Inspection on 14/05/08 for King Charles Court

This inspection was carried out on 14th May 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

King Charles Court 19/11/07

King Charles Court 25/06/07

King Charles Court 13/02/07

King Charles Court 16/02/06

King Charles Court 01/09/05

King Charles Court 15/02/05

King Charles Court 17/08/04

King Charles Court 08/01/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE King Charles Court Marlborough Road Falmouth Cornwall TR11 3LR Lead Inspector Melanie Hutton Unannounced Inspection 14th May 2008 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 King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service King Charles Court Address Marlborough Road Falmouth Cornwall TR11 3LR 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) 01326 311155 01326 319548 kcc@comfortcaregroup.co.uk King Charles Court Limited Manager post vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (30), Terminally ill (30) of places King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service users to include up to 30 adults of old age (OP) Service users to include up to 30 adults under pensionable age with a physical disability (PD) Service users to include up to 30 adults with a terminal illness (TI) Total number of service users not to exceed a maximum of 30 Date of last inspection 19th November 2007 Brief Description of the Service: King Charles Court is a care home with nursing located in Falmouth. It is situated above the town, although close to the amenities. Many of the rooms have views over the Carrick Road and Falmouth Docks. The home is registered for up to 30 residents who require personal and/or nursing care. There is a qualified nurse on duty at all times and community nurses visit regularly. Accommodation is provided on two floors with a lift to access the first floor. Two rooms are accessed by a chair lift. A number of bedrooms have en-suite facilities and all the bedrooms have 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 residents. There is a very small garden in the grounds at the back of the home; this is not currently accessible to residents. The car parking space to the front of the building is limited. The front door to the home is locked at all times and accessible by a keypad. The visiting arrangements are flexible. Fees range from £475.00 t0 £700 per week. this does not include toiletries, newspapers, equipment purchased solely for the benefit of the resident, costs arising from trips and visits outside the care home. The fees payable by service users whose care is commissioned and purchased by the Cornwall Department of Adult Social Care or the Primary Care Trust will depend upon their financial circumstances. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 5 King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service potentially experience adequate quality outcomes. This was an unannounced key inspection that was undertaken by two inspectors spending 8.5 hours in the home. People who use the service are referred to as residents in this report to reflect the terminology used in the home. The Annual Quality Assurance Assessment (AQAA) has been returned to us since the last inspection. The Improvement plan required following the last key inspection has been returned to the Commission for Social Care Inspection (CSCI) as required by law. A random unannounced inspection took place on 14 January 2008. This inspection focused on prioritised requirements set at the last key inspection. One requirement regarding equipment in the home was considered to be met at the random inspection. It was evidenced that four requirements regarding, staffing, care planning, risk assessing and maintenance of the home had not been met. One new requirement regarding medication was set at the random unannounced inspection. At this key inspection we met with the residents, manager and staff. We were assisted during the inspection by one of the Directors of the company who owns the home and the newly appointed manager. We looked at records, care documentation, policies and procedures and inspected the environment. Case tracking and direct observation were used. What the service does well: Staff were observed to respect resident’s privacy and dignity by knocking before entering private bedrooms. Respect is shown as the staff use the preferred form of address of the resident. Residents told us “the staff are kind and helpful”, “they are always polite to me and I enjoy our conversations”, “they do extra things for me, some more than others, but they are all kind”. Visitors are made welcome to the home by the staff and observations were made of positive and friendly interactions between the staff and visitors. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 7 Residents told us that they enjoyed the food provided to them and it was clear that choices of meal are offered at each meal. Residents can also choose a different option to the choices detailed on the menu if they so wish and if available. What has improved since the last inspection? What they could do better: The resident’s individual care plans do not consistently inform and direct care staff on how to support the resident’s own capacity for self care and meet their needs. No evidence supports that the resident and / or their representative were involved in the development of the care plan and some have not been regularly reviewed. Further information should be recorded of when referrals have been made to external professionals for additional advice / assistance e.g. tissue viability, continence advisor. The registered person must ensure that medication systems are followed in order to protect people. Medication, presumably previously dispensed for a resident, was seen left unattended in the lounge area. