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Inspection on 07/11/06 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 7th November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 environment of the home is lovely. The communal areas of the building have had a refurbishment including new carpets, curtains and pictures. Some of the residents` rooms have also been redecorated and had new furniture and co-ordinated soft furnishings. Removal of a dividing wall in the special needs unit has given much better use of the main lounge/diner allowing more freedom for people who like to wander. Staff recruitment practice is good with all checks undertaken prior to a new member of staff commencing in post. Staff are given a comprehensive induction that gives a good grounding to move towards achieving an NVQ level 2 qualification. Ten comment cards from relatives were received before this inspection and all say the staff are always welcoming and friendly. Residents spoken with said staff are willing and patient. The staff team is stable and people spoken with said they enjoy working together.

What has improved since the last inspection?

All fire doors that need to remain open during the daytime have been fitted with self-closure devices. Fire exits were clearly signed. Medication practice has improved. All MAR sheets have a photograph of the resident for identification purposes and there were no gaps noted in the signature boxes. The drugs being stored in the CD cupboard were all ones that fall under Schedule 2 and were appropriately in the cupboard. The home has obtained an up to date folder of Suffolk`s Inter-Agency Policy Operational Procedures and Staff Guidance from the Vulnerable Adult Protection Committee for reference for the staff. Food stored in the kitchen was properly labelled and dated for storage. Meals being taken around the home were hygienically covered. The external grounds have been tidied and there are plans to do some landscaping in the courtyard so the residents who enjoy wandering can do so in a secure space.

What the care home could do better:

Compliance with control of substances hazardous to health (COSHH) regulations is poor. Cleaners trolleys were observed unattended and a cupboard used for storing cleaning products was found unlocked and accessible to residents. A vacuum cleaner was left in a corridor in the special needs unit for a period of time, posing a trip hazard to staff and residents. In the sluice in the special needs unit there was half a bottle of mouldy apple juice and a large cardboard box that was being used as a rubbish bin. The manager dealt with that issue as soon as it was pointed out. Some risk assessments in residents` files had not been completed although they had an assessment of need that showed they were at risk. One care plan had a confusing series of interventions that did not directly relate to the assessed problem. Two rooms where residents have a continence problem smelt strongly of urine. The manager said there are plans to remove the carpet and lay laminate flooring in both rooms. Some medication administration practice could put residents at risk of cross infection. Lack of hand washing between administering eye drops and not using a non-touch technique to give tablets were observed. The amount of liquid medicines and the number of tablets given when a prescription gives a choice of dose is not always being recorded. One prescription for paracetamol to be administered four times daily was only being given twice with no evidence why the resident had not had it at the other times. Two carers were observed moving a resident in bed with the door to the corridor open as they took the bed sheet down. One resident was seen being wheeled to their room in a wheelchair with no footplates on.

CARE HOMES FOR OLDER PEOPLE North Court Residential And Nursing Home Northgate Street Bury St Edmunds Suffolk IP33 1HS Lead Inspector Jane Offord Key Unannounced Inspection 7th November 2006 09:15 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.V317638.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.V317638.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 (33), Old age, not falling within any other of places category (32) North Court Residential And Nursing Home DS0000024456.V317638.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. 4th May 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.V317638.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second key unannounced inspection of the inspection year 20062007. All the core standards for care of older people were looked at during the day. The inspection took place on a weekday between 9.15 and 16.00. The registered manager was present through out the day to assist with the inspection. During the day a number of residents’ and staff files were seen, a tour of the home was undertaken and various policies, maintenance records, minutes of meetings and supervision records were looked at. Part of a medication administration round was followed and some medication administration records (MAR sheets) and the controlled drug (CD) register were inspected. A number of staff and residents were spoken with, care practice was observed and the serving of the lunchtime meal was seen. The home was clean and tidy with unpleasant odours confined to two rooms where the residents have a continence problem. Residents all looked well dressed and comfortable. Interactions between residents and staff were friendly and appropriate. What the service does well: What has improved since the last inspection? All fire doors that need to remain open during the daytime have been fitted with self-closure devices. Fire exits were clearly signed. North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 Page 6 Medication practice has improved. All MAR sheets have a photograph of the resident for identification purposes and there were no gaps noted in the signature boxes. The drugs being stored in the CD cupboard were all ones that fall under Schedule 2 and were appropriately in the cupboard. The home has obtained an up to date folder of Suffolk’s Inter-Agency Policy Operational Procedures and Staff Guidance from the Vulnerable Adult Protection Committee for reference for the staff. Food stored in the kitchen was properly labelled and dated for storage. Meals being taken around the home were hygienically