CARE HOMES FOR OLDER PEOPLE
Probert Court Continuing Care Home Probert Road Oxley Wolverhampton West Midlands WV10 6UF Lead Inspector
Rosalind Dennis Unannounced Inspection 10th July 2007 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Probert Court Continuing Care Home DS0000017198.V340863.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. Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Probert Court Continuing Care Home Address Probert Road Oxley Wolverhampton West Midlands WV10 6UF 01902 444067 01902 444068 jayne.lilley@heantun.co.uk 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) Heanton Care Housing Association Limited Post Vacant Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th October 2006 Brief Description of the Service: Probert Court is a care home providing accommodation, personal and nursing care to 25 older people. It provides a service to people who have continuing care needs. The home has two designated respite care beds. It is owned by Wolverhampton Primary Care Trust and is one of a group of homes in the district and was first registered in February 2001. The home is situated in the Oxley area of Wolverhampton, a short distance away from local shops and amenities. The single storey building was purpose built, with twenty one single occupancy bedrooms with two double rooms. The communal areas inside the home are spacious and homely in character. The gardens are easily accessible for service users and are secure. People are generally admitted to the home direct from a hospital setting with fees paid by the local Primary Care Trust. Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and was conducted by one inspector over a period of around seven hours. All ‘key’ standards were assessed during the day- that is those areas of service delivery that are considered essential to the running of a care home. Time was spent speaking with people living at the home, their significant others, speaking with staff and management, observing staff working and looking at range of documentation. Since the last inspection the home has appointed a new manager, Janette Jarvis, who was present throughout the inspection. The regional manager was at the home at the start of the inspection and returned for the purpose of feedback at the end of the inspection. What the service does well: What has improved since the last inspection?
The last key inspection in October 2006 identified some deficits with medication storage and a subsequent inspection by the CSCI pharmacist in March 2007 resulted in the issuing of twelve requirements needing immediate
Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 6 action. The home has now improved medication processes and can show that it has achieved the requirements that were made. The home has continued to improve recruitment practices and all required preemployment checks are now routinely undertaken. Key staff involved in the fitting of bed rails have received training -the home has good processes in place to promote the appropriate and safe use of bed rails. What they could do better:
No requirements were made as a result of this inspection. However a number of recommendations for improvements to practice were made. The manager had submitted an Annual Quality Assurance (AQAA) document to CSCI some weeks prior to the inspection-this document assists CSCI to assess the home’s performance. What is positive is that the manager has recognised weaknesses within the service and identified how the home intends to improve. One of these areas is communication and as a result of this inspection it is agreed that the home needs to improve the way it communicates with representatives of people living at the home. During and immediately after the inspection it became apparent that people did not feel comfortable to raise concerns, so it is necessary for the home develop strategies to provide opportunity for people to comment and contribute to the running of the home. Although the service user guide contains a complaints procedure it is recommended that additional copies of the procedure are provided in different locations around the home to ensure that the procedure is accessible to all. The home needs to develop the assessment and care planning processes to show how it has consulted with people at the time of their admission to the home and on an ongoing basis. This is to ensure that people and/or their representatives are involved in the planning and review of care and are kept informed of any changes to care needs. Two anonymous complaints received after the inspection raised concerns about whether the change in location of the manager’s office affected the privacy of people cared for in rooms near to the office and for this reason it is recommended that the home should assess and monitor the change in office location to ensure it is not compromising the dignity of people living at the home. Medication Administration Record charts do not have photographs of people attached and the home is advised to implement a process to enable identification of people living at the home.
Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 7 Staffing levels appeared satisfactory at this inspection to meet the needs of people living at the home, however staff were concerned that they are having to rush to enable care needs to met and ‘quality time’ is limited. The regional manager is advised to meet with staff to enable a discussion to take place regarding staffing levels. 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. Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 8 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 Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 9 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): 3. Standard 6 is not applicable to this service. Quality in this outcome area is adequate. The home has a satisfactory admission procedure and the assessment processes in use demonstrate that the home is able to meet the needs of people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observation of three people’s care files shows that the admission process usually involves information being sent direct to the home from hospital, which then enables the home to determine how it will be able to meet that person’s needs and plan care accordingly-all the care plans and risk assessments seen had been developed soon after the person’s admission to the home. The manager confirmed that senior staff may also visit people prior to their admission for the purpose of conducting assessments of need.
Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 10 In looking at care files it became apparent that there was nothing to show how the home recognises and promotes equality and diversity, senior management acknowledge that this is an area needing improvement as is information to show how the home consults with people and their representatives at the time of admission and during the planning and review of care. Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9 and 10 Quality in this outcome area is good. There is clear and consistent care planning in place, which provides staff with the information they require to meet individual needs. Care planning processes will be further enhanced by the home’s plans to implement a more person-centred approach to care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at the home who were able to communicate their views spoke positively about the care they receive; comments included; ‘staff are first class-no complaints’, ‘carer’s are very good’ and one person spoke about how their condition had improved greatly since living at the home ‘good food, good staff-no complaints’. The care files seen contained a range of well-written care plans and risk assessments, providing clear guidance to staff on how to safely meet individual needs. All care plans and risk assessments had been regularly reviewed by staff.
Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 12 The new manager commented within the home’s annual quality assurance assessment (AQAA) and during the inspection that increased consultation with people and their representatives is needed to provide a more ‘person-centred approach’ to care and it is considered that this should enhance communication and the provision of care. During the inspection the majority of staff responded to people’s requests with sensitivity and showed empathy when speaking with individuals and their families. An incident, during the inspection where it was felt that communication was not entirely satisfactory, was discussed with management and it was confirmed that this had been identified for action. Following the inspection CSCI received two anonymous complaints regarding the home and both included concerns about privacy, in that the new location of the manager’s office requires people to walk past individual bedrooms to gain access-it was also identified that the receptionist is now based here. This needs monitoring by the home to ensure that people do not feel that their dignity and privacy is compromised. The last key inspection in October 2006 identified some deficits with medication storage. A subsequent inspection by the CSCI pharmacist in March 2007 resulted in the issuing of twelve requirements needing immediate action. The home has produced an action plan to confirm that it has achieved these requirements and observation of the medication room at this inspection shows that medication processes have improved. Medication Administration Record (MAR) sheets, which were examined, had been completed accurately although it was seen that none of the current people had photographs attached to assist with identification-and the home needs to ensure that a means of identification is implemented without delay. Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14 and 15. Quality in this outcome area is good. The meals at Probert Court offer choice, variety and cater for different nutritional needs. People living at the home are provided with recreational and social activities and planned improvements to this area should further enhance social wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two members of care staff are now responsible for planning and organising activities, one taking the lead for providing activities on a daily basis and one organising visits by entertainers and trips outside of the home-observation of an ‘entertainments book’ shows that the home has planned musical entertainment, boat trips and a Black Country Museum video evening. People living at the home confirmed that bingo, quizzes and paint activities have taken place recently. People were being assisted to make ‘Thank You’ cards on the day of inspection, with most saying they were enjoying this activity although others seemed unsure about what they were doing.
Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 14 Individual care plans describe people’s preferred hobbies and activities, however a file where staff record different activities could not be located at the time of inspection, therefore it could not be evidenced that the activities provided met with individual wishes. The regional manager confirmed that training in the provision of activities is to be provided to key staff and the new manager has recognised that more work needs to be done to evidence how the home identifies individual likes/dislikes, assesses social needs and to improve relative’s meetings. Five members of staff who were spoken with, spoke of their commitment to ensure that people are offered choice and flexibility in their day to day lives according to individual capabilities. All people spoken with confirmed their satisfaction with the meals provided by the home, confirming that choices are available and that staff assistance with meals and drinks is good. The lunchtime meal was observed, which was wellpresented and appeared to be enjoyed by all the people present. Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 15 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): 16 and 18. Quality in this outcome area is adequate. The home has a complaints procedure, however further effort is needed to ensure that the home develops a culture where people feel fully able to express their views and raise concerns. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the complaint’s procedure is available within the home’s service user guide. One person was not aware of this procedure and it was discussed with the manager that it may be beneficial to consider improving the accessibility of this procedure, by providing copies in other locations within the home. The manager reported that the home has not received any recent complaints. Records show that staff have received training in adult protection/abuse awareness. It was established that the home does not have a copy of the recently updated local area adult protection policy and the manager was strongly recommended to obtain a copy of this procedure and make staff aware of its location. Contact details are readily available of the local adult protection team At the time of this inspection and through information received immediately afterwards it became apparent that some people do not feel able to raise their concerns direct with the home. The AQAA completed by the manager prior to
Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 16 this inspection had identified a need to improve communication between staff and people living at the home and/or their relatives. The home is planning training for staff on ‘customer care’ and it is considered essential that the home develops a culture where people feel comfortable to raise concerns, knowing that any concerns will be taken seriously and dealt with appropriately. Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 17 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): 19 and 26. Quality in this outcome area is good. The home provides people with a comfortable and clean place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has sufficient communal rooms, to provide ‘quiet areas’ for people to access if they wish, these rooms were observed to be well-equipped and welcoming, with furnishings of a good standard. Individual bedrooms were observed to be clean although the décor noted to be a little dull and requiring redecoration in places-the home submitted a planned programme of redecoration to CSCI in June 2007 and the manager confirmed that the implementation of this is to take place soon. Good systems of control are in place for the prevention of cross infections and observations of staff working confirm that staff follow appropriate guidance.
Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 18 Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 19 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): 27, 28, 29 and 30. Quality in this outcome area is good. Training opportunities within the home are good which ensures that staff are appropriately skilled and competent to carry out the duties for which they are employed. The home has improved its recruitment processes and this protects people living at the home from the employment of inappropriate staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at the home and visitors that were spoken with felt that staffing levels were sufficient to meet assessed needs. Observations made during the inspection confirmed that people’s needs were met, with staff attending to people’s requests promptly. However five members of staff provided the view that staffing levels are such that individual care needs are met through staff rushing to complete care resulting in a lack of “quality time” with people living at the home. These concerns were raised with the regional manager and a discussion confirmed awareness that staffing levels need to be calculated according to the dependency and needs of the people living at the home and that staffing levels need to be adjusted accordingly. It was clarified that the tool currently used by the home to calculate numbers of staff should only be used as a baseline.
Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 20 An anonymous complaint received after the inspection refers to insufficient staff and the impact that this is having on the provision of activities and in meeting people’s care needs -the home needs to ensure that levels meet the changing needs of people living at the home on an ongoing basis. It is recommended that the regional manager meets with staff to enable a discussion to take place regarding staffing levels. Two staff personnel files selected for inspection contained all required preemployment checks, including confirmation that CRB Disclosures are obtained for staff prior to starting work at the home. The staff training plan is linked to the home’s business plan and individualised training plans which were seen show that staff are provided with a range of training, including mandatory training and NVQ. Staff spoken with confirmed that good training opportunities exist, staff supervision provided and a newly appointed member of staff provided confirmation that the home operates an effective induction programme. During the inspection staff were observed moving people safely. The manager has taken on the role of moving and handling trainer and at the start of the inspection was working with staff to assess competencies with moving and handling techniques and equipment. Two anonymous complaints received by CSCI commented on a lack of appropriate identification of the manager-this was not found on the day of this unannounced inspection-the manager was in uniform with an identification badge clearly visible. Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 21 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): 31, 32, 33, 35, 36 and 38. Quality in this outcome area is adequate. The home monitors and reviews processes to ensure that people receive a range of quality services, however further strategies are needed to provide opportunity for people to comment and contribute to the running of the home. The home is well maintained and the staff group appropriately skilled to ensure that the health, safety and welfare of residents is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection in October 2006 a new manager, Janette Jarvis has been appointed to lead and manage the home and discussions during the inspection confirmed an enthusiasm to develop the home-Janette has yet to
Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 22 commence the formal registration process with CSCI. One area already identified by the manager as needing improvement is the area of communication with an aim of holding regular meetings for relatives. Comments received during the inspection and immediately afterwards provide confirmation that action needs to be taken to ensure that there is an open, positive and inclusive atmosphere within the home. A comment received after the inspection made reference to how the care is good but the ‘warmth’ has been lost from the home. The regional manager was present for part of the inspection and confirmed that the home has recently distributed questionnaires to people living at the home and/or their relatives and an action plan has yet to be formulated to address any areas needing improvement. Previous inspections have shown that the home operates an effective quality assurance process. The regional manager continues to conduct regular unannounced visits to the home, and a copy of this report is sent through to CSCI. The home operates a process whereby if people require ‘sundry’ expenditure, then payment is made through the home’s petty cash system and an invoice raised for the resident or representative-observation of these records show a robust process, with two staff signing to confirm correct amounts at each shift change. Documentary evidence was available to show that the home promotes and protects the health, safety and welfare of people living at the home, staff and visitors. Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 23 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 2 3 X 3 3 X 3 Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 OP3 Good Practice Recommendations The home needs to develop the assessment and care planning processes to show how it has consulted with people at the time of their admission to the home and on an ongoing basis. This is to ensure that people and/or their representatives are involved in the planning and review of care and are kept informed of any changes to care needs. . Processes to enable identification of people living at the home must be implemented. This is to avoid the risk of medication being administered to the wrong person The home needs to assess and monitor the change in office location for the manager. This is to ensure that people living at the home do not feel that their dignity and privacy is compromised and to ensure that the manager is easily accessible. Consideration should be given to providing copies of the
DS0000017198.V340863.R01.S.doc Version 5.2 Page 25 2 3 OP9 OP10 4 OP16 Probert Court Continuing Care Home 5 OP18 6 OP27 complaint’s procedure in other locations of the home. This is to ensure that the complaint’s procedure is accessible to all. It is strongly recommended that the home obtain a copy of the new local area adult protection policy. This is to ensure that the manager and staff are kept informed of the processes to follow should any incident or allegation of abuse occur. It is recommended that the regional manager meets with staff to enable a discussion to take place regarding staffing levels. This is to enable staff working at the home to raise any concerns they have in the provision of care. The home needs to improve the way it communicates with representatives of people living at the home. This is to promote a culture where people feel able to share their views and raise any concerns. 7 OP32 Probert Court Continuing Care Home DS0000017198.V340863.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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
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