CARE HOMES FOR OLDER PEOPLE
King Charles Court Marlborough Road Falmouth Cornwall TR11 3LR Lead Inspector
Diana Penrose Unannounced 01 September 2005 09:30 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 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. King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service King Charles Court Address Marlborough Falmouth Cornwall TR11 3LR 01326 311155 01326 319548 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) King Charles Court Limited Mrs Ann Holmes Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (30), Terminally ill of places (30) King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 15/02/05 Brief Description of the Service: King Charles Court is a Care Home located in Falmouth. It is situated above the town, although close to the amenities, many of the rooms have lovely views over the Carrick Roads and Falmouth Docks. The home is registered for up to 30 elderly people requiring personal and/or nursing care. Accommodation is provided on two floors with a stair lift and a shaft lift to access the first floor. All bedrooms have en-suite toilet and washing facilities and all rooms have accessible call bells. There is a large dining room, with a lounge area at one end, on the ground floor; this is next to the kitchen. There is a smaller lounge on the first floor. There is a small kitchenette on the first floor where staff can make drinks and serve snacks for service users. There is a very small garden in the grounds at the back of the home, this is not accessible to service users. There is limited car parking space to the front of the building. Qualified nurses and care staff provide care within a relaxed, friendly atmosphere. There is a qualified nurse on duty at all times and the community nurses visit regularly. Staffing is flexible to meet the needs of service users. There are opportunities for socialising and visitors are openly encouraged. King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited King Charles Court Nursing Home on the 01 September 2005 and spent six hours at the home. This was an unannounced visit. The purpose of the inspection was to gain an update on the progress of compliance to the requirements that were identified in the last inspection report dated 15.02.05. In addition the inspector focused on the following key areas of care: choice of home, assessment and care planning, medications, leisure, complaints, some of the environment, staffing and some management areas. On the day of inspection 27 people resided in the home; one was in hospital. The methods used to undertake the inspection were to meet with a number of residents, visitors, staff, the registered manager and registered provider to gain their views on the services that King Charles Court offer. King Charles Court’s records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. The home has recently been sold and there has been a change in Company Directors. They are reviewing the premises and the operational systems; this report takes this into consideration. Many of the areas for improvement will be addressed following their review. What the service does well:
The home makes every effort to meet the requirements and recommendations set by the Commission for Social Care Inspection. The Registered Manager visits prospective residents whenever possible prior to admission to undertake a needs assessment. The assessment forms the basis of the residents’ individual care plan. There are risk assessments in place for each resident and these are reviewed monthly along with the care plans. Informative daily records are kept for each resident. There is a medicines policy and relevant guidelines and reference books for staff to refer to. A trained nurse administers medicines and appropriate records are kept. The home endeavours to provide activities and trips out to suit the residents accommodated. Residents told the Inspector about recent trip to Perranporth. Visitors said they are welcome in the home at any time and can phone whenever they wish. They said their relatives are treated with care and respect. There is a complaints procedure and the home has received no complaints. The home is clean, comfortable and homely. The bedrooms are individualised with personal possessions. Hand-washing facilities for staff are good and
King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 Page 6 alcohol cleansing gel is provided. Protective clothing is also provided and staff were seen using it appropriately. Staffing levels are suitable and the Registered Manager said that more staff are brought in when the need arises. There is a qualified nurse on duty at all times. The management of the home try to make sure that working practices are safe. Staff have regular training and equipment service checks are undertaken and up to date. Accidents are reported as they should be and audited by the Registered Manager to try and prevent future occurrences. What has improved since the last inspection? What they could do better:
The assessment of prospective residents must be recorded in more detail. There must be further improvements made to the care plans so as to fully inform and direct the staff in all aspects of the residents’ individual care needs. Where it is not possible to obtain the signature of the resident or representative to agree the care plan, the reason should be recorded. The medicines policy requires updating, the Registered Manager said that this would be done as all policies are to be reviewed. The number of tablets remaining in stock should be carried forward when a new medication administration chart is started. The Registered Manager should ensure that Patient information leaflets are supplied for all medicines and it is recommended that they be maintained in a file for reference. There are areas in the home that require some decoration and refurbishment; the registered provider said these would be addressed when the environmental audit has been completed. Lighting must also be addressed as part of the audit as strip lights did not have covers fitted. There must be a review of the storage facilities in the home as some areas are very cluttered and may cause a problem if there were a fire. The Registered Manager must have sufficient time allocated to undertake her management role, she said the whole system is under review and she hopes this will improve. She also hopes that the office arrangements will improve so that she can have more privacy when needed.
