Inspection on 16/07/07 for Northbourne Court

This inspection was carried out on 16th July 2007.

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.

Other inspections for this house

Northbourne Court 01/09/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Northbourne Court Harland Avenue Sidcup Bexley DA15 3LJ Lead Inspector Ms Pauline Lambe Unannounced Inspection 16th July 2007 09:15 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.V339905.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.V339905.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northbourne Court Address Harland Avenue Sidcup Bexley DA15 3LJ 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 Vacant Care Home 120 Category(ies) of Dementia - over 65 years of age (120), Old age, registration, with number not falling within any other category (120) of places Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 The registered person may provide the following category of service only: care home only code PC to service users of the following gender: either whose primary care needs on admission to the care 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) 19th February 2007 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. This area enables residents and relatives to enjoy a snack and to have a drink as the home has a licence to serve alcohol. Outside there is ample parking space and pleasant garden areas for the residents to enjoy. Day care services were provided and although this part of the service is not registered its impact on resident care would be considered as part of inspection. The current weekly fees ranged from £410 to £484. Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Three inspectors from the Commission undertook the site visit for this unannounced key inspection on 16th July 2007. The acting manager was in charge of the home on the day and with residents and staff assisted with the inspection. The Commission pharmacist inspected medicine management separately on 1st August 2007. The inspection process included a review of the information held on the service file, information provided by the provider in the annual quality assurance assessment, a review of satisfaction surveys returned by residents and relatives to the Commission, spending time in three of the fifteen bed units, inspecting care, safety and other relevant records. Time was taken to talk to residents, staff and relatives and to view the environment. The report for the inspection could not be completed until the Commission pharmacist visited to review medicine management. Feedback from residents was generally satisfactory but a number of people were concerned about staffing levels and activity provision. Feedback from relatives was varied with no concerns being expressed about staff attitude, visiting arrangements or the complaints procedures. The environment lacked appropriate signage to assist residents with dementia to identify specific areas of the home. What the service does well: What has improved since the last inspection? The atmosphere in the home was more relaxed and staff worked as a more cohesive team. A system was in place to monitor resident’s weight but this was not consistent in all units. A list of valuables kept in the home for residents was held on the computer. Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 6 What they could do better: The registered person must ensure efforts are made to address requirements made in inspection reports. The service user guide required updating. Improvements were needed to care planning, monitoring all residents weights, staff ability to interpret documentation used and management must ensure residents are not asked to pay an additional fee for personal care. A system must be in place to follow up unexplained injuries sustained by residents and action taken to reduce a recurrence. Requirements were needed to ensure the safe management of medicines. Improvements were needed to social activity provision, activity recording and preparation of individual social care plans. Residents must have condiments, dressings and sauces provided to ensure they enjoy their meals. All the information about a complaint must be kept and made available for inspection. Efforts must be made to improve the signage to assist for residents suffering from dementia to identify specific areas of the home such as bathing and toilet facilities. Residents must have access to call bells unless these are not deemed appropriate based on risk assessment. Accurate and fully detailed rosters must be kept to show staff on duty an all times. All information required by regulation must be obtained for employees and made available for inspection. The home must have a registered manager and the Commission kept informed of progress made to meet this regulation. Money from the resident amenity fund must not be used to purchase equipment for use in the home. The registered person must provide equipment required to meet resident’s needs. Fire drills must be held at times to include night staff, must be dated, signed and include a comment regarding staff response. A risk assessment must be undertaken in relation to the openings of the smaller windows above the ground floor. A system must be in place to ensure bed rails are safely fitted and regularly checked to ensure they do not pose a risk to residents. All safety records must be kept in the home and made available for inspection. Please contact the provider for advice of actions taken in response to this Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 7 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.V339905.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.V339905.