Inspection on 16/05/07 for North Court Residential And Nursing Home

This inspection was carried out on 16th May 2007.

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

North Court Residential And... 08/05/08

North Court Residential And... 07/11/06

North Court Residential And... 04/05/06

North Court Residential And... 12/01/06

North Court Residential And... 14/02/05

North Court Residential And... 10/11/04

North Court Residential And... 11/03/04

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

CARE HOMES FOR OLDER PEOPLE North Court Residential And Nursing Home Northgate Street Bury St Edmunds Suffolk IP33 1HS Lead Inspector Cecilia McKillop Unannounced Inspection 16th May 2007 09:00 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.V340155.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. North Court Residential And Nursing Home DS0000024456.V340155.R01.S.doc Version 5.2 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 north.court@fshc.co.uk Four Seasons Homes (No 4) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Elspeth Anne Nicol Care Home 65 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (65), Old age, not falling within any other of places category (32) North Court Residential And Nursing Home DS0000024456.V340155.R01.S.doc Version 5.2 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. 7th November 2006 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, Primrose, Rose and Heather provide care and accommodation for 33 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. Fees for the home are £575 to £650 weekly for residential care and £680 to £750 for nursing care. The fees do not cover hairdressing, newspapers, toiletries or chiropody. North Court Residential And Nursing Home DS0000024456.V340155.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows an unannounced inspection where the core standards for care of older people were examined. The inspection took place on a weekday between 9.00am and 16.45pm. The registered manager was present through out the day to assist with the inspection. During the inspection a number of residents’ and staff files were seen, a tour of the home was undertaken, various policies and maintenance records were looked at. Part of a medication administration round was observed and some medication administration records were examined. A number of staff , visitors and residents were interviewed about the care at the home. Care practice was observed and the serving of the lunchtime meal was seen. The inspectors findings were positive. What the service does well: What has improved since the last inspection? The home was clean and tidy and all areas were fresh smelling. Cleaning staff have undertaken training regarding the requirements under COSH. Cleaning products were not accessible to residents on the day of the inspection. Medication was being better managed. North Court Residential And Nursing Home DS0000024456.V340155.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. North Court Residential And Nursing Home DS0000024456.V340155.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 North Court Residential And Nursing Home DS0000024456.V340155.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. People who use this service can expect to have an assessment of need completed before they are admitted to the home. This service does not offer intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files of a number of newly admitted residents were seen and each one contained a pre-admission assessment. The assessment had details of the resident’s past medical history and medication regime, any known allergies, contact details of the next of kin and the GP. Areas of care were assessed including personal hygiene needs, mobility, diet, continence and cognition. Some social history and relatives’ involvement with the resident was recorded. The statement of purpose was not examined at this inspection as it was found to comply at the last inspection. A new brochure and information leaflets were on display. The information leaflets are aimed at service users and their North Court Residential And Nursing Home DS0000024456.V340155.R01.S.doc Version 5.2 Page 9 families and addressed areas such as palliative care, bereavement, incontinence, eye care, hearing loss and elder abuse. North Court Residential And Nursing Home DS0000024456.V340155.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. People who use this service can expect to have their needs documented and met. Medication practices offer protection to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four residents’ files and care plans were seen and each contained a comprehensive preadmission assessment identifying resident’s needs. In addition there were risk assessments for moving and handling needs, continence, nutrition needs and falls. Each file had a Waterlow score for tissue viability. The sample of care plans examined were detailed and informative and there was evidence of regular review and updating. There was evidence in the records and from discussion with residents, of the home working with other health professionals such as speech therapists. North Court Residential And Nursing Home DS0000024456.V340155.R01.S.doc Version 5.2 Page 11 A risk monitoring system is in place to monitor residents whose needs are increasing and who are becoming increasingly frail. Weight blood pressure and pulse are taken on a monthly basis on all residents. The home have begun to develop an end of life plan for residents who require palliative care. This is at an early stage of development and progress will be followed up a future inspection. The end of the medication round was observed and the medication administration sheets were