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Inspection on 12/01/06 for North Court Residential And Nursing Home

Also see our care home review for North Court Residential And Nursing Home for more information

This inspection was carried out on 12th January 2006.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has a positive and welcoming atmosphere. Residents continue to say that carers and nurses will do whatever they ask and come quickly if they ring their call bell. Staff also remain keen to improve their skills and knowledge and spoke openly about how the home operates. Residents at North Court have some diverse needs. Although the special needs area of the home is separate, residents and staff mix together well and the home operates as one.

What has improved since the last inspection?

The Activities Co-ordinator is continuing to develop ideas and the Registered Manager confirmed that they would be attending a course to further this. Two staff had attended a two-day course on dementia. They said that this had been very beneficial. Professionals are also visiting the home to help with the development of the Special Needs unit. Care plans are still being developed and worked on by staff. Information is clearer and more informative.

CARE HOMES FOR OLDER PEOPLE North Court Residential And Nursing Home Northgate Street Bury St Edmunds Suffolk IP33 1HS Lead Inspector Jo Govett Unannounced Inspection 12th January 2006 12:30 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 North Court Residential And Nursing Home DS0000024456.V278368.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. North Court Residential And Nursing Home DS0000024456.V278368.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service North Court Residential And Nursing Home Address Northgate Street Bury St Edmunds Suffolk IP33 1HS 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) 01284 763621 01284 725980 Four Seasons Homes No 4 Limited Mrs Elspeth Anne Nicol Care Home 65 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (23), Old age, not falling within any other of places category (42) North Court Residential And Nursing Home DS0000024456.V278368.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. One Place with the category Physical Disability (PD) The home is registered for one place under the category Physical Disability (PD) for the named individual specified in the letter dated 25th November 2003, for the duration of their residence. 14th February 2005 Date of last inspection Brief Description of the Service: North Court is located on the main road leading into the town centre of Bury St. Edmunds. The home was originally purpose built by Suffolk County Council as a home for older people but was sold in 1994 and purchased by the current owners, Four Seasons Health Care Ltd. in December 2000.The home is set well back from the roadway and accessed by a circular driveway with ample car parking spaces available. There are landscaped gardens to both the front and rear of the property with appropriate seating areas for service users. The home is registered to provide both nursing and residential care for up to 65 older people. The ground floor is divided into four units. Fern provides care for ten frail elderly residents while Primrose, Rose and Heather provide care and accommodation for 23 older people suffering from dementia. The remaining units are sited on the first floor of the home and provide care for 32 frail elderly people who require either nursing or residential care. North Court Residential And Nursing Home DS0000024456.V278368.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on the 12 January 2006. We spoke with staff, residents, the Registered Manager, Mrs. Elspeth Nicol and one of the two Deputy Managers, Christine Andrade. At the time of inspection five residents were being cared for in bed, while others were spending time in their rooms or the communal areas of the home. We looked at the progress of requirements and recommendations made from the last inspection and completed inspecting the Key Standards. It is therefore recommended that any reader of this report should also see the previous report completed on the 14 July 2005. What the service does well: What has improved since the last inspection? What they could do better: Wedging open of fire doors and obstacles restricting access to some toilets and bathrooms needs addressing to ensure that residents are free from risk so far as possible. Assessing and care planning now needs to be completed and maintained on an ongoing basis to ensure and evidence that the home can meet individual needs. North Court Residential And Nursing Home DS0000024456.V278368.R01.S.doc Version 5.1 Page 6 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. North Court Residential And Nursing Home DS0000024456.V278368.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 North Court Residential And Nursing Home DS0000024456.V278368.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): 3 (Standard 6 is not applicable) Residents can expect that their needs will be assessed prior to admission to North Court. However, failure to ensure that the home can meet the needs of individuals under its current registration with the CSCI, may put residents and staff at risk. EVIDENCE: The previous inspection of the home had required that pre assessments be complete and in full order to ensure that all residents’ needs are highlighted and followed through in the development of the care plan. The pre assessments seen for new admissions are now complete signed and dated. However during the visit we became aware that a resident, who had been admitted to a residential bed, had a pre assessment that recorded them as having dementia. As a result it was noted that the home could be over numbers in the category of (DE(E)), being registered to take no more than 23 residents with dementia, over 65 years of age. An Immediate Requirement notice was left for Registered Manager to confirm whether the resident had a diagnosis prior to admission. North Court Residential And Nursing Home DS0000024456.V278368.R01.S.doc Version 5.1 Page 9 North Court Residential And Nursing Home DS0000024456.V278368.