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 standard 6 did 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 and service user guide was provided however the service user guide needed some amendments. Residents were admitted to the home based on a pre-admission assessment of care needs. EVIDENCE: A statement of purpose and service user guide was provided. Copies of the service user guide were seen in some of the bedrooms viewed. At the last inspection it was recommended that the service user guide should be reviewed but this had not been done. The document contained some misleading information about the provider’s responsibility to the Commission. For example in relation to residents attending A&E department and staffing levels. Other information was also out of date in relation to the service for example the service had a change of manager and no longer had a hotel services manager. A copy of the revised service user guide must be sent to the Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 10 Commission. Relatives and residents were generally satisfied with the information provided about the service. Requirement 1. The organisation had a full time assessment officer who completed most of the pre-admission assessments. The assessment officer was also involved in assessing residents admitted to hospital prior to their return to the home. Suite managers said the role of the assessment officer worked well and they did not have any problems with it. All the care records viewed included a preadmission assessment of need completed by the assessment officer and some files included a care manager assessment report. The assessment officer remained in contact with the resident, relative and placing authority for a period of approximately six weeks until the placement was made permanent. Discussion took place with the acting manager regarding extending the KCHT assessors role further to include preparing a pre-admission care plan. 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 acting manager said she would look into this suggestion. All beds in the home were contracted to Bexley Council. Recommendation 1. Northbourne Court DS0000067696.V339905.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. Care plans and risk assessments were prepared and reviewed, however some improvements were needed to these and to involving residents in the process. Systems were in place to ensure residents healthcare needs were met. Some improvements were needed to accident reporting and follow up of unexplained injuries sustained by residents. Medicine managed required further improvement. Resident’s privacy and dignity was respected. EVIDENCE: Six care plans were viewed and records seen contained care plans and risk assessments. Overall, the care plans seen were person centred and provided staff with relevant information about the person’s care needs and how these affected their lives. The care plan format used included a section on ‘daily routine’ and where completed provided good information on the residents personal preferences. However some areas of care planning required improvement. For example some residents did not have a care plan prepared at the time of admission even though staff had access to relevant information about their care needs in the pre-admission assessment, some care plans did Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 12 not provide adequate information about bathing, shaving, continence management, nutrition assessment or evidence of monitoring residents weight. The KCHT moving and handling assessment form was colour-coded however staff used black and white photocopies of the document, which made it difficult to understand. Some staff had difficulty explaining the use of the risk assessment and said they had not received training on how to use the document. At the last inspection it was noted that residents could pay a fee to a member of staff for nail care and removal of facial hair. This was considered inappropriate and this care should be part of general personal hygiene and included in care plans. This situation remained unchanged and the acting manager said she would look into the matter. The care plan format did not include any way to evidence that residents were involved with care planning. Care plans were reviewed and in some instances it was evident that reviews were done with relative involvement. Requirements 2. Arrangements were in place to ensure residents had access to routine health care. All residents were registered with a GP, had access to a visiting dentist and a district nurse spent three days a week in the home. Staff aid they found this input supportive and beneficial to resident care. A visiting district nurse was seen and said that staff used the service appropriately and followed advice given relevant to resident care. Private arrangements were in place to provide residents with chiropody. There was evidence on the care records seen that residents had access to other healthcare professionals such as a dietician and a diabetic specialist. Accident records were sampled on all of the units visited. Most of the records provided a factual account of an event if witnessed or in some cases the resident’s account of the incident. The procedure to record accidents was quite complex with two different forms used when the person sustained an injury and another form used for a ‘near miss’. Staff also recorded the event in the resident’s daily care notes. Staff spoken with were not clear what type of accidents or incidents were considered a ‘near miss’. Therefore there is a strong possibility that different staff members interpret the procedure in different ways. There was some evidence to show that accidents were followed up but this was not done in a consistent manner. There was no system in place to follow up unexplained injuries sustained by residents. Twenty-two of the care staff had first aid certificates. The manager completed a monthly accident report for head office. Feedback from residents and relatives indicated an overall satisfaction with the standard of care provided. Requirement 3 and recommendation 2. Since the last inspection Bexley social services noted serious concerns with medicine management and communicated this to the Commission. The issues noted were investigated by Bexley under their safeguarding adults procedures. The Commission pharmacist visited the home on 19th June 2007 and assessed medicine management as poor. For example the system to order medicine supplies were not robust and led to medicines being out of stock, administration records were not accurate placing residents at risk by not having prescribed medicines and staff were not following the homes medicine Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 13 procedures. The provider implemented an improvement plan and the Commission pharmacist revisited the service on 1st August 2007 to assess progress made to meet the requirements made and to implement the provider’s improvement plan. The findings