Inspection on 19/02/08 for Philips Court

This inspection was carried out on 19th February 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

Philips Court 16/11/09

Philips Court 22/12/08

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Philips Court Bluebell Close Sheriff Hill Gateshead Tyne & Wear NE9 6RL Lead Inspector Miss Nic Shaw Key Unannounced Inspection 19th & 28th February 2008 09:30 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 Philips Court DS0000070979.V360879.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. Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Philips Court Address Bluebell Close Sheriff Hill Gateshead Tyne & Wear NE9 6RL 0191 4910429 0191 4913428 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) Southern Cross BC OpCo Ltd Mrs Cynthia Guy (not yet registered) Care Home 75 Category(ies) of Dementia (75), Mental disorder, excluding registration, with number learning disability or dementia (75) of places Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Dementia - Code DE, maximum number of places 75 Mental Disorder, excluding learning disability or dementia, Code MD, maximum number of places 75 The maximum number of service users who can be accommodated is: 75 14th June 2006 ( This is the home’s first inspection with Southern Cross as the owner). 2. Date of last inspection Brief Description of the Service: Philips Court Nursing Home is a 75-place facility. It has a 15 place unit, which provides personal care and two 30 place units which provide nursing care for predominantly people with dementia. The two nursing units are located at one side of the home, with the personal care unit being at the other side of the home. The reception area, a large communal room and office are located at the centre of the home. Each unit contains dining rooms, lounges, bathrooms, toilets and bedrooms. Philips Court is a purpose built home that stands in its own grounds. The home is near to the Queen Elizabeth Hospital and located within a recently built residential area. It is within close proximity to a range of local amenities and facilities such as shops and churches. There are bus stops nearby which link with the main regional centre of Gateshead. The fees payable range from £370 for residential care to £546 for the highest band of nursing care. There is an additional “top up fee” of £15 for all rooms. Philips Court DS0000070979.V360879.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 that the people who use this service experience adequate quality outcomes. Before the visit: We looked at: • information we have received since the last full visit on 14th June 2007. • how the service has dealt with any complaints & concerns since the last visit • any changes to how the home is run • the views of people who use the service and their relatives. The Visit: An unannounced visit was made on 19th & 28th February 2008. During the visit we: • talked with people who use the service, staff &the manager • looked at how staff support the people who live here • looked at information about the people who use the service and how well their needs are met • looked at other records which must be kept • checked that staff had the knowledge, skills and training to meet the needs of the people they care for • looked around parts of the building to make sure it was clean, safe and comfortable • checked what improvements had been made since the last visit • as the majority of people, due to their dementia, are unable to tell us what they think about living in the home, time was spent observing what happens in the home for them. We told the manager what we found at the end of each visit. Southern Cross purchased Philips Court in November 2007 and therefore most of the standards were looked at during this visit. What the service does well: Service users are provided with enough information about the home. They are always invited to visit the home before they move in to help them decide if it’s the right place for them. Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 6 The new owner has made sure that new service users have been given a copy of their contract so that they know what to expect from the service. Families and friends can visit the home at any time. Relatives all said they knew how to complain and would have no hesitation in doing so. The staff are friendly and approachable. There are good recruitment procedures so that only suitable people are employed to work in the home. The manager is a qualified nurse and has many years experience of managing a care home. There are good quality assurance systems in place to help make sure care standards are improved in the home. Relatives said: “The staff are always helpful if we have concerns about mam” “they are very helpful when it comes to inform us of any changes in her (service user’s) health”” “she (the new manager) has worked miracles” “it’s a lovely place” “I think its wonderful” What has improved since the last inspection? Since Southern Cross took over this home a number of significant improvements have been made. There has been a great improvement to how the staff treat the service users. They are now treated with dignity and respect. For example; staff no longer refer to people as “wanderers” or “feeders” but called each individual by their chosen name, responding sensitively to each individual’s needs. Staff no longer “drag” people backwards in their wheelchairs and they have all been provided with up-to-date moving and handling training. Staff help service users to make choices about how and where to spend their time. For example; a reminiscence room has been created so there is a wider variety of places for people to choose to spend their time. The mealtime experience is much better. Although some people still need to wait before they are assisted with their meal, (this is because nearly everyone needs support at this time), this is managed sensitively by staff. The new owner has improved the environment for people with dementia. No expense has been spared implementing a refurbishment programme and providing specialist equipment for people. The home is a much more pleasant place for people to live. Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 7 Lots of training has been provided for staff so that they can carry out their job well. It has also helped them to better understand the needs of people with dementia. Staff said: “It’s much better” “More professional” “Lots of changes” “More training” “Its good to see things developing” What they could do better: Care plans need more information in them and be kept up-to-date so that staff can make sure the service user’s health and personal care needs are fully met. Some improvements need to be made to medication records. For example; records need to be kept of the checks staff carry out to make sure that service users have been given their prescribed medication at the right time. There needs to be more activities for everyone. The manager needs to get training in the Local Authority safeguarding adults policy and procedure, so that she knows what to do should suspected abuse be reported to her. Risk assessments must also be completed for everyone who uses a recliner chair. This is important as people are unable to get out of these and they should only be used for those people who are at high risk of falling. Risk assessments must also be carried out for the hot trolleys, as these are very hot to touch and therefore a potential hazard. The refurbishment programme needs to continue as parts of the home, such as bathrooms, are in need of attention. Extractor fans in bathrooms and toilets also need looking at as these are noisy and dirty. Staff should make sure that service users only use their own personal items so that their dignity is respected at all times. It also will reduce the risk of cross infection. Night staff need more regular fire instructions so that they know what to do in the event of a fire at night. The owners need to write a policy and procedure for the use of supermarket loyalty cards, for example Sainsbury’s Necta card. This is so that service users are fully protected when staff go shopping for them. Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 8 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. Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 9 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 Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 10 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): 1, 2, 3, 4 and 5. Quality in this outcome area is good. We have made this judgement using a range of evidence, including a visit to this service. Sufficient information is available to help prospective service users make an informed choice about where to live. The admissions process ensures that service users needs are adequately assessed prior to care being offered. This means that service users will be offered the right type of care at the home. Intermediate care is not provided at Phillips Court. EVIDENCE: Southern Cross has produced a Statement of Purpose and Service User Guide that are specific to the home. They tell people about what services and facilities are provided at Phillips Court. Copies of these, as well as an Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 11 information leaflet about the home, are available in the entrance foyer of the home. For service users placed by the Local Authority in a residential care bed, a full social work assessment is obtained from the social worker prior to their admission to the home. A nurse assessment is now always obtained for those people who require nursing care. In addition to this the service also completes its own pre-admission assessment documents. Prospective service users are encouraged to visit the home prior to their admission. All new service users have been provided with a copy of Southern Cross’s contract. A copy of this is held in the service user’s file. Relatives and service users in surveys commented that they either “always” or “usually” were provided with enough information about the home to help them make decisions. The majority of service users who responded to surveys confirmed that they had received a contract. Philips Court DS0000070979.V360879.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 and 10. Quality in this outcome area is adequate. We have made this judgement using a range of evidence, including a visit to this service. Although staff care practices preserve the service users privacy and dignity, the service users health and social care needs are not fully reflected in the care plans. This means that guidance is not always available to ensure that the staff provide continuity of care. Medication procedures are generally satisfactory offering protection to the service users. EVIDENCE: Each person has a care plan, which is based on the admission assessment Risk assessments for nutrition status, pressure sore prevention, moving and handling, falls prevention, continence promotion, mental health and personal care are available. Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 13 The four plans looked at were all at different stages. There are three styles of care plan in use, which is very confusing for the staff and anyone else trying to find out information about individuals. The previous company used “core care plans”. Some of these are still in use and do not show how people are being helped with any aspect of their care. For example; “mobility reduced two staff for all hygiene needs”, and “to feel orientated at all times, to remember important information by continuous reminders”. This latter plan shows that staff potentially have little insight into the type of care they are delivering, as people at this stage of dementia will not be able to recognise or hold on to any type of information for any length of time. Orientating people by reminding them of events that were stressful and upsetting could cause people to become very agitated and distressed. Another style of care plan was based on “strengths”. It consisted of a tick list for all of the care plans and did not show how that person was to be cared for. This care plan did not evidence catheter care, moving and assisting, infection control or pressure sore care. When questioned the nurse was able to find the needed care plans filed away Another care plan showed that someone was “non compliant” and “trashed” the room. By describing people in terms of their behaviour is poor practise as it does little to promote person centred care. There was little evidence to show what management arrangements are in place to show what staff need to do when someone presents with any behaviour that would challenge Two plans showed that staff are starting to look at peoples previous lifestyles and histories. Information was available about likes, dislikes and family contacts. For example; one person had no family but enjoyed motorbike holidays, ran their own business and was an animal lover. Another person had brought up eight children on their own and had been a cook for sixty years. This information is important to make sure that individuals receive person centred care whilst in the home. Doll therapy is being used but there is little evidence in the care plans about how this works and staff did not know much about it apart from “they are really settled when they have the doll”. Daily records are kept and vary in detail. Comments such as “fair diet” “give copious fluids”, “requires hoist and sling due to cognitive impairment” do not show how or why the staff are giving care. Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 14 Care staff do not yet have access to the care plans although some spoken to indicated that “this was coming”. People who have low weight or have poor appetite have food charts and fluid balance charts so that staff can see what they have eaten and drank daily. These charts are still not being completed in detail nor do they show what alternatives are offered and taken. Staff were, however, offering hot and cold drinks throughout the visit Staff involve other professionals in the provision of care. Weights are regularly recorded and should there be weight loss or difficulty with eating or drinking, a referral is made to the GP and to speech and language therapists. The new owners have provided a number of pressure reliving devices to minimise any skin damage to those at risk. People who have a degree of skin damage have care plans in place to show what staff have to do to improve or prevent further problems. The staff involve the tissue viability nurse when necessary. Everyone living in the home has access to all NHS facilities. There are regular visits from GP’s and other health professionals including, opticians and chiropody services. The home has comprehensive medication policies and procedures for staff to follow. Staff see the prescriptions and keep photocopies Senior care staff, who have had safe handling of medication training, and qualified nurses administer medication. Nurses confirmed that each service user has a six monthly medication review, or more regularly if the nurse in charge has concerns about a person’s health. There were no gaps on the Medicine Administration Records, (MAR), however, there were other gaps in record keeping. For example, the nurse in charge said that it was the responsibility of the night staff to complete monthly audits of medicines to make sure that medication had been given as prescribed. However, there were no records available to show that this had taken place in recent months. Records had not always been completed to show which medicines had been ordered. A random audit of Controlled Drugs was satisfactory. The temperature in the medication room is being monitored and regularly found to be 26 C, which is above that needed to store medicines appropriately. Since the last visit the attitude of the staff team has much improved. Staff were seen to spend time with individuals talking to them and making sure their Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 15 dignity was protected as far as possible. People were called by their preferred name and individuals responded well to the staff throughout the visits. Relatives said that the home “always” met the needs of their family member. One relative commented that they felt that a strength of the service was “the time and attention to each individual’s needs”. The majority of service users said that they “always” received the medical support they needed. Philips Court DS0000070979.V360879.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 and 15. Quality in this outcome area is adequate. We have made this judgement using a range of evidence, including a visit to this service. The range of activities available to all service users is adequate, but could be improved to ensure that opportunities to lead a fulfilling lifestyle are provided. Service users are able to maintain family and other contacts to a good degree should they wish. This ensures they do not become socially isolated. Service users are encouraged by staff to exercise choice and control over their lives, which helps them to remain independent. Service users receive a varied menu, and the experience of eating food in the home has improved, thereby promoting the general health and wellbeing of the service users. EVIDENCE: The home has two activities organisers who try to arrange events both inside and out