Inspection on 11/06/07 for Glynn Court

This inspection was carried out on 11th June 2007.

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

Glynn Court 03/05/06

Glynn Court 14/11/05

Glynn Court 04/05/05

Glynn Court 21/12/04

Glynn Court 30/06/04

Glynn Court 04/02/04

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

CARE HOMES FOR OLDER PEOPLE Glynn Court Fryern Court Road Tinkers Cross Fordingbridge Hampshire SP6 1NG Lead Inspector Craig Willis Unannounced Inspection 11th June 2007 9:30 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 Glynn Court DS0000012344.V338715.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. Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glynn Court Address Fryern Court Road Tinkers Cross Fordingbridge Hampshire SP6 1NG 01425 652 349 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) Glynn Court Limited Mrs Sally Crook Care Home 31 Category(ies) of Dementia (31), Dementia - over 65 years of age registration, with number (31), Mental disorder, excluding learning of places disability or dementia (31), Mental Disorder, excluding learning disability or dementia - over 65 years of age (31), Old age, not falling within any other category (31) Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the category MD and DE referred to above are not to be admitted under the age of 55 years. 11th October 2006 Date of last inspection Brief Description of the Service: Glynn Court is a care home providing personal care and accommodation for up to 31 residents who require support due to old age, dementia or a mental health need. The home is owned by Glynn Court Ltd; Mrs Sally Crook is the registered manager and one of the directors. Glynn Court is located in a rural area on the outskirts of Fordingbridge in the New Forest. The accommodation is in two separate buildings. The main building accommodates 23 people on two floors, in both single and shared bedrooms, none of which have en-suite facilities. The second floor can be accessed using stairs or a stair lift. There is a communal sitting room, dining room and conservatory. The second building can accommodate eight people; one bedroom has an ensuite bathroom. The second floor is accessed using a stair lift. The building also contains a kitchen with seating for four and a sitting room. There is a bathroom upstairs. Day and night staff are based in the main building. The home has a large garden, which can be used by the residents. Potential residents are given a brochure and a copy of the home’s Service Users Guide that provide information about the services and facilities provided by the home. At the time of the fieldwork visit to the home on 11 June 2007, the deputy manager reported that highest fee was £545 per week but did not know what the lowest fee was. The fees did not include the cost of hairdressing; newspapers; chiropody and dry cleaning. Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The evidence used to write this report was gained from a review of the information the provider sent to the Commission for Social Care Inspection (CSCI) since the last visit. This information included incident reports, an annual quality assurance assessment and a comment card from one resident. A site visit to the home was made on 11 June 2007. During the site visit the inspector spoke with several residents and observed the interactions between residents and staff. The inspector also spoke with the deputy manager and two members of staff on duty. A tour of the building was made and documents relating to the running of the home were inspected during the visit. A random inspection was carried out on 11 October 2006 to follow up on actions that were required following the previous inspection. It was found that all of these issues had been addressed. What the service does well: What has improved since the last inspection? What they could do better: The care planning and risk assessment systems need to be improved to include details of how staff should meet all of people’s needs. Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 6 Accurate medication administration records need to be kept and medication systems need to be improved to ensure they keep people safe. The provider was told to take immediate action to do this. The manager needs to make sure that the way staff respond to residents who are physically aggressive does not place the resident at risk. The provider was told to take immediate action to do this. The home’s recruitment practices and lack of staff training does not help to ensure residents are protected and needs to be improved. The provider was told to take immediate action to do this. 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. Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems to assess the needs of residents before they move into the home, which assures people that their needs can be met. EVIDENCE: Prior to admission to the home the deputy manager completes a full assessment of prospective residents to ensure that their needs can be met. This covers physical, psychological and cultural needs. Information is obtained from the resident’s family, care manager and health professionals where appropriate. Following the assessment, the manager decides whether or not the home can meet the needs of that prospective resident. The needs identified during this assessment form the basis for the care plans that are written when the resident moves into the home. The assessments were seen in residents’ care Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 9 files for the six residents whose care was tracked. People spoken with said they visited the home before deciding whether to move in. The home does not provide intermediate care and therefore standard six is not applicable. Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care planning system does not provide sufficient information to ensure people’s needs are met safely and the medication practices in the home are not safe and place residents at risk. EVIDENCE: A random inspection visit was carried out on 11 October 2006 to follow up on a requirement made at the previous inspection that written medication procedures must be developed. It was found that this requirement had been met. The care plans of seven residents were viewed during the visit. These documents set out the care staff should provide and were reviewed monthly. Most of the plans contained sufficient information, however, the care plan and risk assessment for one person who could be physically aggressive did not contain specific information on how staff should support them during these Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 11 times. There was also a contradiction between the care plan and risk assessment, with the care plan stating two staff were needed at all times and the risk assessment stating that more than two carers are needed. Staff spoken with said that they had to restrain this person when they are aggressive by