from this pharmacy inspection were that improvements had been made and four of the requirements made at the June inspection were met. The requirement relating to out of stock medicines has been carried forward as three medicines for three separate residents were out of stock for between two to four days. Other issues identified were that staff were not recording the administration of prescribed medication for external use such as the application of topical medicines or when food supplements were given. There had also been an incident in the previous month where a small quantity of controlled drugs had gone missing. No errors in administration were found and a likely explanation could be theft by a member of staff. Management were carrying out an investigation into this, and must review the arrangements for access to the Controlled Drugs cupboard. There was no evidence that staff knew what the medicines they were administering were for. The National Minimum Standards, CSCI Guidance on Training Care Workers to Safely Administer Medicines in Care Homes and the Skills For Care Medication Knowledge Set all require that care staff have knowledge of how medicines are used and are able to recognise and report possible side effects of medication. Boots supplied medicines in a monitored dose system and provided pre-printed medicine administration charts (MAR charts). Medicines were appropriately stored on each unit. Records were kept for medicines received, administered and returned to the pharmacy. Requirements 4,5,6, and 7. Interactions observed between staff and residents were appropriate. Staff were seen to respect residents privacy and dignity when assisting with personal care. One issue noted was that a residents name had been written directly on clothing and the ink had permeated through the fabric and was clearly visible. This was considered unacceptable practice and the acting manager agreed to look into the matter and to consider replacing the damaged clothes. Residents were well presented and those spoken with made positive comments about the staff. This applied to relatives also however some relatives, residents and staff were concerned that there was not always adequate numbers of staff on duty. Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. There was evidence to show that some but not all residents had access to suitable and adequate activities. Residents were supported to maintain contact with family and friends. Residents were supported to make decisions. Residents were generally satisfied with the meals provided. Management must ensure the provision of day care does not affect the permanent resident’s quality of life or privacy. EVIDENCE: Improvements had been made to the activity organiser hours provided and the staff team now included one full and two part time activity organisers. 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 ‘well-being’ room, a small activity room and a café staffed by volunteers. A diary was kept to show what activities had been arranged including visits by external entertainers and outings. However this did not provide evidence to show that each resident had access to adequate activities. One activity organiser spoken with said that it was very difficult to arrange social activities when they worked alone as it took so long to assemble residents from separate units that the residents became fed up waiting and Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 15 become disinterested or wandered off. Also residents with dementia needed closer supervision and assistance to participate in activities. It was suggested that the acting manager arranged a meeting with activity staff to look at ways to improve this aspect of the service. The activity organiser was aware that relatives felt there were not enough activities taking place, however she said some residents declined to take part in activities and she would record this in daily records. It was good to see that activities were arranged on different units to enable residents to move around the home and spend time outside their own unit. On the day of the inspection there was a visiting clothing supplier in the home the notice regarding this was displayed in the office on Wordsworth unit and not easily accessible to residents. The activity programme seen in unit dining rooms for the day was not being implemented, as the activity programmed was not taking place on some of the units visited. On the records viewed social care plans were either not completed or had little information as to how this need was to be met. Daily care records did show that residents had access to limited activities. A number of residents, relatives and staff raised concerns about the quality of activity provision. Other records viewed such as staff meeting minutes and regulation 26 reports also indicated there were concerns regarding this aspect of the service. Requirement 8. The home continued to provide day care service. The current arrangements in place to care for this group was not satisfactory and could lead to an intrusion into the lives of the permanent residents. The acting manager said that plans were in place to discontinue providing day care service completely in October 2007. It was not clear if the registered person had informed the fire service and insurance company about the day care service. Recommendation 3. Feedback from relatives indicated that they were made to feel welcome when visiting the home. Relatives were aware of the complaints procedure. Residents enjoyed contact with family and friends and spending time in the café with them. Residents were encouraged to choose their meal, to say where they wanted to spend their time and staff respected their right to refuse care if relevant and participation in organised activities. Residents had access to a telephone for private calls. There was evidence is some of the care plans seen to show that residents were encouraged to make decisions about their lives. For example some included times for getting up in the morning, going to bed, how to manage when support with hygiene or meals were refused and that residents were assisted to go back to bed when if they said they were tired. Feedback from residents indicated that staff listened to them. Lunch was observed in three units. All units had a separate dining room and tables were nicely laid with