of the home. However, they only work between 10.00.am and 2.00pm Monday to Friday, which limits the time available for them to arrange and carry Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 17 out activities for the large number of people living in the home. They said that they are really keen to develop the garden area but that there is limited money available for them to purchase the items they need. They have started to create “hand of life” pictures with service users (which includes details of their social history) and these will be put in frames and displayed around the home. The home no longer has a minibus which limits the opportunity for service users to take part in community activities. The notice board in the reception area shows photographs of some events that have taken place. On the ground floor attempts have been made to make the corridor area a pleasant place to spend time. The area has been redecorated and a large mural of a spring garden has been painted on one of the walls. This is a nice conversation point with staff, service users and their visitors. Visitors were seen to come and go throughout the inspection. They are able to use the lounges or service users bedrooms for visits. There are no restrictions regarding visiting times. Staff were aware of individual needs. The service users were more alert and engaged as far as possible in the daily routines. There are “rummage boxes” in the lounge areas and hat stands have a variety of hats which some of the service users enjoyed trying on and wearing for a short time. Service users are able to exercise choice about where they spend their day. One service user, who has advanced dementia, chose not to sit it in a particular dining area. This decision was respected by staff who clearly understood this person’s needs and how best to encourage them to eat. If service users indicated they wished to leave communal areas, staff supported them to do so. The environment has also been improved to offer more choices to people about where to spend their time. For example; a reminiscence room has been created on the first floor of the home. Relatives commented in surveys that the care service “always” supported people to live the life they choose. There are dining rooms on all three units and small kitchenettes where staff can make drinks and offer snacks throughout the day. Fridges contained juice, milk and yoghurts Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 18 The home does not have a menu displayed either in large print or in picture style to help people choose what they would like to eat. At mealtimes the service users are all taken in and sat at the tables to wait for the hot trolleys and food to arrive from the kitchen. The meals are then served to them. There is now only one sitting for meals. The majority of service users need assistance to eat their meal, which means that some of them have to wait for some time before they can be helped. Nevertheless staff said this has improved the dining experience for the service users. Lunchtime was calmer, staff supported people in a sensitive dignified manner and did have more time to spend helping people with their meal. Tables were nicely set and service users were offered choices for the main course and dessert. Hot and cold drinks were available. The hot trolley was extremely hot to touch and could be a safety risk should a service user fall against it or touch it. The practice of scraping left overs into an open dish should be reviewed as one person who was walking past put their hands into this, then did not know what to do. One member of staff had to leave the dining room to help them wash their hands. Staff said that they had been given training about mealtimes and people with dementia which had really helped them understand what they needed to do to make this a positive experience for each individual. Philips Court DS0000070979.V360879.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 and 18. Quality in this outcome area is good. We have made this judgement using a range of evidence, including a visit to this service. Good complaints and protection procedures are in place to ensure that service users and their relatives are listened to and protected from abuse. EVIDENCE: The home has a complaints procedure that meets the national minimum standards. It is displayed in the entrance foyer area of the home. The manager said that it would be provided in alternative formats, such as large print, if required. Relatives said that they knew how to make a complaint and would have no hesitation in doing so if unhappy. There is a procedure for recording complaints including details of the complaint as well as the outcome of any complaint investigation undertaken. There have been no complaints since Southern Cross purchased the home. All staff will be provided with training on prevention of abuse on 20th March 2008. There have been no safeguarding meetings since Southern Cross purchased the home. There are two copies of the Local Authority safeguarding adults Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 20 procedure available in the office. Although the manager understands the procedures for safeguarding adults she has not received training to help her understand her role within Gateshead Local Authority framework. Staff demonstrated an awareness that the use of recliner chairs should only be used after a full risk assessment has been completed for them. This is because they may be regarded as a form of restraint. However, risk assessments were not available for everyone using such equipment. Such assessments such always involve the service user, where possible, their representative and any other professionals involved such as the care manager or GP. Philips Court DS0000070979.V360879.