covered. The external grounds have been tidied and there are plans to do some landscaping in the courtyard so the residents who enjoy wandering can do so in a secure space. What they could do better: Compliance with control of substances hazardous to health (COSHH) regulations is poor. Cleaners trolleys were observed unattended and a cupboard used for storing cleaning products was found unlocked and accessible to residents. A vacuum cleaner was left in a corridor in the special needs unit for a period of time, posing a trip hazard to staff and residents. In the sluice in the special needs unit there was half a bottle of mouldy apple juice and a large cardboard box that was being used as a rubbish bin. The manager dealt with that issue as soon as it was pointed out. Some risk assessments in residents’ files had not been completed although they had an assessment of need that showed they were at risk. One care plan had a confusing series of interventions that did not directly relate to the assessed problem. Two rooms where residents have a continence problem smelt strongly of urine. The manager said there are plans to remove the carpet and lay laminate flooring in both rooms. Some medication administration practice could put residents at risk of cross infection. Lack of hand washing between administering eye drops and not using a non-touch technique to give tablets were observed. The amount of liquid medicines and the number of tablets given when a prescription gives a choice of dose is not always being recorded. One prescription for paracetamol to be administered four times daily was only being given twice with no evidence why the resident had not had it at the other times. Two carers were observed moving a resident in bed with the door to the corridor open as they took the bed sheet down. One resident was seen being wheeled to their room in a wheelchair with no footplates on. North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 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. 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 four 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 and service users guide have been updated to include aims and objectives for all the categories of resident in the home. North Court Residential And Nursing Home DS0000024456.V317638.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 adequate. People who use this service can expect to have their health needs met and a plan of care for their daily requirements but they cannot be assured that all medication administration practice will protect them or that care practice will always protect their right to privacy. 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 evidence of an assessment done on admission to the home looking at wide areas of care from nutritional needs to cognition and personal hygiene to communication. There were risk assessments for moving and handling needs, continence, nutrition needs and falls. Each file had a Waterlow score for tissue viability and two files had an assessment for pain. In one file for a resident who was registered blind the falls risk assessment was not completed. Other assessments in the files had evidence of regular review and updating. North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 Page 11 All the residents had high-risk scores for nutrition and a Malnutrition Universal Screening Tool (MUST) form had been completed and there was evidence of regular monitoring of the residents’ weight. The care plans seen had individual interventions relevant to the resident and their assessed needs. One resident had a chronic condition that meant they became short of breath needing oxygen therapy. The care plan interventions included information about the use of oxygen. Another intervention for a resident with dementia referred to their need to wander and said, ‘likes to walk in the garden on a good day’. One care plan for a resident with a pressure sore had muddled the interventions for mobility and managing the pressure area care. There was no separate care plan for wound care. Each file seen had records of visits to or by health professionals and notes of the treatment prescribed. Records showed some residents had had appointments with community psychiatric nurses (CPN), chiropodists and opticians. Part of a medication administration round was observed and some MAR sheets inspected. Each MAR sheet had the residents’ photograph with it for identification purposes. The medication trolley is kept securely locked in the clinic room and was locked each time the nurse left it to give a resident their medicine. Residents were asked if they needed ‘as required’ (PRN) analgesia and helped to take tablets sensitively. The nurse did not wear gloves to administer eye drops to a resident and did not wash their hands before commencing. Tablets were not always dispensed with a non-touch technique. There were no gaps noted in signature boxes except for one prescription that was for 5mls. Paracetamol liquid to be given six hourly that had been signed only twice a day since the beginning of the MAR sheet with no reason for nonadministration. Some PRN prescriptions that offered a choice of dose i.e. 2-4 5mls. teaspoons as required did not have the amount administered recorded. The controlled drugs (CD) register was seen and has been correctly completed. A random check was carried out on the drugs in the CD cupboard and the amounts tallied with the records. Care practice was observed during the day and generally staff were respectful to residents. 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 knocked on doors prior to entering bathrooms and bedrooms. While observing the medication administration two carers were seen to enter a resident’s room to turn them in bed. They removed the top sheet from the resident who appeared to only have nightclothes on before closing the door to ensure privacy. North Court Residential And Nursing Home DS0000024456.V317638.