Inspection on 31/03/08 for Northleach Court Care Centre

This inspection was carried out on 31st March 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Northleach Court Care Centre 08/03/09

Northleach Court Care Centre 13/10/08

Northleach Court Care Centre 30/10/07

Northleach Court Care Centre 12/06/07

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 Unannounced Inspection 08:20 31 March & 1st April 2008 st 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.V359769.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.V359769.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 Anne Manby Roberts Mr Jeremy Walsh Care Home 60 Category(ies) of Dementia - over 65 years of age (60) registration, with number of places Northleach Court Care Centre DS0000016515.V359769.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. To accommodate one named service user under 65 years of age with Dementia 30th October 2007 2. Date of last inspection 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 £389.00 to £680.00 less any Funded Nursing Contribution (FNC). 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.V359769.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Two Inspectors carried out this inspection over two days in March/April 2008. One of these was our pharmacist inspector who looked at some of the arrangements for the management of medicines and to follow up the last medication inspection on 30th October 2007. This inspection took place over 4¾ hours on a Monday morning. 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 new manager was available during the inspection as were other members of the homes team and the Director of Care. A total of 27 standards were inspected. Where possible, people living at the home were spoken with to ascertain their views on the care and services provided and any visitors to the home. Staff were observed interacting with people who use the service. The comments received from speaking to people during the inspection have been used in the report. The staff were spoken with throughout the inspection and were helpful and cooperative. What the service does well: The home has procedures in place to ensure that prospective people have an assessment of their needs prior to admission to ensure they can be met by the home. The home has an activities coordinator that provides a range of activities five days a week. These include group activities and one to one sessions. People who use the service where able were asked if they enjoy the meals provided and they all said yes. Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Whilst people who use the service have individual care plans that have ongoing evidence of frequent reviews they did not always reflect the actual care being given. The home needs to appoint a competent and suitably qualified person to manage the home and to continue to maintain the improvements we found at this inspection. Whilst improvements have been found with the environment a small number of rooms belonging to people who use the service were found to have an odour and these need to be addressed. Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 7 On examining the training matrix it was found that a number of staff require training and updates in a number of areas. Whilst dates were booked for these during the inspection the home needs to monitor this area to ensure the staff have the appropriate skills to care for people who use the service. 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.V359769.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.V359769.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): 2, 3, 4, 5 & 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who may use the service are not admitted without an assessment of their needs and confirmation that they can be met. Some staff have now received or going to receive specific training to ensure the particular needs of some people will be met by the home. EVIDENCE: The systems for managing people who privately fund their nursing care and who receive Funded Nursing Care (FNC) were examined. The Director of Care explained that each person pays the fees in full then each month they are refunded the amount of FNC they are entitled to. An invoice was seen that stated how much FNC they receive weekly and a total amount of the refund. The residents contract also contains a brief description about FNC but does not contain information about how the Registered Provider manages the payment. However the Director of Care said that they plan to send a letter to all people Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 10 who receive FNC explaining about how they manage this. A copy of this letter was sent to us following the inspection and it explains how the Registered Provider manages the FNC payments. A section in the terms and conditions that relates to additional services available was examined and the home has information about how these are accessed, paid for and the cost. A pre admission assessment of a person who was admitted to the home during the inspection was examined. The new manager had been to the local hospital to assess this person. The assessment contained information about their care needs and the medication they are taking. An enquiry form had also been completed by the home with this person’s details. Community and Adult Care Directorate (CACD) funds this person and the home was still waiting for a copy of the assessment and care plans from the Social Worker involved. Due to the medical condition of the people in the home they are not able to view the home prior to moving in, this is normally done by their relatives/representative. The letter confirming that the needs of this person can be met by the home is sent out by the Registered Provider with the contract and therefore was not examined at this inspection. During the inspection several relatives of people who are looking to move into care homes were shown around the home and they had turned up unannounced. At the last two inspections we (The Commission) raised concerns that the qualified staff did not have the specific skills to meet the needs of some of the people who use the service. At this inspection the home was able to demonstrate that all of the qualified staff have undertaken training in venepuncture. Some qualified nurses have completed the training for male catheterisation and others have this training booked for April. The home is also making plans to ensure that the competency of the nurses is monitored for these two skills as part of the Nursing Midwifery Council (NMC) guidance that all qualified nurses have to follow. At the time of the inspection the home does not have any male residents with catheters. The homes improvement plan states that all qualified nurses have attended training in wound progression and dressing selection, pressure area care and equipment selection provided by the Care Home Support team in February 2008. We have only received one notification since the last inspection that the home has worked under their set staffing numbers, which is good for people who use the service as it ensures they are receiving the care and supervision they require. Standard 6 is not applicable to Northleach Court, as they do not provide intermediate care. Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 11 Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 12 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs, however people’s care records do not always reflect their current needs. There are safe arrangements in place for the management of medicines. EVIDENCE: Three people who use the service were randomly selected during the inspection had their care examined in detail. This includes reading care records, where able speaking to the person and observing staff interaction with them and speaking to staff. Two people had been at the home for a number of years and the third person for a couple of months. One of these people had their care examined in detail at a previous inspection and this was to follow up on the care they had received. Each person had an assessment of need in place but two had no evidence of reviews and one was completed a year ago. As part of the format used by the Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 13 home each person has a day and night profile and these did have evidence of reviews but one was last reviewed over seven months ago. Whilst the other two had more frequent reviews the staff had not always updated these assessments when a change to the care plans had been made, for example one person has had a change with their continence needs but this had not been updated in their assessment of need or day/night profile despite staff signing to say a review had taken place. Each person had a care plan in place for each assessed need that was detailed and contained information pertinent to that person. Frequent reviews had taken place for each care plan. However on discussing the care of each of these three people with care staff it appeared that what was written in some care plans was not taking place, for example one person has a special chair that they sit in for specified amount of time. The care plan states they should sit out twice a day, however care staff said they only sit out once a day, this needs to be amended. Where a care plans mentions the use of an ‘as and when required’ medication full instructions were not always in place, for example one person requires an inhaler for asthma and it was written in the care plan to give as prescribed. The Medication Administration Record (MAR) states to give 1-2 doses four times a day as required. The home must amend the care plan to ensure care staff are given clear instructions on when to use this medication. Two people require pressure area care and in their care plans it says to apply Sudocream to any red areas, however one person did not have this written up for them on their MAR and the other person had Cavilon cream written on their MAR, again this needed to be amended. Risk assessments were in place in both a hand written format and set format. These include falls, moving and handling, nutrition and pressure areas; again a few amendments are needed to these where changes in people’s care plans have not been transferred into some risk assessments. The home uses charts to document the personal care people receive and these were examined for the three people who had their care examined in detail. Whilst the care staff are recording the majority of care given, no records were seen for hair washing and it appeared that only one person had a bath in the last few months. From observations of all people in the home it was evident that people are having their hair washed and the hairdresser confirmed she is at the home every week. From discussions with care staff two people who had their care examined in detail are unable to have a bath or shower at the present time due to medical conditions, however this is not clearly documented. The manager said he would speak with staff about the importance of documenting accurately the care they give. One person’s care records had documented evidence that their care plans had been discussed with a member of their family. Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 14 Two members of care staff were spoken with in relation to the care these three people receive and both demonstrated very good knowledge of their care needs. Two of the three people whose care was examined in detail use incontinence pads. The care plans state one size is being used but on checking these people’s rooms another size was found. A discussion with the manager took place about nutritional needs of the people at the home, he said only two people are recorded as losing weight and the appropriate action has taken place to include more frequent monitoring and informing the GP; detailed records of this was seen in their care plans. The cook is adding additional calories to people’s food and the home are providing milkshakes made on a daily basis that include additional calories. Bowls of fruit and other snacks are available in the communal areas for people to help themselves and this was seen. This is good practice. One person who had their care examined in detail at this inspection and the last inspection; has put on weight and their appetite has increased as concerns about their weight was documented at the last inspection. Records were seen in each person’s care records of health professional visits to include the GP, Community Nurses, Chiropodist and Continuing Health Care Nurses. Medication Since the last inspection we have received an improvement plan from Blanchworth telling us the action the home has taken to address medication issues and requirements we made at the last inspection. We found there was an improvement of the way in which medicines were managed and the requirements we made have been actioned. Registered nurses are responsible for the management and administration of medicines. The company provides additional medication training for these staff. The arrangements for the actual administration of medicines have improved with changes in place to help make sure that medicines are administered more promptly and with the correct time intervals between doses. The arrangements for the instillation of eye drops have changed so that the privacy and dignity of people in the home is better respected. At the time of the inspection staff managed the medication on behalf of all the