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 8 The records of medication must be improved, as on the day of inspection the controlled drugs register did not accurately demonstrate the quantity of some drugs in the home. Further information should be gathered to reflect people’s wishes around the gender of the carer who provides assistance with their personal care. Attention should be paid to the duty roster to ensure that a balance of the gender of care staff is reflected on shifts. Consideration must be given to the times that meals are served and the length of time between each meal. During this inspection records did not provide full evidence that the systems in place to protect vulnerable adults had been followed fully. This must be addressed to ensure that residents are protected at all times. Some areas in the home would benefit from additional cleaning and measures must be taken throughout the home to promote infection control. The bathrooms and toilets would benefit from upgrading. It has been commented at previous inspections that residents should have lockable storage space and lockable doors to their bedrooms and be provided with the key, if they wish this and if an appropriate risk assessment is in place. Detailed records must be maintained if money or valuables are held for safekeeping on behalf of a resident. All records relating to individuals that are kept in the home must be held in accordance with current legislation e.g. accident records and usage of a communications book. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 9 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 King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with information that enables them to make an informed choice about the home providing them with care and accommodation. Care needs assessments are undertaken prior to admission so that the home can ensure they can meet the needs of the service user. EVIDENCE: The statement of purpose and service user’s guide have been updated since the last inspection. The director provided us with the up to date documentation on the day of inspection and told us that each resident and/or their representative has been issued with this information. The guide and statement of purpose given to us on the day of inspection form one document, presented in a folder. The statement of purpose should not refer to the manager as the registered manager until such times as the application to CSCI has been approved. Further information should be provided to inform people about the procedure when an emergency admission occurs. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 11 Case tracking of the records of the most recently admitted people show that a care needs assessment has been undertaken and detailed records are kept of this. We were told that each prospective resident is assessed to make sure that the service is able to meet the needs of the individual and that the prospective resident and their relatives or representatives are invited to participate in this process. The contract provided to service users has been amended, the newly developed form is in the service users guide. The director told us that this will be provided to existing residents. This will be inspected in full at the next inspection when the contract has been reissued. We were told that this service does not provide intermediate care or rehabilitation services. A period of respite care can be available to people when there is accommodation available. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans do not consistently inform and direct staff as to the action they must take to meet the individual needs of the residents. The medication policy and procedure in place is robust. Medication systems do not always follow good practice or safe practice guidelines – the manager is aware of this and is addressing these areas in order to ensure residents are protected. EVIDENCE: Each resident has a care plan in place for them. These have been developed since the last inspection, but as identified at the previous inspection the care plans do not consistently inform and direct care staff on how to support the service user’s own capacity for self care and meet their needs. We were told that a new system of care planning is to be implemented, the director and manager were positive about this step. It was not clear when this system would be in place. The care plans inspected varied in detail and some did not reflect the complexity of need. Others were informative and detailed. Some written information was contrary to observations of the service user and the information they provided to us verbally. Not all care plans have been King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 13 reviewed on a monthly basis and they do not consistently evidence the involvement of the resident and/or their representative. Some residents told us they are satisfied with the manner in which their health needs are met and expressed confidence in the staff. It is clear that residents are visited by the General Practitioner and District Nurses. Individual records did not always inform us that appropriate referrals had been made to external professionals e.g. tissue viability service. Guidance around promoting continence for individual service users was limited, with no evidence of continence assessments and vague information in care plans regarding the use of continence aids (e.g. pads) and any specific assistance needed to promote the continence of individual residents. Communal pads were observed in toilets and bathrooms. Pressure relieving equipment is available in the home. The last inspection report identified that no regular exercise activities are provided in the home. This has been addressed by the employment of an activities co-ordinator. We were able to talk with this member of staff during this