Inspection on 05/10/05 for Howard Court Nursing Home

This inspection was carried out on 5th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 28/07/05

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 Announced Inspection 5th October 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.V257894.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.V257894.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.V257894.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28 July 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 within 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.V257894.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Announced Inspection of Howard Court, a forty bedded residential home with nursing for older people suffering from severe mental infirmity. This was the second scheduled inspection in the inspection year 2005/2006. The inspection took place on 5th October 2005 over a period of six hours. This report should be read in conjunction with the Unannounced Inspection report dated 28 July 2005. All core standards have been assessed over the two inspections. The registered manager, Mrs. Audrey Sayers, helped with the inspection process. Information contained within this report is taken from the submitted pre-inspection questionnaire, discussions with the manager, staff, residents and family members and from eleven relative/visitor comment cards returned to the Commission before the inspection took place. Due to severe mental frailty it was difficult for residents to comment on the quality of the service, although throughout the inspection service users appeared happy and relaxed and were interacting well with staff members. What the service does well: What has improved since the last inspection? Over the last year the home has adopted a much more pro-active approach to the provision of appropriate activities for residents. Again relevant training undertaken by the Manager and staff in dementia care has informed practice in relation to this area of service provision. The owning organisation continues with its plan of improvement to the environment and several communal areas have benefited from redecoration. The Manager has instigated several smaller changes within the environment which has provided additional stimulus for residents and a more homely atmosphere. Howard Court Nursing Home DS0000024421.V257894.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.V257894.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.V257894.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 and 2 Residents and their families are provided with appropriate and detailed information on which they can base a decision about whether they wish to live at the home and whether their needs will be met. At the present time not all residents and/or their representatives can expect to be provided with a copy of the terms and conditions of their placement. EVIDENCE: The home was able to evidence that it has produced a “Welcome” pack for all newly admitted residents and their families. Information contained within the Service User Guide complies with the requirements made under Regulation 5 of the Care Homes Regulations 2001. A Statement of Purpose is also included in the “Welcome” pack and at the time of the inspection was in the process of being updated to include the registered manager’s qualifications. A copy of the home’s Statement of Purpose is also placed in the relative’s “resource” file which is sited in the main dining room. In the previous inspection it was identified that those residents placed via the local authority do not receive a document which details the terms and Howard Court Nursing Home DS0000024421.V257894.R01.S.doc Version 5.0 Page 9 conditions of their residence. The manager advised that this matter was being dealt with by BUPA’s legal department who were working towards issuing a terms and conditions document which would cover both local authority and private placements. Howard Court Nursing Home DS0000024421.V257894.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): 8, 9 and 10 Residents can expect to have their health needs fully met, inclusive of diet and nutrition. Residents can now be assured that practices within the home will promote their privacy and that they are protected by the home’s policies and procedures for the administration and safe keeping of medication. EVIDENCE: In response to a requirement made during the previous inspection, the home is now able to evidence that all staff have received specific training in nutritional assessment care planning and these records are now reviewed and kept up to date. Additionally the home was able to evidence that all staff are to undertake a training session from a dietician at Ipswich Hospital on “Screening for Malnutrition”. These sessions are to be held at the home during October 2005. Again, in response to a requirement made at the previous inspection, the Manager of the home has re-iterated with staff that all medical consultations are to be carried out in the privacy of resident’s bedrooms. As part of the inspection process the systems used for the administration and safe keeping of medication were examined. The home has a clear and detailed Howard Court Nursing Home DS0000024421.V257894.R01.S.doc Version 5.0 Page 11 written medication procedure, providing guidelines on how medication is to be administered to residents. Medication is pre-dispensed into dosset boxes and stored in two separate “fit for purpose” trolleys. Medication administration for two residents was examined as part of the inspection process. Administration records were maintained and correctly reflected the drugs and dosages indicated on the reverse of each dosset box. The home was able to evidence that the systems used for both storage and administration were secure. A medication care plan is produced for each resident which also includes a current individual photograph as an additional safety measure. Controlled drugs were stored securely and appropriate records maintained. Howard Court Nursing Home DS0000024421.V257894.