CARE HOMES FOR OLDER PEOPLE
Nelson Court Linked Service Centre Nelson Terrace Luton Chatham ME5 7JZ Lead Inspector
Andrea Leverett Announced 9 June 9.45am
th 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 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 H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 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 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 Ms Janet Mary Newell CRH Care Home 27 Category(ies) of OP Old Age (27) registration, with number of places Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24 March 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. Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection, the first in the year running from April 1st 2005 to March 31st 2006. The visit lasted from 09.45am until 14.30pm on the first day of inspection and 11.30am until 13.30pm on the second day. The visit was spent talking directly with residents privately and collectively; 2 care staff, 2 activities co-ordinators, 2 relatives and the acting 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 followed by discussion with support staff and evidencing records held at the home. A tour of the premises was undertaken. 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. Personal health care needs are well supported. Discussion with relatives and records seen 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 acting manager. Care staff work in a way that promotes a relaxed atmosphere. Comments received include: “I can’t fault the Home, my wife is well cared for”, “ The staff are so helpful and always make me welcome when I visit my husband.” Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
The Home could do more to further enhance the quality of life of residents by offering more community activities and make use of the minibus which the Home has access to. Staff in the Home could do more to enhance the feeling of safety and privacy for residents by ensuring, as far as reasonably possible, that they know how to use the locks on their bedroom doors. To improve direct communication between the Chef and residents in order to further enhance residents’ choices and provide more opportunity to give feed back on food provided. To improve financial arrangements where the money of individual residents is managed by exploring ways of providing individual accounts instead of pooling money. Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 Page 7 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 H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 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 standard(s) 3,4,5 Residents benefit from having comprehensive assessments undertaken prior to admission so that they might be confident their assessed needs can be met before a place is offered. Prospective residents and their relatives are encouraged to visit the Home and are visited in their own home or hospital by staff before agreeing to commence a trial period of one month so that they are able to assess for themselves the quality, facilities and suitability of the home. EVIDENCE: Relatives spoken with and records seen evidenced that detailed assessments were undertaken before a place was offered. Two relatives talked about the assessment process and how they were visited in their own Home and the detailed information that was sort. They also confirmed that they had visited the Home with their partners and were given appropriate information in order to make an informed choice about the Home. Relatives spoken with highly praised the staff and manager on their open and supportive roles at this time. Records showed that multidisciplinary reviews are undertaken after the trail period to ensure that the Home is able to meet needs.
Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 Page 10 The home does not provide intermediate care. Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 Page 11 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 standard(s) 7,8,9,10 Whilst residents are treated with genuine respect and dignity by care staff more could be done to improve privacy for residents. The residents can be confident that their individual health and social care needs are well supported. The Home benefits from a well managed storage and medication administration and recording system. EVIDENCE: Care plan records seen were sufficiently up to date, detailed and contained clear information to support staff to meet the needs of the individuals. Relatives confirmed their involvement with care staff in sharing information to help to develop their relatives care plan. Those spoken with felt fully involved and aware of their relatives care. It was noted that care staff were attentive to residents, taking time to sit and talk or walk with them. Support was observed being given in a sensitive manner. Care staff are mindful of how to prevent risk of falls, taking action to ensure safety for individual residents and this is clearly and comprehensively recorded.
Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 Page 12 Feedback from a recent pharmacy inspection evidenced that an appropriate medication storage, administration and recording system is in place and records showed that all staff who administer medication are appropriately trained. Observation and feedback from residents and relatives evidenced that generally residents right to privacy was supported but two residents told the inspector they did not know how to lock their bedroom doors and had occasionally been disturbed by other residents. Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 12,13,14,15 Residents are encouraged to make choices about aspects of their daily lives in that the lifestyle experienced in the home matches their expectations and preferences however, more could be done to improve communication between the home’s chef and residents and choice and frequency of community outings. EVIDENCE: Residents and relatives spoken to and observation on the day evidenced that residents were supported to make choices regarding daily activities, times for getting up and going to bed and drinks and snacks. Discussion took place with residents regarding the food at the Home and the majority of feedback was positive. Two residents said they had not met the chief and felt that some minor personal preferences were missed. This was discussed with the manager and it was agreed that these could easily be addressed by improving direct communication between the chief and residents. The lunchtime period was observed to be well managed by care and catering staff with residents getting freshly served and hot food immediately they sat down. Regular activities are provided inside the Home, which stimulate and encourage interaction with residents. It was noted that community activities are less frequent and residents expressed a wish to go out more often.
Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 Page 14 Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 Page 15 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 standard(s) 16,18 Residents and relatives know how to complain and their complaints are listened to and acted upon. Service users are protected from abuse by the home’s robust policies and procedures and god quality staff training. EVIDENCE: Relatives told the inspector that they had been given a copy of the complaints procedure, although had not had cause to use it. They felt they could approach staff and the management team regarding minor issues and felt that these were listened to and prompt action was taken. Records showed that the Home has an Adult Protection Procedure and staff have received Adult Protection Training. Staff spoken to confirmed that they had received training and demonstrated an understanding of the issues and good practice in this area. The Home is currently the subject of a complaint and adult protection investigation and have co operated fully with investigations. Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 Page 16 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 standard(s) 19,20,25,26 Residents benefit from living in a well designed, warm, nicely decorated and clean Home though further improvements of the environment are needed to improve safety of residents. EVIDENCE: Residents were observed walking comfortably and safely around the Home, having easy access to well designed and maintained indoor and outdoor spaces. 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. Safety of residents could be improved by ensuring that pipe work and radiators are guarded or have guaranteed low temperature surfaces.
Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 Page 17 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 H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the above standards were inspected on this occasion. EVIDENCE: Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,35,38 Residents’ personal preferences, support and care needs are encouraged through the acting managers open leadership and the promotion of a safe home and working environment. EVIDENCE: The acting 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 acting manager was approachable and staff said they felt well supported. The acting manager demonstrated through discussion, a very clear understanding if the needs of current residents and current issues. Monitoring health and safety in the home is to a good standard and equipment is serviced as required to maintain a safe home and facilities.
Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 Page 20 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. Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 x x x x 2 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 3 x 2 x x 3 Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 Page 22 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 OP25 Regulation 13(4)(a&c ) Requirement The registered person must ensure that subject to risk assessments, radiators and hot pipes must be fitted with guards.Ongoing from last inspection 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. The registered person must ensure that service users are consulted regarding community outings. Timescale for action 31.12.2005 2. OP35 20(1)(a) 30.09.2005 3. OP12 16.2(m) 20/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations It is recommended that the explore ways of improving communication between the homes chief and residents. Nelson Court Linked Service Centre H56-H06 S36738 Nelson Court LSC V230266 090605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent. ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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