence of induction was seen on the file of a recently recruited staff member, and a separate file of induction, foundation and NVQ records was seen. Records of all staff training were available and well organised, but a training analysis had not been drawn up, so it was not possible to identify any shortfalls within the time available. Evidence of a recent PoVA course, provided by the manager and senior team leader, by video and discussion for staff was available. The Manager and assistant manager did not have information regarding the training undertaken by the nursing staff, which is funded by the trust, and the nursing staff spoken with were unsure how the manager would know what ongoing and up dating training they had received. Although one of the nurses advised that they had received PoVA training, the homes management were unable to provide evidence of this. A schedule of manual handling training for care staff including updates and planned up dates was available, and showed this to be on line. Service users on Cedar, who, as noted under the environment section of this report did not like the bath seat – which stuck on occasions, were very clear that despite this they had confidence in the staff and their ability to handle them safely. One said, “ they are all different, but all very good.” The manager advised that all care staff who work on the ground floor, are Unisafe trained, to level two, and that six refreshers a year are provided. A member of care staff spoken with confirmed that they had received this. Two nurses spoken with advised that they received training through the health service that was not Unisafe, but was equivalent. They confirmed the manager’s advice that efforts had been made over the years to seek to combine the training for carers and nurses so that they all were working with the same philosophy, but that this had never been achieved. Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 20 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): 32, 36, 37, 38 Good quality control systems are in place to monitor the impact of the service on the well being of service users with dementia. The joint management of the home with nurse led care on the ground floor has posed challenges for the Management team which were being addressed, and was not found to be negatively impacting on service users. EVIDENCE: The home’s business plan for 2004/5 was still current, and the manager advised that the home is aiming to produce the next one at the end of 2005. The manager advised that the different terminology, training and culture of the care staff and the nursing staff, and the reduction of nursing input was challenging for all workers, this was confirmed by nursing staff and apparent in the clarification that was required in the inspection process around different Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 21 types of notes, reviews and categories of care. The manager was also expecting to receive a written complaint regarding how a recent practice issue concerning nursing staff hade been addressed. Despite these difficulties all staff spoken with demonstrated good knowledge of service users needs and a strong commitment to their work. The manager advised that the current structure was being reviewed by the provider’s senior management, and notes of a meeting concerning this were seen. As noted elsewhere in this report, Dementia mapping, a person centred quality assurance measure had been carried out in May 2005. An analysis of incidents reported over the last three years, involving employee’s service users and others showed a significant drop in the number of incidents involving staff over this period. The atmosphere on Beech, the new dementia unit, and Cedar, one of the older people’s units was found to be remarkably good. Service users on Cedar, when asked what they liked best about the home, said that the staff and the residents were “what made it”. Supervision records of two care staff chosen at random were inspected and two care staff were spoken with about the frequency and content of supervision. Supervision was found to be on line with the standard. One of the carers advised that in addition to regular supervision, that if they had any problems they can always ask to speak with the senior team leader, and that this was helpful as they found she always acted immediately on any decisions made. Records seen were generally in good order, but three omissions were noted; one compass assessment of five seen had not been dated and one personal possessions list had not had the name of the person competing it entered. One CPA review that took place in September had not been written up. A record of servicing of Gas installations was seen. Records of temperatures for fridge, freezer, hot trolley and meats were seen to be kept. A programme of works to put all fire doors on automatic closures, linked to the fire alarm is due to commence in December. No doors were found propped open on the day of the inspection. Service users spoken to confirmed that they heard the fire alarm go off on a regular basis for a drill, and described what happened. Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 22 A kitchen cleaning product which states that medical assistance must be sought if ingested, was in an unlocked cupboard on the new dementia unit. This was removed immediately. A new certificate of registration had recently been issued to the home: the document on display was the accompanying letter rather than the certificate. It was unclear how this situation arose. Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 23 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 2 2 3 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 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 2 X 3 3 3 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 X 2 X X X 3 2 3 Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 24 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 2 3 4 Standard OP1 OP2 OP7 OP19 Regulation 5(2) Requirement Timescale for action 30/11/05 15/12/05 30/11/05 15/12/05 5 OP4 The Service User’s Guide must be supplied to all service users. 5(1) An appropriate contract for service users admitted for respite care must be provided. 12(1) Service Users reviews should be available on file in a timely manner. 23(2)(a) Action must be taken to minimise the risk of tripping presented by a small lip on the doorway to the sensory garden which represents a tripping hazard. Reg on The home is operating outside of Regs 2001 the category and must provide details to the CSCI of the number of service users who fall outside of the current registration, and any legal status that applies. 30/11/05 Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 25 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 OP4 Good Practice Recommendations Discussion, communication and forms pertaining to the newly converted unit for older people with dementia should reflect that this unit specifically cares for older people with dementia and not after mental health care needs. The complaints log should include the outcome. A hoist which staff can reliably use without it stalling must be provided in the bathroom on Cedar unit. A standard lamp to provide adequate lighting for service users to do fine work or read should be provided in the residents lounge on Cedar unit. Staffing levels must be maintained and dependency levels of service users monitored to ensure levels remain adequate. A training analysis which includes care staff and nursing staff should be drawn up. Records should be dated and signed and available in a timely fashion. 2 3 4 5 6 7 OP16 OP21 OP25 OP27 OP30 OP37 Glastonbury Court DS0000037079.V265293.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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