CARE HOMES FOR OLDER PEOPLE
King Charles Court Marlborough Road Falmouth Cornwall TR11 3LR Lead Inspector
Diana Penrose Announced Inspection 16th February 2006 09:30 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.V277304.R01.S.doc Version 5.1 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.V277304.R01.S.doc Version 5.1 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 King Charles Court Limited Mrs Ann Mayne Holmes 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.V277304.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Residents to include up to 30 adults of old age (OP) Residents to include up to 30 adults under pensionable age with a physical disability (PD) Residents to include up to 30 adults with a terminal illness (TI) Total number of residents not to exceed a maximum of 30 Date of last inspection 1st September 2005 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 residents. There is a very small garden in the grounds at the back of the home; this is not accessible to residents. 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 residents. There are opportunities for socialising and visitors are openly encouraged. King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 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 16 February 2006 and spent seven hours at the home. This was an announced visit. The purpose of the inspection was to gain an update on the progress of compliance to requirements identified in the last inspection report dated 01.09.05. In addition the inspector focused on the following key areas of care: assessment and care planning, healthcare, leisure, personal choice, food, adult protection, some of the environment, staffing, recruitment, training, quality assurance and residents money. The Registered Manager, a Registered Nurse and a Care Assistant have unfortunately been on sick leave for some time, this has caused staffing difficulties at the home. The Deputy Manager has been responsible for the day to day running of the home working closely with the registered providers. She was in control and very helpful on the day of this inspection. On the day of inspection 28 residents were living in the home. The methods used to undertake the inspection were to meet with a number of residents, staff and the Deputy Manager to gain their views on the services offered by King Charles Court. Records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. What the service does well:
The management make every effort to meet the requirements and recommendations set by the Commission for Social Care Inspection. The home is clean, comfortable, warm and homely. It is well maintained and the grounds are tidy. Hand-washing facilities for staff are good and alcohol cleansing gel is provided. Protective clothing is also provided and staff were using it appropriately Prospective residents are visited whenever possible prior to admission to the home and a needs assessment is undertaken. The assessment forms the basis of the residents’ individual care plan. There are risk assessments in place for each resident and informative daily records are kept. The home aims to meet the resident’s healthcare needs and external health professionals are involved when necessary. Student nurses are seconded to the home to gain knowledge in the care of the elderly. Equipment is provided for moving and handling and pressure relief. Residents said they can exercise choice and control over their lives and the daily routines are flexible. Resident’s rooms are personalised with their own belongings including some furniture. King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 Page 6 The food provided is nutritious and mostly homemade, there is plenty of fresh fruit and vegetables. Residents had no complaints about the food; in fact they said it was always very good. The home has an adult protection policy and a copy of the local authority procedures. Staff are trained to recognise abuse and how to report any incidents or allegations. Daytime staffing levels are good and staff are competent in their roles. 53 of care staff are qualified to at least NVQ level 2 in care and there is a qualified nurse on duty at all times. There is an open management style and residents said they could air their views at any time and they are listened to. The home has a policy not to hold money for residents and this works very well. What has improved since the last inspection? What they could do better:
The review of care plans and risk assessments does take place but is not consistent and the resident or their representative must be involved if possible. Activities must be provided according to the resident’s wishes; it is appreciated that there has been a high level of staff sickness at the home and that the situation should improve soon. King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 Page 7 The medicines policy still requires updating and the number of tablets remaining in stock should be carried forward when a new medication administration chart is started. There must be evidence in the home that all staff are attending fire training at the statutory intervals. Some staff would benefit from attending the local Social Services adult protection training. Low energy light bulbs are not suitable in areas requiring instant light, for example bedrooms and bathrooms; 60-watt bulbs should be used. The manager needs to undertake a review of the staffing levels in line with the dependency of the residents, to ensure that if there are sufficient staff to meet the care needs of the residents, especially at night. Recruitment procedures must be more robust with necessary checks carried out prior to employment. A satisfaction survey of residents and their relatives should be undertaken to ascertain their views of the home and the services provided. 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 DS0000009186.V277304.R01.S.doc Version 5.1 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 King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 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): 3 Residents are only admitted to the home following an assessment of their needs to ensure the home can provide adequate care. EVIDENCE: The deputy 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. It is recommended that the assessment states who is involved in the assessment, with signatures where possible. Social Services assessments and information from the hospital are obtained as appropriate. King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8 Individual care plans are generated for each resident that direct staff in the care provision. Residents have access to health care services as necessary to ensure their assessed needs are met. EVIDENCE: The deputy manager said she is hoping that a new computerised system of care planning will be implemented. The existing care plans have been revised and typed and are much more informative for staff. There is no evidence that care plans are compiled with the resident or their representative. There is some evidence of review of care plans and risk assessments but most of the review sheets were missing in the records inspected. Daily records are written by the nursing staff and are informative. Residents are registered with a GP and other healthcare professionals are involved when required to ensure that needs are met. The home has sufficient equipment for moving and handling purposes and pressure relief. Residents are encouraged to exercise by walking and joining in games with skittles and balls. The home has a very good relationship with the specialist community nurses and some of the home’s nurses are links for specific subjects like continence and tissue viability. Student nurses are seconded to the home, mainly on their first placement.