King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 Page 7 Formal supervision of care staff should take place six times a year, it is understood that one of the Directors of the Company will be doing this. All staff must attend regular fire training according to the statutory requirements and the Registered Manager must ensure that all staff are aware of the location of the COSHH data sheets. 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. King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 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 standard(s) 1 and 3 Prospective residents are given information about the home enabling them to make an informed decision. Residents are only admitted to the home following an assessment of their needs, however, the pre admission assessment process requires expansion to address all care needs to ensure the home can provide adequate care. EVIDENCE: The home has a statement of purpose and service users guide. These documents are under review due to the change in Company Directors and will be updated. A copy of the new documents will be sent to the Commission. The Registered Manager said she visits prospective residents whenever possible to undertake a needs assessment. This enables her to decide if the service is suitable and can meet the needs of the individual. A specific document is completed which forms the basis of the individuals’ care plan. The Registered Manager agreed that this form requires more detail. King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 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 standard(s) 7,9 and 10 Individual care plans are generated for each resident but do not fully inform and direct the staff in their care provision. There are suitable systems in place for dealing with resident’s medicines although the policy must be updated to fully inform staff and assure residents safety. Systems are in place to ensure that residents are respected and their privacy is upheld and residents benefit from this. EVIDENCE: The residents care plans have been improved since the last inspection and more information is recorded. A nutritional screening tool is used but is being replaced with a more detailed version. Where it is not possible to obtain the signature of the resident or representative to agree a care plan, the reason should be recorded. The daily records are informative but the care staff do not write in them at the moment. Care plans and risk assessments are reviewed monthly. Care plans must be further improved by ensuring all needs are included and that they are more personalised to the individual resident. There is a suitable medicines policy and system in place for the administration of medicines. Storage is safe and secure. All medicines received into the home are recorded in a file. The number of tablets remaining in the pot / box should be carried forward when a new medication administration chart is started. Two members of staff sign transcribing onto the charts. Medicines are suitably
King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 Page 11 disposed of through a waste company. Medicine pots are washed appropriately in the upstairs kitchenette. Patient information leaflets are supplied by the pharmacist for most medicines. The Registered Manager should ensure that Patient information leaflets are supplied for all medicines and it is recommended that they be maintained in a file for reference. The medicines policy requires updating, the Registered Manager said that this would be done as all policies are to be reviewed. The are suitable arrangements for ensuring the residents’ privacy and dignity. Staff were observed to respect residents privacy during the inspection, apart from one isolated incident discussed with the Registered Manager. Residents are addressed by their preferred name. King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 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 standard(s) 12 and 13 The home provides a range of activities and aims to offer a lifestyle that meets individual residents needs. Links with family, friends and the community are good and allow residents the opportunity to socialise. EVIDENCE: A member of the care staff is responsible for co-ordinating activities. There is a four-week programme displayed on a board in the lounge/dining area. Activities include games, bingo, nail painting, art, films and reminiscence. Records of attendance are maintained. Trips out are organised and residents told the inspector about a recent trip to Perranporth. Some residents said there was nothing to do in the afternoons but most were satisfied with the activities provided. There is a record of visitors to the home and there were visitors in the home during the inspection. Residents said they could receive visitors in private and at any time. Residents said they could go out with relatives and friends if they wish. King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 Page 13 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 standard(s) 16 The home has a satisfactory complaints procedure that ensures complaints are listened to and acted upon. EVIDENCE: There is a suitable complaints policy in the home and a method for recording complaints, the action taken and the outcome. There have been no complaints to the home since the last inspection but two complaints have been made to the Commission. The concerns were regarding the attitude of the Registered Manager, care and cleanliness, both were partially upheld. A file is kept for thank you cards and letters; it also includes newspaper cuttings and photographs of special occasions. King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19 and 26 The home and grounds are well maintained however there are areas to be addressed to ensure a safer environment for residents, staff