Inspection on 28/07/05 for Howard Court Nursing Home

This inspection was carried out on 28th July 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

Howard Court Nursing Home 26/03/09

Howard Court Nursing Home 05/11/07

Howard Court Nursing Home 18/12/06

Howard Court Nursing Home 05/10/05

Howard Court Nursing Home 20/01/05

Howard Court Nursing Home 15/07/04

Howard Court Nursing Home 11/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Howard Court Nursing Home 9 Burlington Road Ipswich Suffolk IP1 2EU Lead Inspector Jane Higham Unannounced Inspection 28th July 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Howard Court Nursing Home DS0000024421.V253010.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. Howard Court Nursing Home DS0000024421.V253010.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Howard Court Nursing Home Address 9 Burlington Road Ipswich Suffolk IP1 2EU 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) 01473 210787 01473 233619 BUPA Care Homes Limited Mrs Audrey Sayers Care Home 40 Category(ies) of Dementia (40) registration, with number of places Howard Court Nursing Home DS0000024421.V253010.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th January 2005 Brief Description of the Service: Howard Court is a forty-bedded nursing home for older people suffering from severe mental infirmity and is located with a residential area of Ipswich, close to the town centre and all its facilities and resources. Originally owned by the local authority, the home now forms part of the BUPA care group and was registered under the name of this organisation in December 1994. The home has twenty-six single bedrooms and a further seven shared rooms. Howard Court Nursing Home DS0000024421.V253010.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced Inspection of Howard Court, a forty bedded residential home with nursing for older people suffering from severe mental infirmity. This was the first scheduled inspection in the inspection year 2005/2006. The inspection took place on 28 July 2005 over a period of four hours. The inspection was facilitated by the Registered Manager. During the inspection, feedback was actively sought from service users. However, due to impaired cognitive ability it was very difficult for residents to comment on the quality of care provided at the home. However, throughout the inspection, residents appeared happy and relaxed. Several staff members were spoken to during the inspection as was a visiting GP. Requirements from the previous inspection had been addressed within the timescales set. In addition to assessing required records and documentation an environmental tour of the building was carried out. Unfortunately on the day of the inspection, no visiting family members were available to speak to. What the service does well: What has improved since the last inspection? Since the previous inspection a more organised approach has been adopted towards the provision of activity to residents and the home now ensures that activity is provided on a daily basis in addition to the various functions that are held such as the forthcoming summer fayre. Whilst during the previous inspection the staffing level was running at a lower rate than required, the home has since ensured that an adequate “pool” of staff is available to cover sick and annual leave. Wheelchairs are no longer stored in communal bathrooms. Howard Court Nursing Home DS0000024421.V253010.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. Howard Court Nursing Home DS0000024421.V253010.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 Howard Court Nursing Home DS0000024421.V253010.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): 2, 3, and 6 Residents being admitted to the home can expect to be provided with a placement contract which sets out the financial contributions of each party. However, residents can not necessarily expect to be provided with a copy of the terms and conditions of placement unless they are privately funded. Prospective residents will have their individual needs assessed prior to moving into the home, although information on assessed needs determined by Social Care personnel will not necessarily have been gained. The home does not offer an intermediate care service. EVIDENCE: As part of the inspection, the documentation relating to the two most recently admitted residents was examined. The home was able to evidence that in both cases service users were issued with a placement contract. However it was noted that residents who were placed via the local authority did not receive a statement of the terms and conditions of residence. It was agreed that regardless of whether residents are funded privately or via the local authority Howard Court Nursing Home DS0000024421.V253010.R01.S.doc Version 5.0 Page 9 all should be provided with information about the terms and conditions of residence. Whilst in all cases the Management of the home carries out their own preadmission assessment in relation to prospective residents, as in previous inspections the home was not ensuring that a copy of the Community Care Assessment was received prior to admission in the case of prospective residents being placed via the Social Care Services Dept. Howard Court Nursing Home DS0000024421.V253010.