King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 Page 11 King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14 and 15 The home aims to provide a range of activities that offer a lifestyle to meet individual residents needs; this has lapsed recently as there has been no coordinator in the home. Residents are helped to maintain control over their lives and staff respect their individual preferences and choice. Dietary needs of residents are well catered for with a varied selection of food available that aims to meet their taste and preference. EVIDENCE: A member of the care staff is normally responsible for co-ordinating activities but due to sickness activities have lapsed. Residents must be consulted and suitable activities provided. Residents spoken with said there is not much to do and the art class has stopped due to lack of interest. They did not recall being consulted about the activities they would like. Trips out are organised and the deputy manager said a trip to see the Christmas lights was enjoyed. The deputy manager said that staff do spend time reading mail to residents and assisting with their letter writing. Residents said they are encouraged to exercise choice and control over their lives, this is evidenced in care plans and daily records. Resident’s rooms are personalised with their own belongings. Choices are available on the menu and residents said they could get up and go to bed when they like. One resident said she likes to lie in and go to bed late and the staff accept this. Residents
King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 Page 13 have a choice of carer to a degree, one female resident said she prefers a female carer and this is respected. All residents spoken with said they enjoy the food provided. Fresh fruit and vegetables are provided and homemade cakes are baked for teatime. Residents said special cakes are provided for birthdays and at Christmas there was cake and mince pies. Meals are ordered on the day before they are eaten and the menu is varied and nutritious. Menus are reviewed with the residents and it is hoped to compile a book of resident’s favourite recipes. Food records are kept. King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Arrangements are in place for the protection of residents safeguarding them from harm or abuse. EVIDENCE: The home has an adult protection policy and a copy of the local multi-agency code of practice. In house training takes place and the Registered Manager has attended the local Social Services adult protection training. It is recommended that more staff attend this training. King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The home and grounds are well maintained providing a safe environment for residents, staff and visitors; re-decoration and refurbishment is in progress. The home is clean and on the whole free from odours making it a pleasant place to live in. EVIDENCE: Residents live in a safe well-maintained environment, which is clean, homely and comfortable. The home has an ongoing maintenance programme and a redecoration and refubishment programme is in place. This will address areas of the home that look jaded and furniture that needs replacing. Two rooms have already been redecorated and new furniture has been purchased. Lighting in resident’s rooms must meet recognised standards (lux 150). Low energy bulbs should not be used where instant light is required, for example bedrooms and bathrooms. Strip lights have been fitted with covers apart from one in a stairwell where it is proving difficult to find a suitable cover. If a cover cannot be provided alternative lighting must be fitted. Personal laundry is dealt with in house, the sheets and towels are contracted out. COSHH data sheets are
King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 Page 16 available in the laundry. There are suitable hand-washing facilities for staff and alcohol hand cleansing gel is used. Protective clothing is provided. King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 and 30 Staffing levels during the day are good but the numbers at night do not always seem appropriate for the needs of the residents accommodated. Residents are in safe hands and benefit from the number of care staff that have achieved an NVQ qualification. Recruitment procedures are not robust enough to offer maximum protection to the residents. The home is endeavouring to improve training for staff so they will be more competent in their roles. EVIDENCE: There is a qualified nurse on duty at all times and care staff levels average 6 in the mornings, 4 in the afternoons, 2 from 20:00 – 24:00 and 1 or 2 at night. It is recommended that the manager undertake a dependency study to ensure that sufficient care staff are on duty overnight. There must be sufficient staff on duty at all times to meet the assessed needs of the residents whilst taking into consideration the size and layout of the home and the number of residents accommodated. The manager’s hours are now supernumerary; the deputy manager said there is no on-call system. 53 of care staff are trained to at least NVQ level 2 in care. Truro College is the NVQ provider. Four personnel files were inspected. Three had no POVA or CRB checks on file. Staff must not commence work in the home without a satisfactory POVA check and must work under constant supervision until a satisfactory CRB check has been obtained. Copied references addressed ‘to whom it may concern’ are not suitable, they may be held in addition to the two statutory references that must be obtained by the home. Gaps in employment must be investigated and evident on the interview records.