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 meaningful activities and have a wellbalanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents’ files seen all contained details of their next of kin and some had life story work to help identify relationships within the family context. Ten relatives’ comment cards were received by CSCI prior to this inspection and five of them make a specific comment about how welcome they are made when visiting their relative. The manager said visitors are welcome to the home at any reasonable time. During the day people were observed visiting residents in the communal lounges and residents’ own rooms. The home has an activities co-ordinator who was not present in the home on the day of inspection but staff said they organised craft work sessions for the residents. This was confirmed by the display of pictures proudly shown by one resident in their own room. North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 Page 13 Daily records made notes of activities participated in by the resident. Activities included bingo, snakes and ladders, listening to music and stories. Staff were observed chatting with residents and encouraging them to sing with music being played. The serving of part of the lunchtime meal was observed. The meal looked hot and appetising. Residents spoken with said they had enjoyed their meal. Residents who required help with their meal were supported sensitively. One resident said they were still hungry and was offered a choice of snacks to fill them up. They chose a banana and a carer fetched one for them from the kitchen. The kitchen was visited after lunch and was clean and tidy. Records showed that the refrigerators and freezers were all functioning within safe limits for food storage. Left over food stored was labelled and dated properly. Dry food was stored correctly and showed there was a wide range of goods. The chef said residents have a choice of meals each day and there are always alternatives such as salad or omelettes available. All the cakes offered are home made. Special diets are catered for but try to minimise highlighting that the resident has a nutritional need so diabetic diets are the same as the main menu but sweetened with artificial sweeteners. The white coats hung at the entrance to the kitchen to use when entering the area looked very grey and grubby. A member of staff took them to the laundry to wash. The manager said the coats were in need of replacement and they had some more ordered. North Court Residential And Nursing Home DS0000024456.V317638.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, 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 by the staff knowledge but they cannot be assured that all staff have received updated protection of vulnerable adults (POVA) training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy and log were seen. The policy offers investigation of complaints and a written response. It meets the standard. Since the last inspection there has been one anonymous complaint made to CSCI. It covered standards of care, recording of food charts, unexplained bruising seen on residents and the overuse of the disciplinary procedure by the manager. The complaint was investigated by the regional manager for Four Seasons Homes. The regional manager found no evidence to support any of the allegations. As the complaint had been made anonymously the complainant could not be notified of the findings but CSCI were kept informed. The home has obtained the most recent guidelines issued by the vulnerable adults protection committee of Suffolk since the last inspection so staff have up to date reference. The home also has a comprehensive whistle blowing policy to protect staff. North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 Page 15 Staff spoken with were clear about their duty of care and the action they would take if they suspected any potential abuse was happening. Two members of staff said they had not had recent POVA training although it is covered in the induction programme. North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 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. 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 attractive well-maintained surroundings but they cannot be assured that there will be no unpleasant odours in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection a major refurbishment of the home has been undertaken. All communal areas have been redecorated, carpeted and refurnished. The entrance to the home has been altered and now offers a welcoming area with seating for general use. Each room or area has had colour co-ordinated furnishings and furniture used and some attractive prints and pictures added to the walls. In the special needs unit there are a number of wall decorations called, ‘memory boxes’ with items to help residents recall favourite pastimes such as cricket and angling. North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 Page 17 A number of residents’ rooms have also been redecorated with plans in place to complete the rest, as they are available to do. The rooms seen were attractive with new light wood furniture. Residents spoken with said they loved their new décor. Some work has been done to tidy the gardens that were unkempt at the last inspection. The manager said the company has plans for landscaping the gardens and the central courtyard. The large magnolia tree in the courtyard needs to be pruned to make it safe and let more light in the special needs lounge. The manager says this will be done during the landscaping and then the courtyard will offer a secure outside area for residents with dementia to access. Two residents’ rooms had a strong odour of urine on the day of inspection. The manager said there were plans to change the carpets for laminate flooring as the residents had a continence problem and the domestics could not eradicate the smell even with daily cleaning. The rest of the home was odour free. The laundry was visited and has washing machines with sluicing programmes. The worker in the laundry was able to explain the procedures for managing soiled linen and reducing the risk of cross infection. Protective gloves and an apron were being worn for the laundry tasks. They said they had had training in Health and Safety and control of substances hazardous to health (COSHH). They had achieved their NVQ level 2 in domestic care. North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 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 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 supported by adequate numbers of correctly recruited and well-trained staff. 