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 10 and 11 Residents can expect to be provided with an individual plan of care which correctly reflects their care needs and is reviewed regularly. Residents can also expect to have both their physical and mental health care needs met and wishes in relation to their death carried out. Residents could not necessarily expect to have their privacy protected. EVIDENCE: Care Plans for the two most recently admitted residents were examined during the inspection. These documents were detailed in their content and gave a clear picture of the assessed needs of each person and what interventions were required to ensure that these needs were met. The home was able to evidence that individual risk assessments were completed as part of the care planning process and that areas of risk assessed for each person involved the risk of falling, moving and handling and nutrition. It was noted however that the nutritional assessment for one service user did not correctly reflect their current poor dietary intake and required reviewing and amending. A detailed care plan is also produced in relation to the administration of medication for each person and identifies interventions required to ensure that each resident receives their medication safely. A “pen picture” of the diagnosis and basic Howard Court Nursing Home DS0000024421.V253010.R01.S.doc Version 5.0 Page 11 care needs of each resident is completed and helps to ensure that if a resident is admitted to hospital that their care needs will continue to be met. Records seen evidenced that resident care plans were reviewed on a regular basis and amendments made in line with the changing needs of individuals. Care planning documentation and daily records evidenced that both the mental and physical health needs of residents are monitored and that any medical interventions are carried out by the trained nurses of by community health staff such as GPs. On the day of the inspection, a visiting GP was asked for his feedback in relation to the care offered at the home. The GP reported that residents were well looked after and that they felt confident that any concerns raised were dealt with effectively. It was noted however that a member of care staff was heard to ask a visiting GP whether a resident could be seen/examined in the communal dining room. The GP declined this offer and asked to see the resident in their own bedroom. This was brought to the attention of the Manager and it was emphasised that the privacy and dignity of residents must be maintained at all times and all consultations with visiting professionals must take place in the privacy of bedrooms. On the day of the inspection a resident was receiving the services of a community chiropodist in the privacy of their own room. Residents and families wishes following death are recorded and on the day of the inspection, the funeral cortege of a resident who had recently passed away was leaving from the home. The Inspector was informed that the Wake was to be held there later in the day on the wishes of the family who had regarded Howard Court as the late resident’s home. Howard Court Nursing Home DS0000024421.V253010.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, and 15 Residents accommodated at the home can expect to be provided with a range of activities which are appropriate to both their physical and mental abilities. Residents can also expect to be provided with a range of meals which are both nutritious and varied and to receive assistance with eating where required. EVIDENCE: On the day of the inspection, a weekly activities plan was posted on the resident noticeboard advertising such daily activities as nail and handcare, reminiscence, “sing along” and dominoes. Forthcoming events were also advertised and these included a summer fayre at the beginning of August, a coffee morning and a resident’s support group. Whilst the appointed activities co-ordinator was on sick leave, the home had ensured that a member of the care staff had been provided with additional hours to ensure that residents received meaningful activity on a daily basis. Since the previous inspection a more organised approach has been adopted to this area of service provision. Later in the day it was noted that some residents were enjoying an activities session with “play doh”. The variety of meals provided to residents was examined as part of the inspection. Menus seen evidenced that residents are provided with a range of meals which are both nutritious and varied. On the day of the inspection, Howard Court Nursing Home DS0000024421.V253010.R01.S.doc Version 5.0 Page 13 residents were being offered the choice of a Pork Casserole or tagliatelli for the mid-day meal. In addition to the two choices offered there are a standard range of alternatives which are available every day. It was noted that lunch was undertaken in a calm and pleasant atmosphere. Food was served from a hot trolley which had been brought to the dining room and residents were able to serve themselves to vegetables which has been provided in dishes, placed on each table. Whilst some residents had to have liquidized meals, each component was liquidized individually so that the resident could still enjoy the different colours and tastes. Two residents were being assisted to eat by care staff. The chef advised that the home was introducing more fresh juices, such as cranberry, to the diet of residents. Training in relation to nutrition and dementia was discussed with the chef. Howard Court Nursing Home DS0000024421.V253010.