inspection and she told us that activities are being increased. During this month an exercise session has been planned with the use of balloons and music. Throughout the afternoon on the day of inspection, it was noted that some residents appeared to be sitting for prolonged periods of time without being assisted to the bathroom or to have a walk. A chiropodist visits the home regularly. The last inspection identified that several concerns had been received regarding the lack of opportunity for regular bathing/showering. Inspection of records at this inspection implied that some residents were going for many days (e.g. 18) without a shower or bath. It was not clear from the care planning of the residents preference of a bath or shower although on talking with some residents they were able to inform us. Daily records have a tendency to state ‘care as plan’ but are bolstered in some cases with reference to a social activity e.g. ‘ attendance at church’. The trained nurses reference any health issues. A qualified nurse administers all medication and a Monitored Dosage system is used. The quantities of medications received into the home is identified on the Medication Administration Record (MAR), and a separate record identifies any medication leaving the home. MAR sheets were inspected and were observed to be completed appropriately, evidencing why and when any medication has been omitted. Each resident has a photograph held on their medication sheet to ensure their protection during the administration of meds. Records of medication received into the home and disposed of are kept. There are policies and procedures in place. There is a designated fridge to store medication that requires this facility with temperatures recorded on a daily basis. The fridge was locked on the day of the inspection. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 14 There is a Controlled Drugs (CD) cupboard and a CD register. A check of the controlled drugs identified there had been an error in the records. The CD register should identify accurately the number of controlled drugs held on the premises and it does not, although it was possible to track the medication through the return / destroyed drugs book. There were gaps in recording, the nurse on duty explained that this had been when a bank nurse was on night duty and had not completed the book. No residents self administer their medication and no lockable facility is available in rooms for this purpose. On the morning of the inspection, it was observed that a tablet was left in a medicine pot on a side table in the lounge. The trained nurse on duty stated this must have been left from the day before. Oxygen was stored or in use in two bedrooms and a bathroom in the home with no signing to identify its presence. The staff were observed to knock on resident’s doors prior to entering. It is not evident residents have chosen to share a double room, although the director told us that this is the case and that a request has been made for a new resident to share a room on admission to the home. Screening is provided in the shared rooms. There were un-named items of clothing in the laundry. Residents preferred names are recorded on the documentation and the staff were observed to use these and speak to the residents respectfully. One resident told us “the carers are kind and helpful and always so nice to me”. Two members of staff told us that whenever possible they would meet individual preferences for choice of gender of carer providing personal care. On the afternoon of the inspection the three carers on duty were all male with one female trained nurse. A similar staffing situation was observed at the last key inspection. We were also told that current residents have not expressed a preference regarding the gender of their carer, although this has been an issue in the past. There was no evidence in resident documentation that this information had been gathered. There are currently no people who use the service from ethnic minorities, although it is understood the home would be happy to accommodate people who use the service from other cultures. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13 and 14 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activities programme has been developed to try and cater for resident’s leisure and social needs. Visitors are welcomed in the home at a time convenient to them and the resident. Residents enjoy the meals provided. EVIDENCE: An activities co-ordinator has been appointed since the last inspection. Evidence around the home showed us that social and recreational opportunities are taking place and residents are made aware of these. A number of outings have been arranged and people visiting the home to provide entertainment. Records are made of the activity provided and whether the resident chose to attend or not. The record does not show the enjoyment or participation of the resident with the activity. On talking to residents and staff it appears that ‘ad hoc’ activities are taking place that are much appreciated by the residents but not recorded. E.g. manicures, help with a crossword and collection of reading material. The resident’s care plans and assessments contain varying degrees of information about social, leisure, spiritual and recreational interests. The activities coordinator is aware of this and plans to develop the written King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 16 information including the life story and pen picture – some of which were blank. Visitors are able to visit at any time, information about this is included in the service users guide. The visitors book shows that the home receives many visitors at varied times of the day. The front door of the home is locked for security purposes. The director told us that regular visitors to the home