tablecloths, napkins, and cutlery. On Keats and Chaucer units there was a lack of condiments for residents and salads were served without any dressings. Most of the residents ate in the dining rooms but if they wished they could eat in their bedrooms. Meals were brought to the Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 16 suites in heated trolleys and staff wore appropriate protective clothing when working in the dining rooms. It was noted that staff wore plastic gloves when serving meals, which seemed unnecessary and clinical. Staff did not like wearing gloves for this task and this was discussed with the acting manager. Provided staff practiced proper hand-washing there should be no need to wear gloves when serving meals. Since the last inspection staff referred to as ‘servers’ were employed specifically to serve lunch. Servers were seen on two units but there was none on Chaucer unit. Residents choose their meal the day before and if they did not like what was on the menu they could ask for an alternative. Comments made to inspectors varied about the quality of food provided with some people satisfied and some not. During lunch residents were supported and encouraged to eat their meal and staff were attentive. Pureed foods were served separately and juice and water was readily available. On Wordsworth unit there were some problems noted with residents who were anxious about having their meal in the dining room. This may have been due to resident relationships and should be monitored and managed by staff. On Keats unit staff felt that all the dining chairs should have arms. It was observed that some residents found it difficult to get up from chairs that did not have arms. Requirement 9 and recommendation 4. Northbourne Court DS0000067696.V339905.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 good. This judgement has been made using available evidence including a visit to this service. Policies and procedures were in place in relation to management of complaints and safeguarding adults. Some improvements were needed to complaint records. EVIDENCE: A complaints procedure was provided and included in the statement of purpose. A record of complaints was kept in the home but it was difficult to assess how some complaints were managed, as all the documentation was not available. For example in some instances the original complaint was not available to view. Since the last inspection nine complaints had been made about the service. Records seen showed that most of these had been managed appropriately. Relatives and resident feedback indicated they knew how to make a complaint. Requirement 10. A policy and procedure was provided in relation to safeguarding adults and staff had access to training on this topic. Staff spoken to had a good understanding of safeguarding adults and how to manage such a situation. Since the last inspection concerns about medicine management was being investigated by social services under safeguarding adult procedures. Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 18 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 space provided. Bedrooms were clean, tidy and personal and adequate bathing facilities were provided. Satisfactory systems were in place to manage infection control and laundry. Signage used to identify areas could be better particularly for residents with dementia. EVIDENCE: The home was purpose built and complied with the current environmental standards. The home and was bright, well ventilated, decorated and furnished to a good standard. A wide range of communal space was provided and accessible to residents. Lifts were provided to give residents access to both floors. Since the last inspection work had commenced on making the corners of the grab rails safer for residents and others. There were identification signs on the bathroom and toilet doors but these were positioned rather high and were not particularly eye catching. Two residents accompanied one inspector Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 19 on a tour of Chaucer unit, both residents were alert and articulate but neither could identify the rooms from the signs. The doors had to be opened for residents to see what the room was. This issue was raised at the last inspection. Bedrooms were identified with the resident’s name and their photograph, which did help them locate their rooms. Requirement 11. 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. Bedrooms seen were clean, tidy, and comfortable and many personalised with the resident’s belongings. Residents and relatives were very satisfied with the environment. A number of bedrooms seen did not have call leads provided for residents to use. Management must consider how relevant these are to resident safety and security and ensure these are made available based on an assessment of the resident’s ability to use them. Requirement 12. Each suite had its own sluice area. Appropriate facilities and protective clothing was provided to enable staff to practice infection control management. Two laundry areas were provided, the main laundry for the home and a smaller one for residents to use. Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 20 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. Management must ensure staffing levels meet resident needs. Staff had access to relevant training and NVQ qualification. Information obtained for employees needed some improvements. EVIDENCE: It was reassuring to see that the staff team were more settled and worked together as a team. This was evident in all units viewed. Staff said they felt more settled and the atmosphere in the home clearly reflected this. Staff attributed the previous staffing problems experienced to the merging of staff from three homes into one team. Staff felt that as new staff were employed the team dynamics had changed for the better. Residents made positive comments about staff such as theyre good girls, they work really hard, “good people, they look after you” and staff are “very friendly”. Care and ancillary staff maintained good communication with residents. The provider information supplied to the Commission showed that there had been a decrease in the number of shifts covered by bank and agency staff since the last inspection. The staff roster formats varied for the units. The unit manager hours were not included