Inspection on 17/01/06 for Lord Harris Court

This inspection was carried out on 17th 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lord Harris Court 31/01/09

Lord Harris Court 31/01/07

Lord Harris Court 30/06/06

Lord Harris Court 02/08/05

Lord Harris Court 22/02/05

Lord Harris Court 05/07/04

Lord Harris Court 20/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Lord Harris Court Mole Road Sindlesham Wokingham Berkshire RG41 5EA Lead Inspector Susan Burton & Lorna Somerville Unannounced Inspection 17th January 2006 09:25 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 Lord Harris Court DS0000011003.V273704.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. Lord Harris Court DS0000011003.V273704.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lord Harris Court Address Mole Road Sindlesham Wokingham Berkshire RG41 5EA 0207 405 8341 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) mtong@rmbi.org.uk arichards@rmbi.org.uk Royal Masonic Benevolent Institution ***Post Vacant*** Care Home 90 Category(ies) of Old age, not falling within any other category registration, with number (90), Physical disability (1) of places Lord Harris Court DS0000011003.V273704.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd August 2005 Brief Description of the Service: Lord Harris Court is Royal Masonic Benevolent Institution Home that provides accommodation and care for up to ninety-four service users over the age of sixty-five years, of which up to forty-four service users may require nursing care. Lord Harris Court is situated in Sindlesham and is close to local shops, supermarkets and train station. There is an in-house shop one day a week, and transport in the homes mini bus to local shops for those more mobile. There are a number of garden areas and 3 large lounges for the residents and their visitors to use and a large dinning room. The home has a wide ranging activity programme, a library and hairdressing facilities. Lord Harris Court DS0000011003.V273704.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection on Tuesday the 17th of January 2006, which commenced at a 9:25 a.m. The inspection focused on staffing arrangements, financial arrangements and care planning and followed up requirements and recommendations from the last inspection. The CSCI pharmacy inspector focused on medication policies and practises and the current administration records and arrangements. The homes manager was not present during the inspection but both deputy managers were on duty and assisted with the inspection process. What the service does well: What has improved since the last inspection? Care planning records have improved with much more detailed information and assessment now recorded. The manager and staff team have spent time auditing the records to ensure they are appropriate. Nutritional screening and psychological assessment documentation had generally improved since the last inspection but need to continue to ensure all aspects of care needs are fully covered. Lord Harris Court DS0000011003.V273704.R01.S.doc Version 5.1 Page 6 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. Lord Harris Court DS0000011003.V273704.R01.S.doc Version 5.1 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 Lord Harris Court DS0000011003.V273704.R01.S.doc Version 5.1 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): None of these standards were inspected on this occasion. EVIDENCE: Lord Harris Court DS0000011003.V273704.R01.S.doc Version 5.1 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): 7,8,9,10 Care plan documentation sets out personal and social care needs for each individual resident. The recording of detail in care plans has improved since the last inspection, but need to ensure that a complete overview of all of an individuals health care needs are assessed and documented. Procedures for medication have improved, although the records of medication administered by staff are not complete. The timings of medication rounds and staff required need to be reviewed. Some residents are responsible for some or all of their own medicines. Clear policies are in place. Staff treat residents with respect and their privacy is protected. EVIDENCE: The inspector examined a number of care plans from the nursing section of the home. The manager and staff team had recently been auditing the care plans Lord Harris Court DS0000011003.V273704.R01.S.doc Version 5.1 Page 10 to ensure that all care needs were assessed and documented. The inspector was pleased to see significant improvements made on the detail and information recorded and the general presentation of the plans. At the previous inspection requirements had been made in regard to nutritional assessments and emotional/ psychological assessments. The records appeared to show some improvement in this area, but when the inspector decided to audit the fluid intake of one resident who was assessed by the home as high risk the information recorded did not reflect what the resident told the inspector. The resident did not have a fluid balance chart and the care plan instructed staff to provide the lady with glasses of milk. What had been provided were glasses of water, apple juice and a cup of tea which were untouched. The resident advised the inspector that she did not drink tea and did not understand why she was given tea to drink; no milk had been apparently offered or provided. The inspector discussed with the deputy manager the psychological assessments of two residents. Staff were aware of the emotional needs of one individual but these had not been fully recorded, no consideration appeared to have been given for the treatment of depression. The care plan records of another individual recorded medication for the treatment of anxiety but this had not been reflected on his psychological/emotional assessment and did not include what actions staff were to take to support him. Information for staff on how to care and support residents with nutritional deficits and psychological/emotional needs to be more effectively demonstrated. Medication storage arrangements were checked. Some controlled drugs were found in the outer section of a medication cupboard - these should be stored in the inner controlled drugs cabinet. It is recommended that maximum and minimum temperatures are monitored