have been provided with the keypad code. Visitors attending the home on the day of inspection were observed to be greeted warmly by the staff and they told us that this is always the welcome they receive. Individual choices and preferred routines are not always recorded. One resident told us that they were used to and preferred showering at home, but since being in the care home only had baths. On examining records it is not evident that residents are bathed regularly. Residents did not seem aware of the choices they could make and one commented ‘they are so busy I would not want to give them any more work’. Another resident told us they were not aware of their care plan. The kitchen was clean and orderly on the day of inspection and uses the ‘Making Food Safely’ programme. The home provides three varied meals each day with the menu operating on a rolling programme and offers a choice from two options at the main meal of the day and tea time. Food records are kept that show the choices that residents make. Kitchen staff told us “they (the residents) can have what they want really”. Residents told us that they enjoyed the food and confirmed that there was a good choice. One person said ‘sometimes I have something different if I don’t like the menu’. The staff discuss daily choices with the residents. Breakfast, continental in style, is served by the care staff from the kitchenette, people did not appear to go to the dining room for their breakfast. Consideration must be given to the times that people have their breakfast as it was observed that some people did not receive theirs until 10.30a.m. The main meal of the day is then served at 12.30 hours. It may also be a considerable length of time between tea or supper and breakfast for people to go without food. One resident told us at 10.30 that she had not had any breakfast, the staff immediately provided this and told us that sometimes this person has more than one breakfast. Fresh fruit and vegetables are available. On the days of the inspection there was the Head Cook and Kitchen Assistant on duty all day. The Head Cook has completed her Intermediate Food Hygiene, other staff who work in the kitchen have completed their Foundation Food Hygiene Certificate. Special diets are catered for individually. The dining room is comfortably decorated and enjoys views across the sea. An orientation notice board was in place in the lounge / dining room but did not reference the menu and was several days out of date. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their representatives are provided with information on how to complaint should they need to do so. Residents are not fully protected from abuse, as the homes procedures are not robustly followed by staff. EVIDENCE: The service users guide includes the complaints procedure for the home, this states if the process is unsuccessful the person can refer onto CSCI or the Department of Adult Social Care (DASC). Since the last inspection there has been one complaint made to the home. Records of the subsequent investigation were available for inspection. The director told us that an ongoing complaint made prior to the last inspection has been concluded. The complaints related to the care provided to residents. There is a procedure for the Protection of Vulnerable Adults that includes whistle blowing and is provided to staff. One part of the policy refers to Sheldon House as oppose to King Charles Court. The policy informs staff of the action they must take should there be any suspected abuse noted. The procedure does not include the support/care to be offered to the resident. All staff are provided with training on the protection of vulnerable adults (POVA) at induction. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 18 Whilst case tracking, daily records and accident reports evidenced that bruising had been observed on two residents. It was not clear of the reporting process or subsequent action taken to ensure that residents were protected. These matters have been followed up, since the inspection, by the director and the manager. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that meets the needs of the resident’s currently living there. The home is planning a refurbishment programme with the assistance of an external company, as some parts of the care home require updating and redecoration. Records show that checks and maintenance have been carried out. There are some areas of risk to residents. EVIDENCE: The home is located in Falmouth overlooking the harbour, there is a car park to the front of the home. Some rooms have sea views. Generally the residents informed the inspectors that they liked their accommodation. The environment is generally comfortable and homely. There is a lounge/dining room on the ground floor, which enjoys pleasant views of the sea and a cosy lounge on the first floor. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 20 Since the last inspection the director told us that the hallways have been redecorated and it is planned to renew some of the carpets. There is a maintenance record book and the maintenance person is shared with the sister home. Alarms are fitted on external doors and the front door of the home is locked, as mentioned previously some visitors are provided with the entry code. The garden is at the rear of the home and currently not accessible to residents. It is accessed via a number of steps and the grass area is overgrown. The manager told us that plans are being discussed to develop this area to make it useable to residents. Since the last inspection the fire officer has visited the home and carried out a fire safety audit. Written evidence shows that a previous enforcement notice served by the fire service has been withdrawn as the home now meets the relevant legislation. A firewatch certificate of