CARE HOMES FOR OLDER PEOPLE
James Hince Court Windsor Gardens Carlton-in-Lindrick Worksop Nottinghamshire S81 9BL Lead Inspector
Richard Ramsden Unannounced Inspection 23rd November 2005 11:00 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 James Hince Court DS0000035527.V262063.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. James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service James Hince Court Address Windsor Gardens Carlton-in-Lindrick Worksop Nottinghamshire S81 9BL 01909 733821 01909 541108 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) Nottinghamshire County Council Vacant Care Home 45 Category(ies) of Dementia (35), Dementia - over 65 years of age registration, with number (35), Old age, not falling within any other of places category (10), Physical disability (5) James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 35 DE - 55 years and over (to include 35 DE(E) to be accommodated in either Rufford, Carburton, Clumber or Welbeck. 10 OP to include up to 5 PD 55 years and over to be accommodated in Thoresby. The total number of residents must not exceed 45 Date of last inspection 22/06/05 Brief Description of the Service: James Hince Court is a purpose-built, single storey care home, providing personal care and accommodation for 45 residents. It is owned and operated by Nottinghamshire County Council Social Services. The home was opened in 1986 and is located in the middle of a housing estate in the village of Carlton in Lindrick, 3 miles north of Worksop. A day centre is attached to the home and is jointly used by social services and the local health authority as a specialist dementia assessment unit. The home is separated into five units each with its own kitchenette, dining and sitting areas, bathroom and toilet facilities. One of the units is designated to provide respite care. The home is surrounded by well-maintained gardens, which are fully enclosed by fencing and provide a safe area for people to wander freely. James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was completed over one day and lasted for approximately 4 hours. It included the inspection of care and other records, a discussion with the acting manager, one team leader and one of care staff, as well as speaking with two residents and two visitors to the home. A partial tour of the building was also completed. What the service does well:
The residents spoken with during this inspection remain very satisfied with the services provided within the home. They said that staff are always friendly and respectful and that they ensure that their privacy and dignity is maintained at all times. The observed interaction between staff and residents was of a very good standard. One person said how much they enjoyed the activities and outings provided by the home they said that there is always something to keep them busy. People said that their visitors are always made very welcome and two visitors to the home confirmed this. The residents said that the food provided is of a very good standard and that they believe that an alternative would always be provided if they did not want the food suggested on the menu. A visitor stated that he regularly has Sunday lunch with his wife. He stated that the Sunday lunches are so popular that they now have to be booked in advance. Three residents said that they like their bedrooms and there was evidence that people have been encouraged to personalise their rooms with ornaments, photographs and small items of furniture. The premises have been well maintained and were appropriately clean at the time of this inspection. The care plans produced for individual residents are of a very good standard and contains sufficient information to ensure that staff are always aware of what individual support and assistance each resident requires. James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
The literature supplied the prospective residents must contain more detailed information. This will help to ensure that people can make an informed choice as to whether the home will be able to meet their individual assessed needs. The registered person must ensure that the homes call bell system, is fully functional at all times. It would be good practice to ensure that the literature informing residents or their representatives how to contact external advocates is displayed in a prominent position within the home. James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 7 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. James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3. The literature supplied to prospective residents does not contain sufficient information to enable them to make an informed choice as to whether the home will meet their individual needs. Staff are ensuring that prospective residents have their needs fully assessed prior to their admission to the home. EVIDENCE: Following the last inspection a requirement was made that additional information must be included in the literature supply due prospective residents and their representatives. This work should have been completed by the 31st of August 2005. The acting manager stated that this work has not been completed. The records of three residents were assessed as part of this inspection; a pre admission assessment had been obtained for each resident. This has helped to ensure that staff can meet the residents assessed needs and ensure that people are not admitted inappropriately.
James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 10 James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7. Individual residents care plans contain comprehensive information and help to ensure that staff are aware what support and assistance each resident requires at all times. EVIDENCE: Three residents care plans were assessed as part of this inspection, they all contained information detailing what assistance and support each resident required. The care plans had been signed by the resident’s relatives to confirm that they had been included in the planning and review process. (This is considered good practice). The majority of care plans were being reviewed on a monthly basis and where changes were made to the care plans there was evidence that family members had been informed. It was however noted that two care plans had not been updated since September 2005. A member of staff whose responsibility it is to update the care plans, was spoken with during the inspection. She stated that the care
James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 12 plans had been updated but that she had forgotten to sign the appropriate forms. The inspector reminded senior staff that records must be kept up-to-date at all times. James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 13 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): 14,15. Residents are helped to exercise choice and control over their lives. The diet is provided for residents appeared wholesome and nutritious and there were choices of food at each mealtime. EVIDENCE: As far as possible people are encouraged to keep some control over their lives. People are asked at the point of admission and at subsequent reviews if they wish to manage their own finances. However as all the residents have dementia the majority of their families manage people’s finances. There is an information pack in each residents bedroom which includes a copy of Nottinghamshire county councils access to records policy and information on how to contact local advocates. The access to records policy is also displayed on a notice board at the main entrance to the home. The inspector recommended that the information on how to contact advocates have also be displayed in that area. All of the bedrooms viewed during the inspection, contained the resident’s personal possessions.