holding on to their arms. The care plans and risk assessments did not contain any details of restraint for the person and staff have not been trained in restraint. No records were available of occasions when this person was restrained. As a result of these serious concerns an immediate requirement was made on the day of the visit and followed up by letter to the provider. This required action to be taken to ensure people were not restrained unless it was agreed as necessary by everyone involved in their care, staff are trained and records are kept of all incidents of restraint. All residents are registered with a local GP practice. GPs visit the home when requested by the staff and one was visiting on the day of the visit. Residents’ records showed that they were supported to attend regular health appointments, both in the home and the community. Residents spoken with said they were able to see their GP and other health professionals when they need to. Medication is securely stored in a locked trolley and is supplied in a monitored dosage system. None of the medication that had been administered at 8am on the day of the visit had been signed for by the member of staff responsible. There were also a number of other gaps in the medication administration records for the current month. The deputy manager reported that she and the manager had raised this issue with staff on several occasions but there had been little improvement in practice. The deputy manager also reported that not all staff administering medication have received training as they had not attended sessions that were planned. It was also noted that the medication for one resident was being removed from the packets it was dispensed in and placed in a ‘dossett box’, to be given to them by other staff later in the day. This is classed as secondary dispensing and is deemed to be unsafe practice. Records were available of medication that had been returned to the pharmacist to be destroyed. As a result of the serious concerns about the safety of medication practices, an immediate requirement was made on the day of the visit and followed up by letter to the provider. This required action to be taken to ensure accurate medication records are maintained and staff have received training in the administration of medication. People spoken with said that staff treated them well and provide support in a manner that maintains their dignity. Screening is provided in the double bedrooms and residents are given the opportunity to move into a single bedroom when one becomes available. Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 – 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good support for most people to take part in social activities and further improvements are planned to ensure this meets the needs of all people. A choice of good food is provided and meal times are a relaxed, social occasion. EVIDENCE: The manager reported in the annual quality assurance assessment for CSCI that the frequency of events and entertainment has been increased over the last year and an activities co-ordinator has been appointed. Following feedback from residents, more regular bingo sessions have been organised. The home organises a range of other activities including visiting singers and memory games. The deputy manager reported that it was planned to start one to one sessions for people with dementia who are not able to take part in group activities. People spoken with said they were able to choose whether they took part in the organised activities. People’s spiritual needs are recorded as part of their initial assessment before moving into the home, and they are supported to practise their religion within the home. Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 13 People spoken with said their friends and relatives were able to visit at any time and were made to feel welcome. During the visit a mealtime was observed. Staff were observed providing appropriate support to people who needed help to eat and there was a relaxed and friendly atmosphere in the dining room. People spoken with said that the food was good and that alternative meals would be provided if requested. Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are confident any complaints will be taken seriously and acted upon however, the practices in the home to respond to physical aggression and lack of staff training place residents at risk of abuse. EVIDENCE: A random inspection was carried out on 11 October 2006 to follow up on requirements made at the previous inspection that the complaints procedure must be updated and the manager must obtain a copy of the local safeguarding adults procedures. It was found that these requirements had been met. People spoken with said they know how to complain and expressed confidence that any complaints would be taken seriously and investigated. The manager reported in the annual quality assurance assessment for CSCI that no complaints have been received in the last year. The deputy manager confirmed this during the visit. The manager reported in the annual quality assurance assessment for CSCI that there have been no safeguarding adults investigations in the last year. However, there has been an investigation by Hampshire County Council adults services under the safeguarding adults procedures into whether the home Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 15 could meet the needs of some residents. As reported in the Health and Personal Care section of this report, staff reported that they were restraining one resident, due to physical aggression. No records were available of whether this restraint was agreed or what form any restraint should take and there was no record of incidents where restraint had been used. As a result of serious concerns about this practice a safeguarding adults referral was made to Hampshire County Council adults services on the day of this visit. Records demonstrated that most staff have not received training in abuse and adult protection. The manager reported in the annual quality assurance assessment for CSCI that training in elder abuse is planned over the next year. Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, safe and well maintained, which provides a comfortable and homely environment for people. EVIDENCE: A tour of all the communal areas of the home was made during the visit. The home was clean and smelt fresh throughout and people spoken with said this was always the case. Since the last inspection new carpets have been fitted in some of the bedrooms and people spoken with said that repairs were completed promptly when required. There is a large lounge for residents to use and a dining room, although not all residents can use the dining room at the same time. There is a separate house at the back of the main building, which accommodates eight people. This house has a small kitchen, which is used by the residents and their guests to make drinks and snacks. There is Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 17 also a lounge, although it was being used for storage of spare wardrobes. The provider needs to take action to remove these so that the lounge can be fully used by residents. The home has a separate laundry room, which is fitted with specialist washing machines capable of safely washing soiled clothing. There are suitable handwashing facilities throughout the home. Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s recruitment practices and lack of staff training does not help to ensure residents are protected. EVIDENCE: A random inspection was carried out on 11 October 2006 to follow up on a requirement in the previous inspection that the provider must demonstrate how and when 50 of the staff will achieve the NVQ level 2 or above. This requirement was met. The manager reported in the annual quality assurance assessment for CSCI that one of the twenty three care staff had achieved the award and seventeen were working towards it. On the day of the visit there were six care staff between 8am and 1pm, three between 1pm and 5pm, four between 5pm and 8pm and two between 8pm and 8am. Of the six care staff in the morning, one was the deputy manager who was running the home for the week in the absence of the manager. The deputy manager reported that it was preferable to have seven staff in the mornings, but this wasn’t possible at present due to staff shortages. The deputy manager also said she was in the process of recruiting new staff and did not think the lack of staff was having an effect on the residents, but making things more difficult for staff. Residents spoken with said they felt Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 19 there were enough staff working at all times. In addition to the care staff, there were kitchen and domestic staff. The manager reported in the annual quality assurance assessment that all staff who have worked in the home in the last year have had satisfactory preemployment checks. The recruitment records of four staff were inspected during the visit. Of these four records, two did not contain evidence of a Criminal Records Bureau (CRB) disclosure or Protection of Vulnerable Adults (PoVA) list check. Two of the records contained only one written reference for the staff member, which was a personal reference rather than from the person’s previous employer. As a result of the serious concerns about the safety of recruitment practices, an immediate requirement was made on the day of the visit and followed up by letter to the provider. This required action to be taken to ensure staff do not work at the home unless the provider has completed satisfactory pre-employment checks on them. The home has a training programme in place that includes courses in moving and handling, first aid, health and safety, food hygiene, fire safety and medication. The deputy manager reported that training courses in abuse and challenging behaviour were planned for July and September 2007. Staff have not completed specific training in the care of people with dementia. As reported in the health and personal care section of this report, not all staff administering medication have completed training. Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are systems in place to manage the service and assess the quality of what is provided, however, they are ineffective and have not identified serious shortfalls that place residents at risk. EVIDENCE: The registered manager has trained as a nurse in the past, but is no longer on the register of the Nursing and Midwifery Council. She has managed Glynn Court for approximately 29 years. The manager reported in the annual quality assurance assessment for CSCI that she has created an open, transparent, positive and inclusive environment and atmosphere. Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 21 The home has a quality assurance system and satisfaction surveys of residents are completed. The results of these surveys are collated and used to make improvements to the service, for example, the increase in bingo sessions. The deputy manager reported that a director of the company visits the home to assess the quality of service that is provided, including talking with residents about their experiences. The deputy manager was not aware whether the manager received a report of these visits. These management systems have not identified the serious concerns set out in this report concerning how staff respond to residents who are aggressive, medication practices, staff recruitment checks and training. The deputy manager reported that the home does not hold any money for residents or operate any bank accounts on their behalf. The manager reported in the annual quality assurance assessment for CSCI that equipment in the home such as the fire alarm, electrical systems and heating system were regularly checked and serviced. These records were sampled during the visit and confirmed this. Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 22 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 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 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 3 Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 Requirement The registered person must ensure that care plans contain information about how to meet all the identified needs of residents. Actions that involve physical intervention must be agreed with the resident or their representative and health professionals involved in their care . The registered person must ensure that medication practices in the home are safe, specifically; 1) accurate records must be kept of medication administered to residents; 2) medication must only be administered from the packaging it was supplied in by the pharmacist; 3) staff administering medication must receive training. The registered person must ensure that staff do not work in the home unless they have obtained a full Criminal Records Bureau disclosure or Protection of Vulnerable Adults list check DS0000012344.V338715.R01.S.doc Timescale for action 30/06/07 2. OP9 13 12/06/07 3. OP29 19 12/06/07 Glynn Court Version 5.2 Page 24 4. OP30 18 5. OP30 13 and two written references. The registered person must ensure that staff working in the home receive training suitable to their role. Care staff must receive training in safeguarding adults and care of people with dementia. The registered person must ensure that staff do not restrain a resident in any way unless they have received training and there are clear risk assessments that this is in the best interest and protection of the resident. 31/08/07 12/06/07 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 Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. Extracts may not be used or reproduced without the express permission of CSCI Glynn Court DS0000012344.V338715.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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