people living in the home as no people were assessed as able to safely look after their own medicines. This information was shown in three of the five care plans looked at in detail. All care plans must reflect choices people have made about the way their medicines are managed and administered. Where people may lack capacity to consent to treatment consideration must be included in the care plans about the provisions of the Mental Capacity Act 2005 in respect of medication administration. The pharmacist spoke to some people but they were not able to talk about their medicines. Records for the receipt, administration and disposal of medicines were in place and checks we made showed on the whole these were properly completed and Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 15 contained the required entries. Complete and accurate records about medication are important so that all medicines can be accounted for and people are not at risk from mistakes such as receiving their medicines incorrectly. Checks we made indicated all the medicines needed for people in the home were in stock and records showed these were administered according to the doctors’ directions. We looked in more detail at the medicines and records for five people. We drew to the attention of the staff and manager two anomalies we found. Where medicines were prescribed to use ‘as required’ care plans contained entries to guide staff on the use of the medication for each person. We discussed with the manager and staff a few examples where more specific details should be included. There was one plan for skin treatment, which was confusing with the various changes in creams used, so should be rewritten. One nurse described which creams are applied to which skin area and told us that carers apply the creams and she then signs the medication record when they tell her this is complete. The nurse said that she does look at the skin areas and carers draw her attention to any changes. Consideration needs to be given to the responsibility of the nurses in signing for treatment they have not seen given. The records showed there was contact with the doctors and staff said that a doctor makes a regular weekly visit when medication can be reviewed. Medicines are stored safely and suitable arrangements for the management of controlled medicines are in place. The cupboard identified as not secure at the last inspection has been repaired and also a new medicine fridge provided. Staff adjusted the thermostat during the inspection as temperature records showed that the fridge had been running slightly too cold on some days. If this is allowed to continue too long it may affect the potency of the medicines. We found that not all medicines (particularly creams and ointments) had a date of opening written on the container. This is an important safeguard to help make sure that stocks are rotated suitably and helps with audit checks to show that all medicines can be accounted for. There are arrangements for audits of medication to be carried out each month. The Director of Care had carried out a detailed audit a few days before this inspection. These are important checks to help make sure that medication is always managed to a good standard. No concerns were found in relation to privacy and dignity. Staff were observed speaking to people in a respectful manner and ensuring that doors were closed when any personal care tasks were taking place. Northleach Court Care Centre DS0000016515.V359769.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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to make choices within their daily lives. A range of activities is provided to meet people’s recreational needs. EVIDENCE: There have been no changes to the activities provision at this home since the last inspection in October 2007. The activities coordinator works Monday to Friday. On the first day of this inspection the activities coordinator was off sick and we witnessed no activities taking place. On the second day of this inspection the activities coordinator returned from sick leave and activities were seen taking place. These involve both group and one to one activities. A timetable is put up on the notice board informing people what is planned for the week. Photographs are displayed in the home of activities undertaken. The hairdresser was visiting the home on the second day of the inspection and she confirmed that she visits the home on a weekly basis. Two people were going out with their relatives during the inspection. Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 17 A number of visitors were seen at the home and one confirmed that there are no restrictions on visiting and they are able to go to a quieter lounge to see their relative. Staff were observed offering and taking refreshments to visitors. A number of rooms belonging to people who use the service were observed and they had their personal items on display. One person has a lock on the door to their room. Due to the medical condition of the people in the home they are not always able to make decisions about their daily lives. However care staff were observed offering people choices and this includes if they wanted to go to the dining room or stay where they were to have their meals. At previous inspections the home has confirmed that they have information available to relatives/representatives about advocacy services. Due to the medical condition of the people in the home the vast majority would not be able to manage their own finances. The home follows the menus provided by the Registered Provider and each day it is written up on the notice board what is planned for each meal and what alternatives are available. On the second day of the inspection there was a change to the menu due to a delivery problem. From discussions with the cook he is able to adjust the menus to suit the likes and dislikes of the people who use the service. In the kitchen is a board that lists peoples’ likes and dislikes. As mentioned in the previous standards the cook is able to provide food that has increased calories for people who are assessed as being nutritionally at risk. Records relating to food and health and safety checks were examined and all are in place. Bowls of fruit were available for people to help themselves. In the afternoon of the second day of our site visit, people were seen eating crisps and one person was also enjoying an alcoholic drink, which they said they were enjoying very much. Hot and cold drinks are offered at frequent times during the day and biscuits are offered with the morning hot drink and cakes with the afternoon hot drink. The manager said that on the first day of the inspection the home was trying out a new arrangement to ensure that more staff are available to help people who need assistance. On the first day it worked very but not so well on the second day. However the manager was going to have a meeting with all the staff to discuss the new system. Two meal times were observed and we found staff offered assistance discreetly and made sure they were sat down when assisting people to eat. Soft diets are liquidised individually for presentation and all people observed were enjoying their meals. Several people were asked if they had enjoyed their lunchtime meal and they all said yes. Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 18 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service and their relatives/representatives have access to a complaints procedure and systems are in place to help protect people from possible abuse or harm. EVIDENCE: The home has received two verbal complaints since the last inspection and records were seen of these. We have not received any complaints since the last inspection. A copy of the complaints procedure is displayed on the notice board in the home. Due to the medical condition of the people who use the service we were not able to ask their views on the complaints policy, however one relative was spoken with and they were happy with the care their relative was receiving. All but one member of staff has received training in relation to abuse and challenging behaviour provided by the Registered Provider in the last few years. This one member of staff has received training but prior to the changes with local reporting procedures. During the inspection a date was arranged for them to receive an update. Staff spoken with at this inspection and the last inspection confirmed they have received training about abuse and challenging behaviour. Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 19 Policies and procedures in relation to abuse, challenging behaviour and whistle blowing are available to staff on their computer system. At the last inspection two people who use the service had been referred to the adult protection unit at Gloucestershire County Council, one was made by outside health professionals due to concerns about the care of one person and the other was made by the home. These have all been investigated and closed. An improvement was noticed at this inspection by us in the physical condition of one person referred by the external health professionals. The home has since referred another person who uses the service to the adult protection unit due to external concerns that is still being investigated by them. The Director of Care said that we had been notified, however we have not received this and the home must send it to us again. The personnel records were viewed on the computer system for staff that had started work at the home since the last inspection. All had evidence of a POVAfirst check and Criminal Records Bureau Disclosure (CRB) had been undertaken and returned except for one member of staff, which they were waiting to be returned. Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 20 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, 22 & 26 People who use the service experience adequate quality outcomes in this area. 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 the home needs to find ways to address the odours that were found in certain areas. EVIDENCE: A tour of parts of the home took place and a number of rooms were seen that belong to people who use the service. The maintenance issues identified at the last inspection were also followed up. The homes improvement plan said that all maintenance issues would be addressed by the end of February 2008. The new manager and maintenance person have also completed an audit of the environment, which included all rooms used by people being examined. The manager said that a maintenance man has started to address all the Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 21 issues they have found. Room 17 still has water damage above one of the windows, however the Director of Care said that the roof has been repaired and it had been re-painted. During the inspection the home booked decorators to visit the home within the next few days after the inspection. In room 39 the wardrobe doors are still loose but the manager was confident that this information was on the maintenance man’s list to address. A stain was noted on the ceiling in the lounge past the staff toilets and this was relayed to the Director of Care who said it would be addressed. Specialist equipment was seen in a number of rooms belonging to people who use the service and this includes pressure-relieving mattresses, profiling beds and hoists. A ‘wet room’ is available for people who wish to have a shower and aids are provided in some bathrooms and toilets. Since the last inspection a number of new carpets have been fitted which has improved these areas of the environment. The windows have also been recently cleaned inside and outside. The standard of the cleanliness is good and the improvement plan states that at best they will have three domestics working but normally two will be on duty and that was the case during the inspection. Six rooms belonging to people who use the service were found to have odours and the room numbers were given to the manager following the inspection for him to follow up. At this inspection no bags of soiled linen were found on the floor, which is good practice. The homes improvement plan states that a new policy has been introduced for the disposal of incontinence pads and appropriate bags have been provided for this. The laundry was seen and the assistant was able to discuss the policy the home has in place for managing soiled linen. Staff were seen wearing protective clothing when needed. Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 22 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is confident that they have sufficient numbers of staff to meet the needs of the people in the home. However some staff require training to ensure people who use the service are cared for by staff that have the appropriate skills and knowledge. EVIDENCE: The staffing numbers were discussed with the manager and he was confident that the numbers on duty meet the needs of the people who use the service. Care staff are allocated to look after a number of people and to complete certain tasks. The home is using agency staff but they are all familiar with the home and the people who use the service. Ancillary staff are available to support the care staff. Since the last inspection the home has only notified us of two occasions where their staffing numbers were under their agreed limits, this is an improvement since the inspection in October 2007. Staff spoken with all said they enjoy coming to work and that the standards in the home are continuing to improve. The Director of Care said that seven care staff have NVQ 2 or 3 in health and social care. A member of ancillary staff also has an NVQ 2 and 3 in health and social care. Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 23 The personnel records of three staff who have been employed by the home since the last inspection were viewed on the computer system. All three have the required checks in place and the reference numbers for two of the staff Criminal Records Bureau Disclosures were seen, as one is waiting to be returned to them. POVAfirst checks for two of these staff members were also seen. A full employment history was available for each person with evidence that any gaps had been explored. Induction training was examined for two new members of staff. One has been booked on Blanchworth Care three-day induction training and a letter was seen confirming this and the other member of care staff had all ready completed this. The manager said that he has also undertaken some induction in the home with this new member of staff but has not recorded this yet as he is also new and was not sure what document to use. The Director of Care was able to direct him to the correct form and this was completed during the inspection. The manager confirmed that as part of his induction he has ‘shadowed’ other staff and has spent a day at Blanchworth Care head office. The induction training includes, health and safety, abuse and challenging behaviour and medication for staff that will be administering medication. The training matrix was examined in relation to the ongoing training of the staff in the home. A number of gaps where staff need training were seen for moving and handling, infection control, communication and dementia. During the inspection the Director of Care organised training in these areas for the staff that required it and written evidence was given to us. The home needs to ensure they have members of staff who are trained as an appointed firstaider; the Director of Care was in the process of arranging this training during the inspection. Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. To maintain the improvements in this service the home needs to appoint a suitably qualified and experienced person to supervise the management and administration of the home. This will help to ensure it is run in the best interests of the people who use the service. EVIDENCE: Since the last inspection the Registered Manager and deputy manager have left the home. A new manager was in post during the inspection and had been at the home for four weeks. However he is planning to leave shortly and the Registered Provider will have to inform us how the home will be managed in Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 25 the absence of a manager. As improvements have been noticed at the home during this inspection it is crucial that the home appoints a new manager quickly to ensure these improvements are sustained. Staff spoken with all felt the new manager is approachable, friendly and they all liked working with him. As the new manager has only been at the home for four weeks he has not undertaken any quality assurance, however he has completed an environment check. Regulation 26 visits are taking place and a recent one included a medication and care plan audit. From these audits some areas were highlighted that the home needs to improve on. Accident records are also audited as well as monies that are held by the home for people who use the service. The home manages monies for a number of people who use the service. Records, receipts and an ongoing total are maintained. Records were seen of checking of the monies. Supervision records for staff were examined. The new manager has completed a session for three qualified staff. Other care staff last had supervision in January 2008. On checking the files we could not find any supervision records for the activities coordinator or ancillary staff. Whilst the recommended six times a year is for care staff the home must also demonstrate that other staff are also receiving supervision. The home now has their fire risk assessment in place and evacuation procedure that is stored where staff can easily find it. The home has an ‘evac’ chair and slide to assist staff with any evacuation if the need ever arise. Records relating to fire training and testing of fire equipment were seen. Water temperatures are taken on a monthly basis and these were all seen to be in safe limits. Maintenance records relating to wheelchairs were also seen. Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must reflect the current care needs of people who use the service. This will make sure that staff have the information available to them for consistency in care and to make sure they know how to meet the needs of people who use the service. The home needs to address the odours in the rooms identified and given to the manager, to make sure people live in an odour free and pleasant environment. The home must make sure that as part of promoting the safety of people who use the service some staff are trained in first aid. The home must demonstrate that all staff are being supervised. This is to make sure the needs of people who use the service are being met and they are not being put at unnecessary risk. The home must appoint a suitably qualified and competent DS0000016515.V359769.R01.S.doc Timescale for action 04/06/08 2. OP26 16(k) 30/04/08 3. OP30 13 (4c) 04/06/08 4. OP36 18(2a) 30/04/08 5. OP31 8&9 01/09/08 Northleach Court Care Centre Version 5.2 Page 28 person to manage the home and apply to us (The Commission) to be considered for registration. This will help to make sure that the home is run in the best interests of the people who use the service. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP8 OP9 Good Practice Recommendations Assessment of needs should be updated with any changes that are made to care plans. Risk assessments need to be updated with any changes that are also made to the care plans. Care plans should reflect what choices people who live in the home have made about how their medicines are administered and their consent to the way in which staff manage the medicines on their behalf. Where people may lack capacity to consent include consideration about the provisions of the Mental Capacity Act 2005 in respect of medication administration. Write the date on all containers of medicines when they are first opened to use to help with good stock rotation and allow audit checks that all medicines can be accounted for. 4. OP9 Northleach Court Care Centre DS0000016515.V359769.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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