maintenance is displayed in the entrance hall dated August 07, with additional checks on the fire system by a company named Holland and Lang in April 2008. Records in the home show that the environmental health officer last visited the home in 2007. Resident’s rooms were observed to be clean and comfortable in appearance. It is recommended that residents are able to lock the doors to their room if they wish to and if their risk assessment is appropriate. Lockable facilities should be available to residents in their own rooms. The bathrooms are clinical, not homely and in need of upgrading. We saw unnamed toiletries left in one bathroom. One of the bathrooms has been converted into an assisted shower room, this needs a sign on the door to inform residents. Additional toilets are located near the communal areas of the home. The toilet located by the lounge / dining room was in need of cleaning. A strong odour was noted here and the toilet stained. A clinical waste bin in use did not have a lid in place and soiled pads were exposed. The hot water tap in one upstairs bathroom was turned on and we felt the water to be very hot. The director told us that she was not sure if hot water thermostatically controlled valves were in place and another director was dealing with this issue. There are two sluices in the home. Both sluices were observed to be difficult to access due to large clinical waste bins in front of them. The sluices are not turned on and staff were not observed using them. We discussed this with the manager and the director and expressed concerns regarding the cleaning of commode pans if the sluices are not used. The manager plans to address the issue of infection control within the home as a priority and is due to complete an audit of the home in relation to this. We were told that plans are in place to provide thorough training for staff in this area. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 21 One hoist sling was soiled and hanging up to be used again. The housekeeping staff work hard to kept the home clean and since the last inspection another member of domestic staff has been appointed. The house keeping staff told us that carpets are regularly shampooed and the extra member of staff appointed has meant that more thorough cleaning is carried out now. There were odours in some areas of the home. Some ventaxias were observed to need cleaning, these may cause a risk of fire. The laundry room has two industrial washing machines with a sluice facility and three tumble driers. A system is in place to separate soiled and clean laundry and red bags are used for soiled linen. Individual baskets are provided to each person. Since the last inspection hand washing facilities have been installed in the laundry room. Walls within the laundry, are painted but are not impermeable. Resident’s clothes appear well cared for. General laundry e.g. sheets and towels are contracted to an external laundry for washing and plentiful supplies were observed within the linen cupboards around the home. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient staff on duty to meet the individual and collective needs of the residents. Residents are safeguarded by the recruitment procedures. Limited evidence is available to show that care staff are trained and competent to meet the resident’s specialised needs. EVIDENCE: On the day of inspection, there were sufficient staff rostered on the duty rota to meet the needs of the current residents. The duty rota did not accurately reflect who was on duty that day as a change had been made and the rota not updated – this however did not affect the numbers of staff. The director told us that a dependency tool has been used to determine the staff levels. Generally two trained nurses are on duty during the mornings with five carers. The rota’s shows that the manager is available within the home – currently during office hours- this is planned to change following a period of induction and we were told that the manager will undertake some shifts throughout the working week. The afternoon/evening shift is covered by one trained nurse and three carers. Staff told us that the staffing levels are good and allow them time to provide care fully. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 23 As previously reported there has been an additional member of staff to the housekeeping team which has had a positive effect to existing staff and on the home. The updated statement of purpose told us that thirteen out of eighteen staff have completed their National Vocational Qualification training. Six have NVQ level 2 and six have level 3, one person has level 4. This equates to seventy two percent of the staff. A robust recruitment procedure is in operation. A number of new staff have been recruited since the last inspection. New staff complete an application form, written references and an enhanced Criminal Records Bureau check are obtained. There is evidence of an interview assessment. Evidence of registration is sought from the Nursing and Midwifery Council. All staff are provided with terms and conditions of employment. No volunteers are employed in the home. It is recommended that consideration is paid to the references obtained as in one staff file only character references/testimonials were available and provided by a friend/family member. On another file there was only one written reference plus a verbal reference. The interview records inspected showed varying levels of detail. The home’s induction training has recently been reviewed, consideration must be paid to the Skills For Care Induction training standards. There is a structured three day induction training course provided internally which incorporates fire training, moving and handling, infection control, POVA, person centred planning, general health and safety and food handling. The manager told us that privacy and dignity and end of life care is going to be added to this training programme. Records of training are kept, these must be kept up to date. It appears that sometimes staff do not provide copies of the training attended. Registered nurses are supported to undertake training to ensure that they remain up to date, with details of forthcoming training displayed clearly on the office wall. One of the trained nurses told us that she has attended training regarding syringe drivers, venepuncture, cannulation and tissue viability over the last six months. Further consideration should be given to ensure that care staff are trained and competent to meet the specialised needs of residents e.g. diabetes, dementia. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36,37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the management of the home since the last inspection – this will be increased once there is a registered manager in place. People’s views of the home have been sought, we are unable to make a fully informed judgement at this time as to whether the home is run in their best interests. Resident’s money and property is not fully protected by the staff. The health, safety and welfare of the staff and resident’s may be compromised by the lack of risk assessments in areas where protective measures are not in place. EVIDENCE: A new manager has been appointed and had started work in the home recently before the inspection. This home has been without a Registered Manager since May 2007. We were told that the manager’s application would be submitted to CSCI for the process of registration as soon as the CRB check was received. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 25 The manager is a registered nurse and has considerable management and clinical experience – as detailed in the statement of purpose. The manager was able to tell us about her previous role in the NHS. We have received a record of a Regulation 26 visits carried out by one of the directors. On the day of the inspection the manager held a staff meeting, this was well attended with many staff coming to the meeting when on their day off. Positive comments were made to us from staff, about the way in which this meeting was conducted. Staff appeared positive and confident in their roles and the support they have received from the manager and director recently. Comments were made that the ethos and philosophy in the home has changed and one member of staff who had left during the latter part of 2007 told us that since returning improvements are very noticeable within the home. We did not evidence an annual development plan for the home. The views of the residents, relatives, staff and stakeholders have been sought by the sending out of surveys. A large number of these have been returned and were made available to us at the inspection. The director plans to audit these surveys within the next month and publish the results to all interested parties (including CSCI). An insurance certificate is displayed within the entrance hall and is up to date. The director and manager told us that no personal monies are kept for the residents by the director and manager. However when inspecting the medication, money and a wallet was evidenced within the CD cupboard with records in the form of notes recorded on the envelope it was contained in. No lockable space is provided for residents to keep their valuables safely. A programme of supervision has been developed. Staff have been advised of who their supervisor will be and informed that it is their responsibility to ensure this takes place. Some supervision records were in place in individual files. It is not clear that the named supervisors e.g. the trained nurses have been provided with training to ensure they are competent for this role. Records are stored securely in a locked office – this is accessed by a master key held by staff. There is a visitor’s book in the reception area of the home. The accident book in use did not have the pages removed as required under the Data Protection Act – this was discussed at the last inspection. A communication book is in use with resident’s names in it. A company has visited the home to look at the health and safety issues and provided environmental risk assessments – these were not evidenced at this King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 26 inspection. The hot water provided to the sinks appears to be unregulated and there are no risk assessments in place. The director was able to show us evidence of maintenance and servicing of equipment within the home e.g. hoist servicing, laundry machines, passenger lifts, nurse call system and PAT testing. A check of the home’s hard wiring system is to be confirmed. King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 27 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X 2 X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 2 2 2 2 King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement It is required that the registered person shall prepare a written plan after consultation with the service user or a representative as to how the service user’s needs in respect to his health and welfare are to be met. This shall be made available to the service user and be kept under review. The service user or representative should be involved in any revisions and notified of changes. Full detail must be included to inform and direct care staff of the action they must take to meet the identified personal care and health needs of the individual service user. This requirement has been included in this report again as whilst some care plans are in sufficient detail to inform and direct staff, not all are. Previous timescales not met 02/05/07, 01/03/08 2. OP8 12(1 & 2) It is required that the registered