CARE HOMES FOR OLDER PEOPLE
Probert Court Continuing Care Home Probert Road Oxley Wolverhampton West Midlands WV10 6UF Lead Inspector
Pat Scott Unannounced Inspection 16th March 2006 09:40 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 Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 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.V275929.R01.S.doc Version 5.1 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 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 Jayne Margaret Lilley 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.V275929.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th October 2005 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. Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 16th March 2006 and commenced at 09.40am for the duration of the morning. The National Minimum Standards for Care Homes for Older People focus on achievable outcomes for service users – that is the impact on the individual of the facilities and services of the home. Evidence was looked for that the standards were being met and a good quality of life enjoyed by service users through: • Discussions with service users, families and friends, staff and managers. • Observation of daily life in the home • Scrutiny of written records (including care plans for 6 service users). The statement of purpose was used to assess how far the home’s objectives to be able to meet service user requirements and expectations were being met. Outcomes from the previous inspection and CSCI’s risk assessment of the home were taken into account to determine the core standards focused on and depth of inspection this time. What the service does well: What has improved since the last inspection? Matters relating to management of medication systems in the home have been addressed. Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 Page 6 What they could do better:
Each service user has been issued with a statement of terms and conditions of their residency. To meet the Regulations in full this document requires amendment. The registered person must ensure that service users are made aware of the fees that they are expected to pay and the source and amount of funding from external sources. This is needed even if nursing care is fully funded by the Primary Care Trust to secure transparency about the cost of the nursing care provided. There is poor quality in the recording of assessments and completion of the care plans. The homes service users guide provides information in a statement that reads: “ each residents needs and abilities are assessed on admission and re-assessed monthly by a named primary nurse. Following assessment a care plan is created which details how residents health and social care needs will be met”. There is no evidence in the care plans seen of this statement being met. Further work needs to be undertaken to ensure that the assessments and care plan records meet the minimum standards. Given the additional responsibility placed on qualified staff by the record keeping guidelines of the Nursing and Midwifery Council this aspect of care must improve. Supervision of staff has not been maintained. As above, staff need to be able to assess, plan, provide and monitor the outcomes of care for service users. Supervision is an important element which brings together all these practices and ensures that staff are competent to do their job and that competency is maintained. The manager has a clear vision of how this and care planning should be implemented but acknowledged that on occasions staff do not always comply with instructions despite being spoken with on an individual basis. It is recommended that the manager be more pro active in dealing with issues through the homes supervision and disciplinary procedures. The manager understands that there are shortfalls to meet her responsibilities under the Care Homes Regulations 2001 regarding record keeping in the above areas. There are major shortfalls regarding care planning, supervision and appraisal records which must be addressed as part of the process of demonstrating ‘inputs’ in order to achieve the outcomes observed at this inspection. Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 Page 7 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. Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 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.V275929.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4 The statement of terms of residency is incomplete in that service users are not aware of the fees to be paid and by whom. The recording of admission assessments is poor and does not demonstrate that service users needs will be met. EVIDENCE: Each service user receives a statement of terms and conditions upon moving into the home. These were seen on individual service user care files. These statements lacked additional information to meet The Care Homes (Amendment No 2) Regulation 2003. Although service users are referred by the Primary Care Trust, admission assessments and risk assessments such as those for nutrition support and
Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 Page 10 pressure area score assessments were incomplete on one service user file seen. The activity of daily living formats had also not been completed. The home does provide some care as ‘step down’ from hospital prior to going home and so they may have a shorter stay. This does not negate the need for thorough assessment and planning of all care provided at the home. The manager stated that intermediate care provision is being explored. It is considered that the home does not currently have adequate facilities to meet the service specific standard for this type of care. Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10 The quality of the completion of care plans is poor and as such cannot be relied upon to gauge whether appropriate personal or health care is delivered to an individual. EVIDENCE: Three of the four files looked at had no care plan in place. One had activities of daily living recorded that gave no direction to staff as to planned care to be provided. The others had very little information other than a brief assessment. The nutritional risk and waterlow score assessment were incomplete on another. Bed rails risk assessments were in place that had been signed by the service user or relative, but one had not been completed by the assessor. The manager acknowledged all the above. Staff are given direct responsibilities for completing care plans and are allowed shift time in which to do this. She is also exploring an alternative format to implement. Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 Page 12 Because care plans are lacking there is no evidence of review or evaluation. Daily notes detail some clinical input and the general well being of individuals, some of which have quite complex needs. Service users seen and spoken with during the inspection looked well cared for and expressed contentment in their relaxed manner and interaction with staff. The quality assurance survey results of December 2005 noted that service users and their supporters were very pleased with the care provided and felt that the their condition had improved. Staff were seen attending to service users respectfully. Manual handling with equipment in communal areas was conducted in as dignified a way as possible. Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14 Staff have an understanding of the service users support and leisure needs and use this to assist them to exercise choice and control in their lives. EVIDENCE: The home produces information providing a diary for the planned activity events. Sight of these shows that a varied amount of events take place. Staff are aware of service users’ personal preferences for recreation given their ability and capacity. The service users at Probert Court have very individual cultures, lifestyles and interests and some preferred very much doing their own thing. This was reflected in the way they could personalise their rooms, have contact with family and the choice available for meals. However, this is an area that is also poorly documented within the care files. Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Staff have been provided with induction and on-going training regarding adult protection. This provides staff with the relevant knowledge to safeguard service users from many types of abuse. EVIDENCE: Staff training ‘cards’ showed that training has been provided on the subject of abuse. Policies and procedures are available for staff to refer to and comply with. Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The standard of décor within this home is good and the premises present as a comfortable environment for service users. EVIDENCE: The standard of hygiene and cleanliness in the home is good. The home has separate domestic input and there were no odours in any part of the premises. Rooms entered into were personalised according to the occupant’s wishes. Equipment is in place to meet the varying needs of service users within the categories the home is registered for. Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 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): 27,28,30 The home employs an enthusiastic workforce that works positively with service users to improve their whole quality of life. Staff are provided with induction and training relevant to their job roles to ensure that service users are well cared for. EVIDENCE: Staff are supported to undertake NVQ and a variety of other training. Current topics include manual handling and fire safety. A training plan has been in place for 2005/6. 2006/7 has not been produced yet so the manager is unable to plan ahead. Agency staff are provided with information as an induction into the home when they commence their first shift. Staff keep their training cards up to date and certificates for courses attended are reported to be kept on files. It was suggested that rather than completed training being recorded on cards, a date is entered onto a matrix so that everyone who needs to refer to the matrix can see what training is up to date and what needs to be repeated. This can then provide a useful planning tool for management as well as a record of the home’s position regarding training provision. Staff meetings take place which are the forum for discussion about professional responsibility and accountability.
Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 Page 17 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): 33,36,38 Service users views have been sought and they perceive them as having an effect in changing how the home is run. Improvements to supervision of staff are still required in order to ensure that they remain competent to carry out their roles and ensure service users are in safe hands. Health and safety in the home is managed in a way that safeguards service users from risk of harm EVIDENCE: The results of the quality survey carried out in December 2005 have been collated. Overall the results show that service users, relatives and supporters are very happy with the care provided. Comments such as “ first class”, “the
Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 Page 18 home is a personal one” and “friendly and helpful staff” were included. The manager stated her intention to discuss these results at the next nurses meeting and put an action plan in place to address any negative comments which were few but included one about wishing to be more involved in their care planning. It is intended that the action plan will be relayed to service users at their next quarterly meeting. A proportion of the manager’s time has been spent included in the nursing numbers because of RGN vacancies. This had had an impact in the way she carries out her managerial duties under the Care Homes Regulations 2001. It has not affected the overall provision or standard of care. There is no record of formal one to one supervision to meet the national minimum standards. The home’s manager stated that formal staff supervision had not been maintained but that a system for implementing it has been devised for when the qualified staff complement is up to correct numbers. It is essential that a commitment to this process is made to ensure that training, when provided, the care planning process and key working all come together to improve outcomes for service users. The planned matrix which records the date of supervision and signed off by both supervisor and supervisee will help the overall monitoring of this task. Maintenance checks are carried out such as fire, hot water, electrical testing etc. A sample of these was examined and all were in order. Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 Page 19 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 2 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X X STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 1 X 3 Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP2 Regulation 5(A) Requirement The registered person shall provide to each service user, by not later than the day on which he becomes a service user, a statement specifying the fees payable by or in respect of the service user of the services of the home. This shall include the method of payment of the fees and the person or persons by whom the fees are payable. Timescale for action 30/04/06 2 3 OP3 OP7 14 15 (1)(20© The registered person must 30/06/06 ensure assessments of need and risk are completed. The registered person shall 30/06/06 ensure that care plans give clear, consistent information and are developed in consultation with relevant others at all times. The registered person shall ensure that staff receive appropriate supervision and that it is recorded. 30/06/06 4 OP36 18(2) Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 Page 21 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 OP30 Good Practice Recommendations To produce a matrix to monitor the provision of training. Probert Court Continuing Care Home DS0000017198.V275929.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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