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, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. We have made this judgement using a range of evidence, including a visit to this service. Overall the standard of decoration and furnishing in the home has much improved and the commitment of the new owner to improving the environment to meet the diverse needs of people with dementia is commendable. EVIDENCE: The new owners have made improvements to the communal areas of the home. The walls have been painted in neutral colours and include grab rails. Bedroom doors have been painted in striking contrasting colours in order that they can easily be seen. Some bedroom doors have been provided with door knocks so that they resemble a front door. The new owners are going to use the long corridors to create streets and each will be given a street name in consultation with relatives. These changes will provide a more appropriate Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 22 environment for people with dementia and will help them to find their way around the home. A large mural of a library has been painted on the wall in a small lounge and service users can access a secure pleasant garden area. The new owners are aiming to develop the garden, so that people with dementia can get involved in gardening activities. They also intend on creating a family type environment where relatives will be encouraged to bring children into the home. Corridors now have some interesting postcards of local scenes, such as the building of the Tyne Bridge, Saltwell Park in its original state and old photographs of the local mining community Bedroom doors were not locked. The bedrooms were nicely furnished and decorated and many service users have brought small items with them making their own rooms very personalised. A number of bedroom carpets have been replaced. The people living on the residential unit have access to all areas of the unit and the garden area. Books and magazines were available and they were able to make choices about how to spend their day. The communal areas have been nicely redecorated making the unit bright and fresh. Profiling beds have been purchased and window locks have been replaced or repaired. The decorators are continuing to re-decorate throughout the home. Once they have finished new carpets are to be purchased for all communal areas. The extractor fans in the majority of bathrooms, shower rooms and toilets were very noisy and have not been cleaned for some time. This means that air is not exchanged within areas such as en-suites and toilets and could increase the risk of cross-infection. In the shower room opposite room 28 there are tiles missing, the flooring is marked, the light cord knotted and dirty. The radiator is rusty and the walls damaged from wheelchairs. The linen trolley held a bag of incontinence pads and a small blue basket containing hair brushes, combs, pop socks, nail clippers and a bag of underwear. The use of communal items increases the risk of cross infection and more importantly shows that residents dignity is possibly not respected all of the time. There is a separate secure laundry. It has a clean and soiled area and sufficient washing and drying equipment. On the day of the site visit it was very busy with four baskets of wet washing waiting to be dried Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 23 The home appeared much cleaner and there were no noticeable odours throughout the home Philips Court DS0000070979.V360879.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 and 30. Quality in this outcome area is excellent. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from skilled, experienced staff and the good staffing levels ensure that the service users needs are readily met. The service operates a robust recruitment procedure which protects service users from being supported by unsuitable people. EVIDENCE: The new owners have provided staff with a range of training since November 2007. The training has been targeted and has been focused upon improving outcomes for people. It has included training in sensory deprivation, “Yesterday Today and Tomorrow” training, which is specialist training on the needs of people with dementia, “good lunch is coming” which is about mealtimes and people with dementia, tissue viability and restraint training. Seventeen care staff have completed the NVQ level 2 qualification in care and a further seven staff are currently undertaking this. During this inspection staff reported high levels of satisfaction about the new owners, and some of them said that for the first time they felt valued. They were working better together and putting the needs of the service users first. Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 25 Relatives said “the home is always friendly when we come in and say to mam here is your son or daughter by name when we walk in” and “ they (the staff) seem to know all the service users very well”. On duty during the inspection were the manager, 2 nurses and 5 care staff on the first floor of the home, 1 nurse and 6 care staff on the ground floor nursing unit and 1 unit manager and 1 care staff on the residential unit. There was also a domestic on each floor and a housekeeper. Relatives commented “there are always plenty of staff around” when they visit. There has been a low turnover of staff, which is good in terms of ensuring continuity of care for the service users. The manager plans to introduce regular team meetings. In a recent team meeting care standards were discussed. Staff files showed that the company’s recruitment procedures are followed. All contained completed application forms, interview records, two written references, terms and conditions of employment and induction records. Criminal Record Bureau checks are carried out and these records are held securely. Philips Court DS0000070979.V360879.