and visitors. The home was clean and on the whole free from offensive odours making it a pleasant place to live in. EVIDENCE: The inspector toured the building and a sample of resident’s private accommodation was inspected. Rooms were decorated to a good standard and personalised, residents spoken with said their rooms were suitable for their needs. The home was clean and comfortable on the day of inspection and every effort was being made to combat a few offensive odours. It was very warm and there were a number of electric fans in use. There are areas in the home that require some decoration and refurbishment; the registered provider said these would be addressed when the environmental audit has been completed. The downstairs corridor was very cluttered with wheelchairs and equipment, which looked untidy but would also be a hazard if there were a fire. One toilet was noted to contain a lot of plastic bags, packets of pads and a dustbin; toilets and bathrooms for use by residents should not be used for storage. There must be a review of the storage facilities in the home. Strip
King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 Page 15 lights must always have covers on them to prevent injury in the event of a tube exploding. Suitable 60-watt bulbs must be used where instant light is required, for example in bedrooms and bathrooms. The registered provider said the light bulbs used were low energy but the equivalent of 60 watt and provide instant light. The homes’ laundry facilities are adequate for the number of residents. There are suitable hand-washing facilities for staff and alcohol hand cleansing gel is used. Protective clothing is provided. King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Staffing levels meet the needs of residents and staff morale appears to be good. EVIDENCE: The Registered Manager said she aims to maintain a care staff/resident ratio of 1:5 although extra staff are brought in if the need arises. There is a qualified nurse on duty at all times. There are two domestic staff, one works in the laundry as well and there are sufficient catering staff employed. A maintenance person is soon to be employed who will work between the two homes in Falmouth run by the directors. The Registered Manager works as part of the care team; she must have sufficient time allocated to undertake her management role. King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Appropriate training is provided and safety checks are undertaken, however more attention must be given to fire training to further ensure the health safety and welfare of residents and staff. EVIDENCE: The management endeavour to ensure that working practices are safe. Relevant service checks take place as required. Staff receive statutory training regularly however all staff must attend fire training, six monthly for day staff and four monthly for night staff. The training records have been updated since the last inspection. There is a person trained in first aid on duty at all times. The kitchen staff have all received food hygiene training and the cook has achieved the Intermediate Food Hygiene Certificate. Accident reporting complies with data protection and the Registered Manager audits accidents in the home every three months. The Registered Manager said that COSHH data sheets are available to staff. The laundry worker could not find any in the laundry during the inspection. The
King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 Page 18 Registered Manager must ensure that all staff are aware of the location of the COSHH data sheets. King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 2 x x x x x x 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 Standard No 16 17 18 Score 3 x x x x x x x x x 2 King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 Page 20 yes Are there any outstanding requirements from the last inspection? 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 3 Regulation 14 Requirement The initial assessment process must be expanded to address all care needs and thus ensure the home can provide adequate care. Care plans must be improved to ensure all needs are included and they are more personalised to the individual service user. The medicines policy must be updated and refer to the ‘The Royal Pharmaceutical guidelines for the administration of medicines in care homes’ There must be a review of the storage facilities in the home Strip lights must always have a cover fitted The Registered Manager must have sufficient time allocated to undertake her management role All staff must attend fire training according to the statutory requirements The Registered Manager must ensure that all staff are aware of the location of the COSHH data sheets Timescale for action 06/03/06 2. 7 15 06/03/06 3. 9 13 06/03/06 4. 5. 6. 7. 8. 19 19 27 38 38 23 13, 23 12, 18 23 13 19/12/05 21/11/05 19/12/05 19/12/05 21/11/05 9. King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 Page 21 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. 2. 3. Refer to Standard 7 9 9 Good Practice Recommendations Where it is not possible to obtain the signature of the resident or representative to agree a care plan, the reason should be recorded The number of service users tablets remaining in stock should be carried forward onto their new medication administration chart . The Registered Manager should ensure that Patient information leaflets are supplied for all medicines and it is recommended that they be maintained in a file for reference Formal staff supervision needs to be implemented and should take place six times a year 4. 36 King Charles Court D52-D04 S9186 King Charles Court V246667 010905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection John keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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