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 10. North Court places high importance on residents needs and has good policies and procedures in place. However when these are not adhered to and/or records are incomplete, residents and their carers could be at risk. EVIDENCE: We looked at two care plans. The Registered Manager confirmed that there is ongoing monitoring and development, but the majority of risk assessments should be complete within two weeks of admission, in line with the homes policy and procedure. A new admission had a social assessment partly completed, in handwriting and type. The Registered Manager confirmed this had been written by two people and acknowledged that neither had signed it. A moving and handling assessment had not been completed despite the pre assessment noting that the resident had a history of falls. In addition since their admission they had fallen and an incident report had been completed. Continence and weight charts not been completed. The Registered Manager said that they monitored the accident book but had not reviewed it recently. There is no policy and procedure for this although we agreed that this may help to monitor and highlight any patterns of concern. North Court Residential And Nursing Home DS0000024456.V278368.R01.S.doc Version 5.1 Page 11 Previous requirements for Medication Administration Records (MAR), not to be deleted, written over or tip-exed out had been complied with. MAR charts seen were complete and where a mistake had been made an explanation on the rear of the chart was available. No tip-ex was seen. Lockable cabinets had been fitted in the nurse/carer station to store care plans securely. Although care plans had been left out and unattended, when the inspector returned some time later they had been replaced in the lockers and secured. North Court Residential And Nursing Home DS0000024456.V278368.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): 15 The practice of transporting multiple meals on open trolleys does not benefit residents and could place them at risk. EVIDENCE: During lunch in the special needs unit we observed that meals for residents’, who needed one to one feeding in their rooms, were being transported together, at the same time, by one carer going from room to room. Staff covered six meals with foil and then took two open trolleys (three meals each) to resident’s rooms in turn. Staff said that it could take up to 15 minutes to feed each person. This potentially meant that the last meal on the trolley would be there for up to an hour. The majority of carers who were involved in one to one feeding so did so in a patient and kind manner. One example of bad practice was fed back to the Registered Manager. North Court Residential And Nursing Home DS0000024456.V278368.R01.S.doc Version 5.1 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): 18 Residents can expect to benefit from the homes polices and procedures that should ensure they are protected from harm. EVIDENCE: The home has an abuse policy and procedure. They also have the local area protection committee guidelines for reporting concerns. Staff cover issues relating to abuse and protection of vulnerable people during induction training. The Registered Manager stated that the home had made no Protection of Vulnerable Adult (POVA) referrals since the last CSCI inspection. The recruitment policy and procedure was updated following the introduction of the POVA list checks and updated guidance on recruitment and applications. North Court Residential And Nursing Home DS0000024456.V278368.R01.S.doc Version 5.1 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, 21, 23, 24, 25 & 26. Residents can expect the management to place high importance on the home being kept clean and tidy. Some concerns around appropriate storage and the wedging open of fire doors lets down otherwise good practice. EVIDENCE: We were able to walk freely around North Court. Residents said they thought the home was “kept well” and they had no concerns about cleanliness. We fed back information to the Registered Manager regarding the use of aprons and gloves for some domestic duties, in order to protect staff and residents and prevent cross infection. They agreed that this was standard practice and all staff should comply. We were able to talk with domestic staff who discussed their training and their general duties. This involved daily, weekly and seasonal activities around the home and training to update their knowledge about the chemicals they use, safe storage and infection control. North Court Residential And Nursing Home DS0000024456.V278368.R01.S.doc Version 5.1 Page 15 The Registered Manager shared information about ongoing redecoration of some rooms. They also said that the homes owners Four Seasons, would be visiting the home in the near future to discuss and plan the homes full refurbishment. Two residents said that they liked their rooms and the redecoration. They both said that they enjoyed arranging their room with carers and deciding where pictures should go. Where rooms are shared screening is provided for privacy and in the shared rooms seen each side reflected the interests of the resident. Many residents (or their representatives) have signed risk assessments stating they understand the risk, but wish their bedroom doors to be wedged open during the day. Those people talked with said they understood that fire regulations state that should not be done but they like to have their bedroom door open. Staff and residents confirmed that fire doors are all closed at night. At a previous inspection 13 February 2005 documentation was available that confirmed that the fire precautions had been reviewed and a plan of implementation for self closing devices and zoning of areas was being developed. The full plan would be forwarded to the CSCI. However this has not been received. Previous reports have required the home to ensure that communal bathrooms and toilets are free from equipment which blocks access. At this visit two bathrooms had laundry equipment, a hoist and a wheelchair blocking access to the toilet and/or basin. North Court Residential And Nursing Home DS0000024456.V278368.R01.S.doc Version 5.1 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): 29 Some missing information needs to be in place in order for the home to assure its residents that it complies with its own recruitment policies and procedures, and that of the National Minimum Standards. EVIDENCE: The home has a policy and procedure for the recruitment of staff. This differs