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Inspection on 17/05/05 for Premier Court Nursing & Residential Home

Also see our care home review for Premier Court Nursing & Residential Home for more information

This inspection was carried out on 17th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All feedback received from service users was very positive. Care practices observed was individualised and dignified. All relatives and visitors spoke highly of the service. Service users accommodation were kept clean and offered a comfortable and homely environment. Staffing levels in the home were adequate. The home provided a wide range of activities and entertainment organised by the activity co-ordinator. Staff members spoken to were very positive about the home and appeared committed to their work. Some of the service users spoken to said the following about their experience in the home. `Staff are nice and so is the food and I am well cared for at the home`. One service user said that `if I have a worry I would be listened to` and ` staff are caring, food is good and plenty of it`. Good care plans with progress notes were kept up to date. There was a weekly activity chart on display in the main hall and it was noted that alternatives to the menu were provided. There is an ongoing quality assurance system in place.

What has improved since the last inspection?

Door guards have been fitted to service users bedrooms. Sso that Service Users can have their doors open if they wish and fire safety is not compromised. Staff records were kept up to date and ongoing staff training were provided. Good management of medication system with adherence to the procedures for the receipt, recording, storage, administration and disposal of medicines. In relation to infection control, it was noted that alcohol gel was provided. There was a good feel about the home and pleasant atmosphere with staff and service users interacting well.

What the care home could do better:

The home should continue in providing the good quality of care but particular attention must be paid to the fire safety procedures. It should maintain staff records as required by the relevant legislation. All clinical diagnosis and treatment must be recorded as part of the care plan and must be monitored, evaluated and reviewed.

