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Inspection on 06/12/05 for Prince Michael Of Kent Court

Also see our care home review for Prince Michael Of Kent Court for more information

This inspection was carried out on 6th December 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 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

All the residents who took part in the inspection said that they are happy in the home and that the staff provide a good quality of care. Comments included " It is a nice home", "I can`t fault the home", and "The nurses (sic) are lovely". The care plans provide detailed information on all the residents` personal care and health care needs. Residents are involved in decisions about their care, and consulted about their lives in the home. All the care staff spoken to were enthusiastic about their work, and said that they have a good level of training and support to enable them to meet the needs of the residents. The staff were observed to have a good relationship with the residents and to treat them with courtesy and respect.

What has improved since the last inspection?

The improvements noted in the last inspection report have been maintained, and all the requirements made in that report have been acted on. It was particularly pleasing to note that the procedures for administering and recording medication are being carried out effectively, and no requirements on medication were made on this occasion.

What the care home could do better:

In terms of service delivery and the quality of care there is very little that is needed to improve the life and experience of the residents. All the staff have training in dementia care, but the quality of life of the residents on Jersey unit would be further improved by specific training on activities for dementia care for the activities organiser. All staff must also have training on prevention of abuse in order to ensure that the residents are fully protected from the fear of abuse. The kitchens on the units are in need of refurbishment, and the staff do not have suitable changing facilities.