examined. Staff were observed administering medication appropriately and there were no gaps noted in the sample of records examined. The systems in place for the administration, recording and storage of controlled drugs were examined and found to be satisfactory. Medication reviews are undertaken by one of the local surgeries on a rolling basis. Residents and their families who were interviewed as part of the inspection spoke positively about the care that they received. Staff were described as being friendly and kind and the manager as approachable. Care practice was observed during the day and staff were observed interacting warmly with residents. The atmosphere was relaxed and unhurried. Residents were offered choice about where they wanted to be and what they wanted to do. Staff were seen supporting residents and encouraging independence. Staff with one exception were observed knocking on doors prior to entering bathrooms and bedrooms. North Court Residential And Nursing Home DS0000024456.V340155.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. People who use this service can expect to be encouraged to maintain contact with family and friends, be offered a range of activities and have a wellbalanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Resident’s files contained details of next of kin. Visitors were observed coming and going throughout the day and reported that they were made to feel very welcome. The activity organiser was not working at the home on the day of the inspection, but staff were observed undertaking puzzles and games with the residents. The inspector was informed that staff can take residents into town if planned. One resident interviewed said that they would like to see more organised outings but said that a survey had recently been undertaken and this may be one of the outcomes. The serving of lunch was observed as part of the inspection. Roast chicken and vegetables were served which looked appetising although the mashed potatoes were reconstituted, as the potato peeler was broken. The manager said that North Court Residential And Nursing Home DS0000024456.V340155.R01.S.doc Version 5.2 Page 13 this would be repaired within two weeks of the inspection. Residents said that they enjoyed the meal and one resident was overheard saying “the meat was very tender” The inspector was informed that there is normally a choice at lunch but this was not the case on the day of the inspection as a roast was prepared. The inspector was informed that there was one vegetarian and they were due to have sardines on toast. The inspector was shown a new booklet, which had been developed by the homes management called food for thought. This booklet provided information to staff on various conditions such as celiac disease and the impact of such conditions. New menus were due to be introduced as part of this development. North Court Residential And Nursing Home DS0000024456.V340155.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is good. People who use this service can expect to have any complaint handled properly and be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure was seen at the last inspection and found to comply. Relatives who completed a questionnaire indicated that they were aware how to make a complaint. CSCI have not received any complaints about the care provided since the last inspection. The complaints log within the home was examined and no recent complaints had been received. The home has a copy of the guidelines issued by the vulnerable adults protection committee of Suffolk and a comprehensive whistle blowing policy to protect staff. Staff interviewed confirmed that they were aware of the policy and the steps that they would take if they suspected that any abuse was happening. There was evidence from the discussion with the manager that the home are aware of how to access advocacy services should they need to. North Court Residential And Nursing Home DS0000024456.V340155.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. People who use this service can expect to live in a clean, attractive and well maintained home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has recently undergone an extensive refurbishment. The entrance has been altered and made more welcoming. All the communal areas have been redecorated and recarpeted and the work has been undertaken to a high standard. A number of the bedrooms have also been redecorated and looked very comfortable and attractive. Resident are able to personalise their rooms with pictures and other items. Residents who were visited in their rooms were able to access their call bell however one resident who was interviewed said that they had difficulty reaching the bell at night. This was raised with the manager North Court Residential And Nursing Home DS0000024456.V340155.R01.S.doc Version 5.2 Page 16 who investigated the matter and said that she would ensure that the bell would be better positioned in future. Residents informed the inspector that they were able to have a choice between a bath and a shower. There were no handles in the shower for residents to hold on but the inspector was informed that residents generally used one of the shower chairs. One of the residents interviewed said that he had showered without a chair and this was information was passed on to the manager, who said that she would immediately remind staff of the procedure. The manager said that there are plans in place to upgrade the bathroom and shower facilities in the very near future. The home was clean and smelt fresh on the day of the inspection, although the kitchen was somewhat untidy. The home have been asked under separate cover to forward details of the homes cleaning schedules for the kitchen. The laundry was visited and there were a number of washing machines with sluice programmes. Clean linen was found stored in a store room but this was very cluttered and some items were being stored on the floor. The manager said that she would immediately address this. Protective gloves and aprons were noted at key locations throughout the home, and staff were observed using them. However it was agreed with the manager that these would be placed in the toilets after the inspector observed a member of staff taking a resident to the toilet without first obtaining gloves. Liquid soap and paper towels were available for hand washing. North Court Residential And Nursing Home DS0000024456.V340155.