Inspection on 10/01/06 for Little Court Nursing Home

This inspection was carried out on 10th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Little Court Nursing Home 27/06/07

Little Court Nursing Home 06/04/05

Little Court Nursing Home 02/09/04

Little Court Nursing Home 11/05/04

Little Court Nursing Home 26/11/02

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Little Court Nursing Home Roopers Speldhurst Tunbridge Wells Kent TN3 0NY Lead Inspector Maria Tucker Announced Inspection 19th January 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 Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Little Court Nursing Home Address Roopers Speldhurst Tunbridge Wells Kent TN3 0NY 01892 863414 01892 861454 manager@thelittlecourt.co.uk/ p.gregory@ 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) Mr Peter Francis Gregory Neatbell Limited Mr Peter John Hart Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care is given to one service use with a d.o.b. 22 October 1939 Date of last inspection 6th April 2005 Brief Description of the Service: Little Court Nursing Home is a care home with nursing. It is a large old house standing in its own grounds with new buildings attached. The home is arranged on two floors, there is a passenger lift. Twenty rooms are for single occupancy and there are four double rooms. Ten rooms have en suite. Car parking on site is available albeit limited. There are ample car parking spaces on surrounding roads. Little Court provides accommodation for twenty-eight older persons. The home utilises a staff roster that gives 24-hour care cover, with a Qualified Registered Nurse on duty at all times and waking night staff. The home also employs staff for catering, domestic and maintenance purposes. The public transport bus service stop is within 800 yards and High Brooms railway station is approximately five miles away. Tunbridge Wells is the nearest large town and it has all the usual facilities. The home is a non smoking establishment. Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, the second in the year running from April 1st 2005 to March 31st 2006. The inspection lasted from 09.30 until 15.00 the inspection was conducted by the lead inspector Mrs M Tucker. Time was spent meeting the manager, registered provider and staff going through various records and documentation. About one hour and a half was spent meeting service users collectively and individually. A partial tour of the premises was made which included service users rooms and communal areas. The pre inspection documentation was received by the CSCI. 38 comment cards were received, comments included: • It is the best I can’t praise it enough it is home to me and we have laughs and we have a wonderful matron I cant ask for more from anyone they are great. From a service user • ‘Little court provides a good level of care’. From a relative. • ‘We are happy with all aspects of our care and would be only too pleased to recommend the home to others’. From a relative. • ‘Demonstrates individual specific understanding of my clients needs and wishes of being able to partially self manage. Very comfortable accommodation’. From a care manager. It is recommended that this report be read in conjunction with the last inspection report to enable the reader to gain a full picture of the home, as some of the standards that were inspected and met during the last inspection were not inspected during this inspection. What the service does well: Service users continue to receive a high standard of care based upon individual needs, choice and preferences. Service users commented to the inspector “Staff so nice and so caring”, “we all get that lovely feeling of security and safe”, “nothing bad, wouldn’t change anything”. Service users health and well-being is monitored and maintained through a comprehensive detailed care planning system. This is regularly updated and reviewed by a well-trained, motivated and dedicated staff team. The home works very well with other health colleagues and professionals in assuring the health care needs are met and the quality of care provided is based upon best practice. Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 Page 6 The owners are committed to providing a high quality service, which is service user led and focused. The owners, manager and staff have worked hard in improving the overall service including meeting most items identified during the last inspection and recommendations from other professionals. The manager is very competent and skilled, which enables the home to run smoothly and meet its stated aims and purposes. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 4, 6 standards 3 and 5 were met during the last inspection 3 exceeded. Service users have comprehensive information on which to base the decision to move into the home. They can feel confident that their needs will be fully assessed and met. EVIDENCE: A revised copy of the statement of purpose/service users guide ‘Little Court Nursing Home welcome pack’ was given to the inspector. This document was found to be very informative and contain all items required. The home does not provide intermediate care. Service users spoken with were clear about what their needs were and detailed how these are met. Good practice is adhered to in supporting service users to maintain their independence and choice in being supported with their own health care. Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8, 9, 10, standard 7 was met during the last inspection. Service users receive a high standard of professional care developed from comprehensive care planning systems that fully meets their health care needs. EVIDENCE: The home has overall good systems in place for medication. One service user spoken with was supported by staff to assist in the administration of their own medication. There are risk assessments in place to support this. Service users were generally aware of their health needs and what their medication was for. It was discussed that the homes PRN procedures would benefit from being firmed up so that a record is assessable in the medication sheets of the specific details of the PRN medication that a pain reassessment is conducted in conjunction with the monitoring of medication. The front information sheet is more detailed i.e. preferred name; service users preferences or allergies. The service users dignity is maintained through good practice being adhered to by staff. The building of a conservatory, which can be used as a room to meet visitors in private, has made a big difference. Service users felt generally that their dignity was respected. The area that needs to be addressed is the office area, which needs to be enclosed or re sited. Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 Page 10 The standard of health care and working in partnership with other agencies to support this remains high. A letter received from the Elderly Care Nurse Specialist commented that ‘the home is run in the best interests of the service users. The link nurse system in relation to tissue viability issues has proved very successful, the link nurse fulfilling her role and therefore minimizing the number of residents acquiring pressure damage’. Another comment received by a specialist health professional stated ‘The residents receive excellent care’. Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 standard 14 was met during the last inspection. Service users are consulted as to their preferences. They are encouraged to choose from planned activities or to relax watching the television or listening to music. EVIDENCE: The menu was seen to contain a good selection and variety of meals. A comment received in a comment card from a service user reiterated this stating there is ‘A great variety of food’. Service users spoken with confirmed that they had enough to eat, it was of good quality and they felt able to ask for seconds, something different or snacks. A service user spoke of how the cook had visited them and discussed their lunchtime meal and was cooking an omelette especially for them. Another talked about a meeting held where it was discussed that stronger cheese would be nice and this was acted upon. The area that it is recommended be changed is the practice of the late supper being given on request. It is therefore recommended that service users are offered a snack supper with their drinks. There is an activity coordinator who provides structured activities for 12 hours a week. Service users spoken with on leisure and recreation felt that there was enough to do should they wish to join in. Particular favourites included bingo and quizzes. Service users who chose to remain in their room were visited by the activity coordinator and received one to one attention. One service user said, “I must admit the entertainment is good here”. Another Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 Page 12 service user expressed that they enjoyed the bingo, but did feel that it was a bit hectic for the coordinator, so extra support would be nice. This service user sits next to another service user and helps with marking their card. The new conservatory has provided a room for service users to meet visitors in private. Service users spoke of what an improvement the conservatory was, stating “Its lovely”. The de cluttering of the lounge and rearrangement of the furniture has created more space for service users to enjoy the company of their visitors. Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 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 the following standard(s): 17, 18 standard 16 was met during the last inspection. Service users can feel safe, protected and listened to. Service users can feel safe, protected and listened to. EVIDENCE: Service users were happy and relaxed and confident with staff. Service users expressed that they feel safe, and they have no concerns about their private personal possessions or the need to keep anything locked. Two service users have advocates. Service users spoke of how their families supported them. Staff receive adult protection training. Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 22, 23, 24, 25, 26 Service users live in a comfortable environment, which is safe, accessible and comfortable for service users to live in and enjoy spending time with their relatives. EVIDENCE: A comprehensive occupational therapist report on the environment has been undertaken with recommendations made and addressed. A comment in this report stated ‘Little Court Nursing Home is an institution with good standards throughout, it is apparent that each residents needs are considered’. The shared room that is small has been rearranged to provide more space with smaller more compact furniture. The call bell system is old and in need of replacing as part of the homes overall ongoing improvements. There is one tap in a bathroom that cannot have restrictors fitted as the manager explained that the lead pipes would not make this possible. There is a hot water warning sign up. Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 Page 15 The laundry room walls are painted and in need being refurbished i.e. tiled so that it is easily cleaned. The room is limited in space and the refurbishment may assist in this area. Good practices for the prevention of infection control are put in place as is the facilities such as hand alcohol gel. Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 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 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, 30 A competent trained staff team cares for Service users. EVIDENCE: The home employs designated staff for housekeeping; entertainment and care, which ensures that care staff are able to dedicate their time in meeting the direct care needs. There is 24 hour qualified nursing staff provided. The staffing levels are 2 RGNs and 4 care assistants in the morning; 1 RGN and 4 care assistants pm and 1 RGN and 2 care assistants at night. This enables the same quality of service at night as there is during the day. The extra hours provided in cleaning has improved the overall standard of cleanliness. There is a low turn over of staff and a continued commitment for care staff to be trained at NVQ level 2. Staff receive regular training and planned future training needs are identified, the training for staff has increased. The home operates a stringent recruitment policy and procedure. It was discussed that the staff files would benefit from having a check list at the front for tracking and monitoring purposes during the recruitment stage. Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 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 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): 31, 32, 33, 35, 36, 38 Service users benefit from an exceptionally well run and managed service. EVIDENCE: The manager has commenced the Registered Managers Award NVQ level 4 in management. Since starting this there have been significant improvements made to the overall management structures and administration of the home. Without exception all service users and staff expressed how competent and effective the manager was. The home has been awarded the Investors In People Award. The manager is pro active in working with outside agencies to raise concerns and issues to better the care of the service users. The home is open and transparent in its running and management. There are regular meetings held with the shareholders to discuss the aims and objectives of the home and plan for current and future needs. Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 Page 18 The home had a relaxed atmosphere where all staff and service users appeared to enjoy each other’s company and interacted in a positive way with genuine concern for each other. Service users spoke highly of the staff. There are systems in place to seek the views of the service users and other stakeholders. The monitoring from the manager forms part of the overall quality assurance. Regulation 26 visits are conducted and reports received. It was discussed that the external management support from this visit could be more constructive. The manager receives clinical supervision from the Elderly Nurse Care Specialist. Formal supervision for other areas needs to be conducted. Service users spoken with confirmed that the home does not manage their money either relatives take on this role or the financial affairs officer at social services. Invoices are sent for money paid by the home i.e. hairdresser. Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 X 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 3 3 X 2 3 3 3 2 STAFFING Standard No Score 27 4 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 X 2 Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 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 OP10 Regulation 12(4a) Timescale for action The registered person shall make 23/02/06 suitable arrangements to endure that the care home is conducted in a manner, which respects the privacy and dignity of service users. A person shall not manage a 23/02/06 care home unless he has the qualifications necessary for managing the care home. In that the NVQ Level 4 in management/registered managers award is completed. Requirement 2 OP31 9(1)(2)(i) 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 Refer to Standard OP9 OP15 Good Practice Recommendations It is recommended that the PRN medication procedures be firmed up. That the front information sheet be more detailed. It is recommended that service users are offered supper when given their evening drink as currently a snack is DS0000026188.V267686.R01.S.doc Version 5.0 Page 21 Little Court Nursing Home 3 4 5 6 7 OP22 OP26 OP28 OP29 OP26 given on request. It is strongly recommended that the call system be updated and replaced. It is very strongly recommended that the laundry room be refurbished so that it is easily cleaned and the limited space is maximised. It is recommended that a minimum of 50 of care staff be trained to NVQ level 2 or equivalent. It is recommended that the staff files have a checklist at the front for tracking and monitoring purposes during the recruitment stage. It is very strongly recommended that the manager receive formal supervision for other areas than clinical. Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Little Court Nursing Home DS0000026188.V267686.R01.S.doc Version 5.0 Page 23 - 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. 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