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. One of the registered nurses is a registered mental nurse (RMN) and works in the special needs unit. The home has a team of ancillary staff to work in the kitchen, laundry and undertake domestic duties. The files of three newly appointed staff members were inspected. They all contained a full work history, interview questions and responses, two references and a contract detailing terms and conditions. There was documentary evidence that proof of identification had been taken up and for people from overseas there was a work permit. Criminal record bureau (CRB) checks had been done before the member of staff commenced work and the evidence retained in the files. North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 Page 19 Four Seasons Homes have a comprehensive induction logbook that each member of staff works their way through during the 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. The induction is designed as a sound base to progress to NVQ level 2 studies. Some staff training files were seen and certificates were present for attendance to moving and handling, food hygiene, first aid and fire awareness updates. Staff spoken with confirmed they had attended the sessions. Two staff said they had not recently attended a POVA update. One member of staff said they had had dementia care training and had recently attended a stroke seminar. They also said the RMN would give staff dementia care training and work alongside carers in the special needs unit. North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 Page 20 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, 36, 38. Quality in this outcome area is adequate. People who use this service can expect the registered manager to be a competent person, that staff receive supervision and that the system for managing their personal monies is safe but they cannot be assured that all aspects of health and safety practice will be enforced. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has been in post for three years and has completed their registered managers award. They are a trained nurse and worked many years in the National Health Service (NHS) prior to joining the team at North Court as nurse manager, a post they held for seven years before they became the registered manager. North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 Page 21 The system for managing residents’ personal monies remains the same as previously. It is safe and individual transactions are traceable but, as noted in the last report, the money does not accrue interest while in the ‘pooled’ account. Prior to this inspection CSCI received ten ‘have your say’ comment cards from residents at North Court. All ten indicated that staff listen and act on what they say. One commented, ‘I know I can rely on every one of them’. All the cards showed residents knew who to talk to if they had any concerns. There was evidence in the care plans that residents, when able, are consulted about their care and take part in reviews of care. Records of staff supervision were seen and showed that all aspects of care are open for discussion. Staff spoken with said they feel able to raise any issues they need at supervision. Trained staff each have a group of carers they supervise. The fire log was inspected and showed that the fire alarms and emergency lighting are tested weekly as well as the fire extinguishers and fire exit routes. External contractors have tested fire alarms in September 2006 and emergency lighting in July 2006. A general fire risk assessment has been done since the refurbishment and the manager said they were in the process of changing all the plastic rubbish bins for metal ones to reduce the fire risk. During the tour of the home a cleaner’s trolley with COSHH products on it was seen unattended in an area accessible to residents. A cleaners’ cupboard on the first floor was unlocked and also contained COSHH products. In a corridor in the special needs unit a vacuum cleaner was left unattended for twenty minutes posing a trip hazard to residents and staff. In the downstairs sluice in the special needs unit part of a bottle of apple juice that had gone mouldy was seen together with a large cardboard box being used for rubbish. The manager dealt with both issues as soon as they were aware of them. During observation of care practice it was noted that one resident was wheeled through the lounge in a wheelchair with no footplates on it. North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 Page 22 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 2 8 3 9 2 10 2 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 X 18 2 3 X X X X X X 2 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 3 X 1 North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 (1) Requirement The registered persons must ensure assessments of need are correctly completed and reflected in the care plan interventions. The registered persons must ensure that prescriptions are accurately followed and that the amounts given are recorded. The registered persons must ensure that during a medication administration round adequate precautions are taken to prevent cross infection. The registered persons must take steps to ensure carers respect the dignity and privacy of residents at all times. The registered persons must enforce COSHH regulations. This is a repeat requirement. The registered persons must ensure residents are moved in equipment that is suitable for the purpose. The registered persons must ensure that rubbish is disposed of in appropriate containers. Timescale for action 07/11/06 2. OP9 13 (2) 07/11/06 3. OP9 13 (2) 07/11/06 4. OP10 12 (4) (a) 07/11/06 5. 6. OP38 OP38 13 (4) (a) (c) 13 (5) 07/11/06 07/11/06 7. OP38 13 (4) (c) 07/11/06 North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 Page 24 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. 2. Refer to Standard OP18 OP26 Good Practice Recommendations The registered persons should take steps to update all staff with POVA training. The registered persons should advance the proposal to have laminate flooring laid in the two bedrooms occupied by residents with a continence problem. North Court Residential And Nursing Home DS0000024456.V317638.R01.S.doc Version 5.2 Page 25 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.V317638.R01.S.doc Version 5.2 Page 26 - 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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