Inspection on 12/06/07 for Northleach Court Care Centre

This inspection was carried out on 12th June 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

Northleach Court Care Centre 08/03/09

Northleach Court Care Centre 13/10/08

Northleach Court Care Centre 31/03/08

Northleach Court Care Centre 30/10/07

Northleach Court Care Centre 22/06/06

Northleach Court Care Centre 12/12/05

Northleach Court Care Centre 16/12/04

Northleach Court Care Centre 12/05/04

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

CARE HOMES FOR OLDER PEOPLE Northleach Court Care Centre High Street Northleach Cheltenham Glos GL54 3PQ Lead Inspector Sharon Hayward-Wright Key Unannounced Inspection 12th June 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Northleach Court Care Centre DS0000016515.V343041.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. Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northleach Court Care Centre Address High Street Northleach Cheltenham Glos GL54 3PQ 08453 455746 01451 861179 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) Mrs Sally Roberts Mr Jeremy Walsh To be considered for registration. Care Home 60 Category(ies) of Dementia - over 65 years of age (60) registration, with number of places Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Temporary variation to client categories OP (Old Age) for 1 (one) named service user. The Home will revert to the original client categories when this service user no longer resides at the home. Date of last inspection 19th December 2006 Brief Description of the Service: Northleach Court is situated close to the centre of Northleach, which is about 12 miles from Cheltenham and 10 miles from Cirencester. The Home is a registered Care Home with nursing and has 60 beds with a category of dementia care for predominately older people. Accommodation is on two floors; on the ground floor there are a number of communal rooms including a conservatory, dining areas and lounges. The home has grounds comprising of a number of enclosed courtyard areas and small lawns. Current fees are £389.25 to £662.00 less any Registered Nurse Care Contribution. Hairdressing, chiropody, escort and personal toiletries are charged extra. People are able to ask the home for a copy of their Statement of Purpose and Service Users Guide. Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Three Inspectors carried out this inspection over two days in June 2007. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes in to account the views and experiences of people using the service. The manager was available during the inspection as were other members of the home team. A total of 25 standards were inspected. Where possible, people living at the home were spoken with to ascertain their views on the care and services provided. Surveys were sent to relatives/representatives of the people living at the home prior to the inspection to obtain their views and visitors to the home were spoken to during the inspection. The comments received from the twenty-one surveys returned and from speaking to people during the inspection have been used in the report. The manager and care staff were spoken with throughout the inspection and were helpful and co-operative. Feed back on the inspection findings was given on completion and were received in a constructive and positive way by the manager and Director of Care for the Blanchworth Care Group. Six requirements have not been complied with fully since the last inspection. On this occasion the timescale has/have been extended as indicated in the requirements made. However, unmet requirements impact upon the welfare and safety of residents. Failure to comply by the revised timescale may lead to the CSCI considering enforcement action to secure compliance. What the service does well: The home has more than 50 of care staff trained to the minimum level of NVQ level 2. Comments received from people who use the service said they enjoy the lunchtime meals provided. Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 6 Visitors to the home said they are made to feel welcome and are offered refreshments. One relative said they often stay for meals at lunchtime. What has improved since the last inspection? What they could do better: The home must review all people who live at the home care plans to ensure they reflect their current needs and keep them under review. Some improvements are needed with the medication systems used by the home to ensure they are safe. Activities need to be improved to ensure all people in the home receive some form of stimulation. Training of staff needs to be improved to ensure that the staff have the skills and knowledge to meet the needs of the people living at the home. The home needs to monitor its staffing levels as at times they have been working under their agreed numbers and this can have an impact on the care the people receive at the home. The home needs to demonstrate that they have effective management in the home in the absence of the manager and deputy manager. Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Northleach Court Care Centre DS0000016515.V343041.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 Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who may use the service will have confirmation that their needs will be met, however in the case of some people their needs are not being met. EVIDENCE: The pre admission assessment of a recently admitted person was examined. This assessment was completed by the new manager at another home where this person was living prior to moving to Northleach Court and a Social Worker was also present. This assessment identified the care needs of this person. There was no evidence in this person’s care file that that the home had written to their family informing them that the home can meet their assessed needs, however the manager said that they do inform them verbally. Following the inspection Blanchworth Care Group confirmed that a letter is sent out with copies of the contract stating their needs can be met. From this assessment care plans had been devised. Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 10 The care needs of a number of people who use this service were examined. In the case of one person concerns were highlighted with regard to their care and this was also the case for the health professional involved in their care. There appears to have been a delay in requesting the appropriate pressure relieving equipment, but as the records are not very clear it is difficult to ascertain when the equipment was ordered and if it was when the risk was identified. Their care plans were not up to date with their specific needs, however the deputy manager said the staff are documenting the care being given and they are receiving the correct care. The failings in the care of this person took place when the manager and deputy manager were not on duty. Another issue has also arisen where the nurses in the home are not able to undertake male cathertisation and venepuncture, as the training has not been provided. At the present time Community nurses have to take blood for people who are in receipt of nursing care. However Blanchworth Care Group have now identified courses for the nurses and the nurses now need to be booked on these courses to ensure the people who receive nursing care have their needs met. Following this the nurses will need to be assessed as competent in this role before being able to undertake them. A recent incident occurred where a person could have been put at risk because the nurses do not have the skills to meet the needs of the people living at the home. Again this happened when the manager and deputy manager were not on duty. The home has a number of pressure relieving mattresses that are set by weight, one mattress was checked against the weight of the person and was found to be set 20kgs higher that the weight of the person. This could result in the person being put at risk. Since December 2006 there have been a number of times where the home has worked under their staffing levels set by Blanchworth Care Group and in one incident they worked three care staff below their numbers. This also impacts on the care the people in the home receive. Care documentation was also not up to date for a large number of people at the home as the manager and deputy manager are working their way through the care records. This is discussed further in Health and Personal Care. Relatives/representatives were asked a question in their surveys if they felt the home is meeting needs of their relative, eight people said ‘always’ ten said ‘usually’ and two said ‘sometimes’. Some comments received include lack of stimulation for the people living at the home, there seems to be no attempt to make the home homely, the home has started to improve since the new management has be appointed and my relative has been at the home for over two years and I have never had to question the treatment they receive and my relative is very happy there’. Intermediate care is not provided at this home. Northleach Court Care Centre DS0000016515.V343041.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): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Quality in this outcome area regarding medication is adequate. This judgement has been made using available evidence including a visit to this service by a pharmacist inspector. People who live in this home are generally protected by the home’s policy and procedures for dealing with medication but the report identifies some issues for attention to make sure of their health and wellbeing. The health and personal care that some people receive is based on their individual needs, however the majority of people’s care records do not reflect these. The principles of respect, dignity and privacy are not always put in to practice for everyone living at the home. EVIDENCE: The care records for four people who live at the home were examined. Three had been re-written by the management team and these contained detailed information about the care needs and risk assessments. The remaining one did not contain up to date care plans. The deputy manager said that the Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 12 appropriate care is being provided and recorded. The manager said that they are aware that they have to update all the care plans and records for each person, however it is taking time to do this as they are trying to involve people’s families in this. Prior to this inspection the home has been issued with requirements to update care plans and to date this had not been met. Whilst the Commission is mindful that the management team have not been at the home for very long it is imperative that people living at the home have care plans that reflect their current needs and the home also has other qualified nurses that could have undertaken this task. One member of care staff spoken with said that they are now allocated people so it makes it easier for the staff to care for each person. During the tour of several rooms belonging to people living at the home it was noticed that their toothbrushes were very dry and the toothpaste tubes were also in the same state. On person was seen to have dentures but their denture pot was also very dry, therefore it would appear that people in the home are not receiving appropriate mouth care. This was relayed to the manager and the Director of Care who was at the home on the second day of the inspection. Risk assessments were in place for pressure sores, moving and handling, falls, nutrition and mouth care. Again some of these require updating to reflect the current risk. The manager has identified a number of people who are at risk nutritionally and are looking at ways to address this. The home now feels they have the appropriate weighing facilities. Wound care is another area where records are not always up to date. One person’s records were not up to date when their dressing had been last changed and a description was also missing, another person’s records were very confusing therefore difficult to understand. A list of health professional visits is maintained. Local health professionals have expressed concerns about the care of people in the home. Regular meetings with the home are taking place to improve working relationships. In surveys sent out to relatives/representatives they were asked if the care home provides the support/care to their relative they expect or agreed, eleven people said ‘always’, six said ‘usually’ and one said ‘sometimes’. Comments include, the staff do their best but they are short staffed at times, my relative is satisfied with the care they receive, high turn over of staff that at times have poor English language skills and little knowledge of the cultures and traditions and my relative is looked after to a degree but more attention to their appearance is needed. The home has a medicine policy and procedures so that staff are aware of how the home expects medicines to be managed. A copy should be kept in the clinic room for agency staff but this was not found. Following the inspection Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 13 the manager of the home said that a copy is kept in the clinic room in the agency handover file. There is a homely remedies protocol on display. The manager wants to review stocks of these medicines and update the protocol. This is needed, as records for two of the medicines in stock did not agree with the record book. A cough mixture had an expiry date of April 2006. There are records of medicines received, administered and disposed of to make sure there is no mishandling. The pharmacy provides most medicines each month in a monitored dose system with printed medicine charts on which staff record the medicines administered. Most charts looked at had been completed satisfactorily. The manager has now arranged to see the prescriptions each month before they are sent to the pharmacy, which is good practice to help make sure the right medicines and directions are received. Handwritten entries were double signed as checked. Issues noted for attention are: Some people are prescribed medicines to use ‘as required’. Some information was found in some care plans about this but additional information is always needed that clearly describes to staff exactly how to use such medication so that it is used consistently for the benefit of that person. Medicine administration records for one person who had recently returned from hospital were looked at and this indicated that the medicine regime was implemented properly according to the medicines supplied when discharged. It is a concern that the home was not supplied with any records from the hospital about the medicines to be continued. The manager should consider following this up with the relevant hospital or PCT. For this same person there were two eye treatments from the hospital in the fridge but they were poorly labelled and so with no other information supplied staff had not used these. Action should have been taken to find out if this treatment is still needed and the manager was contacting the GP. Some audit checks of medicines in stock were carried out. Most were correct indicating that medicines are given as recorded. A few of the checks did not agree, possibly indicating that medicines may not have been given as recorded or some records were not correct. A bottle of eye drops for one person had been in use for more than the 28 days as advised by manufacturers to avoid risks from using contaminated drops. The deputy manager put a new bottle into immediate use. Other eye drops were in use correctly. A tablet given at night to one person had been out of stock for four nights recently. According to the records there should have been stock but the deputy manager had already found out that some were missing and is carrying out a full investigation. Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 14 Another person’s night medication had also been out of stock for two nights recently and there was none in stock for the evening of the day of the inspection. The manager was taking action to deal with this. Where people are prescribed various creams and ointments for application to their skin there are some records made in various places but these do not always include enough information to show exactly what treatment is used. This is important to help make sure each person has the right treatment. Nurses give each person the medicines they are prescribed and some of this procedure was seen during the inspection. The last medicines due at 8am were given out at 10.45am, as there was only one nurse on duty instead of two. The concern here is that there may be too short an interval before the lunchtime doses due at 1pm. The nurse had prioritised those people due a lunch dose and given their morning doses first so was aware of this risk. There are two medicine trolleys in the home to help with a safe system for administering medicines and safe procedures were seen at lunchtime. It is not safe though to walk around the home for some distance with medicines just in a small cup as was seen for at least one person as this can lead to mistakes. Staff must be reminded to make sure safe practices are always followed. Medicines are stored safely and recent records indicated at a safe temperature. The double doors to the cupboard used for storing medicines for external use should be secured better as they could easily be pulled apart. A particular cream for one person must be stored in the fridge as the pharmacy label directs. One tube was found in that person’s bedroom and two tubes in the stock cupboard at room temperature. This was dealt with during the inspection. Some containers of creams that are in use are kept in bedrooms and those seen did belong to the person in each particular room. Storage arrangements in rooms must be checked to make sure there is no risk to anyone living in the home. One person was spoken to about creams he uses and he said that staff always apply these for him. There are suitable arrangements for storing and recording controlled drugs and there is a special record book. None of these medicines given to three people the evening before the inspection (11/6/07) were signed for in the record book although these were all recorded on the three medicine charts. Other random checks in the record book were satisfactory. At the last inspection it had been highlighted that staff were sharing peoples toiletries, however at this inspection a number of rooms were examined and found that names of people had been put on toiletries to prevent this from happening. Staff were observed interacting with people who live at the home and it was noticed that some good interactions took place. On the second day of the inspection