and recorded in the medicines refrigerator, in order to assess whether the required temperature range of 2-8 degrees is maintained. Clear records are kept of medicines received into the home and those being sent for destruction. A contract has now been set up for the removal of unwanted medicines. There were some blank spaces in the medication administration records where it is not clear if medication has been given as prescribed by the doctor. For all regular medication there should be a signature of the member of staff administering the dose, or a clear reason for omission recorded. It is a requirement to keep an accurate of all medicines administered. On the day of the inspection the 8am morning medication rounds were still unfinished at 10.45am. The nurse administering the medication was constantly distracted from her medication administration by the ringing of the telephone Lord Harris Court DS0000011003.V273704.R01.S.doc Version 5.1 Page 11 and the questions or instructions needed by other staff. Staff administering medication should not be distracted and be allowed to complete the task safely. The timings and staff required for giving medication needs to be reviewed and re-assessed. This is important for residents requiring medication for symptom control e.g. pain relief, and also for those residents on multiple daily doses, which should be given as evenly spaced as possible over the day. Some residents are responsible for their own medication, and clear documented risk assessments are in place in the residents care plans. The inspector observed and listened to numerous interactions between staff and residents during the inspection, staff were heard to be respectful to residents and mindful of their privacy when providing care. Doors were knocked upon before entering, residents were spoken to respectfully. A resident had died that morning and both managers and the staff were seen to be sensitive to the familys needs and the support they needed. The inspector spoke to three of the homes administrators who also provide service and support to the residents in the home in regard to finances and contractual matters. All staff appeared professional and knowledgeable and understanding of the respect and sensitivity required when dealing with residents and their finances. Lord Harris Court DS0000011003.V273704.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): 13,14,15 Residents are able to maintain contact with family and friends. Residents are encouraged and supported to exercise choice, although in some areas this could be improved. The dining room experience is comfortable and the food provided wholesome and appetising. Special diets are provided for by knowledgeable and experienced chef. EVIDENCE: During the course of the inspection the inspector observed numerous visitors coming and going from the home, some family members joined their relatives in the dining room for lunch. The inspector observed the staff welcoming and assisting friends and relatives with questions and queries. The home has a vibrant and friendly atmosphere. During the course of the inspection the inspector examined the care plans and found that staff had recorded residents preferences in regard to morning and evening routines, the time they wish to get up in the morning, their choice of drink and any other individual requests. Documentation also included in-depth Lord Harris Court DS0000011003.V273704.R01.S.doc Version 5.1 Page 13 information on night time routines and arrangements for individuals and demonstrated that staff had spent some time getting to know the individuals choices and preferences which is good practice. As stated in standard 7 not all care plans robustly demonstrated this degree of consultation. The inspector had lunch with staff in the homes pleasant dining room. The food that was seen to be provided looked wholesome and appetising and the meal that was served to the inspector supported this. Residents are able to exercise their likes and dislikes from the menu selection provided on the table. The inspector spoke to the new Chef about special diets. He was able to confirm the processes involved to ensure that residents on special diets are provided with and served appropriate meals. Lord Harris Court DS0000011003.V273704.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): None of these standards were inspected on this occasion. EVIDENCE: Lord Harris Court DS0000011003.V273704.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): 19,26 Residents in the new extension are provided with safe, well-maintained and comfortable bedrooms. The home is clean, pleasant and hygienic. Hand washing facilities in the laundry are still problematic and good practice guidance on hand washing is not displayed. EVIDENCE: The new extension on the second floor has been registered since the last inspection. The inspector visited the new extension and found that there were some vacancies, but nearly half were now occupied. The bedrooms are all ensuite and provide modern and comfortable accommodation. The inspector spoke very briefly to one new resident who was about to go out bowling, he was able to confirm his satisfaction with the room and the service provided. Lord Harris Court DS0000011003.V273704.R01.S.doc Version 5.1 Page 16 The inspector visited the sluice in the nursing unit following a recommendation made at the last inspection. There were no good practice hand washing guides and procedures displayed by the facilities. The deputy manager assured the inspector that she was attempting to reorganise this area and that plans were in place to improve the facility. The inspector also visited the laundry and found again that there were no guidance posters being displayed for staff on appropriate hand washing techniques. The sink in the laundry does not appear to be used by the staff for hand washing purposes as access is blocked by a number of laundry containers and an open topped rubbish bin. The laundry staff advised the inspector that they go across the corridor to the cloakroom to wash their hands, this is not good practice. Lord Harris Court DS0000011003.V273704.