King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 Page 18 The registered providers are reviewing staff training and an audit has been done. The deputy manager said that training needs are identified through staff meetings, supervision and appraisals. She said it has been difficult to get formal training done as several staff have been off sick. There is a new induction booklet for new staff to complete over a 3-month period. Statutory training takes place in house and dementia training is being arranged. Staff records contained copies of training certificates. The fire training records were not available for inspection. King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 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): 33 and 35 The home is run in the best interest of the residents and they benefit from the Quality Assurance systems in place. There is a suitable system in the home for dealing with residents’ money that ensures the residents’ financial interests are safeguarded. EVIDENCE: The deputy manager said there is an open style of management in the home and residents can air their views at any time. Residents said they can speak freely to staff and management and action is taken as necessary. Residents meetings did not come to fruition but it is hoped to set up a relative’s forum. The accidents and pressure sores are audited. It is recommended that a satisfaction survey of residents and their relatives be undertaken. 3 CSCI residents comment cards and 4 relatives comment cards were received about the home, all were generally positive, three of the relatives felt there are not always enough staff on duty.
King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 Page 20 The homes policy is not to handle residents’ money or hold valuables. If a purchase is required unexpectedly the relative / representative is invoiced. Receipts are kept and records maintained. King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 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 2 3 Standard OP7 OP7 OP9 Regulation 15 (2) (c) 13 (4) (c) 13 Requirement Care plans must be reviewed with the resident or their representative Residents risk assessments must be reviewed regularly The medicines policy must be updated and refer to the The Royal Pharmaceutical guidelines for the administration of medicines in care homes Residents must be consulted and suitable activities provided. A cover must be fitted to the strip light in the stairwell or alternative lighting provided Lighting in resident’s rooms must meet recognised standards There must be sufficient staff on duty at all times to meet the assessed needs of the residents whilst taking into consideration the size and layout of the home and the number of residents accommodated. Staff must not commence work in the home without a satisfactory POVA check and must work under constant supervision until a satisfactory
DS0000009186.V277304.R01.S.doc Timescale for action 02/05/06 02/05/06 02/05/06 4 5 6 7 OP12 OP19 OP25 OP27 16 (2) (n) 13, 23 23(2)(p) 18 (1)(a) 02/05/06 02/05/06 02/06/06 16/02/06 8 OP29 19 Sch 2 16/02/06 King Charles Court Version 5.1 Page 23 9 10 11 OP29 OP29 OP38 19 Sch 2(6) 19 Sch 2 (3) 23 CRB check has been obtained Gaps in employment must be investigated and explanations written Two written references must be obtained for all new employees All staff must attend fire training according to the statutory requirements 16/02/06 16/02/06 02/05/06 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 4 5 6 Refer to Standard OP7 OP9 OP18 OP27 OP33 OP36 Good Practice Recommendations The resident or representative should sign to agree their care plan, where it is not possible to obtain a signature the reason should be recorded The number of resident’s tablets remaining in stock should be carried forward onto their new medication administration chart. Some staff should attend the local Social Services adult protection training The manager should undertake a dependency study to ensure that sufficient care staff are on duty overnight A satisfaction survey of residents and their relatives should be undertaken. Formal staff supervision needs to be implemented and should take place six times a year King Charles Court DS0000009186.V277304.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection St Austell Office 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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