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 and 14 Residents can expect to be provided with a range of leisure activities which are appropriate to their needs, enjoyable and therapeutic. Residents can also expect to be enabled to maintain contact with family members and friends and to be supported to use community resources where appropriate. EVIDENCE: The provision of appropriate activities for residents was assessed as part of the previous inspection and this standard was found to be met. During the afternoon of this inspection, residents were being entertained by a musician who makes regular visits to the home. The musician played both the electric organ and guitar and encouraged residents to play simple instruments such as bells and “shakers”. The whole entertainment session was extremely vibrant and it was clear to the observer how much residents had enjoyed the music. Many of the residents got up to dance and even those people with very severe mental infirmity responded positively to the songs being played. Many of the staff on duty were taking part in the session, positively encouraging residents to participate and giving out fruit and sweets. It was clear that residents had positively benefited from this session and staff should be commended on their pro-active approach and interaction with residents. Howard Court Nursing Home DS0000024421.V257894.R01.S.doc Version 5.0 Page 13 The inspector noted that an “interest area” with the theme of “Sports” had been created in a small corridor on the ground floor of the home. Various items of sports equipment had been mounted on the wall including a cricket bat, stumps and golf clubs and acted as a stimulus and conversation point for residents. The home has an open visiting policy and on the day of the inspection several visitors arrived in the home and took part in the music session in the afternoon. Some personal photographs of residents on special occasions are displayed within the building. For example there was an old photograph of one resident meeting a member of the royal family. The Manager advised that a recently arrived vicar from the local parish had agreed to visit the home and provide a monthly service. Where appropriate, residents can access local community facilities and resources like, for example, shops and cafes with support from staff members or family and friends. Despite severe mental frailty residents are encouraged by staff to make choices around what and where they would like to eat and to express choices in relation to preferred routines. In order to further enable residents to make informed choices about the meals they would like to eat, the Inspector suggested the use of digital photographs of meals on offer each day. Howard Court Nursing Home DS0000024421.V257894.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 and 18 Residents can be assured that any complaints or concerns raised will be investigated by the home and actioned. Residents and their families can expect to be provided with sufficient information which will enable them to make a complaint should the need arise. Residents can further expect that the home’s policies and procedures protect them from abuse. EVIDENCE: The home was able to evidence that it has a copy of the joint health and social services local procedure on the Protection of Vulnerable Adults. Staff training on the recognition and reporting of abuse is provided on a yearly basis and is also covered in the BUPA Induction training for all newly employed staff. The Manager reported that scenarios in relation to suspected abuse are used as part of the interview process for prospective staff members. In addition to the home’s complaints procedure, which is available to all residents and their families, a copy is displayed within the home. The home was able to evidence that it takes a very pro-active approach to the receipt of any complaint. Complaints are recorded on an individual log sheet which provides a clear audit trail of investigations carried out, outcomes reached and feedback provided to the complainant. The record of complaints evidenced that all complaints which are received by the home, no matter how small are investigated and addressed. Howard Court Nursing Home DS0000024421.V257894.R01.S.doc Version 5.0 Page 15 Since the previous inspection, no complaints have been received by the Commission in relation to this service. Feedback contained within relative/visitor comment cards returned to the Commission prior to the inspection indicated that a high percentage of respondents were not aware of the home’s complaint procedure. Howard Court Nursing Home DS0000024421.V257894.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, 22, 23, 25 and 26 Residents can expect to be provided with accommodation which is maintained to a good standard of decorative order and repair and is clean and pleasant. Residents can also expect the home to be maintained in a safe manner which does not pose a risk to their health and safety. Residents are provided with sufficient bathroom facilities to meet their personal care needs. EVIDENCE: Accommodation within the home is sited on two floors both of which are accessible via a passenger lift which is sited centrally. Since the previous inspection several improvements have been made to the environment and have been influenced by current training in dementia care by both the manager and staff. Additional pictures and pendulum clocks have been added around the building and communal bathrooms have been brightened with the addition of tile transfers. Additional stimuli such as light and bubble tubes have been added to one of the main lounges and the other lounge has recently benefited from new carpeting and is due for redecoration in the near future. Howard Court Nursing Home DS0000024421.V257894.R01.S.doc Version 5.0 Page 17 New carpeting has also been provided throughout all ground floor corridor areas. Both communal lounges are comfortably and attractively furnished and one is equipped with a wide screen television. Additionally there is a spacious dining room which overlooks the gardens and also provides additional lounge furniture. Comfortable and pleasant seating areas have also been created within hall areas sited by the main passenger lift on all floors. The home has very pleasant gardens which are freely accessible to residents and equipped with appropriate furniture and raised flower beds. The home has 26 single bedrooms, 17 of which have ensuite facilities and a further 7 shared bedrooms, 4 of which have ensuites. In addition to these bathroom facilities the home has an adequate number of communal bathroom and toilet facilities to meet the needs of residents. Since the previous inspection, the staff toilet has been redecorated and refurbished and is now maintained to a much improved standard of hygiene. Lighting within communal areas has been improved. A weekly audit of residents’ accommodation is carried out and repairs or decorative requirements are noted. At the time of the inspection all bedrooms which require redecoration have been identified and the Manager advised that these rooms will be redecorated following the work being carried out in one of the communal lounges. In general terms the home is maintained to a good standard of decorative order and repair, is comfortably and appropriately furnished and maintained to a good and improved standard of hygiene. It was noted however that ground floor corridor areas in the buildings extension would now benefit from redecoration. No unpleasant odours were detected. The Manager should be commended on the work that she has done to make the environment more attractive and dementia friendly. One family member visiting on the day of the inspection commented that currently there were fewer unpleasant odours and that the Manager had done a lot of little things to make the environment more pleasant for its residents. Howard Court Nursing Home DS0000024421.V257894.