Inspection on 01/09/08 for Northbourne Court

This inspection was carried out on 1st September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Northbourne Court 16/07/07

Northbourne Court 19/02/07

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/12/2008.

CARE HOMES FOR OLDER PEOPLE Northbourne Court Harland Avenue Sidcup Kent DA15 7PG Lead Inspector Ms Pauline Lambe Key Unannounced Inspection 1st September 2008 09:25 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 Northbourne Court DS0000067696.V370418.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. Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northbourne Court Address Harland Avenue Sidcup Kent DA15 7PG 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) 020 8269 9840 020 8269 9841 susan.ilott@kcht.org.uk www.kcht.org Kent Community Housing Trust Post vacant Care Home 120 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age not falling into any other category - Code OP Dementia, over 65 years of age - Code DE(E) The maximum number of service users who can be accommodated is: 120 16th July 2007 2. Date of last inspection Brief Description of the Service: Northbourne Court is a purpose built care home for older people requiring personal care and older people with dementia. The registered care provider is Kent Community Housing Trust, which is a not for profit organisation and the home was registered on 13th September 2006. Accommodation is provided on two floors, all bedrooms are for single occupancy and have en-suite showers, toilets and washbasins and complies with the current environmental standards. The home is divided into four suites each with a named manager and a designated staff team. The suites are further divided into fifteen bed units each with its own lounge, dining room and suitable bathing facilities. Other communal areas include ‘the Piazza’ on the first floor. This area provides a meeting point for residents, a piano bar, a café, a hairdressing salon and internet facilities. Residents and relatives can enjoy a snack and have a drink as the home has a licence to serve alcohol. Outside there is ample parking space and pleasant gardens for residents to enjoy. The current weekly fees ranged from £545.00 to £595.00. Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Three inspectors from the Commission undertook the site visit for this unannounced key inspection over two days. Two inspectors were involved on 1st September 2008 and two on 2nd September 2008. The manager was in charge of the home on both the days and with residents and staff assisted with the inspection. The last key inspection was carried out on 16th July 2007. Since the key inspection two random inspections were carried out, one on 30th January 2008 to assess compliance with requirements and one on 27th March 2008 to assess improvements with the management of Insulin. The inspection process included a review of the information held on the service file, a review of the information provided in the annual quality assurance assessment (AQAA), a review of satisfaction surveys returned by five residents and three members of staff. The Commission does not currently send surveys to relatives so where possible feedback was obtained from relatives during the site visits. Time was spent in six of the fifteen bed units inspecting care, safety, relevant records, talking to residents, staff and relatives and viewing the environment. This service has suffered from frequent manager changes. The current manager plans to register with the Commission and a period of management stability will benefit the residents and the service in general. Outcomes for residents were generally satisfactory and many residents and relatives spoken with were satisfied with the way their care and health needs were being met. This report contains a number of requirements and a number of repeated requirements, which were not met from previous inspections. What the service does well: What has improved since the last inspection? Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 6 The service user guide had been reviewed and amended to include accurate information about the role of the Commission. A new care plan format had been introduced. Management of Insulin had improved and was assessed as safe. The induction procedures for agency team leaders employed had been amended to include medicine management. Staff rosters included the full name of the people on duty and had been uniformed throughout the home. The organisation had refunded money used from the resident’s amenity fund to purchase shower chairs. A fire risk assessment was in place. What they could do better: Initial care plans must be prepared for residents at the time of admission to ensure staff know how to meet their assessed needs in relation to health and welfare. The registered person must ensure a care plan is prepared to show how all assessed needs will be met and where possible the resident must be included in this process. Management and prevention of pressure sores must be reviewed. Care staff must understand how to identify residents at risk of developing pressure sores, how to prepare care plans in relation to prevention of pressure sores and how to prepare care plans to show how guidance provided by the district nurses to manage pressure sores will be implemented. Residents must be referred to relevant healthcare professionals such as dieticians once this need is identified. Management must ensure adequate supplies of medicines are available so that residents do not miss doses. Accurate records must be kept for all medicines so that