Inspection on 12/08/09 for Primrose Court Residential Home

This inspection was carried out on 12th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Primrose Court Residential Home 11/06/07

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Primrose Court Residential Home 241 Normanby Road South Bank Middlesbrough Cleveland TS6 6SX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jacqueline Herring     Date: 1 2 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Primrose Court Residential Home 241 Normanby Road South Bank Middlesbrough Cleveland TS6 6SX 01642456806 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Jay Mal Sangan Odedra care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 24 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 24 Date of last inspection Brief description of the care home Primrose Court is a care home providing personal care for older people. It is a twostorey building providing single and shared accommodation for up to 24 residents. There are 18 single bedrooms and 3 double bedrooms; 17 bedrooms have an en-suite facility, with a wash-basin and toilet. There are stairs as well as a passenger lift, giving people access to the first floor. Communal rooms are: a large lounge, conservatory and a dining room that has a seating area. Primrose Court has a small car park at the front of the building and the home is close to local shops and amenities. The fee, for residents at Primrose Court, is £465 weekly. Care Homes for Older People Page 4 of 27 Over 65 24 0 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one stars. This means the people who use this service experience adequate quality outcomes. This Key Inspection was to check that the home meets the standards that the Commission for Social Care Inspection say are the most important for the people who use the services, and that it does what the Care Standards regulations say it must. This inspection was conducted by two inspectors in one inspection day. During the inspection, a number of records were looked at, including records of people who use the service, along with staff recruitment and training records. The medication systems was also looked at and discussed at length. Discussions also took place with people living at Primrose Court as well as a number of staff and the manager. Care Homes for Older People Page 5 of 27 An Annual Quality Assurance Assessment (AQAA), the services self-assessment of how well they think they are meeting standards. This was received prior to the inspection and some of information has been reflected within the report to support the judgements made. We have reviewed our practice when making requirement to improve national consistency. Some regulations from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Further discussion took place with the manager and it is acknowledged that she has been away from the home for a period of four months and as such some of the management systems are not fully up to date. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 7 of 27 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information about the service, which enables them to make decisions about the home. People have their needs assessed prior to being admitted to the home, ensuring that their needs can be met. Evidence: The AQAA, which was completed by the manager and detailed the following about the admission process, Visit clients before they come in to assure we meet clients needs. Spend time with clients and their families. before clients decide on our home we encourage a daily visit to see the run of the home . A person was being admitted on the day of inspection. Their pre admission assessment had been completed by the manager and contained sufficient detail to show that their needs could be met. The care records of two other people were looked at, both people had lived at Care Homes for Older People Page 10 of 27 Evidence: Primrose Court for a number of years. There was a copy of the local authority/care managers assessment, which detailed care needs along with copies of care management reveiws. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receiving the service are happy with the way in which care is delivered by staff. However records detailing how health and personal care is to be delivered and associated risks is insufficient. The way in which medication is managed is good. Evidence: The care records of two people living at Primrose Court were looked at. Whilst there was an assessment of need in place in both records, these had not been updated for a number of years and not fully reflective of peoples current needs. The assessments of needs that were in place contained limited information about the person. It would be beneficial to have more detailed information within the assessment and for this information to be more person centered. There is also the need to ensure that information is cross referenced, for example one person has been diagnosed with a potential terminal illness, however this information is not reflected within the assessment of need and there are no specific care plans in place. Currently the care plans looked at were multi care plans with no clear outcomes and interventions. These were not being evaluated monthly, so it was unclear whether the Care Homes for Older People Page 12 of 27 Evidence: care was effective or not. Three monthly reviews are taking place, however care is needed with these as they do not always match up with other information contained within the care records. For example, one persons weight has been fluctuating over the past seven months, the review details their weight as stable. It was also identified where risks were identified such as weight loss, then there is the need to ensure that people are weighed on at least a monthly basis to allow for this to be monitored. Currently people are having their weights checked on an intermittent basis. Whilst peoples care records show that a daily record is made there is the need to develop these further so that they contain more valued based information about the person and care provided. Currently the records contain comments such as, usual self, no problems or fine, no problems. People living at the home are very satisfied with the care provided and believe their care needs are being met. Good interactions were observed between the staff and people living at the home. Staff spoken to clearly knew the people they cared for very well and were well aware of their care needs. The home has policies and procedures in place for the ordering, receipt, storage, disposal and administration of medication. Staff who administer medication had undertaken training in the safe handling of medication. The medication administration records showed a photograph of the person at the front to assist with identification. Where a Doctor visited a person at the home and prescribed new medication, the records needed to be hand written and were signed by two members of staff. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with opportunities for activities, this would be enhanced further if a social and lifestyle assessment were completed. Individuals have choice and control over their lives and people are able to keep in touch with families and friends. The home provides a varied and balanced diet for people who use the service. Evidence: The AQAA detailed that regular activities are available to people living at the home. A nintendo Wii had recently been purchased and people been enjoying this. A large screen TV had also been purchased and the garden was in the process of being improved so that people could sit out more often. There are also entertainers who visit as well as a twice monthly, motivation class. A daily diary detailing the activites is kept, these listed the activities but did not contain information about who particpated or whether is was successful or not. There was however discussion with the manager as the care records did not contain a social assessment or information about hobbies, interests and lifestyle. Four people who live in the home were interviewed. They all said that they could get up and go to bed when it suited them. One lady said I like to go to bed early and Care Homes for Older People Page 14 of 27 Evidence: then staff bring up my supper. Another person said I like to get up early and then come downstairs for a cup of tea. They said they enjoyed the entertainment in the home and also just like to sit and chat. A relative interviewed said she was welcome to visit at any time. The menu was looked at which was a three week rotational menu. The meals provided are traditional british meals. The cook said she chats to people when they first move into the home to ask about their likes and dislikes and any special diets they may have. There are choices at every meal and people are asked what they would like on a morning. The cook is aware of each persons individual likes and dislikes, for example: two people do not like mayonnaise in their sandwiches, one person does not like dinners. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that their concerns and complaints will be taken seriously and acted upon. People are genreally protected from harm, however further training is needed for staff to enhance this further. Evidence: The AQAA detailed that there had been one complaint since in the last twelve months. The manager confirmed that this had been investigated and correspondence sent to the complainant, however this had been completed by the proprietor and none of the information was available within the home. Complaints and concerns were discussed with the manager who confirmed that there had been no further complaints had been received, however there were concerns made but these are not being recorded. It was recommended as good practise to record concerns. People living at the home said, I have no complaints at all, but if I did I would speak to the manager or any of the carers they are all very good. Staff said, There was training regarding No Secrets as part of NVQ, however no further training has been received. Three members of staff said they would immediately reported any suspected abuse to the manager or deputy. At last inspection it was recommended that staff be updated in regard to Protection of Vulnerable Adults and No Secrets. To date this training has not been carried out Care Homes for Older People Page 16 of 27 Evidence: however the manager confirmed that it was planned and would be taking place later on in the year. Whistleblowing and Protection of Adults is covered during the in house induction for new staff. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, homely and well maintained environment, which meets their needs. Evidence: A tour of the home was carried out. Since the previous inspection refurbishment had been ongoing. The main lounge had been re decorated and a new capet fitted. A number of bedrooms had also been re decorated, the manager said that whenever a room becomes vacant it is re decorated. If the person moving in does not like the colours the room will be re done to their particular taste. All the bedrooms contained personal posessions: small items of furniture, pictures, photographs. The manager said she encourages people to bring in personal items, to make their rooms more homely. This was confrimed during discussion with a person who lives in the home and her relative. The garden area had been extended to provide a larger space for people to sit out in. A new lower outside fence had been installled which enabled people to sit out and watch the world go by. It was noted that although the tour of the home was carried out early in the morning the home was very clean and without any odours. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met by the staff, who have the skills required. People are protected by the way the home recruits staff. Evidence: Two files for the most recently appointed staff were looked at during this inspection. In the main they contained the required information to show that the way in which people are recruited is good. This included completed application form, appropriate references and a Criminal Records Bureau check. There is a tick sheet in house induction for all staff who commence employment at Primrose Court. The manager confirmed that if new care staff commenced employment who did not have their NVQ Level 2 in care then the Skills for Care Common Foundation Standards would be used as their induction. The manager confirmed that the proprietor of the service had recently downloaded these from the internet. The AQAA contained details of current permanent staff with their NVQ Level 2 in care, which was seventeen out of nineteen. On the inspection day, this had increased to 100 , which is excellent. Two permanent members of staff were interviewed and a trainee from an Agency, who Care Homes for Older People Page 19 of 27 Evidence: was in the process of NVQ training. They said they felt part of large family and met the individual needs of the people who lived in the home. The permanent members of staff had achieved NVQ level 2 in care either in previous employment or via a Training Agency. Care Homes for Older People Page 20 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Primrose Court are assured that their home is well run. The health, safety and welfare of people who live at the home and staff need further development to ensure that they are fully promoted and protected and that systems are in place to show that it is being run in the best interests of people living there. Evidence: The manager has been in post for a number of years, and the experience needed to manage Primrose Court. There is the need for her to complete an NVQ Level 4 in care. The personal allowance system was looked at and found to be in order. Peoples balance of monies corresponded to what was recorded and there was evidence of two signatures. Receipts are kept for items purchased, The manager confirmed that the proprietor visited the home on a weekly basis and once a month completed a regulation 26 visit as part of the quality assurance system. There were however very few of these written reports available at the time of the Care Homes for Older People Page 21 of 27 Evidence: inspection. Monthly themed quality assurance had been taken place, however none have been completed since November 2008. There was a copy of a previous relatives satisfaction survey, but again no recent information was available in regard to customer satisfaction. Health and safety records showed that equipment such as fire and laundry was being serviced on a regular basis. Weekly fire checks are generally being carried out. There was however the need to fully record information in respect of fire drills, such as staff in attendance, time of drill and effectiveness of the drill. Fire drills should also include night staff. The manager said that the most recent fire drills were planned and staff attended the home for these. It was agreed that more unannounced drills should take place. Accident records were looked at, there is the need to ensure that the book is numbered. Accident analysis takes place, this was however last completed in May 2009. Staff are not fully up to date with training in respect of mandatory training such as fire, moving and handling and health and safety. These records in the main were last updated in 2007 and there were no certificates available to show that staff had undertaken recent mandatory training. Staff also confirmed that they were in need of updates. Staff said they received supervision every six weeks. The manager had been off work for a period of four months earlier this year and said that she had a range of information at home and she was in the process of updating a number of records and systems. Care Homes for Older People Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be 01/12/2009 developed that are reflective of the individual needs identified. The interventions must be specific and achievable.The evaluations of care should be relevant to the care plan and should give information about the effectiveness of the planned care. This will ensure that staff have up to date information about peoples needs and how their needs are to be met. 2 8 13 Risk assessments must be developed for more individual specific risks. This will ensure that all risks are considered and care plans developed where needed to manage these risks. 01/12/2009 Care Homes for Older People Page 24 of 27 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action It will also ensure that information is in place for the safety and wellbeing of people. 3 18 18 Staff must receive training in regard to protection of vulnerable adults. The planned training must take place. This will ensure that staff have the information needed to fully protect people. 4 38 13 All staff must receive regular 02/11/2009 health and safety training, which is updated at the required intervals. This will ensure the health, safety and well being of people living at Primrose Court, relatives and staff. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 01/12/2009 1 2 3 1 7 12 The contracts of residency should be updated and need to include the individuals room number as well as the fees. Peoples daily reports should contain more information about them and the care they have been provided with. The care records should contain information about peoples social needs including their hobbies, interest and lifestyle along with information about preferences, likes and dislikes. Page 25 of 27 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 16 Where complaints have been made a copy of the complaint information, associated investigation, outcome and correspondence should be available within the home. As a good practise recommedation informal complaints and concerns are also recorded as this will then show the actions taken to address these matters. 5 6 7 30 31 33 All staff should have an individual training and development plan. The manager should have a qualification at National Vocational Qualification Level 4 in care or equivalent. There should be a written monthly report available within the home for the regulation 26 visits conducted by the proprietor. All staff should be involved in fire drills at the frequency determined by the local fire service. These drills should be fully detailed. The water temperatures to baths and showers to be tested and recorded on a weekly basis as recommended by the health and safety executive. 8 38 9 38 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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