Inspection on 06/07/06 for Nelson Court Linked Service Centre

This inspection was carried out on 6th July 2006.

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

Nelson Court Linked Service... 28/11/05

Nelson Court Linked Service... 09/06/05

Nelson Court Linked Service... 24/03/05

Nelson Court Linked Service... 02/04/04

Nelson Court Linked Service... 07/01/04

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

CARE HOMES FOR OLDER PEOPLE Nelson Court Linked Service Centre Nelson Terrace Luton Chatham Kent ME5 7JZ Lead Inspector Andrea Leverett Unannounced Inspection 6th July 2006 9:30 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 Nelson Court Linked Service Centre DS0000036738.V291676.R01.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. Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nelson Court Linked Service Centre Address Nelson Terrace Luton Chatham Kent ME5 7JZ 01634 845337 01634 819316 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) Medway Council Mrs Theresa Ann Ward Care Home 28 Category(ies) of Dementia - over 65 years of age (28) registration, with number of places Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th November 2005 Brief Description of the Service: Nelson Court is a care home providing care and accommodation for 27 older people who are diagnosed with Dementia. Some also have additional needs. The Home is owned and managed by Medway Council. The property is located in Luton, a suburb of Chatham and is situated close to local shops, public transport and other amenities. The single storey property was purpose built and is subdivided into three wings each accommodating up to nine people. Whilst most service users are permanent residents, three places are set-aside for short term or respite care, and a fourth place has recently been designated for emergency use. The home has a large front area, mostly used for parking, and attractive courtyard and gardens at the rear. The homes current scale of charges is £367.00 Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which took place on the 6th July and lasted from 9.30am to 1pm. The visit was spent talking directly with residents privately and collectively; 2 relatives, 3 staff members and the manager. Due to the nature of the service, it is difficult to reliably incorporate accurate reflections of the service users in the report. Some judgements about quality of life and choices were taken from direct conversation with residents and their relatives, observation and evidencing records held at the home. A tour of the premises was undertaken. The inspector found that the Home continues to provide a high standard of care in a well-designed environment. What the service does well: Nelson Court provides a welcoming and homely environment, is decorated and furnished to a good standard and is clean, bright and airy. The Home benefits from well laid out communal spaces, including outdoor spaces, which are particularly suited to the needs of this service user group. Discussion with relatives evidenced that personal health care needs are well supported and records seen at this inspection evidenced that the Home ensured that detailed assessments underpinned care plans. Assessments included detailed health and personal histories including likes and dislikes, mobility risk assessments. Relatives strongly commended the staff on their caring. The home benefits from a stable, well-trained and highly motivated care team with a motivated and experienced manager. Care staff work in a way that promotes a relaxed atmosphere. Comments received include: “Brilliant can’t fault this place, staff are excellent I haven’t had any problems with them and I know they will call me if there is a problem” “Care workers are excellent, always very attentive, always available 24 hours a day” Comments from other professionals about the Home included. “Excellent understanding of the needs of clients, and each individual qualm or difficulty is addressed carefully and tactfully with all concerned with an acceptable conclusion. Friendly recommended home and is the benchmark I wish other OPMHN homes were even almost as good.” Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 Page 6 “ I can honestly say I have always had the highest regard for Nelson Court and its staff. Both myself and my colleagues frequently voice when talking that if either our selves or our parents had to go into a Home, Nelson court is the one in Medway we would choose.” Service users benefit from a broad range of activities including communitybased activities, group and 1:1 outings. Direct communication between the Chef and residents is good enabling more opportunity for residents to give feed back on food provided. Residents receive an excellent respite and intermediate care service that supports them to maintain independence and return home. 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. Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 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 Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 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): 3,6 The quality of care in this outcome area was considered excellent. Prospective service users benefit from having their needs fully assessed before moving into the Home and know that their needs will be met. Service users receive an excellent respite and intermediate care service that supports them to maintain independence and return home. EVIDENCE: Care records of 2 of the most recently admitted service users showed that Care Manager assessments were in place. In addition to this the Home undertakes its own very comprehensive assessments, which include health and social care needs, risk assessments, life histories and likes and dislikes. The information from these assessments was reflected in the service user care plans. Observation on the day of the site visit showed that staffs were aware of service users needs and likes and dislikes and that meeting them was given a high priority. Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 Page 9 The Home provides respite care to service users living in the community with dementia. Feedback from other professional and family members has evidenced that the home works closely with the dementia day care unit and families to enable service users to receive intermediate care in a timely manner. This supports the wider service’s goal of enabling service users to live in their own homes for longer. Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 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): 7,8,9,10 The quality of care in this outcome area was considered excellent. Service users benefit from having detailed care plans, which show how their health, personal and social care needs, will be fully met. Service users know that their medication will be administered safely and appropriately. Service users feel they are treated with respect and their right to privacy is upheld. EVIDENCE: The inspector case tracked 3 service users records, which showed that detailed care plans were in place. The plans reflected the service users assessed needs and showed how service users health, personal and social care needs would be met. It was noted that daily records did not give enough detail to evidence that care plans were being followed and a requirement regarding this has been made. It was evident from the records that access to health professionals was facilitated. Service users spoken to and relatives confirmed that access to GP’s, community nurses, chiropody, options, dentists and other specialist health services was available as needed. Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 Page 11 An inspection of the home’s medication storage and administration systems was undertaken. None of the service users currently are able to manage and administer their own medication, but the home’s medication policy would support service users right to do this if a risk assessment showed that it was safe to do so. An inspection of Medication Administration Record sheets and medication storage showed that medication was being stored and administered appropriately. The Home had an appropriate system for storing and administering controlled drugs and an up to date medication returns book was being maintained. The medication room was well laid out and orderly. Staff spoken to and training records seen showed that all staff that administers medication has undertaken medication administration training. This training is facilitated by the councils training department but does not currently include a competency test. The manager informed the inspector that all future medication training would include this and a requirement has been made to this effect. Observation on the day and discussion and feedback from service users and their relatives showed that service users are treated with the utmost respect. Interaction between staff and service users was seen to be high and staff support was given sensitively and discreetly. Residents and their relatives spoke highly of the staff team and strongly commended the staff on their caring. Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 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): 12,13,14,15 The quality of care in this outcome area was considered excellent. Residents find the lifestyle experienced in the Home matches their preferences and expectations, and satisfies their social, cultural and recreational interests and needs. Residents and their relatives know that the Home will encourage family contact and liaise with relatives in the best interests of residents. Residents are encouraged to access the community in line with their wishes. Residents are offered a varied and nutritious diet and know that their preferences will be taken into consideration when planning meals. EVIDENCE: The home’s very high environmental standards, appropriate communal spaces and garden areas lend it to providing a range of activities for residents to choose from. A choice of communal spaces means that privacy and quiet time can be sort by residents, without having to return to their own room. Relatives can find quite congenial spaces in which to visit residents and lively group activities can simultaneously be accommodated. This greatly enhances the lifestyle options and quality of life for residents. In addition to this the Home has a dedicated activities room, its own transport and 2 part time activity co Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 Page 13 coordinators. Records and discussion with residents and staff showed that these resources are made good use of. On average residents are able to take part in a community group outing at least once a month. In addition, activity co- coordinators and other staff go out with residents on a 1:1 basis to the local pubs and shops. Residents and their relatives told the inspector that visitors are made welcome in the Home at any reasonable time. Family and friends of residents are encouraged to come and go as they wish without prior arrangement and are encouraged to get involved in the life of the home. Relatives spoken to said that they were confident that the staff would communicate with them appropriately in the best interests of their relatives receiving care. Discussion with residents and records seen showed that communication between the chef and residents was good. The chef himself has recently undertaken training in dementia care and diet and feels that this has further enhanced the quality of service he provides. Residents confirmed that they are consulted about menus and their feedback is sort on food provided. An inspection of the kitchen, food stores and menu’s was also undertaken. It was evident that a range of fresh healthy homemade food was provided. Choices were offered and the chef kept detailed records of resident’s likes, dislikes and dietary needs. Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 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): 16,18 The quality of care in this outcome area was considered good. Residents and their relatives know that their concerns and complaints will be listened to and acted upon. Residents are protected from abuse. EVIDENCE: Discussions with relatives and staff evidenced that concerns and complaints are taken seriously and acted upon. Relatives felt that most concerns were dealt with promptly and informally. The Home does have a complaints procedure, which meets this standard and information from previous inspections and information shared by the manager has demonstrated that the procedure is adhered to. All staff have received up to date training in adult protection and the Home has a good track record of dealing with adult protection issues in the best interests of residents. Staff spoken to showed a good understanding of the issues that could indicate abuse and knew what procedures to follow. The Home has an Adult protection Procedure and Whistle Blowing Policy. Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 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 The quality of care in this outcome area was considered excellent. On the whole residents live in a very well designed, safe, nicely decorated and maintained home that is clean, pleasant and hygienic. EVIDENCE: Residents were observed having easy access to well designed and maintained indoor and outdoor spaces, although it was noted that some of the pathing, in the garden was starting to look uneven and a requirement has been made for this to be risk assessed. Indoor and outdoor spaces flow easily into each other allowing residents much needed opportunity to wander safely around the Home. Security keypads have been installed to minimise the risk of residents wandering outside the Home and secure garden areas. The Home is single storey with a total of 7-day areas, which residents have unrestricted access to. Observation and information taken from the homes pre inspection questionnaire evidenced that equipment and facilities in the Home are well maintained. The Home’s pipe work and radiators are now guarded or have guaranteed low temperature surfaces in all areas that are used by residents. Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 Page 16 A tour of the premises and feedback from relatives evidenced that the Home is kept clean, hygienic and free from offensive odours throughout. Gloves and aprons are provided to ensure infection control, as are liquid soap dispensers and paper hand towels. Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 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): 27,28,29,30 The quality of care in this outcome area was considered excellent. Resident’s needs are met by appropriate numbers of staff who are trained and competent to do their job. Residents are protected by the homes recruitment policy and procedures. EVIDENCE: Staffing levels on the day of this unannounced inspection and staff rota’s inspected showed that sufficient staff are on duty to meet residents’ needs. Residents and their relatives also confirmed that staffing levels were sufficient and high activity levels also indicated this. Training records seen and staff spoken to confirmed that a range of mandatory and service specific training was undertaken by staff and over 100 of staff have NVQ 2 or above. A sample of staff files inspected contained all relevant information required to demonstrate safe recruitment practises. Files included application form, passport and birth certificates, 2 written references, Job descriptions and evidence of Criminal Record Bureau checks. Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 Page 18 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): 31,33,35,38 The quality of care in this outcome area was considered excellent. Residents personal preferences, support and care needs are provided through the managers open leadership and the promotion of a safe home and working environment. Although financial systems to safeguard residents from financial abuse are in place more could be done to promote their individual financial interests. EVIDENCE: The manager has worked with this service user group for a number of years and has completed NVQ 4 in Care and Management. Residents, relatives and staff expressed a high regard for the management approach to the home. Residents and relatives felt the manager was approachable and staff said they felt well supported. The manager continues to demonstrate, a very clear understanding the needs of residents and a proactive approach to addressing them. Monitoring health and safety in the home is to a good standard and Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 Page 19 equipment is serviced as required to maintain a safe home and facilities. Risk assessments are completed for individuals and records seen evidenced a clear understanding of accident/incident recording and reporting under regulation 37 to the commission. There is an outstanding requirement that the home improve financial arrangements where the money of individual residents is managed by exploring ways of providing individual accounts instead of pooling money. The inspector has been informed that Medway Council are in the process of moving to such a system and are currently piloting this in another service. The inspection process has evidenced consistently high standards of care and year on year improvements in training, record keeping and quality assurance systems and the quality of the overall service are now considered excellent. Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 Page 20 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 4 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 2 X X 4 Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 Page 21 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 OP35 Regulation 20(1a) Requirement The registered person must ensure that monies belonging to service users should be held in accounts in the name of individual service users. Ongoing from last inspection. New action plan required. Timescale for action 30/08/06 2 OP19 23.2(b) 3 OP7 15.1 The registered person must 30/08/06 ensure that the pathing in the garden is risk assessed to ensure it is safe for use by residents. The registered person must 30/08/06 ensure that daily residents records provide enough information to evidence that care plans are followed. 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 Standard Good Practice Recommendations Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 Page 22 Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oats 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 Nelson Court Linked Service Centre DS0000036738.V291676.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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