James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 14 The residents spoken with during the inspection said that they appreciate having their own photographs, ornaments and small items of furniture in their rooms. One person said that this had helped her settle when she initially moved into the home. The meal on the day of this inspection appeared wholesome and nutritious. The residents spoken with during the inspection all said how much they enjoy the meals provided by the home, they stated that alternative food would be provided if they did not want the meal suggested on the menu. One of the relative spoken with said that the meals are of a very good standard and that relatives often have their Sunday lunches at the home. The kitchen was appropriately clean at the time of inspection and the records of food, refrigerator and freezer temperatures had been accurately recorded each day. James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 15 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): X None of these standards were assessed as part of this inspection. EVIDENCE: James Hince Court DS0000035527.V262063.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): 22,23,25,26. The homes call system was not fully operational at the time of this inspection and residents could not access assistance from staff. The resident’s bedrooms suit their individual needs. Since the last inspection, radiator covers have been fitted in all areas to which the residents have access. This has helped to ensure that residents are not at risk of burning themselves. The home was clean and free from offensive odours that the time of this inspection. EVIDENCE: Three residents bedrooms were viewed as part of this inspection. Each room contained personal photographs ornaments and small items of furniture. The residents in these rooms stated that they liked their rooms and confirmed that they could use them at any time.
James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 17 The call bell in one of the bedrooms was tested and after seven minutes had not been answered by staff. The inspector located the senior member of staff who went to investigate why the call bells had not been answered. Two of the pagers which staff carries with them were not working, but these had not been reported as faulty. The acting manager was informed that this is not acceptable. If the resident had required urgent assistance staff would not have responded. When the pagers were checked it became apparent that the batteries needed replacing. These were replaced while the inspector was on the premises. Since the last inspection radiator covers have been provided to the radiators in all the areas to which residents have access. This will help to ensure that residents are not at risk of burning themselves. At the time of inspection the home was appropriately clean and there were no offensive odours. The residents spoken with said that their rooms are cleaned each day. The resident’s relatives spoken with, as part of the inspection said is that they always find the home to be clean and tidy. James Hince Court DS0000035527.V262063.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. The home has sufficient staff on duty, on each shift, to meet the assessed needs of the current residents. EVIDENCE: The senior staff stated that the residents who require the most assistance and support from staff have been relocated into one unit. Additional staff has been provided in this unit to ensure that each residents needs are appropriately met. The rota for the week of this inspection showed that adequate staffing levels are being provided. James Hince Court DS0000035527.V262063.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): 32. Although the home does not have are registered manager the home is being run in the best interests of the service users. EVIDENCE: The acting manager has left the home since the last inspection. At the time of inspection the managerial cover was being provided by two of the team leaders. The residents spoken with during the inspection were not aware that the acting manager was no longer working at the home. The visitors and the member of staff spoken with said that the home has continued to be well managed. One of the visitors stated that the previous acting manager had set systems in place to ensure that residents and their relatives could voice their opinions about the way in which the home functions. He stated that the current managerial cover are ensuring that these systems are still operational.
James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 20 James Hince Court DS0000035527.V262063.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 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x X X X 2 3 X 3 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X X X X X James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 22 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 OP1 Regulation 5 Requirement It is required that the written information provided to prospective residents includes the following information. 1.The qualifications and experience of the staff. 2.The resident’s views of the home. 3.A copy of the most recent inspection report summary. (This requirement is outstanding from 31/08/05). It is required that the registered person ensures that the homes call system is fully operational at all times. Staff must be informed that, if they note that the system is not working properly it is their responsibility to report the fault. Timescale for action 09/01/06 2 OP22 23.2 (c) 23/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 23 No. 1 Refer to Standard OP14 Good Practice Recommendations It is recommended that the literature informing residents/their representatives how to contact external advocates be displayed in the main entrance. James Hince Court DS0000035527.V262063.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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