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Inspection on 25/10/05 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 25th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Feedback received from service users and their relatives was very positive. Care practices observed was individualised and dignified. Service users accommodation were kept clean and offered a comfortable and homely environment. Staffing levels in the home were adequate to meet service users needs. A wide range of activities and entertainment organised by the activity co-ordinator is provided. Staff members spoken to were very positive about the home and appeared committed to their work. 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?

The home has complied with the requirements and recommendations of the last inspection.

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 social, leisure and psychological needs of service users who require personal care. The care plans were very nursing orientated with little emphasis on social care although half the numbers of service users do not require nursing care. Nutritional and pressure areas assessments were not fully undertaken and recorded.This could leave service users at risk. Personal information on service users which were kept in the corridor outside the nursing office for the benefit of staff must be securely maintained and confidentiality assured at all times.

CARE HOMES FOR OLDER PEOPLE Premier Court Nursing & Residential Home Thorley Lane East Thorley Bishops Stortford Hertfordshire CM23 4BH Lead Inspector Bijayraj Ramkhelawon Unannounced Inspection 25th October 2005 10:30 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 Premier Court Nursing & Residential Home DS0000019499.V260912.R01.S.doc Version 5.0 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.V260912.R01.S.doc Version 5.0 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) BUPA Care Homes Limited Care Home 60 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 (60), Terminally ill (5), Terminally ill over 65 years of age (60) Premier Court Nursing & Residential Home DS0000019499.V260912.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. This home may accommodate 60 older people who require personal care. This home may accommodate 60 older 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 be informed if the named service user leaves the home permanently for any reason and the registration will be amended removing this category. 17th May 2005 Date of last inspection 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 DS0000019499.V260912.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Feedback received from service users, their relatives and visitors was positive 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 acting manager to whom the feedback of the inspection was given. The experience of service users was that the home provided a pleasant and relaxed atmosphere and they were complimentary of the staff, the food, activities and their rooms. The home is being well managed with some minor shortfalls. What the service does well: What has improved since the last inspection? What they could do better: The home should continue in providing the good quality of care but particular attention must be paid to the social, leisure and psychological needs of service users who require personal care. The care plans were very nursing orientated with little emphasis on social care although half the numbers of service users do not require nursing care. Nutritional and pressure areas assessments were not fully undertaken and recorded. Premier Court Nursing & Residential Home DS0000019499.V260912.R01.S.doc Version 5.0 Page 6 This could leave service users at risk. Personal information on service users which were kept in the corridor outside the nursing office for the benefit of staff must be securely maintained and confidentiality assured at all times. 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 DS0000019499.V260912.R01.S.doc Version 5.0 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.V260912.R01.S.doc Version 5.0 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 the following 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 staff from the home prior to an offer of placement is made. EVIDENCE: A written ‘Statement of Purpose and a ‘Service User Guide’ are in place 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 DS0000019499.V260912.R01.S.doc Version 5.0 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 the following standard(s): 7-10 Good care practices and interactions between service users and staff were observed. Care plans were comprehensive and reviewed regularly but these do not include social, leisure and psychological needs. The administration and management of medicines were kept in good order except for the pharmacy failing to identify itself in the MAR sheets. EVIDENCE: Care plans were well documented and included assessment of needs, risk assessments and how these needs were being met. However, these did not include social, leisure and psychological needs. Service users social needs must be recorded so that holistic care can be provided. Daily progress notes and observation were kept up to date with a nutritional assessment. But service users’ weights were not check regularly. All service users were registered with a GP, who refers service users to all other health care agencies as and when required. 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. Premier Court Nursing & Residential Home DS0000019499.V260912.R01.S.doc Version 5.0 Page 10 Records of medicines including the receipt, storage and disposal were kept in good order but the MAR sheets did not show which pharmacy provided the medicines. It was also noted that hand written instructions on the MAR sheets were not signed by the person making these entries. Service users were appropriately dressed and said that they were well cared for. Staff members on duty were observed to deliver care and to attend to service users’ needs in a professional manner 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 so promoting privacy and dignity. 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 DS0000019499.V260912.R01.S.doc Version 5.0 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 the following standard(s): 12-15 Autonomy and choice is promoted. Visitors were welcomed and the home provided planned activities in accordance with service users preferences. EVIDENCE: Currently, there is one full time activity co-ordinator employed who organises a variety of activities and entertainment. Service users spoken to said that there were always various activities provided for them and a copy of the weekly activity programme was given to each service user. 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. However, it was noted that hot puddings were served (and left to get cold) at the same time as the main meal. This practice will detract from the enjoyment service users will get when eating their pudding. Premier Court Nursing & Residential Home DS0000019499.V260912.R01.S.doc Version 5.0 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 the following standard(s): 16-18 A robust complaints procedure is in place of which all service users and visitors spoken to were aware. However, training in the protection of vulnerable adults must be provided to all staff so that all service users are protected appropriately. EVIDENCE: A copy of the complaints procedure was 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 were aware of the ‘Whistle Blowing Policy’ but said that they had not yet received training on protection of vulnerable adults. This must be addressed as staff may not be aware of the procedures to follow if an issue arose. Premier Court Nursing & Residential Home DS0000019499.V260912.R01.S.doc Version 5.0 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 the following 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. 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 promoting infection control. Premier Court Nursing & Residential Home DS0000019499.V260912.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 The skills and experience of staff was varied. There was an enthusiastic, dedicated and caring staff team. Staff files inspected had all the required documents with the exception of some without photographs. Formal supervision must be provided to all care staff. 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. Staff files were inspected and found to generally have all the required documents including the references, CRB and POVA checks. However, photographs were not on all files examined. Staff spoken to confirmed that they have received appropriate training, this included NVQ, moving and handling, first aid and other mandatory training. The home has devised a new programme of formal supervision but this has not been implemented as yet. Premier Court Nursing & Residential Home DS0000019499.V260912.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following 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. Service user personal information must be kept securely. 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 was 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 but some personal information was kept next to the nursing office, which was easily accessible to any visitor. These must be securely kept. Premier Court Nursing & Residential Home DS0000019499.V260912.R01.S.doc Version 5.0 Page 16 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. 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. 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 DS0000019499.V260912.R01.S.doc Version 5.0 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 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 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 3 3 3 3 3 3 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 3 3 3 3 1 1 3 Premier Court Nursing & Residential Home DS0000019499.V260912.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement Care plans must identify individuals needs including social, leisure and psychological needs for service users. All assessments including nutritional and pressure areas assessments must be fully completed. MAR sheets must identify the pharmacy, which supplied the medicines. Hand written instructions on MAR sheets must be signed by the person making the entry. Training in the protection of vulnerable adults must be provided to all staff including ancillary staff. Formal supervision must be provided to all care staff. Service users personal information must be kept secured. Timescale for action 16/12/05 2 OP8 14(1)(a) 16/12/05 3 4 5 OP9 OP9 OP18 13(2) 13(2) 13(6) 18(1)(c) (i) 18(2) 17(1)(b) 02/12/05 02/12/05 16/12/05 6 7 OP36 OP37 02/12/05 02/12/05 Premier Court Nursing & Residential Home DS0000019499.V260912.R01.S.doc Version 5.0 Page 19 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 Refer to Standard OP8 OP15 Good Practice Recommendations Service users’ weight should be checked and monitored on a regular basis. Staff should ensure that hot puddings are not served at (and left to get cold) the same time as their main meals. Premier Court Nursing & Residential Home DS0000019499.V260912.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire 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 DS0000019499.V260912.R01.S.doc Version 5.0 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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