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. People who use this service can expect to be cared for by trained staff who have been recruited to the required standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rotas were seen and showed that there are two registered nurses on duty throughout the twenty-four hours. They are supported by eleven carers on a early shift, eight carers on a late shift and four carers at night. In addition the home has an administrator and the registered manager who is supernumerary. The deputy manager works a number of supernumerary hours each week. The home was fully staffed at the time of the inspection and the manager said that the home had not used agency staff for some years covering sickness and holidays from within the staff team. A newly appointed member of bank nursing staff was in the process of undertaking induction and was working on a supernumerary basis on the day of the inspection. Fours Seasons Homes have a comprehensive induction logbook that each member of staff works their way through during their first six weeks with the help of a mentor. The programme covers all aspects of care and knowledge required to practice safely such as fire awareness, food hygiene, infection control, moving and handling and first aid. Care staff interviewed as part of the North Court Residential And Nursing Home DS0000024456.V340155.R01.S.doc Version 5.2 Page 18 inspection reported that the induction was of a good standard and prepared them for the role. The manager provided evidence to the Commission as part of the inspection to indicate that 50 of care staff have a minimum of NVQ2 in care. The inspector was provided with details of some of the training packages available to staff. This was comprehensive and included areas such as pressure care, continence, medication, pain management and dementia care. The files of two newly appointed members of staff were examined as part of the inspection. They contained evidence of a full work history, interview records and two references. There was evidence of a criminal record bureau check and POVA check being undertaken prior to the member of staff staring work at the home. North Court Residential And Nursing Home DS0000024456.V340155.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. Quality in this outcome area is good. People who use this service can expect the registered manager to be a competent person, and that there are administrative systems in place to protect the rights of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is a trained nurse who is experienced and knowledgeable about the care of older people. The manager has completed the registered managers award. Staff interviewed as part of the inspection confirmed that they received regular supervision with a senior member of staff, which they found helpful. Regular staff meetings are held. North Court Residential And Nursing Home DS0000024456.V340155.R01.S.doc Version 5.2 Page 20 COSH guidance and a range of written procedures were on display in the training room. The inspector was shown copies of the assessment which staff complete to demonstrate their understanding and competency. Named staff are identified as fire wardens and manual handling trainers. One of the staff interviewed was working towards becoming a manual handling trainer and said that this had involved a four day training course and an examination. The inspector was shown evidence on the day of the inspection to confirm that water temperatures are regularly tested, hoists are serviced and checks are undertaken on portable electrical items. Water temperatures were within the recommended levels on the day of the inspection. The inspector was informed that there is a Quality assurance in place, where staff are expected to comment on how well the home is doing against identified criteria. The inspector shown some of the questions relating to training and dementia. In addition questionnaires were due to be sent out to service users and their families as part of the company auditing arrangements. This will be followed up at a future inspection. The systems in place for managing resident’s personal monies were not examined at this inspection, however it was at the previous inspection. The findings at this time were that the transactions are traceable but the money does not accrue interest while in a pooled account. North Court Residential And Nursing Home DS0000024456.V340155.R01.S.doc Version 5.2 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 3 X X N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 North Court Residential And Nursing Home DS0000024456.V340155.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 North Court Residential And Nursing Home DS0000024456.V340155.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 North Court Residential And Nursing Home DS0000024456.V340155.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. Re-publishing this information is in breach of the terms of use of that website. 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