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): 27,30 The numbers of staff on duty during busy periods needs to be reviewed to ensure that the supervision of dependent residents is safe and satisfactory. The organisation provides a range of training opportunities for the staff to ensure their competency. EVIDENCE: As stated in standard 9, both the lead inspector and pharmacy inspector were concerned about the arrangements for the safe administration of medication. There was one RGN on duty with four carers for the 19 residents in the main section of the home that provides nursing care, there were 7 other residents being provided with nursing care located in different areas around the home with another RGN providing and their nursing care. The inspector observed 6 residents in the dining room later that morning that were unsupervised for a period of time which was not satisfactory for residents of such high dependency needs. The other care staff on duty were according to the RGN, still getting other residents washed and dressed. The RGN on duty was managing the arrangements for the death of one resident, answering the telephone, supporting the staff team while trying to give out medication. Both RGNs expressed their concern about staffing levels. The new deputy manager advised the inspector that she has on occasions had to go to the unit to provide extra staffing. The inspector was unclear whether this was a general expectation of the deputy managers role or not. The Lord Harris Court DS0000011003.V273704.R01.S.doc Version 5.1 Page 18 organisations proposals to reorganise their nursing care into a core unit had been put on hold as some residents did not wish to move at the current time and concern had been expressed by CSCI as to the proposed staffing levels. The organisation had been very responsible and entered into discussion with residents and its staff team about the proposals and had decided to postpone any changes at this time. From this inspection evidence would support that further review is required to ensure the safety of those dependent residents in this part of the home. The deputy manager advised the inspector that training had been provided for staff in abuse awareness, health and safety, continents and pressure area care, challenging behaviour, care values, manual handling and communication skills. One deputy manager had been on appraisal training, medication training and plans to do assessor training in the future. Staff are provided with a training passport by the organisation to record all training activities and events and any qualifications achieved. Lord Harris Court DS0000011003.V273704.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): 35,37 The residents financial interests appear to be appropriately safeguarded and protected by the administration arrangements. Residents rights and best interests appear to be safeguarded by the homes record-keeping. EVIDENCE: The inspector spent time with one of the homes experienced administrators who was currently training his replacement. Discussion took place in regard to contracts/terms and conditions and how residents finances are generally protected. The administrator appeared professional and knowledgeable and was sensitive to the needs of the residents when dealing with complicated financial and contractual arrangements. The inspector met with another of the homes administrators who has specific responsibility for the management of Lord Harris Court DS0000011003.V273704.R01.S.doc Version 5.1 Page 20 the residents personal monies. The administrator evidenced on her computer invoices and balance sheets in regard to individual residents transactions. Invoices for hairdressing and other personal services are paid for out of the residents account and then the individual invoiced for that amount. The organisation provides a residents account that the Inspector was advised did not pay any interest, a monthly reconciliation statement is provided. A small cash float is kept securely for residents who require access to cash from their account; the inspector was able to see that the cash sums corresponded with the corresponding balances recorded. The inspector was able to observe and examine the record keeping arrangements in the home and this was seen to be appropriate and well managed and safeguarded the rights and financial interests of the residents. Lord Harris Court DS0000011003.V273704.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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 2 STAFFING Standard No Score 27 1 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X 3 X 3 X Lord Harris Court DS0000011003.V273704.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? N0 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 OP27 Regulation 18 1(a) Requirement Timescale for action 17/03/06 2 3 OP9 OP9 13(2) 13(2) 4 OP9 13(2) The numbers of staff on duty during busy periods is to be reviewed to ensure that the supervision of dependent residents is safe and satisfactory. That controlled drugs are stored 01/02/06 within the inner controlled drugs cabinet. That accurate records are kept of 01/02/06 all regular medication administered, or a reason for omission recorded if a dose is not given. That the timings of medication 01/03/06 rounds, and the numbers of qualified staff available are appropriate to ensure the safe administration of medication. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000011003.V273704.R01.S.doc Version 5.1 Page 23 Lord Harris Court 1 Standard OP8 2 3 OP14 OP26 4 OP9 All care plans robustly demonstrate that all aspects of an individuals nutritional well being and psychological wellbeing are assessed and the actions required by staff to address them are recorded. Residents are fully consulted in regard to their choices and preferences and care plans fully reflect these wishes. Care plans are to document any consultation. Home is recommended to display in sluices and in the laundry good practice guidance on hand washing techniques and appropriate procedures for the control of infection. That the maximum and minimum temperature range in the medicines refrigerator is monitored and recorded. Lord Harris Court DS0000011003.V273704.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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 Lord Harris Court DS0000011003.V273704.R01.S.doc Version 5.1 Page 25 - 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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