on any rosters, the full name of the employee was not included and some rosters did not identify bank and agency staff. Comments from residents included “staff were rushed off their feet” and “staff seem to be overworked Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 21 and stressed”. Staff felt that the additional carer on duty from 07:00 – 11:00 should be on duty for the whole shift to ensure adequate staffing levels were maintained when staff had their break and to help residents with lunch. The additional carer was not always on duty and the lack of this support did put staff under pressure to complete their work in the mornings. This was discussed with the acting manager who said she would review the matter. Requirement 13. Ninety-two care staff were employed and forty-five of them had NVQ level 2 qualification or above and five care staff were working towards this qualification. The organisation was committed to providing NVQ training for all care staff. Five staff files were viewed in relation to recruitment and training. Records seen indicated that staff completed application forms, provided proof of identity and names of referees, which had been followed up on. On the files viewed there was no evidence to show that staff had completed a health declaration. The manager said that staff received a health clearance from the human resources department but his was not evident on the files viewed. Only one file contained a photograph of the employee. Records seen indicated that staff were provided with job descriptions and a contract of employment. Requirement 14. One member of staff was wearing an ID badge that related to another home and the date on the badge had expired. Staff spoken with stated they received induction when they started work and felt they were provided with comprehensive training opportunities. In addition to statutory training such as manual handling and food hygiene, staff said they had received fire safety and adult protection training. Overall staff spoken with indicated they were satisfied with the training provided. Records viewed showed that recent staff training included safe moving & handling, food hygiene and first aid. Records for two employees who had worked in the home for some months were seen and included evidence of relevant training and NVQ qualifications. Recommendation 6 Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 22 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 acting manager was in post. A quality assurance system was in place. Satisfactory systems were in place to manage resident’s personal finances. From the evidence provided further attention was needed to ensure a safe environment was provided for residents and others. EVIDENCE: Since the last inspection there had been a change of manager. The service was currently managed by one of the organisation’s operations manager. Plans were in place to recruit a new manager. Each 60-bed suite had a full time named manager. The staff team included team leaders care assistants, domestic and ancillary staff. Staff said the current manager was approachable, very ”hands on”, visited the units each day to speak with staff and residents and readily available for staff and others. Requirement 15. Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 23 The home had an annual programme of audits covering various topics such as the admission procedure, medication, food and finances and action plans developed to address areas of concern. Meetings to obtain feedback from residents and relatives and to advise them about new developments or service changes were due to take place in September 2007. Regular meetings were not currently being held for residents to enable them to comment on the service. An annual satisfaction survey was completed but this had not taken place for the home as the admission of residents only began in October 2006. A suggestion box had recently been placed in the reception area and a supply of “tell us what you think” cards provided for residents, relatives and visitors to use. Residents and relative feedback indicated that overall they were satisfied with the care provided and the environment. 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. Records for three residents checked were found to be correct and up to ate. An audit of records was completed on 3rd July 2007 but staff had not had any feedback at this time. A record was kept on the computer of valuables held for residents and relatives asked to collect this when visiting. A large number of jewellery items were held in the safe, some for residents no longer in the home. Management should look at how to dispose of these items appropriately. Three safes were provided but none of these were securely bolted to the floor or solid wall. A resident amenity fund was held and the money in this account had been raised through fund raising or from donations. It was noted that money from this account had been used to purchase shower chairs for resident rooms. This was seen as inappropriate use of these funds and the organisation should provide this equipment. The manger agreed to look into this issue and to refund the monies to the account. Requirement 16. The service records for gas appliances, portable electrical appliances, hoists; assisted baths and the passenger lifts were viewed and found to be satisfactory. Regular in-house checks were undertaken to ensure that the fire alarm, fire safety equipment and emergency lighting were in working order. Fire drills were carried out regularly but the time of the drills and the response by staff was not recorded. There was no evidence that any of the night staff were involved in fire drills. Some safety records were not available to view. All of the large windows were restricted but the smaller windows were not. A risk assessment should be undertaken in relation to this and consideration given to restricting these window openings. The maintenance technicians undertook several checks to ensure that hot water temperatures were maintained at the recommended level and to monitor health and safety and security issues. The inspector was told that a small number of residents were using bedrails. This equipment was not checked regularly to ensure that it was Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 24 fitted correctly and safely maintained. A contactor was sanding down all of the sharp edges on the handrails. The work was completed on the ground floor but the rails had not been repainted. Requirement 17 and recommendation 7. Northbourne Court DS0000067696.V339905.