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. Residents can be assured that any complaints or concerns raised will be investigated by the home and actioned. Residents can expect to be provided with appropriate information which will enable them to make a complaint should the need arise. EVIDENCE: The home was able to evidence that all complaints received from service users, family members or any visitors to the home are recorded in the complaints log. This log provides details on the nature of the complaint, the investigations carried out and the outcomes reached. The home has a detailed complaints procedure which was displayed on the resident noticeboard and therefore accessible by all residents, staff members and visitors to the home. BUPA complaints leaflets were also available and provided a detailed breakdown of each stage of the company’s complaints procedure and the contact details for the Commission for Social Care Inspection. Howard Court Nursing Home DS0000024421.V253010.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Residents can expect to live in a comfortable environment and be provided with both private and communal space which is in general well maintained. Residents and their families can expect to be actively encouraged to bring their own possessions with them and to make their private space as personal and homely as possible. Some areas of the building require minor redecoration and two areas require attention to odour control. Residents can expect to be provided with a safe environment, with the exception of one corridor area which requires improved lighting. EVIDENCE: Accommodation within the home is sited on two floors, both of which are accessible via a passenger lift. There is a good provision of communal accommodation which includes two large lounges to the front of the property and communal seating areas which are sited by the lift entrance on both floors. There is a spacious dining room with additional lounge seating which has large picture windows giving a clear view of the attractive gardens. The gardens were secure and safe for residents to access independently and had a gazebo, Howard Court Nursing Home DS0000024421.V253010.R01.S.doc Version 5.0 Page 16 raised flower beds and garden furniture. The home has 26 single bedrooms, 17 of which have ensuite facilities and a further 7 shared rooms, 4 of which have ensuites. On the day of the inspection, an environmental tour was undertaken. The majority of bedrooms seen were maintained to a good standard of decorative order and repair and many had been made to look very homely with the addition of personal belongings, paintings and family photographs. However, it was noted that some bedrooms had flaking paintwork and torn wallpaper that required attention. In addition to the ensuite facilities available the home has an adequate number of communal assisted bathrooms to meet the needs of residents. Since the previous inspection toilet facilities near to the lounge and dining room had been completely refurbished. It was noted that the home uses “dementia friendly” fittings such as the bright red toilet seats provided in the new toilets to aid orientation and recognition. The home has a continued plan of refurbishment and renewal and since the previous inspection, the main hallway had been recarpeted. Unfortunately in June this was damaged by flooding and now requires further replacement. Whilst it was noted that some corridor areas were in need of decoration, work had already commenced on stripping old paintwork. On the first floor of the home a very pleasant seating area had been created on the large landing which including good quality carpeting and attractive and comfortable lounge furniture. Whilst in general the home was maintained to a good standard of cleanliness and hygiene, it was noted that an unpleasant odour was present in one bedroom and in one of the main lounges. The manager advised that the lounge was due to be recarpeted at the end of August 2005 which may well address the problem. It was also noted that the staff toilet was not maintained to an acceptable standard of cleanliness and decorative order. The Manager advised that this staff facility was due for redecoration in the near future. It was noted that some corridor areas would benefit from redecoration and that the corridor near to bedroom 28 was unlit and had very poor natural light, thus presenting a health and safety hazard both to service users and staff members. A staff member spoken to felt that the quality of the environment provided had improved over recent years. Howard Court Nursing Home DS0000024421.V253010.R01.S.doc Version 5.0 Page 17 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, 29 and 30 Residents can expect to be cared for by a staffing level which is appropriate to meet their individual needs and which ensures their safety. Residents can expect to be protected by the home’s robust