DS0000009186.V364955.R02.S.doc Timescale for action 30/06/08 30/06/08 Page 29 King Charles Court Version 5.2 person shall make proper provision for the health and welfare of residents and so far as practicable enable service user to make decision in respect to the care they are to receive. To include a full assessment process on which to plan provision of care and referral to appropriate external professionals. Previous timescale not met 01/03/08 It is required that the registered 30/06/08 person shall make arrangements to ensure the safe handling and administering of medicines. Dispensed medication should not be left unattended in the care home and the CD register must be completed correctly and reflect the quantity of medication held in the care home. Previous timescales not met 01/04/08 4. OP10 12(4) It is required that the registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of residents with due regard for their sex, disability and background. Written evidence must be available to show the service users preference of gender of carer and where such a preference is evidenced this is respected. 30/06/08 3. OP9 13(2) 5. OP18 13(5) Previous timescale not met 30/12/07 The registered person shall make 30/06/08 arrangements, by training staff or other measures to prevent DS0000009186.V364955.R02.S.doc Version 5.2 Page 30 King Charles Court service users being harmed or suffering abuse or being placed at risk of harm or abuse. Staff must follow the internal reporting procedures correctly if there is any suspicion that abuse may have occurred. 6. OP26 13(3) The registered person shall make 30/06/08 suitable arrangement to prevent infection, toxic conditions and the spread of infection at the care home. The cleaning of commodes must be reviewed and clinical waste bins should be covered with a lid and emptied regularly. It is required that the application 30/06/08 for the manager to be registered with CSCI be submitted as soon as relevant paperwork received e.g. CRB check. Reliable and measurable quality 30/06/08 assurance arrangements must be established to evaluate the quality of care, including the quality of nursing and facilities provided. A copy must be sent to the Commission and made available to residents. Previous timescales not met 01/05/08. 9. OP35 17(2) schedule 4(9)(a)(b) It is required that a record is 30/06/08 kept of all money or other valuables deposited by a service user for safekeeping or received on the service user’s behalf which – shall state the date on which the money or valuables were deposited or received, the date on which nay money or valuable were returned to a service user or used, at the request of the service user on his behalf and where applicable, the purpose for which the money or DS0000009186.V364955.R02.S.doc Version 5.2 Page 31 7. OP31 8(1) 8. OP33 24 King Charles Court 10. OP36 18(2) valuables were used and shall include the written acknowledgement of the rerun of the money or valuables. The registered person shall ensure that the persons working at the care home are appropriately supervised. Previous timescales not met 01/02/08 30/06/08 11. OP37 Data Protection Act 12. OP38 It is required that all records held in the home are stored securely and in line with current legislation e.g. accidents records and use of ‘communication books’. 13(4)(a-c) Robust and reliable risk assessments and risk management arrangements must be in place where any situation arises that could potentially compromise a services users health, safety or well being. Previous timescales not met 30/04/07, 01/03/08 30/06/08 30/06/08 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 OP1 Good Practice Recommendations It is recommended that the statement of purpose does not refer to the manager as the registered manager until such times as the application to CSCI has been approved. It is recommended that further information be provided to inform people about the procedure when an emergency admission occurs. DS0000009186.V364955.R02.S.doc Version 5.2 Page 32 King Charles Court 2. OP10 It is recommended that residents share a room only when they have chosen to do so and that written records reflect this choice. It is recommended that written records demonstrate all ‘informal’ activities that take place within the home as well as the organised events e.g. manicures, assistance with crosswords, obtaining of reading material. The record should also identify the level of participation from the resident. It is recommended that individual choices and preferences are recorded and acted upon e.g. when choosing which bathing facility to use. It is recommended that consideration be given to the timing of meals and the length of time between each meal. For the role of the staff supporting the resident to be included in the Protection of Vulnerable adults procedure. For records of routine maintenance and renewal of fabric and decoration of the premises to be kept. To make the bathrooms less clinical and more homely. It is recommended that residents be provided with lockable storage and provided with the key unless the reason is explained in the care plan. It is recommended that doors to accommodation to be fitted to an overrideable lock accessible to staff in emergencies. It is recommended that two written references, including one from the previous employer, are obtained for staff members in addition to character references / testimonials. For hand washing facilities to be provided in the laundry. It is recommended that the induction training be in line with Skills for Care Induction Standards. 3. OP12 4. 5. 6. 7. 8. 9. OP14 OP15 OP18 OP19 OP21 OP24 10. OP24 11. OP29 12. 13. OP26 OP30 King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI King Charles Court DS0000009186.V364955.R02.S.doc Version 5.2 Page 34 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!