CARE HOMES FOR OLDER PEOPLE Premier Court Nursing & Residential Home Thorley Lane east Thorley Bishops Stortford Hertfordshire CM23 4BH Lead Inspector Bijayraj Ramkhelawon Unannounced 17 May 2005 10:30 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 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. Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Premier Court Nursing & Residential Home Address Thorley Lane East Thorley Bishops Stortford Hertfordshire CM23 4bH 01279 758585 01279 758586 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes Limited Lesley Andrew Care Home with Nursing 60 Category(ies) of MD(E) Mental Disorder - over 65 1 registration, with number OP Old Age 60 of places TI Terminally Ill 55 years and over 5 TI(E) Terminally Ill 60 Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: This home may accommodate 60 older people who require personal care. This home may accommodate 60 0lder people in need of convalescent or nursing care. service users under the age of 55 years must not be admitted under the category TI. This home may accommodate 1 named female service user in category MD(E). The Commission is to be informed if the named service user leaves the home permanently for any reason and the registration will be amended removing this category. Date of last inspection 16 November 2004 Brief Description of the Service: Premier Court is a purpose-built care home providing nursing and personal care and accommodation for 60 persons for reason of old age. It was first registered under the Registered Homes Act (1984) with Hertfordshire County Council Inspection Unit in May 1996. It is owned by BUPA Nursing Homes Limited. It is situated on the outskirts of Bishops Stortford and is reached down a narrow lane but has good car parking provision.The home is on one floor and is built around a courtyard to which a number of bedrooms have direct access. All rooms are for single occupancy and have en-suite toilets and wash hand basins. There is a large dining room and lounge with a number of smaller lounges positioned around the home. There are other small garden areas around the outside of the building. A hairdressing salon, kitchen, laundry and disabled aids such as assisted bathing and toilet facilities, ramps and wide corridors provide for the needs of older people. Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a positive unannounced inspection and feedback received from service users, their relatives and visitors was excellent and the standard of care and practices observed were good. The majority of time was spent talking to residents, visitors and staff. Some time was spent in the office scrutinising care plans, staff files and other records. Discussions were held with the Head of Care to whom the feedback of the inspection was given. The experience of service users was that there was a pleasant and relaxed atmosphere in the home and they were complimentary of the staff, the food, activities and their rooms. What the service does well: What has improved since the last inspection? Door guards have been fitted to service users bedrooms. Sso that Service Users can have their doors open if they wish and fire safety is not compromised. Staff records were kept up to date and ongoing staff training were provided. Good management of medication system with adherence to the procedures for the receipt, recording, storage, administration and disposal of medicines. In relation to infection control, it was noted that alcohol gel was provided. There was a good feel about the home and pleasant atmosphere with staff and service users interacting well. Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 6 What they could do better: 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. Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1-5 Adequate information was available to prospective service users and their relatives to assist them in their decision making process when chosing the home. Each service user has an assessment of needs carried out by the home prior to an offer of placement is made. EVIDENCE: The home has a written ‘Statement of Purpose and a ‘Service User Guide’ and both documents were available to prospective and current service users and their relatives. Service users and relatives spoken to confirmed that they were encouraged to visit the home prior to admission. There was evidence in the care plans scrutinised that a pre-admission assessment of needs of the service users were carried out either in their homes or places of residence. Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7-11 Service users appeared to be well cared for, were comfortable and received care and attention in a timely manner. Good care practices and interactions were observed. These were supported by equally good care plans. Care plans were comprehensive and reviewed regularly but where service users have been diagnosed as suffering from MRSA, this is not reflected as part of their care plans. There were service users who were not identified with a recent photograph either in their care plans or their medicine charts. EVIDENCE: Care plans were comprehensive and included all the information required by this Standard including assessment of needs, risk assessments and how these needs were being met. Daily progress notes and observation were kept up to date with a nutritional assessment on admission which was reviewed, if needed, based upon monthly weight gain or loss. All service users are registered with a GP, who refers service users to all other health care agencies as and when required. The care plans were reviewed regularly but the clinical diagnosis, treatment and management of service users with MRSA were not included as part of individual’s care plan but only a risk assessment carried out stating that the service use has MRSA. Thus, it was not reviewed on a regular basis. Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 10 On the day of the inspection, individual care practices observed were commendable. Some service users chose to stay in their individual bedrooms and they were regularly checked and attended to. Records of medicines including the receipt, storage and disposal were kept in good order but not all service users were identified with a recent photograph. All service users were appropriately dressed and were correctly addressed by staff. Staff members on duty were observed to deliver care and to attend to service users’ needs in a professional with respect for their privacy, dignity, choice and wishes whilst actively promoting independence where possible. All personal and intimate care practices were carried out behind closed doors. A policy and procedures were in place for care of the dying. Staff members spoken to were aware of this policy. Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12-15 The home promotes autonomy and choice. Visitors are welcomed and the home provides planned activities in accordance with service users preferences. EVIDENCE: Currently, the home has one full time activity co-ordinator who organises a variety of activities and entertainment. Service users spoken to said that there were always activities provided for them and these included music, board games, sing along songs etc. The lunch was unhurried with assistance and encouragement given by staff sitting down next to service users. Tables were laid nicely and a choice of drinks was available and there were individual cutleries provided. Service users spoken to were complementary of the food and choices provided. Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16-18 The home has a robust complaints procedure of which all service users and visitors spoken to were aware. EVIDENCE: A copy of the complaints procedure is available to prospective and current service users. Those spoken to said that they were aware of the complaints procedure but would prefer to speak to a member of staff or the manager if they had any concerns. No complaints had been received since the last inspection. Staff confirmed they had received training on adult abuse and were aware of the ‘Whistle Blowing Policy’. Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19-26 The home and its surroundings offer a pleasant, comfortable and safe environment to its service users. The home was kept clean and well maintained and bedrooms were personalised offering a homely, lived in feel. However, bathrooms must not be used for storage. EVIDENCE: All bedrooms are for single accommodation with ensuite facilities. These were kept clean and contained service user’s personal furniture and belongings. Adjustable beds and pressure-relieving aids were provided for service users following an assessment of need. The home has adequate number of domestic staff on duty. Staff spoken to were aware of infection control and it was noted that alcohol gel was provided. It was observed that old chairs and trolleys were stored in the bathrooms. This detracts from the homeliness of the bathrooms. Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27-30 The skills and experience of staff is varied. There was an enthusiastic, dedicated and caring staff team who took great pride in the service provision. Staff files inspected had all the required documents with the exception of some without photographs. EVIDENCE: There was adequate numbers of care staff rostered on duty per shift during the day and night. Service users were complimentary about the staff and management of the home. stating ‘ staff are nice, kind and I feel well cared for’. Others said ‘that staff are marvellous’. Staff files were inspected and found to have all the required documents including the references, CRB and POVA checks. However, not all the staff files had a recent photograph. The Head of Care said that the home is in the process of purchasing a camera. Overseas care staff were provided with English Language lessons to help them improve and enhance their understanding of the spoken words. Staff spoken to confirmed that they have received appropriate training, this included NVQ, moving and handling, first aid, adult abuse and other mandatory training. The home has a programme of formal supervision for all care staff but this was not being provided 6 times a year. Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31-38 The home is well managed and is achieving its aims and objectives. The staff team who have direct involvement, appear to be dedicated to providing a good quality service. Fire doors must not be wedged open. This could compromise both staff and service user safety in the event of a fire. EVIDENCE: Staff spoken to said that the manager has an open-door policy where staff could see her at any time with any issues or concerns they may have. Pride and dedication is taken in every aspect. Service users and their relatives have commented positively on the good practices and quality of service provision. All statutory records were available for inspection and maintained in accordance with legislation. Records inspected were up-to-date and accurate and were held securely. Staff spoken to were aware that service users can access their records and information held about them in accordance with the Data Protection Act 1998. Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 16 The home has policies and procedures in place to ensure that the health, safety and welfare of service users and staff are promoted and protected. These records are accessible to all staff. All accidents and injuries are recorded in the accident book and RIDDOR forms have been completed where applicable. The CSCI has been kept informed of all accidents and admissions to hospital. Regular checks on hot water temperatures and moving and handling equipment are recorded. However, it was noted that the fire door between the dining room and the kitchen was wedged open. A valid insurance certificate is displayed in the reception area and this offers cover of no less than £5 million. The home adopts the organisation’s employment policies and procedures and facilitates the induction and training for staff. Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 1 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 2 3 3 3 1 Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 18 yes Are there any outstanding requirements from the last inspection? 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 OP 7 Regulation 15(1) & (2)(b) and 17(1)(a) Schedule 3(3)(k). 23(2)(1) & (m) Requirement Service users care plans must include all clinical diagnosis, medical conditions and treatment. Timescale for action 22/07/05 2. OP 22 & 38 3. OP 29 19 (1) (b) (i) Schedule 2 23(4)(c) (iii) 4. OP 38 The registered person must 22/07/05 ensure that suitable and allocated storage areas are available to store equipment including wheelchairs. The bathroom must be kept locked if being used a storage room. This requirement remains outstanding from previous inspection. The registerd person must not 22/07/05 employ a person to work at the care home unless a proof of identity, including a recent photograph has been obtained. Fire doors must only be kept 22/07/05 open by means approved by the Community Fire Safety Officer. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 19 Premier Court Nursing & Residential Home 1. Standard OP 9 Service users should be identified with a recent photograph especially in relation to the administration of medicines. Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City AL7 3BQ National Enquiry Line: 0845 015 0120 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 Premier Court Nursing & Residential Home I52 s19499 premier court v227244 170505 stage 4.doc Version 1.30 Page 21 - 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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