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 and 30 Residents can expect to be cared for by a level of staffing which ensures that their individual needs are met. The level of National Vocational Qualifications (NVQ) amongst care staff remains low at the present time. However, residents can expect to be cared for by staff who have received training in the care of people with dementia. EVIDENCE: On the day of the inspection, the home was being staffed by two trained nurses who were supported by seven members of care staff. During the afternoon period, the staffing level decreases to two trained nurses supported by four members of care staff and at night there are two trained nurses supported by two members of care staff. An additional member of care staff was in attendance on the morning of the inspection offering support to a colleague. Staffing rotas seen on the day of the inspection correctly reflected the number of staff on duty. In addition to the staff offering direct care and nursing to residents the home employs housekeeping staff, a laundry assistant, maintenance personnel, an activities co-ordinator, a chef manager and a kitchen assistant. At the time of the inspection, only one member of care staff had achieved an NVQ qualification. However, the Manager advised that four care staff were currently working towards NVQ Level 2 and one was working towards NVQ Level 3. Seven members of care staff will be commencing NVQ qualifications Howard Court Nursing Home DS0000024421.V257894.R01.S.doc Version 5.0 Page 19 at the end of the year. If all these candidates are successful and the current staff remain in the employ of the home, a ratio of 50 of staff will have achieved an NVQ qualification by 2006. One relative spoken to at the time of the inspection reported that they believed there were sufficient staff to meet the needs of residents and that in their opinion staff were both kind and approachable. In order to ensure that the special needs of residents suffering from dementia are met, the home provides all newly employed staff with a self learning work pack entitled “Understanding Dementia”. Additionally the home has been very pro-active in providing specialist training for staff. Seven members of care staff have completed the 3 day level 2 dementia training accredited by the Alzheimer’s Disease Society and five members of trained staff are in the process of completing assignments for the Level 3 dementia course. The dementia training course is affiliated to the University of Sunderland. Howard Court Nursing Home DS0000024421.V257894.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): 33, 35 and 38 Residents and families can expect their opinions on the service to be sought and for the home to have its own quality assurance systems. Residents can also expect that the home’s procedures will safeguard their financial interests and that their health and safety will be promoted and protected. EVIDENCE: Monthly quality assurance visits are made to the home by a representative of the owning organisation in compliance with Regulation 26 of the Care Homes Regulations 2001. A written report of such visits is provided to the Commission. The Manager advised that Relative Support Group meetings are held every six weeks, although these are poorly attended at the present time. The owning organisation carries out an annual satisfaction survey which is distributed to family members and resident representatives. Feedback is then collated, analysed and acted upon where possible. The survey results for last Howard Court Nursing Home DS0000024421.V257894.R01.S.doc Version 5.0 Page 21 year indicated that although families were satisfied with the care received by their family members there was some dissatisfaction with regard to environmental issues. The home has gone some way to addressing these issues throughout this year. The home holds responsibility for the administration and safe keeping of monies for two residents. The home was able to evidence that all transactions made on behalf of these residents are documented and “backed up” by invoices. Charges made for the supply of personal toiletries etc are listed in the Service User Guide and residents who are supplied with these products are issued with an invoice for settlement. Records in relation to the health and safety were examined as part of the inspection process. The home has a very organised approach to the recording of accidents occurring within the home. Accident/incident sheets are completed and those seen at the time of the inspection gave a clear description of what had occurred and documented any action that needed to be taken. The premises received an inspection by the Fire Safety Officer on 13 September 2005. One recommendation was made in relation to an external door and this work has since been carried out. Whilst the home could evidence that a fire risk assessment had been completed in relation to some areas of the home and its current practice, a fire risk assessment in relation to the building was not available for inspection. It was agreed that the manager would contact the fire safety officer for advice on how to carry out and complete this assessment. Fire safety records confirmed that fire alarms and emergency lighting were tested on a weekly basis. Records also confirmed that the siting of fire extinguishers was checked monthly. Howard Court Nursing Home DS0000024421.V257894.R01.S.doc Version 5.0 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 3 2 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 4 2 3 3 3 3 x 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 3 x x 2 Howard Court Nursing Home DS0000024421.V257894.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? YES 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 funded privately or via the local authority. The Registered Persons must now make provision for the redecoration of corridor areas sited in the ground floor extension. The Registered Persons must ensure that a fire risk assessment is produced in relation to the building. Timescale for action 01/12/05 2 OP19 23(2)(d) 31/01/06 3 OP38 23(4)(a) 01/12/05 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 OP14 Good Practice Recommendations The Registered Persons should investigate and consider DS0000024421.V257894.R01.S.doc Version 5.0 Page 24 Howard Court Nursing Home 2 OP16 the use of digitally produced photographs of meals to facilitate those residents with impaired cognitive ability to make choices. The Registered Persons should ensure that the all residents and their families are made aware of how they are able to make a complaint and where they can access a copy of the home’s complaints procedure. Howard Court Nursing Home DS0000024421.V257894.R01.S.doc Version 5.0 Page 25 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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