depending on whether the home is employing a nurse or carer. The Registered Manager confirmed that when nurses are interviewed, they interview with one of the Deputy Managers. We looked at 2 new employees files. Criminal Record Bureau Disclosures including POVA checks had been completed and each person had been interviewed, completed an application, provided identification and attended induction training. Both files had one missing reference although a checklist confirmed they had been received. The Registered Manager also confirmed they had seen them but they may not have been filed. They agreed to provide CSCI with evidence of their receipt as soon as possible. Information was also not complete on application forms regarding full employment and education history. North Court Residential And Nursing Home DS0000024456.V278368.R01.S.doc Version 5.1 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, 33, 34, 35, 37 & 38. Overall residents can expect the home to act responsibly. This is undermined by shortfalls in records and practice, which sometimes do not fully adhere to the policies and procedures of the home. EVIDENCE: The Registered Manager is a Registered Nurse and has completed the Registered Managers Award. They have recently spent some time away from the North Court managing another home in the area. They had made the CSCI aware of this and kept us informed. Staff said that this had not caused a problem and that they were only a “phone call away”. The Registered Manager confirmed this and stated that although things had been busy, the Deputy Managers had worked “very well” and had called for advice if there were any concerns. The Registered Manager said that the admission of a resident who had a diagnosis of dementia, to the residential bed was a mistake but that they were on holiday at the time and had not checked the assessment. They confirmed that they would discuss the issue with the staff concerned. North Court Residential And Nursing Home DS0000024456.V278368.R01.S.doc Version 5.1 Page 18 The home has a full time administrator who amongst other duties, looks after the residents personal allowances. They stated that only small amounts of money are kept in the home, for residents to buy newspapers or hairdressing etc, and larger amounts are banked. Further information was needed to confirm whether this money is held in a “pooled” account. Statements received by the home show the total amount banked, without interest. Each resident has an individual record of transactions including receipts. The CSCI has received a copy of the Four Seasons accounts for the year-end December 2004, which have raised no concerns. The home has its own quality audit systems, policy and procedure. The Registered Manager and then the Regional Manager complete quality Assurance Audits every six months in rotation. In addition the home runs an adaptation programme for overseas nurses to qualify to work in this country. As part of this their training and monitoring is subject to audits by the awarding body and the Nursing and Midwifery Council. There is no information about how the results of this are shared with interested parties, including residents, staff and the CSCI. The home had not yet updated the newsletter that had its first issue just before the previous inspection visit in July 2005, but stated that this would be a good tool to feedback results. Although the home was clean and tidy during the inspection, there are still some continuing concerns about fire doors being wedged open and storing equipment suitably, so that access to communal bathrooms and toilets are not restricted. The sections called Environment and Daily Life and Social Activities highlights areas where the distribution of food and some staff practice could have health and safety/infection control consequences. North Court Residential And Nursing Home DS0000024456.V278368.R01.S.doc Version 5.1 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X 2 X 3 3 2 3 STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 3 2 X 2 2 North Court Residential And Nursing Home DS0000024456.V278368.R01.S.doc Version 5.1 Page 20 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 OP3 Regulation CSA 2000 sec 24 14, 15 14, 15 19 Timescale for action The home must provide the CSCI 12/01/06 with evidence to clarify whether (resident) has a diagnosis of dementia. Care plans and related risk 31/03/06 assessments must be completed and kept up to date. The home must be able to 31/03/06 evidence that residents’ health care needs are being met. The home must ensure that staff 31/03/06 files contain all the elements required by Schedule 2 of the Care Homes Regulations 2002 and be available for inspection. The home must make a copy of 31/03/06 any quality assurance reports available to residents, and supply the CSCI with a copy. The home must confirm whether 12/01/06 residents’ money is “pooled” in the same bank account. If this is the case the home must demonstrate that interest is paid separately in proportion to the amount each resident holds. Where residents require one to 12/01/06 one feeding, meals must be kept hot and systems in place to DS0000024456.V278368.R01.S.doc Version 5.1 Page 21 Requirement 2 3 4 OP7 OP8 OP29 5 OP33 24 6 OP35 16 (l) 7 OP15OP38 12, 13, 16 North Court Residential And Nursing Home 8 OP21OP38 12, 13 ensure that there is no risk of cross infection or bacterial growth. The home must ensure that communal bathrooms and toilets are free from equipment which blocks access. This is a repeat requirement from the inspection 14 February 2005. Door wedges must not be used to prop open fire doors. Fire doors that are required to be left open must be fitted with a selfclosure devise. All areas of the home accessible to residents must be free from hazards. Gloves, aprons and/or other protective measures must be taken where there is a risk of infection. 31/03/06 9 OP19OP38 12, 13 04/02/06 10 11 OP38 OP26OP38 12, 13 12, 13 12/01/06 12/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP37 Good Practice Recommendations The home should introduce a policy and procedure to ensure the accident book is reviewed and monitored regularly. North Court Residential And Nursing Home DS0000024456.V278368.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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. 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