two members of staff were very attentive towards several Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 15 people in one of the communal rooms ensuring they had drinks and pieces of cake. However on the first day of the inspection two people were seen to be ‘slipping’ out of the chairs they were sat in and this had to be referred back to the nurse in charge, as the care staff in the room has not noticed. In another room on the first day of the inspection it was noticed that one person was still having their breakfast at 10.45am and it was obviously cold and difficult for this person to eat. Again this had to be reported to the manager, as staff had not picked up on this. One person who was quite independent was noticed going to the toilet during the second day of the inspection, however on their return to the communal room they had been incontinent and the staff did not attend to this and they were left to sit in wet clothing for a period of time. The outcome for this set of standards has been marked as ‘adequate’ and not ‘poor’ as the manager and deputy manager have started to address the care records. However the Commission is considering if any further action is going to be taken to secure compliance in this area due to requirements being repeated for a number of inspections Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A limited number of people who use this service are able to make choices about their life style. However there is a lack of appropriate recreational activities that all people who live in the home can take part in. EVIDENCE: Activities were discussed with the manager as this has been identified as an issue. The activities coordinator has received training in this area and the manager is working with them to improve the stimulation provided for people living at the home. A number of comments received from relatives/representatives had concerns about the lack of stimulation provided, ‘there is an over reliance on television to fill waking hours, more stimulation is needed to keep the body and brain active, people are not able to go outside as there is not enough staff to supervise them and activities for residents are needed rather than them sat as zombies’. One person who lives at the home had recently completed a ‘collage’ but they were the only one involved in this. The manager feels that activities are getting better, however during the two days of the inspection no activities were taking place as the coordinator was on leave and no provision had been put into place to cover them. Following the inspection the Director of Care and Manager said that on the second day of the Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 17 inspection one member of care staff was carrying out an activities session in the conservatory based on craftwork. However both inspectors did not witness this. The television was on in two communal areas even though in one room two people were sat to near to the television to see what was on. However on the second day music was playing in two of the communal rooms and one person was singing along to it. In one of the other communal rooms the radio was on but it was tuned in to a ‘pop’ music channel and the deputy manager re-tuned the radio to more appropriate music. The home has a multi-sensory room but this was not used during the inspection. A list of activities for each week is normally displayed in the corridor by the kitchen but as the coordinator was on leave there was only a poster informing people of this. Visiting to the home is not restricted as visitors were seen on both days. One person living at the home said they are able to go out to the local town and was going out with friends during the inspection. The manager said the home is in the process of raising funds to assist their activities. Where possible people who live at the home are helped to make choices about their daily life. Staff were seen offering people choices of drinks and being offered biscuits to go along with their drinks. On the afternoon of the second day of the inspection staff were seen offering people cake and providing them more drinks. The majority of people at the home would not be able to manage their financial affairs and provision would have been put in place for this. Following the discussion with the manager about the nutritional needs of people living at the home some changes were made and this included on the second day providing bowls of fruit for people to help themselves. Two visitors spoken with confirmed they had not seen this before but were helping their relatives to eat the fruit. A number of people were observed eating the fruit. The chef also made a cake for afternoon tea and people were seen to be enjoying it and several had more than one slice. The manager said that they are looking to continue this. The use of milk shakes and build ups for certain people was also discussed to help improve their nutritional intake. On the evening of the second day of the inspection cream was being added to soup for people who required the extra calories. A mealtime was observed on the second day of the inspection with some people sitting in one of the small lounges and conservatory and others in the main dining room. People where needed were offered a soft diet. One course is served at one time. Care staff were observed offering people assistance when needed, however one member of staff started to assist one person standing up but the rest of the staff assisting people in the communal rooms were sitting down. People where able said they were enjoy the food provided but there has been concerns expressed about the provision of the evening meal. This was relayed to the manager. One of the inspectors had a Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 18 lunchtime meal on the first day of the inspection and found it to be very appetising and tasted delicious. The manager or the deputy manager do not taste the meals and consideration should be given to doing this as part of their quality assurance as the majority of people at the home are unable to speak for themselves. Drinks were seen being offered with meals. The homes Annual Quality Assurance Assessment (AQAA) lists that twenty seven people in this home require prompting, supervision or assistance with eating their meals. The chef was spoken with and he confirmed that the vast majority of food is cooked from fresh and that he works to the menus provided by Blanchworth Care Group but can provide alternatives if needed. Health and safety checks take place and records relating to the food provided are maintained. The chef said they have received ‘4’ stars from the Environmental Health Department following a recent visit from them to inspect the kitchen. Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Relatives/representatives of the people who use the service have access to a complaints procedure and the service has procedures in place to protect people who use the service from abuse. EVIDENCE: The homes Annual Quality Assurance Assessment (AQAA) states they have received seven complaints in the last year and 71 have been resolved within the twenty-eight day timescale. Two of these have been upheld and one is still ongoing. Since the new manager has been in post two complaints have been referred or copied to the Commission. One of these complaints was that they asked for the manager of the home to contact them but the staff in the home did not relay this message. This resulted in a formal complaint being made to the Commission. The home needs to ensure staff are aware of the complaints procedure and the appropriate action to follow if they receive a complaint. One of these complaints has been finalised and other is still ongoing. Copies of the homes complaint procedure can be found in their Statement of Purpose, Service Users Guide and displayed in the home. In the relatives/representatives survey a question asked if they know how to make a complaint, fifteen said ‘yes’, four said ‘no’ and one said ‘cant remember’. Comments included no cause to complain and comments are just brushed aside. Another question asked them if they felt the service responded Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 20 appropriately to any concerns raised by them or the person using the service, eight said ‘always’, eight said ‘usually and one said ‘sometimes’. The home has policies and procedures in place for staff to follow in how to report any suspicions of abuse and how to share this information with other agencies. The training matrix viewed during the inspection showed that several members of staff completed training in this area in 2003 and 2004. This would indicate that they are not up to date with the current local reporting procedures for suspicions of abuse and they must receive this training. Blanchworth Care Group provides training for abuse. Consideration should be given to accessing the Protection Of Vulnerable Adults training through the county’s Adult Protection Team in order to broaden staffs’ understanding on this subject. No staff have been referred to the POVA list. Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service live in a comfortable environment, however improvements are needed to the cleanliness and maintenance of the building. EVIDENCE: A tour of parts of the environment took place with a number of rooms belonging to people at the home were viewed. The majority of toilets and bathrooms were examined following a requirement issued at a previous inspection regarding the cleanliness of these. On the first day of the inspection the lounge/dining area that used to have a secure lock was odorous, however this was not the case on the second day of the inspection. All toilets and bathrooms seen were very clean and not odorous. A number of rooms belonging to people were seen and some had Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 22 personal belongings on display. A list of rooms where odours were found was given to the manager during the inspection. A list of maintenance issues from the last inspection remain outstanding and some other were found during the tour of the home, these are as follows: • Room 17 water damage to ceiling above windows • Rooms 23 broken window catch • Rooms 45 & 46 wall badly scratched near entrance • Room 39 wardrobe doors are loose • Badly scratched door on landing near room 50 • The laminate flooring in the corridor by room 39 is coming apart • Room 27 draws knobs were missing from the chest of draws and bedside cabinet. • Room 13 an electric cable is positioned across the floor and this person requires hoisting so this could place both staff and this person at risk. • The fire door near room 4 has no hammer to break the glass. • A toilet/bathroom near to the quiet lounge has no light and a ladder is being stored in it. If this is out of use the home must secure the door to prevent people from injury. No concerns were found with pillows at this inspection and all bedding checked was clean. A requirement issued regarding lighting in the conservatory has been addressed according to the manager as extra lights have been added. However during the inspection the weather was sunny so it was difficult to assess this. Improvements have been found with the environment since the last inspection as re-decoration has started, but the home still needs to continue to work hard at managing odours. The manager said she has completed an audit of the environment and this has been sent to head office and a number of issues we identified were on this list. Parts of the environment could be improved for the people who live there by aiding their recognition of rooms, for example the home could paint all the toilet doors a different colour from other doors. The home does have signs on their toilets and bathroom doors. The home has received a grant to provide a sensory garden. The manager confirmed that their fire risk assessment is not up to date with the Fire Regulations and they need to review their evacuation procedure to ensure it meets the new guidance. The home is not complying with the Lists of Waste Regulations 2005, which include the European Waste Catalogue Codes. This is in relation to the disposal of continence aids such as pads. Continence pads are currently being disposed of in black bags. Staff are following the company’s policy on waste in doing this, however this waste should be placed in ‘tiger bags’ (yellow with a black stripe) and removed by a licensed contractor. Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 23 This was highlighted at an inspection of another home and Blanchworth Care Group is looking into this. The correct arrangements must be put in place as a matter of urgency. The laundry was inspected and the procedure for managing soiled linen was discussed. No issues were identified and staff were observed wearing protective clothing as required. A number of concerns from relatives/representatives were expressed in their surveys about the laundering of clothes. Some felt that clothing has been damaged whilst being washed; others said that their relatives are often wearing other people’s clothes and clothes keep going missing. Another concern highlighted was that relatives are not being informed when they need to bring in new clothes. This needs to be addressed. The homes AQAA said that only four members of staff have completed infection control training. Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all the staff in the home have undertaken the training needed and at times there are insufficient numbers of staff to meet the needs of the people living at the home. EVIDENCE: The Commission has received notifications that since December 2006 the home has worked under their agreed staffing limits seventeen times. One time the home was three care staff short. On the first day of the inspection only one qualified nurse was on duty instead of two until the manager and deputy manager came in for the inspection. This will impact on the care of the people in the home. The home does use agency staff and tries to have the same staff for consistency for the people living at the home. The manager is at the moment extra to the staffing numbers. Ancillary staff are available to assist the care staff but the home has two vacancies for domestics. The manager has made some changes to the staffing arrangements to include a change of shift time and care staff no longer help in the kitchen. A question on survey for relatives/representatives asked if the care staff have the right skills and experience to look after people in the home, seven said ‘always’ nine said ‘usually’ and two said ‘sometimes’. Several concerns were expressed about the language skills of some of the staff and not enough staff Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 25 on duty. Comments about the staff included that they are caring people, do their best in difficult circumstances and staff are friendly and patient with the people in the home. A number of relatives spoken with during the inspection said they were happy with the care provided. Staff spoken with said they feel there is an improvement in the home since the new manager and deputy manager started. All said they like working at the home as they receive a lot of support and input now from the management of the home. The homes AQAA states that twelve care staff have NVQ 2 or above out of a total of twenty-three care staff and three care staff are working towards this qualification. The personnel files of four recently appointed staff were viewed via the home’s computer system. It was difficult at times to read the information. Two staff had transferred from another Blanchworth Care Group home. Criminal Records Bureau Disclosures (CRB) were not viewed only the number issued. All the required recruitment checks were in place except that a full employment history was not in place for one member of care staff. The Commission will be visiting Blanchworth Care Group head office to view all these documents. The home uses an induction book based on the Skill for Care common induction standards. The manager or deputy manager supervises new care staff for three days then they work with a senior member of care staff. All new staff undertake a four-day induction training with Blanchworth Care Group. The training matrix was examined and this shows when staff need training. A number of gaps were seen where staff require an update or training. This needs to be addressed. Qualified nurses are able to undertake other training and this includes first aid. As the home looks after a vast number of people with dementia not all staff have had this training and this again needs to be addressed. Issues regarding training for male catherterisation and venepuncture also needs to be addressed. The homes AQAA says ‘that if any perosn requires specialist input, this is either accessed via outside professionals, or staff members attend additional training to meet this need’. Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A qualified person now supervises the management and administration of the home, however when this person is away from the home there have been incidents where the best interests of the people living there have not been managed appropriately. EVIDENCE: Since February this year the home has had a new manager and deputy manager in post. She is a qualified mental health nurse with many years experience and she has been a Registered Manager at another home. The manager is waiting for her fit person interview with the Commission and has completed the Registered Managers award but is waiting for verification. Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 27 One of the concerns is that there is not effective management cover in the home when the manager and deputy manager are on days off or on leave as the incidents mentioned happened when they were away from the home. The home must demonstrate that effective management arrangements are in place at the home when the manager and deputy manager are not. The manager said that the staff in the home have access to the Director of Care and other staff based at the head office and they are able to call her on the telephone. Staff and relatives spoken to said they are able to approach the manager if they had any concerns. One member of staff said the manager is good at teaching them new things. Blanchworth Care Group has quality assurance systems in place and this includes sending out questionnaires to relatives and representatives of the people living in the home and then these are returned to head office. From these an action plan is devised to address any areas highlighted. Monitoring systems used include audits by the home manager and Regulation 26 visits by someone from head office. The manager says they have weekly visits from head office to monitor the home. The home manages some monies for a small number of people living at the home and the appropriate records and receipts are kept. Supervision records were seen for a number of staff and the manager said they are now up to date. Appraisals are being undertaken but no records were available in the home. A recent fire training session took place but no date was on the form therefore it was difficult to assess how recent it was. Records were seen for maintenance and health and safety checks both in the home and from the AQAA. There was no evidence that the wheelchairs used had been checked, as this section was not completed on the record form and this was the same for fire alarms and doors. The home is having a new maintenance person starting soon and once in place all the checks will be undertaken. Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 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 2 2 X X X X X 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 2 3 X 3 3 X 2 Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 29 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 OP4 Regulation 18 (1) (c) (i) Requirement Timescale for action 30/10/07 2. OP4 18(1) (c) (i) 3. OP7 15 (2) (b) & (c) 4. OP7 15 (1) The registered person must ensure that persons working in the care home receive training appropriate to the work they are to perform (this refers to the lack of staff knowledge regarding the use of pressure relieving mattresses). This requirement remains outstanding since the last inspection. The home must provide training 30/10/07 and make ensure the staff are competent is specialist skills needed so that the needs of the people who use this service are being met. (this refers to male catheterisation and venepuncture). The registered person must 30/10/07 ensure that service users’ care plans are kept under review and revised where necessary. This requirement has been repeated from the last inspection. The registered person must 30/09/07 ensure that service users have DS0000016515.V343041.R01.S.doc Version 5.2 Northleach Court Care Centre Page 30 care plans for all their assessed needs. This requirement has been repeated from two previous inspections and was detailed in the urgent action letter of 22/12/06. 5. OP8 12(1)(b) The home must ensure that staff are supporting/supervising people to meet their care needs, in particular maintenance of their oral hygiene. When medication is administered to people living in the home safe procedures must be followed with correct intervals between doses. Medicines must always be in stock to administer in accordance with the prescribers’ directions. There must be up to date documented information for each person (where applicable) to clearly describe how to use any medication prescribed for use ‘as required’. This is to make sure that people receive the correct levels of medication. Review the storage and recording arrangements for any medication for external use to make sure that items are stored in a way that is safe for all people living in the home and that any treatments applied are clearly recorded. Improve the way the double doors on the external medication cupboard in the clinic room are secured so that they cannot be pulled apart. Whenever people are admitted to the home (this includes after discharge from hospital) there must be a robust process to check that the correct medication is available and administered to these people DS0000016515.V343041.R01.S.doc 30/07/07 6. OP9 13(2) 31/07/07 7. OP9 13(2) 31/07/07 8. OP9 13(2) 31/07/07 Northleach Court Care Centre Version 5.2 Page 31 9. OP9 13(2) 10. OP12 16(2)(n) before the next doses are due. Complete the investigation into 31/07/07 the particular tablets identified as apparently missing and inform us about the outcome and action to prevent a further occurrence. The home must make 30/08/07 arrangements for all people living at the home to engage in a programme of social activities to suit their varying abilities and needs. The registered person must ensure that the care home is kept in a good state of repair internally and externally. This requirement has been repeated from the last two inspections. The registered person must keep the care home free from offensive odours. This requirement has been repeated from the last inspection. The home must make suitable arrangements for the appropriate disposal of clinical waste (this is with relation to the Lists of Waste Regulations 2005 and the European Waste Catalogue Codes). The home must obtain a full employment history on all proposed staff with written explanation of any gaps in employment to ensure people who use the service are not put at risk. The home must ensure that persons working in the care home receive training appropriate to the work they are to perform (this refers to the DS0000016515.V343041.R01.S.doc 11. OP19 23 (2) (b) 30/10/07 12. OP26 16 (2) (k) 30/08/07 13. OP26 16(2)(k) 30/08/07 14. OP29 19 30/08/07 15. OP30 18 (1) (c) (i) 30/10/07 Northleach Court Care Centre Version 5.2 Page 32 16. OP31 12 (1) (a) staff receiving training in dementia). The home must demonstrate that effective management arrangements are in place when the manager is away from the home. This is to ensure people at the home receive proper provision for their health and welfare. 30/08/07 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 OP7 Good Practice Recommendations It is recommended that a record be kept of any bruises or injuries that are sustained by service users whether their cause is ascertained or not. Consideration should be given to the use of televisions in communal areas and the suitability of the programmes being shown. Carers should be seated when assisting service users to eat. The staff in the home should consider attending the Protection Of Vulnerable Adults training provided by Gloucestershire County Council. The home should review their laundry arrangements following the comments received from relatives/representatives. 2. OP12 3. 4. 5. OP15 OP18 OP26 Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Northleach Court Care Centre DS0000016515.V343041.R01.S.doc Version 5.2 Page 34 - 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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