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, 34, 35 and 38. Quality in this outcome area is good. We have made this judgement using a range of evidence, including a visit to this service. The new manager is qualified and has the necessary experience to run the home for the benefit of the service users. The procedures in place for safeguarding service users finances are not sufficiently robust to fully protect people. There are some areas of potential risk to service users safety, which need to be addressed. The quality assurance system is being implemented to ensure that the home is run in the best interests of the service users. Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 27 EVIDENCE: Relatives said that when the new owners took over the home they were sent a letter telling them about this. The new manager is a Registered Mental Nurse (RMN) and has had 34 years experience of working in care. She has experience of working with people with dementia and is keen to undertake the Yesterday, Today Tomorrow training alongside her staff. In the short period of time she has been in post she has arranged a relatives meeting in order that she can introduce herself. The new owner has a comprehensive internal audit system. This involves a monthly audit carried out by the manager, which in turn is validated by senior staff within the organisation. During the visit a manager from another service was visiting the home in order to commence this process. The personal allowance records demonstrated that receipts and double signatures are maintained for all transactions. However, there is no policy on the use of supermarket or other locality cards when staff go shopping on behalf of service users. This needs to be developed to fully protect the service users. The new owners have provided all staff with fire awareness training. The fire records showed that staff had last been provided with fire instruction in October 2007 but there were no further records available to confirm that night staff had received three monthly fire instructions. This is important as they need to know what to do in the event of a fire at night when there are less staff on duty. Moving and handling practices made sure people were safe. All staff have been recently been provided with moving and handling refresher training. An appropriate record of accidents is maintained and there are good systems in place for monitoring the occurrence of these. As previously mentioned, risk assessments must be completed for the hot trolleys as these could be a potential hazard to service users. Philips Court DS0000070979.V360879.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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 2 X X 2 Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? New Service 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 OP8 Regulation 15&21 Requirement Timescale for action 01/10/08 2 OP9 13(2) The service users health and personal care needs must be clearly outlined in the care plans. These must be kept up-to-date and provide staff with sufficient information to enable them to adequately meet the service users needs. 01/07/08 Records must be maintained to confirm that the home completes its own audit of medication. Records must also be maintained of all medication ordered. This is to ensure that people receive their prescribed medication at the correct time. The treatment rooms must be fit for purpose. This is to ensure that medicines are stored safely. The range of activities available 31/10/08 to service users must be developed, to ensure that opportunities to lead fulfilling lifestyles are provided. The manager must receive 31/07/08 training in the Local Authority safeguarding adults procedure so that she knows how to make a DS0000070979.V360879.R01.S.doc Version 5.2 3 OP12 OP13 16(2)(n) 4 OP18 13(6) Philips Court Page 30 referral should suspected abuse be reported to her. The rationale for using recliner chairs must be clearly documented in the individual’s care plan. The extractor fans in toilets and bathroom must be properly maintained. This is to ensure that the air in these areas is exchanged reducing the risk of cross infection. Communal items must not be used as this increases the risk of cross infection and more importantly shows that service users dignity may not be respected all of the time A policy and procedure must be developed for the use of supermarket loyalty cards. This is to ensure that service users are fully protected. Night staff must receive 3 monthly fire instruction. This is so that they will know what to do in the event of a fire at night. A risk assessment must be completed for the hot trolleys. This is to prevent service users from being harmed. 5 OP25 23(2)(p) 30/04/08 6 OP26 16(2)(f) 13(4)( c ) 31/03/08 7 OP35 13(6) 31/07/08 8 OP38 23(4)(e) 31/03/08 9 OP38 13(4)( c ) 31/03/08 Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 31 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 3 Refer to Standard OP12 OP15 OP15 OP19 Good Practice Recommendations A review of the activities hours allocated to the home should be carried out. This is to ensure that service users are provided with an active fulfilled lifestyle. Menus should be available in large print and picture format to help people choose what they want to eat. A review of the practise of scraping leftovers into an open dish should be carried out. This is to help preserve the dignity of service users. The programme of re-furbishment should continue as planned, with particular attention to bathrooms. Philips Court DS0000070979.V360879.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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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