the remaining stock tallies with the amount supplied, administered and remaining. Hand written entries made by staff on medicine administration records must reflect the information on the pharmacy label. Staff must countersign medicine entries they make on administration charts. Safe systems must be in place to manage medicines. Enforcement action is being considered in relation to medicine management. The GP must be informed when medication is not given for whatever reason. Cupboards used to store controlled drugs must be fitted in line with the British Pharmaceutical Society Guidance. Medicine profiles must be prepared for each resident. Protocols must be prepared for the administration of ‘as required’ medicines such as pain relief or sedatives particularly when a resident is unable to voice their needs. Annual competency assessments must be completed for staff in relation to medicine management. Internal medicine audits completed in the home must be improved to ensure that errors such as those identified through inspection are picked up and addressed by management. Adequate staffing hours must be allocated to activity provision. Accurate records must be kept for all complaints made about the service. Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 7 Management must ensure that the timescales included in their complaint procedures are adhered to and if not that the complainant is told in writing the reason for any delay. Management must ensure that all employees receive training in relation to safeguarding adults and receive update training as appropriate. Management must ensure that adequate numbers of staff are on duty to keep the home clean and that they have the skills and ability to do their work or are supervised if needed. A system to deep clean the home on a regular basis must be considered. The flooring in bedroom 16 on Austen unit must be cleaned or replaced. The carpet in Bronte lounge must be cleaned. An audit of the toilet pans must be completed and those requiring de-scaling must have this done. The registered person must ensure call bell leads are provided in resident’s bedrooms unless an assessment has been done to show this is not needed. Management must review staffing levels to ensure that adequate staffing levels are maintained to meet the needs of all residents. The Commission must be sent a copy of the staffing review. The registered person must ensure that all information required by regulation is obtained for staff working in the home and is available for inspection. Management must ensure that staff receive training and update training relevant to their role and provide evidence to show this had been done. The person managing the service must register with the Commission to ensure compliance with the Care Standards Act. The Commission must be informed in writing of any action taken to comply with this requirement. Fire drill records must be dated, timed, include staff response and are held at times to include both day and night staff. Fire extinguishers must be serviced in line with the manufacturers guidance. Seven of the fifteen requirements made in this report have been repeated from the last inspection. A number of good practice recommendations have been included for management to consider. 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. Northbourne Court DS0000067696.V370418.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 Northbourne Court DS0000067696.V370418.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): Standards 1, 3 and 4. Standard 6 does not apply to the service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A statement of purpose was provided and the service user guide had been amended as required at the last inspection. Residents were admitted to the home based on a pre-admission assessment of care needs and received written confirmation that the service could meet their assessed needs. Management must ensure initial care plans are prepared for residents at the time of admission. EVIDENCE: Copies of the statement of purpose and service user guide were seen in some bedrooms viewed. The service user guide had been reviewed and amended to ensure it included accurate information about the role of the Commission. A full time assessment officer was employed who completed most of the preadmission assessments for homes in the organisation. The assessment officer remained involved with admissions until residents had their first placement Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 10 review meeting and assessed residents admitted to hospital prior to their return to the home. The manager said the role of the assessment officer worked well. Care records were viewed for a total of eight people throughout the home. All files seen included a pre-admission assessment of need completed by the assessment officer and some files included a care manager assessment or the panel papers. It was noted that despite having relevant information about a resident’s needs in the pre-admission assessment initial care plans were not prepared at the time of admission. The home’s admission policy and procedure said that care plans must be prepared within 4 weeks of admission. For most residents this would seem to be inadequate as people admitted to residential care have health and care needs and initial care plans must be prepared to enable staff to know how to care for the person while completing a full assessment while getting to know the person. The manager said she would look into this and would discuss the current admission policy with senior management. All beds in the home were contracted to Bexley Council. There was evidence in some but not all of the files seen to show that residents received written confirmation that the service could meet their assessed needs in line with regulation 14 requirements. Requirement 1. Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 – 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements were required to care planning, meeting healthcare needs and medicine management. No concerns were noted or raised by residents or relatives as to how staff respected resident’s privacy and dignity. EVIDENCE: Care records were inspected for eight people during the inspection. Care plans varied in content between units. For example on Shakespeare and Dickens units the two sets of care records viewed included comprehensive risk assessments and care plans, which were reviewed monthly or earlier if necessary and the care plans had been signed by residents. On Keats and Bronte units three sets of care records were inspected. One person’s care plans did not reflect the information staff provided about the resident’s needs. For example the care plans said the person could choose personal clothing but staff kept the wardrobe locked as the resident did not have the ability to make this decision. Also the care plan indicated the resident was able to manage their continence and personal hygiene but staff indicated this was not the case. In another person’ records it was noted that they had a ‘water phobia’ but how Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 12 this affected the person or was to be managed was not included in their care plan. Also for the same person the care plan said they must use a walking frame at all times but the person was seen walking without this aid. The outcome section on many of the care plans seen was poorly completed and indicated staff did not understand how to write this section. Care plans were not signed or dated and not all of those seen had evidence of review or to show they had been discussed with residents or relatives. Staff spoken with struggled with the new care plan format and most said they did not receive enough training on how to write these and how to ensure the care plans were person centred. On Austen and Wordsworth units three care records were inspected. No care plans had been prepared for one resident who had been in the home for 16 days. The person’s records showed they were prone to falls and a risk assessment had been completed about this but not a care plan. The person had two falls since being admitted. There was useful information in the person’s pre-admission assessment about their needs including that they needed assistance with personal hygiene, had poor vision and suffered from short-term memory loss. No care plans had been prepared in relation to any of these needs. The second set of records inspected had partially completed care plans but some significant areas of need were not included. For instance staff said that the resident had a pressure sore, the daily care records indicated the resident was incontinent and had lost a significant amount of weight but the parts of the care plan record that identified resident’s needs in respect of nutrition, continence, and skin integrity were blank. The pre-admission assessment for this resident stated that they had “lost weight at home” and needed prompting to meet their nutritional needs. Apart from weighing the resident and giving the person a prescribed nutritional supplement there was little evidence to show that staff were taking appropriate action to meet the residents nutritional needs or that the person had been referred to a dietician. There was no information about the pressure sore on the body map form or in the care plan. It was not possible to establish from the records where the sore was located, if it was getting better or worse or what if any action was being taken to ensure the wound healed. The records did show that the pressure sore was discussed with the GP in July 2008 and district nurses were treating the wound. The resident had a pressure relieving foam mattress and cushion. However it was not clear from the records what staff were doing to manage the continence issue, the action they were to take in relation to the pressure sore and to protect the person’s skin. The suite manager selected the third care plan as an example of good practice. This set of records contained a lot more detail and information about the resident’s individual needs and preferences. Care plans were reviewed but it was not always clear if the care plan was amended at this time or was still considered suited to meeting the person’s needs. Residents on this suite had high dependency and staff said that recently three people had been transferred to nursing homes with three more waiting assessment for nursing care. In view of this management should ensure adequate and appropriate staff work on this unit to ensure residents needs and changing needs are monitored and addressed. Requirement 2. Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 13 On all units visited there was evidence in the care records seen that residents had access to relevant healthcare professionals such as the GP, district nurse, community psychiatrist nurses and chiropodist. However staff must ensure they refer residents to other professionals such as a dietician where needed. Also care plans must be prepared to show the input staff have with peoples care following assessment by other professionals. Concerns were noted in relation to management of pressure sores. Staff did not have adequate knowledge or maintain suitable records about the care of people with pressure sores or the number of pressures sores on their units, for example the team leader for two units said that 5 people had pressure sores but the suite manager was unsure of the total number. It was felt that in view of the number of people with or at risk of developing pressure sores that, following training on this topic, senior care staff should assess resident’s at risk of developing pressure sores using a recognised tool like a waterlow scoring system. Currently the district nurses completed a waterlow score but only for residents referred to them. At this stage it was often too late to prevent a sore from developing. Care staff must also have to ability to write care plans in relation to prevention of pressure sores and care plans to show how advice provided by the district nurses in relation to management of pressure sores will be implemented by the care staff. Requirement 3. Medicine management was inspected on all the units visited. Storage facilities were satisfactory and records kept for receipt administration and disposal of medicines. To comply with the guidance form the British Pharmaceutical Society controlled drug cupboards provided and must be fixed to a solid wall as stated by the society. The temperature of storage areas and medicine fridges were monitored, medicine trolleys were used to administer medicines and medicines were provided in blister packs or individual containers together with pre-printed administration records. On two units the management of Insulin was assessed and found to be satisfactory. Care plans were in place for residents who self-administered Insulin and other medicines. On Shakespeare and Dickens units the medicines and administration records for two people were inspected. Hand written entries made by staff on the current administration chart for one person had not been countersigned. Errors were noted in respect of one person’s medicines. The remaining supply did not tally with the amount supplied and administered for two of the person’ medicines. On Austen and Wordsworth units medicine administration records were generally good and no gaps were noted in recording. However a number of errors were noted, for example three medicines were out of stock and had not been administered for periods of between 2-9 days for one person. It was evident that staff had taken some action to address this issue by sending a fax to the GP but this was not done till the day before the stock was due to run out. Staff said the pharmacy were not able to supply one of the medicines that were out of stock. There was no evidence in the doctor’s book or daily care notes to show that this issue was discussed with the GP or the supplying Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 14 pharmacist. When checking supplies of medicines for this person four errors were noted when the remaining supply was checked against the amount supplied and administered. For the same resident the dose of one medicine was incorrectly recorded on one administration chart by staff and had been countersigned and on checking the original prescription the information entered by staff on the administration chart was incorrect. Staff and management said that they sometimes had difficulty obtaining medicines for new residents when the form to register the resident with the GP had not been processed. Management were advised to meet with the GP to discuss this issue or to ensure it was addressed at the point of admission as the issue of medicines being out of stock has been noted in this home during previous inspections. On Keats unit medicine management was good. One person had not had one medicine supplied for the new cycle, which had just started. However staff had taken action to correct this and the pharmacy were due to deliver the item that day. The inspector checked that this had happened during the visit the following day. Medicine supplies checked for two people were correct however hand written entries made on some of the current administration charts by staff had not been countersigned. The Commission is considering enforcement action in relation to medicine management. Requirements 4 and 5 and recommendation 1. No concerns regarding privacy and dignity were noted. Residents spoken with said that staff were very kind and helpful and some extremely caring interactions were observed between some of the staff and residents. Staff were seen spending time talking with residents and listening to their concerns. Staff were observed knocking on doors before entering bedrooms. Residents seen were appropriately dressed for the warm weather and looked well cared for. Some residents spoken with said that staff respected their privacy whilst providing personal care and one resident had their own personal phone in their room. Most of the bedrooms seen were personalised and personal clothing was stored neatly and labelled. Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 15 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): Standards 12 – 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activity hours provided must be reviewed and improvements made to individual resident’s social care plans. Residents and relatives were satisfied with visiting arrangements, involvement in personal choices and with the meals provided. EVIDENCE: At the time of this inspection only one full time activity organiser was in post. One person was on long-term sick leave and a new person had been recruited and was waiting for recruitment checks to be completed before starting work. At the time of writing this report the person had stared working in the home and was employed for 15 hours per week. Therefore a total of 45 hours per week were allocated to activity provision for a possible 120 people. It was therefore not surprising that a number of residents and relatives felt there were not enough activities provided. However some residents spoken with were satisfied with activity programme. The home had a selection of communal areas on the first floor for residents to use including a meeting area, a piano lounge, an Internet café, a hairdressing salon, a gym, a library, a ‘wellbeing’ room, a small activity room and a café staffed by volunteers. During the inspection residents and relatives were seen in the Piazza area enjoying Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 16 refreshments and playing cards. Some residents said that regular group activities such as bingo, exercise classes and quizzes were provided. On one unit on the morning of the inspection half the residents were involved with both care staff and the activity co-ordinator in a “motivation” session that involved physical movement from residents and was evidently enjoyable and promoted communication between individuals. Facilities existed within the home for religious services and to meet cultural needs and two members of staff confirmed this. Records showed that people were given opportunities to attend entertainment sessions and group activities but there was little evidence to show how people were supported to pursue personal interests and hobbies as outlined in their life history record. Requirement 6 and recommendation 2. Feedback from relatives showed that they were made to feel welcome when visiting the home. Residents spoken with said they enjoyed contact with family and friends and spending time in the Piazza area or going on social outings with them. Residents spoken with said that there were no restrictions about the times that they got up or went to bed. One person said they liked to stay up late to watch television or listen to their radio, but always turned the volume down so they didn’t disturb the other residents. Staff were seen offering residents various drinks and were heard asking people if they wanted to return to their room or go to the lounge after supper. Several residents’ rooms were seen and showed that residents had been encouraged to have small personal possessions with them. Residents spoken with said that they were encouraged to make choices about their daily lives and activities. Residents were encouraged to manage their own money although in practice most were helped with this by their family or others. Residents were able to choose their meals and ask for other snacks and drinks during the day. Four weekly menus were prepared and showed that a variety of meals were provided with a choice of meal available. Residents spoken with said they choose their meal the day before but some added that they occasionally forgot what they had selected. Lunch was observed on Keats, Austen and Shakespeare units. The tables were nicely laid and residents were able to sit with their friends. Staff were attentive and offered assistance where needed. On Austen unit there was no choice of meal, as staff did not complete the resident meal choice sheet the previous day. Most residents said they enjoyed their meal but one person said they found the combination of smoked fish with gravy “unusual” and another resident said they did not particularly like fish but would eat it. Although the combination of fish with gravy was odd, the food was nicely cooked and presented and people were given adequate time to eat their meal. Meals were brought to the units from the main kitchen in heated trolleys. The main kitchen was not inspected on this occasion. Each unit had a small kitchen area in the dining room and these areas were clean and tidy. Recommendation 3. Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 17 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): Standards 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements were required to the management of both complaints and safeguarding adult systems. EVIDENCE: A complaints policy and procedure was provided and included in the statement of purpose. A system was in place to record complaints made about the service. From information in the AQAA 6 complaints had been made about the service in the last 9 months and none had been upheld. A monthly record of complaints was maintained and sent to head office. Three complaint records were inspected. Two of the complaints complied with the home procedures in relation to the time for response and one was not acknowledged within the procedure timescales. There was no evidence to show that the complainant was informed as to the reason for the delay. One complaint referred to the provider by the Commission in June 2008 was not recorded and the details of the complaint were lost and had to be dent again by the Commission. Following the inspection the Commission and home manager wrote to the complainant to apologise for the delay in responding to their complaint concerns. Residents and relatives spoken with knew whom they would talk to if they had a complaint or concern. Requirement 7. A policy and procedure was provided in relation to safeguarding adults. From information provided in the AQAA 5 safeguarding adult issues were reported to the local authority for investigation in the last 9 months. Following Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 18 investigation no referrals to the Protection of Vulnerable Adults registered was required. Some Staff spoken to had a good understanding of safeguarding adults and the whistle blowing policy and knew how to manage an allegation or suspicion of abuse. However this was not the case for all staff spoken with as 3 people said they had not received training on this topic since starting work in the home. Training records inspected for 5 people showed that none of them had received safeguarding in the last year. KCHT had recently reviewed their quality manual and all staff were working though this with their supervisor and this included a revision of the home’s safeguarding policy and procedure and the whistle blowing policy. Requirement 8. Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 19 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): Standards 19, 21, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was well maintained and fitted to a good standard with pleasant and varied communal areas for residents to enjoy. Bedrooms seen were generally clean and adequate bathing facilities were provided. However attention to detail was needed in relation to the standard of hygiene. Satisfactory systems were in place to manage infection control and laundry. EVIDENCE: Areas of the home seen were generally clean and tidy and well maintained. Two maintenance technicians were employed to attend to day-to-day repairs and to ensure equipment was maintained and serviced. Lifts were provided to give residents access to both floors. Since the last inspection work was completed on making the corners of the grab rails safer for residents and others. Communal areas were well maintained and were furnished and fitted to a good standard. Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 20 All bedrooms had en-suite units with a shower, toilet and hand basin, which residents liked. Nine bathrooms with assisted baths were also provided. Bathrooms seen were clean and tidy and hot waters checked were within safe limits. Many of the toilet pans seen throughout the home required de-scaling as they were very badly stained. Requirement 9. Resident’s bedrooms seen were comfortable and bright. People could bring their own small items of furniture and personal items with them if they wished. Most of the rooms seen had been personalised with family photographs, ornaments, small furniture items and paintings. A number of bedrooms seen on Keats and Bronte units did not have call bell leads provided. There was no evidence in the care records inspected to show that based on assessment residents had the ability to use or not use call bells. Requirement 10. Although the overall appearance of the home was that it was clean attention to detail was needed. For example the handrail in Keats and Bronte units was sticky to the touch. In bathroom A on Austen unit there were various substances on the floor at the start of the first inspection day and they were still there at the end of that day and there was an upturned, stained, raised toilet seat lying on the floor. The carpet in room 16 was very stained with food remnants embedded in it. The resident in this room had some behavioural problems so the replacement floor covering must be carefully selected to ensure it meets the resident’s needs and helps keep the room clean. The bars on the commode, in the en suite toilet in this room were stained. On Bronte unit the carpet behind the door in the lounge was stained and apparently this had been the case for some time. Feedback received from staff relatives and residents indicated that the environment looked clean but on closer inspection was not. This they said referred to a lack of deep cleaning and furniture not being during cleaning. The home had a number of domestic staff vacancies and the manager said that following a recent recruitment drive 3 people were offered posts but would not be able to start work until recruitment checks had been completed. A high percentage of domestic shifts were covered using agency staff but where possible the agency provided regular staff. Also 3 of the domestic staff currently employed required a high level of supervision to do their work but there was nobody available to provide this. The manager had recently allocated this role to a team leader but the person had not started this piece of work at the time of inspection. Domestic staffing plans were to have one person on each unit daily however staff said and rotas showed that this did not always happen. Often when staff were sick, on leave or absent the domestic on duty had to cover more than one unit. This was not considered adequate particularly in view of the category of some of the residents in the home. Staff were provided with protective clothing and had washing facilities were provided where needed. See Requirement 9. Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 21 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): Standards 27 – 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels in the home require a review. Improvements were required to staff recruitment and training. EVIDENCE: The staffing levels in the home remained unchanged since the last inspection. These were mornings 1 team leader, 3 care assistants and an extra care assistant from 07:00 – 11:00. In the afternoon 1 team leader, 3 care assistants and an extra care assistant from 17:00 – 21:00. At night 8 staff were on duty, 2 team leaders and 6 care assistants. Due to staff vacancies agency staff covered a number of shifts. The manager said that posts had been offered to permanent care staff and they would start work once the recruitment process was completed. Some staff and residents spoken with felt staffing levels were inadequate particularly on the more highly dependent units. There was also a concern about staffing levels at night as to allow for staff breaks units must be left without any staff for a period of time. In the last inspection report management were required to review staffing levels and inform the Commission of the outcome of the review and of any staffing level changes made. This requirement was not met. Residents and relatives spoken with were complimentary about the staff team. Comments made included “I am very happy with the staff”, “staff are informative and helpful”, “its better than paying for a hotel” and “staff are excellent”. Requirement 11. Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 22 From information provided in the AQAA 85 of care staff employed had achieved NVQ level 2 or above. Recruitment files for 5 people were inspected and there were gaps noted in the information obtained for staff. For example none of the files had a recent photograph of the person and 4 references seen had not been verified as genuine. All other information required by regulation had been obtained. Staff spoken with gave details of the information they were required to provide when they were recruited. Requirement 12. Care and domestic staff spoken with said they had access to training relevant to their roles. Training was provided both in-house and through external trainers. Individual training records were kept for staff and 5 records were inspected. One record showed that the person had received 3 days training in the last year. The remaining records seen showed staff had not received this level of training and one person had not received any training since 2005. Requirement 13. Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 23 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): Standards 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A new manager was in post since the last inspection but had not yet applied to register with the Commission. A quality assurance system was in place. Satisfactory systems were in place to manage resident’s personal allowances. Fire safety precautions and records required attention. EVIDENCE: Since the last inspection the service had a change of manager. The current manager was in post for about 9 months and planned to become the registered manager although this application had not yet been made. The manager had the skills and experience to manage the service and three suite managers assisted her to fulfil her role. The manager said that it was a large service to manage and that she left the day-to-day running of the units to the suite managers. The manager was due to go on extended leave and an acting Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 24 manager was employed to cover the absence period. Having a permanent manager in post will benefit the service, staff and residents’ as there has been no stable management since the home registered. Requirement 14. The manager said that she found it difficult to get to know all the residents and relatives. However staff, residents and relatives said that the manager did not visit the units on a regular basis and a number of residents and relatives did not know the manager. No resident/relative meetings were held for a long period and staff meetings were not held regularly. The manager did meet regularly with the suite managers and the team leaders. Internal audits were undertaken on areas such as pre-admission assessments, care planning, health care, accidents, meals and medicines. The organisation had a recognised external quality assurance system in place. Full audits were carried out on the service every 4 years with spot checks undertaken in between these times. The last external audit of this service was in 2007. Action plans to address issues identified were prepared following both internal and external audits. Recommendation 4. Satisfactory systems were in place to manage resident’s personal money. Records were kept for money received and removed from resident’s individual accounts. Receipts were kept for purchases made on behalf of residents such as hairdressing and chiropody. From the information provided all residents had access to personal allowance and the administrator contacted relatives if a resident required personal allowance money. Records for three residents were checked and found to be correct and up to date. A random selection of safety records were inspected. These included lift service, gas certificate, electricity certificate, moving and handling and assisted bathing equipment service. All of these records were up to date. Fire safety records were inspected and showed that the alarm system was serviced on 9/7/08 but the extinguishers had not been checked since June 2006. A fire risk and evacuation policy was provided. Fire alarm tests were carried out weekly. The last fire drill held was on 14/3/08 but the record was not timed and did not include any comments regarding staff response. Records seen showed that 10 members of staff received fire safety training on 14/3/08. Systems were in place to monitor hot water temperatures. Accident records were viewed and were generally well completed however staff must be careful when completing these forms to record what happened and not what they think happened. For example if an accident was not witnessed then this needs to be recorded and the incident reported as seen. Regulation 37 notifications were sent to the Commission and residents received medical treatment following an accident if this was assessed as needed. Requirement 15. Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 25 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 3 X 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X 2 X X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 15 Requirement Timescale for action 24/11/08 2 OP7 15 3 OP8 12 Initial care plans must be prepared for residents at the time of admission to ensure staff know how to meet their assessed needs in relation to health and welfare. The registered person must 24/11/08 ensure a care plan is prepared to show how all assessed needs will be met and where possible the resident must be included in this process. (Timescale of 28/03/08 was not met). Management and prevention of 24/11/08 pressure sores must be reviewed. Care staff must understand how to identify residents at risk of developing pressure sores, how to prepare care plans in relation to prevention of pressure sores and how to prepare care plans to show how guidance provided by the district nurses to manage pressure sores will be implemented. Residents must be referred to relevant healthcare professionals such as dieticians once this need is identified. DS0000067696.V370418.R01.S.doc Version 5.2 Northbourne Court Page 27 4 OP9 13 5 OP9 13 6 OP12 16 7 OP16 22 8 OP18 13 Management must ensure adequate supplies of medicines are available so that residents do not miss doses. Accurate records must be kept for all medicines so that the remaining stock tallies with the amount supplied, administered and remaining. Hand written entries made by staff on medicine administration records must reflect the information on the pharmacy label. Staff must countersign medicine entries they make on administration charts. (Timescale of 30/04/08 was not met). Enforcement action is being considered. Safe systems must be in place to manage medicines. The GP must be informed when medication is not given for whatever reason. Cupboards used to store controlled drugs must be fitted in line with the British Pharmaceutical Society Guidance. Adequate staffing hours must be allocated to activity provision. (Timescale of 28/03/08 was not met). Accurate records must be kept for all complaints made about the service. Management must ensure that the timescales included in their complaint procedures are adhered to and if not that the complainant is told in writing the reason for any delay. Management must ensure that all employees receive training in relation to safeguarding adults and receive update training as DS0000067696.V370418.R01.S.doc 13/11/08 17/11/08 24/11/08 24/11/08 24/11/08 Northbourne Court Version 5.2 Page 28 9 OP19 23 10 OP24 13 11 OP27 18 12 OP29 19 13 OP30 18 14 OP31 Care appropriate. Management must ensure that adequate numbers of staff are on duty to keep the home clean and that they have the skills and ability to do their work or are supervised if needed. A system to deep clean the home on a regular basis must be considered. The flooring in bedroom 16 on Austen unit must be cleaned or replaced. The carpet in Bronte lounge must be cleaned. An audit of the toilet pans must be completed and those requiring de-scaling must have this done. The registered person must ensure call bell leads are provided in resident’s bedrooms unless an assessment has been done to show this is not needed. (Timescale of 28/03/08 was not met). Management must review staffing levels to ensure the adequate staffing levels are maintained to meet the needs of all residents. The Commission must be sent a copy of the staffing review. (Timescale of 28/03/08 was partly met). The registered person must ensure that all information required by regulation is obtained for staff working in the home and is available for inspection. (Timescale of 28/03/08 was not met). Management must ensure that staff receive training and update training relevant to their role and provide evidence to show this had been done. The person managing the service DS0000067696.V370418.R01.S.doc 24/11/08 24/11/08 24/11/08 24/11/08 24/11/08 24/11/08 Page 29 Northbourne Court Version 5.2 Standards Act 2000, Part II (11 – (1)) 15 OP38 23 16 OP38 23 must register with the Commission to ensure compliance with this section of the Care Standards Act. The Commission must be informed in writing of any action taken to comply with this requirement. Fire drill records must be dated, 17/11/08 timed, include staff response and are held at times to include night staff. (Timescale of 28/03/08 was not met). Fire extinguishers must be 17/11/08 serviced in line with the manufacturers guidance. 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 OP9 Good Practice Recommendations Medicine profiles should be prepared for all residents. Protocols should be written for the administration of ‘as required’ medicines. Annual competency assessments should be completed for all staff that manage medicines. Management should ensure that care plans are prepared with the person to show how individual social needs will be met and reflect the person’s interests and preferences. Adequate staffing hours should be allocated to ensure resident’s social and leisure needs are met. Staff should ensure that time is taken to allow residents to choose their meals daily and that this is recorded. Efforts should be made to hold resident and relative meetings so that people know the manager and have the opportunity to provide feedback on the service. 2 OP12 3 4 OP15 OP33 Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Northbourne Court DS0000067696.V370418.R01.S.doc Version 5.2 Page 31 - 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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