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Inspection on 02/07/07 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 2nd July 2007.

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

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

"The home has a very relaxed, pleasant and jolly atmosphere and the staff are most helpful" was one of the many positive comments received about Premier Court either from surveys or in conversation with people living in the home. The staff team appear well motivated and supported and the standard of care observed was good. The physical environment remains good and there was a very high standard of cleanliness again evident throughout this visit, and this was confirmed in conversations with people living in the home or visiting; "It is always nice and clean" was one of several similar comments made.

What has improved since the last inspection?

Some improvement in the medication practice of the home was found, although this still requires further attention.The new care plan format that has now been introduced provides much better information on the social care needs of people living in the home, as well as any nursing needs and this helps staff provide care in a way that recognises the "holistic" nature of an individuals needs.

What the care home could do better:

As inferred above, there is still work to be done to ensure the provision of a consistently high standard of medication administration practice for people living in the home. Activities staff in the home need to be supported to ensure that a consistently varied programme of activities is always available for people living in the home that want to take part in them. The Service Users` Guide and associated documentation needs to be reviewed and updated to ensure that it contains all the information required to help potential residents to make an informed choice about moving into Premier Court, and that what information it does contain is accurate.

CARE HOMES FOR OLDER PEOPLE Premier Court Nursing & Residential Home Thorley Lane East Thorley Bishops Stortford Hertfordshire CM23 4BH Lead Inspector Jeffrey Orange Key Unannounced Inspection 2nd July 2007 07:40 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 Premier Court Nursing & Residential Home DS0000019499.V344279.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. Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 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 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) www.bupa.co.uk BUPA Care Homes (CFC Homes) Limited Patricia Margaret Vincent Care Home 59 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (59) Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. 3rd October 2006 Date of last inspection Brief Description of the Service: Premier Court is a purpose-built care home providing nursing and personal care with accommodation for 59 older people. It is owned and operated by BUPA Care Homes Limited and is situated on the outskirts of Bishops Stortford in a pleasant semi-rural setting. The home is on one floor and is built around a courtyard garden 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. The home also has a hairdressing salon, kitchen and laundry that, together with aids such as assisted bathing and toilet facilities, ramps and wide corridors, provide well for the needs of older people. There are several small garden areas around the outside of the building, including a newly developed sensory garden and there is ample parking provision. The home has a range of documents providing details of its terms and conditions including a service user’s guide and statement of purpose. The report on the last inspection by the Commission for Social Care Inspection (CSCI) is also available. Weekly fees range from £800-£875 for nursing care and £700-£750 for residential care. Personal toiletries, newspapers, hairdressing, optician, chiropody and dentistry are subject to additional charges. (This information was still current at 02/07/07) Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to the home started during the early morning and this provided an opportunity to observe the operation of the home during this key time as people living in the home were being helped to get up, have their breakfasts and prepare for the day. During this inspection visit it was possible to speak to people who live in the home as well as to visitors. This report also draws on the information contained in a number of surveys completed by people living in the home received by the Commission for Social Care Inspection (CSCI) since the last inspection in October 2006. A number of key records were inspected, including those for staff recruitment, medication and care plans. Members of the staff team on duty were also consulted, including the Head of Care. This report also makes use of information provided by the home to the CSCI in their Annual Quality Assurance Assessment, together with any other information about the home received by the CSCI since the last inspection visit in October 2006. What the service does well: What has improved since the last inspection? Some improvement in the medication practice of the home was found, although this still requires further attention. Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 6 The new care plan format that has now been introduced provides much better information on the social care needs of people living in the home, as well as any nursing needs and this helps staff provide care in a way that recognises the “holistic” nature of an individuals needs. 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. The summary of this inspection report can be made available in other formats on request. Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 3 5 (Standard 6 does not apply to Premier Court) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although there is a wide range of information available to people considering moving into Premier Court, some is not always up to date and it does not explicitly provide details of fee levels and how/if these are variable depending on who is responsible for paying them. Admissions are not made to the home unless a full needs assessment has been undertaken, this should ensure that only those whose needs can be appropriately met are admitted. “We visited the home several times before making a decision” was one comment made that confirms that the home welcomes and encourages prospective residents and those who care for them to visit before admission, to make sure it is a place they will feel comfortable in and that can meet their needs. Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 9 EVIDENCE: Pre admission assessments of need for people who have recently moved into the home were seen and found to include the information required to ensure that staff can appropriately identify and meet the needs of people living in the home. It could not be verified that information provided to potential residents, prior to admission, includes the details about fees required in order to make sure that any variation that depends on how or by whom the place is funded can be clearly understood. Several documents on display in the home, including the “useful information folder”, the Statement of Purpose and Service User’s Guide included out of date or inaccurate information. The inspection report on display in the reception area of the home was not the appropriate one. Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of health and social care experienced by people living in Premier Court is good. Care plans have been improved and now provide a more complete assessment and record of the health and social care needs of people living in Premier Court and how they are being met. The basic standard of medication practice, record and administration is satisfactory and provides for the safety and well being of those living in Premier Court. There are however still occasions when medication policies and procedures are not fully followed and this must be monitored and addressed. Care is consistently provided in a way that respects the rights of people living in Premier Court and staff treat those for whom they are caring with dignity and in accordance with their expressed preferences and wishes. EVIDENCE: Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 11 “The carers are wonderful” was one comment made and this view was consistently supported and confirmed in discussions with people living in the home and from surveys returned to the CSCI since the last inspection. The way that carers interacted with people living in the home was observed throughout this visit and was seen to be respectful, thoughtful and appropriate. The “Quest” care plan format that is now in operation contains much better information about the social care needs of residents in addition to an appropriate level information about of nursing care needs. This enables staff to provide care based on good information about the individuals’ “holistic” needs. Medication records were generally satisfactory and previous requirements about storage temperatures have been met. However there were still some gaps found in records, inaccurate carry forwards and one stock record checked was incorrect. In order to maintain a consistently high standard the home’s policies and procedures must be carried out in full by all staff at all times. Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Premier Court are able to influence the way that their care is given and can exercise a reasonable level of choice over day- to- day decisions concerning them. Visitors are welcome and people living in the home are assisted to access the community. The activities programme includes some occasional opportunities for trips out of the home. Activities need to be maintained during the absences of dedicated activities staff so that there is consistent opportunity for people living in the home to take part in meaningful activities each day if they choose to do so. Meal times and meals can be varied to meet the preferences of people living in the home and the home’s catering staff consult people living in the home on a regular basis in order to take their views into account in the development of menus . Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 13 EVIDENCE: “The activities organiser is used for other duties…resulting in nothing being arranged for residents. Those activities which are arranged are good” was one comment made in a postal survey. The activities programme was seen. Those service users spoken to together with comments made in those surveys received by the CSCI consistently indicated that those activities that are available are good but that they are only “usually” or “sometimes” available. People living in the home have indicated that the food provided is generally very good and they confirmed that choices and alternatives are always available. “I seldom have what is on the menu, the chef makes something else for me” one resident noted. The home has again been gained a “Heartbeat” award in respect of a scheme run by Hertfordshire County Council for good practice in nutritional content of meals in care homes. The home’s newsletter, “The Clarion” was seen, and this contained details of residents meetings together with some special events and activities, such as a “Strawberry Tea” that had recently taken place. Breakfast and lunch were observed to be quite sociable events, with people living in the home being able to choose where they had their meals. Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A robust complaints procedure is in place that provides people living in the home and those responsible for them the opportunity to make a complaint with confidence that it will be listened to and dealt with appropriately. Staff receive training in what constitutes abuse and how to respond if it is seen or suspected and this provides people living in the home with confidence that they will be safeguarded from actual or potential abuse. EVIDENCE: Staff training files seen included specific training in issues around the safeguarding of vulnerable people from abuse and the appropriate action to take if it is seen or suspected. There is a comprehensive and prominently displayed complaints policy and procedure in place. The CSCI have not received any complaints about Premier Court since the last inspection in October 2006. Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 20 24 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical environment of Premier Court provides well for the requirements of those who live and work there. The layout, facilities and equipment provided is appropriate for the people who live in the home and the staff who care for them. The home is very well maintained, clean, safe and comfortable. EVIDENCE: “It is always lovely and clean” was a typical comment made and both people who live in the home and those who visit them were very positive and appreciative of the standard of cleanliness. The premises are well maintained and the sensory garden and other external areas accessible to people living in the home are attractive and well cared for. Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 16 There are a range of alternative communal areas both inside and outside the home and the local and regional management have demonstrated a commitment to a process of improvement and development of the built environment and facilities provided for people living in the home. Those peoples’ rooms seen, with their permission, were well furnished and personalised and reflected their individual personality and interests. Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are supported by adequate numbers of care and nursing staff with the skills, training and support that they require to meet their needs. The home’s recruitment policy is robust and thorough and should ensure that only those who are safe and suitable to do so, provide personal and nursing care for people living there. EVIDENCE: Survey returns received since the previous inspection in October 2006 were in general very positive about the standard of staff and the care received from them. “We have been quite impressed with the level of care provided within Premier Court… my grandmother is well looked after” was one of many similar comments made. “I like my visits here, I know the staff and they look after me well” was a comment received on the day from a person who receives regular respite at the home. Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 18 Those members of the staff team spoken to confirmed that they were regularly supervised and that they received support and training on a regular basis. This was confirmed by looking at a random sample of staff training and supervision schedules. Out of 30 permanent care staff, 18 either already hold NVQ2 in care or are working towards it. (Information provided by the home in their annual quality assurance submission to the CSCI) The recruitment files for some recently employed staff were seen and were satisfactory, providing evidence that the necessary checks to protect people living in the home are made prior to employment. Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31 33 35 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed home which provides a high level of care to people who live there and supports its staff team to help them meet the needs of people living in the home and to develop their own skills. The administrative, technical and ancillary staff provide a high level of support to the manager and her care staff and help in achieving good outcomes for those people living in the home. EVIDENCE: The manager has now completed her NVQ level 4 Registered Manager’s Award. Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 20 Those service users spoken to during this visit were very positive about the support they receive from the management and administration team in the home. The good standard of record keeping previously found has been maintained and in respect of care plans has been improved, enabling staff to better understand and therefore meet appropriately the social care needs of people living in the home. Staff supervision is in place and was confirmed as taking place by both the staff spoken to and records seen. Satisfactory insurance certificates and maintenance records were seen and information about maintenance was provided by the home in the annual quality assurance assessment submitted to the CSCI. This should provide people living and working in the home with confidence that their health and safety is being given appropriate priority. Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 4 X X X 3 X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 22 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 OP1 Regulation 5 Requirement All information provided to potential service users, and any documents on display in the home, must be reviewed and updated to ensure that they are accurate and up to date and fully meet the requirements of the revised Care Homes regulations. Staff must, at all times, adhere to the home’s policies and procedures for medication administration and associated records. Timescale for action 31/08/07 2 OP9 13 02/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations The scope and scale of activities available for service users, including those who may be permanently or temporarily confined to bed should be reviewed to ensure that each day there is a reasonable opportunity for those who wish to do so to take part in some meaningful activity DS0000019499.V344279.R01.S.doc Version 5.2 Page 23 Premier Court Nursing & Residential Home 2 OP12 either individually or as part of a group. The activities staff should be encouraged and supported to obtain resources and examples of good practice in the provision of activities in care homes from other activities staff employed by BUPA and from external specialist organisation. Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Premier Court Nursing & Residential Home DS0000019499.V344279.R01.S.doc Version 5.2 Page 25 - 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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