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 2 X 3 X 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 3 17 X 18 3 2 X 3 X X 2 X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 2 Northbourne Court DS0000067696.V339905.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 OP1 Regulation 5 Requirement The registered person must review the service user guide and ensure information about the role of the Commission is accurate. A copy of the revised document must be sent to the Commission. 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. Relevant care plans must be prepared at the time of admission based on the preadmission assessment. Residents must not be asked to pay for routine personal care such as nail cutting and removal of facial hair. A system must be in place to monitor all resident’s weight. Staff must know how to use and interpret documentation used including risk assessments. The registered person must ensure accurate records are kept for all accidents to residents. A system must be in place to DS0000067696.V339905.R01.S.doc Timescale for action 14/09/07 2 OP7 15 14/09/07 3 OP8 17 14/09/07 Northbourne Court Version 5.2 Page 27 4 OP9 13 5 OP9 13 6 OP9 13 7 OP9 13 8 OP12 16 9 OP15 18 follow up unexplained injuries sustained by residents. (Timescale of 16/04/07 was not met). The registered person must ensure that medicines are safely managed and that: All prescribed medicines are available at the home so that resident’s health conditions are not compromised by missing doses of medication. (Timescale of 31/07/07 was not met). The registered person must ensure that the use of all prescribed medicines is recorded, including external products and food supplements. The registered person must ensure that the arrangements for Controlled Drugs are reviewed, in particular the arrangements for access to the Controlled Drugs cupboard. The Registered Provider must ensure that training for care staff includes basic knowledge of how medicines are used and how to recognise and deal with potential side effects, as required by the National Minimum Standards. The registered person must ensure residents have access to suitable and adequate social activities. Care plans must be prepared to show how each resident’s social needs will be met and must involve residents or their relatives in their preparation. Activity records must provide evidence that all residents have access to adequate and suitable activities. The registered person must ensure residents have access to condiments to enable them to DS0000067696.V339905.R01.S.doc 31/08/07 31/08/07 31/08/07 31/10/07 14/09/07 14/09/07 Northbourne Court Version 5.2 Page 28 10 OP16 17 11 OP19 23 12 OP24 13 13 OP27 18/17 14 OP29 19 15 16 OP31 OP35 8 13 enjoy their meal. The registered person must ensure that all the records for complaints made about the service are kept in the home and available for inspection. (Timescale of 16/04/07 was not met). The registered person must ensure appropriate signs are used to help residents with dementia identify areas such as toilets, bathrooms and en-suite units. (Timescale of 16/04/07 was not met). The registered person must ensure call leads are provided for residents in their bedrooms and if this is not appropriate then the decision not to provide them must be supported by a risk assessment. The registered person must ensure accurate rosters are kept to reflect all staff on duty at any given time. Rosters must include all staff on duty, their full name and designation. In view of the concerns raised about staffing levels management must review these and ensure the staffing levels maintained adequately meet the needs of the residents. (Timescale of 16/04/07 was not 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 16/04/07 was not met). The registered person must ensure the service has a registered manager. The registered person must DS0000067696.V339905.R01.S.doc 14/09/07 14/09/07 14/09/07 14/09/07 14/09/07 14/09/07 14/09/07 Page 29 Northbourne Court Version 5.2 17 OP38 23 ensure the funds in the resident amenity fund are used to benefit resident’s quality of life and not to purchase equipment for use in the home. The registered person must 31/08/07 ensure all safety records are available for inspection. Fire drill records must be dated, timed, include staff response and are held at times to include night staff. A risk assessment must be undertaken in relation to the need to restrict all window openings above the ground floor. A system must be in place to regularly check that bedrails are appropriately fitted and are safely maintained. 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 OP3 Good Practice Recommendations The registered person should consider involving the assessment officer with preparation of initial care plans at the time of admission, based on the findings of the preadmission assessment. The registered person should ensure that all staff are aware of the correct procedure to report and record accidents and incidents to residents using the correct paperwork. The registered person should ensure the fire service and insurance company are aware of the service users receiving day care on the premises. The Commission should be informed in writing when the day care service stops. The registered person should ensure residents have the choice as to who they sit with in the dining room or if preferred to have meals in other areas of the home. DS0000067696.V339905.R01.S.doc Version 5.2 Page 30 2 OP8 3 OP12 4 OP15 Northbourne Court 5 OP27 6 7 OP33 OP35 Consideration should be given to providing more dining room chairs with arms for residents. The registered person should review the current format for recording staff rosters. The current format was confusing and copies of rosters provided did not provide a full and accurate record of staff on duty. The registered person should ensure staff wear appropriate identity name badges. The registered person should ensure that safes provided to hold money and valuables are secure. Northbourne Court DS0000067696.V339905.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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