recruitment procedure and to be cared for by staff who receive appropriate training in order to carry out their work. EVIDENCE: On the day of the inspection, the registered manager was on duty, assisted by the deputy manager who has two shifts a week as supernumerary to the staffing rota. Throughout the waking day there are two trained nurses on duty. During the morning period the trained nurses are assisted by six care staff, decreasing to four care staff in the afternoon. During the night period residents are attended to by two trained nurses , assisted by two members of care staff. As part of the inspection, the personnel files of the two most recently employed staff members were examined and were found to contain all the necessary documentation including two written references obtained prior to the prospective staff member commencing duties. The home was also able to evidence that all newly employed staff members are subject to a POVA check and Enhanced Disclosure via the Criminal Records Bureau. Training records seen evidenced that all staff undertake a three day induction programme before they are permitted to work directly with residents. An Howard Court Nursing Home DS0000024421.V253010.R01.S.doc Version 5.0 Page 18 outline of the Induction programme evidenced that it was comprehensive and included areas such as Abuse Awareness and Moving and Handling training. All staff members undertake Induction and Foundation training which complies with TOPPS standards and is provided by BUPA in the form of a “work-pack” which on completion is assessed by the deputy manager. Eight staff had also undertaken a BUPA dementia training course which is recognised by the Alzheimer’s Disease Society. Howard Court Nursing Home DS0000024421.V253010.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 38 Residents can expect to live in a home which is well run and professionally managed. In general the health and safety of residents is protected, although one area in relation to adequate lighting requires attention. EVIDENCE: On the day of the inspection, it was confirmed that the registered manager of the home had recently completed the Registered Manager’s Award and was also about to undertake a three-day training course on dementia in association with Sunderland University. Residents are provided with a safe environment and a risk assessment is completed for each person which looks at how to minimise risk in relation to areas such as falls. Each resident is assessed to relation to their moving and handling needs. The building and gardens were maintained to a safe standard apart from one corridor area which was unit and provided little natural light. Howard Court Nursing Home DS0000024421.V253010.R01.S.doc Version 5.0 Page 20 On the day of the inspection, a health and safety meeting was being held involving key personnel within the home. Howard Court Nursing Home DS0000024421.V253010.R01.S.doc Version 5.0 Page 21 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 X 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 3 3 3 3 3 2 2 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 2 Howard Court Nursing Home DS0000024421.V253010.R01.S.doc Version 5.0 Page 22 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 OP2 Regulation 5(1)(b) Requirement The Registered Persons must ensure that each resident is provided with a copy of the terms and conditions of placement, regardless of whether they are privately funded or funded via the local authority. The Registered Persons must ensure that nutritional assessments carried out as part of the care planning process for individual residents correctly reflect their dietary intake and requirements and that the assessment is reviewed and amended as required. The Registered Persons must ensure that arrangements for health and personal care promote the dignity and privacy of residents. The Registered Persons must ensure that flaking paintwork and torn wallpaper in some bedrooms is attended to. The Registered Persons must ensure that the corridor near to bedroom 28 is provided with DS0000024421.V253010.R01.S.doc Timescale for action 01/12/05 2 OP8 14(2)(a) 28/07/05 3 OP10 12(4)(a) 28/07/05 4 OP19 23(2)(b) 01/12/05 5 OP25 23(2)(p) 01/12/05 Howard Court Nursing Home Version 5.0 Page 23 6 OP26 23(2)(d) 7 OP26 16(2)(k) adequate lighting The Registered Persons must ensure that the staff toilet is maintained to a satisfactory standard of cleanliness and decorative order. The Registered Persons must ensure that unpleasant odours identified in the main lounge and one bedroom are identified and eliminated. 01/12/05 28/07/05 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 OP3 Good Practice Recommendations The Registered Persons should ensure that the home receives a copy of the Community Care Assessment prior to the admission of prospective residents placed by the local authority. Howard Court Nursing Home DS0000024421.V253010.R01.S.doc Version 5.0 Page 24 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. Extracts may not be used or reproduced without the express permission of CSCI Howard Court Nursing Home DS0000024421.V253010.R01.S.doc Version 5.0 Page 25 - 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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