CARE HOMES FOR OLDER PEOPLE Prince Michael Of Kent Court Stratford Road Watford Hertfordshire WD17 4DH Lead Inspector Claire Farrier Unannounced Inspection 6th December 2005 10:40 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 Prince Michael Of Kent Court DS0000019500.V272207.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. Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Prince Michael Of Kent Court Address Stratford Road Watford Hertfordshire WD17 4DH 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) 01923 234780 01923 235125 arichards@rmbi.org.uk Royal Masonic Benevolent Institution Mrs Cindy Jane Alland Care Home 46 Category(ies) of Dementia - over 65 years of age (13), Old age, registration, with number not falling within any other category (46) of places Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home may accommodate 46 older people who require personal care. This home may accommodate 13 older people with dementia who require personal care. 27th July 2005 Date of last inspection Brief Description of the Service: Prince Michael of Kent Court is a care home providing care and accommodation for 46 older people who may also have dementia. It was opened in 1994, and it is owned by the Royal Masonic Benevolent Institution, which is a voluntary organisation. The home is situated in a residential area of Watford, within easy reach of the shops and facilities of the centre of Watford. It consists of a single storey building, with a small first floor that houses one unit. There are four units in the home: Jersey for residents with dementia, Forrester for the frailer residents, and Elgood and Haynes for those who are more independent. The units are situated around a large central lounge that is shared with residents who live in the sheltered housing unit that is attached to the home. All the homes bedrooms are single and all have en-suite facilities. There is a passenger lift. The home has a courtyard area at the front where residents may sit outside, gardens at the side and rear and an enclosed garden for Jersey. All the garden areas are fully accessible for the residents and are shared with residents who live in the sheltered housing unit. Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Three inspectors carried out this unannounced inspection, and including preparation time it took a total of 11 hours. During their time in the home the inspectors spoke with eight residents, one visitor and five members of staff, and feedback was given to the manager and deputy manager. The interaction between residents and staff was observed. The records were checked of residents’ care, medication, staff training and residents’ money. This was a positive inspection, and the majority of the standards inspected on this occasion were met or partially met. All the residents spoken to were happy in the home. New requirements were made concerning specific training and facilities for the staff, and refurbishment of some areas of the home. This was the second inspection of the year. Core standards that were not inspected on this occasion were assessed to have been met in the previous inspection report, to which reference can be made. What the service does well: All the residents who took part in the inspection said that they are happy in the home and that the staff provide a good quality of care. Comments included “ It is a nice home”, “I can’t fault the home”, and “The nurses (sic) are lovely”. The care plans provide detailed information on all the residents’ personal care and health care needs. Residents are involved in decisions about their care, and consulted about their lives in the home. All the care staff spoken to were enthusiastic about their work, and said that they have a good level of training and support to enable them to meet the needs of the residents. The staff were observed to have a good relationship with the residents and to treat them with courtesy and respect. Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Prince Michael Of Kent Court DS0000019500.V272207.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 Prince Michael Of Kent Court DS0000019500.V272207.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): These standards were not inspected on this occasion. EVIDENCE: Prince Michael Of Kent Court DS0000019500.V272207.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, 8 and 9 The individual needs of residents are clearly set out in care plans to ensure that all their needs are identified and can be met. The home monitors and addresses all the residents’ health needs, and has good procedures for the administration of medication. Residents said that staff treat them with respect, and provide a good quality of care. EVIDENCE: Detailed case tracking was carried out through the files of four residents. The care plans contain comprehensive information on all the service user’s assessed needs, with clearly written goals that are related to personal and healthcare needs, and personal development and social activities. The deputy manager has carried out a detailed audit of all care plans, and as a result, they have been reviewed, and they identify areas for improvement in a very detailed way. Appropriate risk assessments are in place for each resident. The residents spoken to confirmed that they are fully involved in their care plans and reviews of their care. Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 10 The care plans contain good information on the residents’ health care needs, with appropriate monitoring of specific health concerns and recording of all contacts with medical practitioners. The district nurses visit the home twice a day to administer insulin to one diabetic resident. A district nurse was in the home on the day of the inspection to administer flu inoculations to the residents. She was observed on Jersey unit explaining what she was doing to each resident in turn. Each resident was taken to their room to have the flu jab in private, and one resident returned to the lounge having refused the jab. It was reported that it would be offered to him again on another occasion. All the residents said that the staff treat them with respect and provide a good quality of care. A visiting relative said that the care workers are wonderful, although she felt that the knowledge of dementia care could be improved (see Standard 30). Medication is stored in appropriate medication cabinets in the office of each unit. Regular medication is supplied in individual monitored dosage blister packs. PRN (when required) medications are stored in a separate container for each resident. The home has good procedures for the administration and recording of medication. Prince Michael Of Kent Court DS0000019500.V272207.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 and 15 Residents are provided with a stimulating environment with a good range of activities and opportunities for social interactions. There is room for some improvement in the activities provided for residents with dementia on Jersey unit. Wholesome and varied meals are provided within the home presenting a well-balanced nutritious diet for the residents. EVIDENCE: Details of residents’ interests are included in their care plans. The home employs two activities organisers, one of whom concentrates on providing appropriate activities specifically for residents with dementia on Jersey. There is a range of activities available in the main lounge including exercises, bingo, coffee mornings and art and crafts. There are one or two entertainments every week and outings to places of interest. The programme of activities is available for the residents in all the units, including the sheltered housing unit, and pictures of the activities and outings are displayed throughout the home. Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 12 A new activities organiser has been appointed on Jersey unit, to provide specific activities for people with dementia. A visiting relative reported that during the summer, since the last activities organiser left, there has been a lack of stimulating activities and outings for the residents of Jersey unit. A musical activity was observed during the inspection, and all the residents joined in, using a variety of percussion instruments with some enjoyment. The programme of activities also includes knitting, painting, flower arranging and cake decoration. The activities organiser is very enthusiastic and imaginative, but she has had no training in specific activities and stimulation for people with dementia. She said that she is working from previous experience, and by trial and error, and she would appreciate and benefit from some specific training (see Standard 30). Lunch was observed on all the units. The residents spoken to commented that the food is very nice and very tasty. The staff were observed to assist those who needed help discreetly and with sensitivity. On Forrester unit soft music played in the background, and the meal was enjoyed by the residents as a social occasion. On Haynes and Elgood the residents said that the food was very good, but they could not remember what they had chosen from the menu. Large menus are placed on all the tables with the week’s menus listed. It may be preferable to provide a daily menu in an easily readable format so that the residents can anticipate their meal and so increase their enjoyment of it. The hot food trolleys are placed in the unit kitchens, and the meals are served plated to each resident. One resident was served with meat and potatoes but no vegetables. She said that she would like vegetables, but this had not been recorded on the list of choices, and the member of staff serving the meals did not ask her. The residents’ enjoyment of their meals may be improved if the vegetables were placed on the tables for them to serve themselves. Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 13 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): These standards were not inspected on this occasion. EVIDENCE: Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 14 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 and 26 The home and gardens provide a comfortable and attractive environment for the residents, but maintenance is needed in some areas. The provisions of the home ensure that the residents are able to maximise their independence and live in a safe and comfortable environment. EVIDENCE: No changes have been made to the fabric of the home since the last inspection. It was purpose-built in a residential area of Watford. The decorations and furnishings in the home are of a high quality. The home has a courtyard area at the front, gardens at the side and rear and an enclosed garden for Jersey Unit. The home is generally well decorated and maintained. However the dining room on Jersey unit is in need of redecoration, and all the unit kitchens need to be refurbished. It was reported that plans are in place for refurbishing the kitchens in the near future. It was reported that the roof by the door of Jersey unit leaks when there is heavy rain, and no remedy has yet been found for this. Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 15 There are no facilities for the staff to change into and out of their uniforms for work, as they are required to do, and they have to use the staff toilet cubicle as a changing room. On Forrester unit slings used for hoists are piled on a cupboard floor, as there are no suitable hooks for storing them more appropriately. The home appeared to be generally clean throughout, although there were traces of food that had not been cleaned off the dining chairs on Jersey unit. Several residents and visitors mentioned that the home is kept clean, and that their bedrooms are cleaned every day. Appropriate procedures are in place for the control of hygiene and there were no offensive odours in the home. Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 16 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 and 30 Staff numbers in the home are sufficient to ensure that all the residents’ needs are met, and staff receive appropriate training. EVIDENCE: The staffing levels in the home have been maintained. On Haynes and Elgood, where the residents are more independent, there is one care worker on each unit throughout the day. On Forrester, for residents with a higher level of need, there are three care workers in the morning and two in the afternoon. On Jersey, for residents with dementia, there are four care workers in the morning and two in the afternoon. At night there are two care workers on Jersey and three for the rest of the home, one of whom can also provide extra assistance on Jersey if required. The home has a stable permanent staff team, and there is very little need to use agency staff. No agency staff have been employed in the home for the past two months. A new deputy manager was appointed in July, and several of the staff commented on the improvements that have taken place in the home since his appointment. The manager has asked the company for extra staffing for key times during the day from next year’s budget allocation. Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 17 Each member of staff has a training passport as a record of their training. Those seen showed that there is a comprehensive training programme that covers induction training and regular mandatory training on all aspects of health and safety. The staff spoken to confirmed that they undertake regular training and updates of the mandatory training. All the staff have had training in dementia care, but the activities organiser for Jersey unit would benefit from specific training in activities for dementia. It was disappointing to note that training in prevention of abuse has not been maintained. It was reported that a suitable training package has not been found for all the staff. Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 18 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): 35 and 38 Adequate records are maintained for the effective management of the home and monitoring of health and safety procedures, and appropriate procedures are in place to ensure that the personal money or the residents is looked after and recorded appropriately. EVIDENCE: An anonymous comment was received by CSCI concerning how the staff handle and record transactions with the residents’ personal allowances. The records of the personal allowances are all recorded on computer and they were not accessible on the day of the inspection as staff member responsible was not in the home. However receipts and petty cash vouchers were seen to be maintained for all transactions and were all in order. Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 19 Health and safety records and procedures were seen to be maintained appropriately during the last inspection. No heath and safety concerns were observed on this occasion. Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 20 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 3 Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 21 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 OP19 Regulation 23(2)(b) Requirement Some areas were seen to be in need of repair and refurbishment, and in particular the unit kitchens. The registered person must ensure that the premises are maintained in a good state of repair. The unit kitchens and Jersey dining room need to be refurbished and redecorated. There are no changing facilities for staff and hoist slings are stored on the floor. Appropriate facilities must be provided for storage, and for staff to change in and out of their uniforms for work, as they are required to do. Training must be provided to meet the needs of the residents and ensure their protection. In particular, training on prevention of abuse must be provided for all members of staff, and training in activities for dementia care for the activities organiser on Jersey unit. DS0000019500.V272207.R01.S.doc Timescale for action 31/03/06 2 OP19 23(2)(I)& 23(3)(a)(i ) 31/03/06 3 OP30 18(1)(c) (i) 31/03/06 Prince Michael Of Kent Court Version 5.0 Page 22 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 OP15 Good Practice Recommendations All the residents spoken to said that the food in the home is good, but their enjoyment of their meals may be improved by providing a daily menu in an easily readable format, and by providing dishes of vegetables for the residents to serve themselves. Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 23 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 Prince Michael Of Kent Court DS0000019500.V272207.R01.S.doc Version 5.0 Page 24 - 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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