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Inspection on 17/10/05 for Probert Court Continuing Care Home

Also see our care home review for Probert Court Continuing Care Home for more information

This inspection was carried out on 17th October 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

The standard of cleanliness and presentation of the home is good and offers service users a well- maintained environment to live in. All services users are appropriately assessed to ensure the home can meet the individual`s needs before they are admitted. Service user feedback shared with the inspector was positive in relation to feeling well cared for. Opportunities are available to all service users that incorporate individuals being able to exercise choice in the lifestyle they lead as far as reasonably practicable. This is dependant upon the individuals capacity to be involved in the decision making process, where this is not possible relatives and representatives including key workers support the individual concerned. Service users are offered a varied, well balanced diet, which takes into account individual likes and dislikes along with seasonal changes.

What has improved since the last inspection?

The Home has purchased some new equipment and furnishings for the comfort of service users. These include two new box chairs and footstools, new dresser and unit purchased for the dining room, a tea service for the new unit, a radio and CD player for the conservatory.

What the care home could do better:

All service users must be issued with a contract stating the terms and conditions of their stay upon admission to the home. This is an outstanding requirement made at the announced inspection on 22nd July 2004 and again at the unannounced inspection on 27th January 2005. Examination of care plans concluded that there is still a lack of written information to confirm service users are receiving the care they require. Staff must ensure that when opening medication such as eye drops these are dated on the day of opening. Oxygen cylinders must be securely chained to the wall to protect the health and safety of service users. Sharps box protocol must be adhered to at all times. In order to fully promote individuals dignity the home should not use `pooled items of night wear/continence pants and communal toiletries. The requirement made at the unannounced inspection on 27th January 2005 that the registered person must produce an action plan from the quality assurance questionnaire findings must be addressed. All staff must receive regular formal supervision sessions. This is an outstanding requirement made at the announced inspection on 22nd July 2004 and again at the unannounced inspection on 27th January 2005.

CARE HOMES FOR OLDER PEOPLE Probert Court Continuing Care Home Probert Road Oxley Wolverhampton West Midlands WV10 6UF Lead Inspector Karen Powell Unannounced Inspection 17th October 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Probert Court Continuing Care Home DS0000017198.V259488.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. Probert Court Continuing Care Home DS0000017198.V259488.R01.S.doc Version 5.0 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.V259488.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th January 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.V259488.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 9.30am and lasted 6 hours. The inspection included discussion with service users, relatives, staff and management. Observation of daily routines, examination of service user records and a home tour took place as part of the inspection. Only one out of the four requirements made at the last inspection had been acted upon. Progress had been made in implementing the recommendations made. The manager must prioritise the requirements made following this inspection and forward an action plan to the Commission for Social Care Inspection. What the service does well: The standard of cleanliness and presentation of the home is good and offers service users a well- maintained environment to live in. All services users are appropriately assessed to ensure the home can meet the individual’s needs before they are admitted. Service user feedback shared with the inspector was positive in relation to feeling well cared for. Opportunities are available to all service users that incorporate individuals being able to exercise choice in the lifestyle they lead as far as reasonably practicable. This is dependant upon the individuals capacity to be involved in the decision making process, where this is not possible relatives and representatives including key workers support the individual concerned. Service users are offered a varied, well balanced diet, which takes into account individual likes and dislikes along with seasonal changes. Probert Court Continuing Care Home DS0000017198.V259488.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: All service users must be issued with a contract stating the terms and conditions of their stay upon admission to the home. This is an outstanding requirement made at the announced inspection on 22nd July 2004 and again at the unannounced inspection on 27th January 2005. Examination of care plans concluded that there is still a lack of written information to confirm service users are receiving the care they require. Staff must ensure that when opening medication such as eye drops these are dated on the day of opening. Oxygen cylinders must be securely chained to the wall to protect the health and safety of service users. Sharps box protocol must be adhered to at all times. In order to fully promote individuals dignity the home should not use ‘pooled items of night wear/continence pants and communal toiletries. The requirement made at the unannounced inspection on 27th January 2005 that the registered person must produce an action plan from the quality assurance questionnaire findings must be addressed. All staff must receive regular formal supervision sessions. This is an outstanding requirement made at the announced inspection on 22nd July 2004 and again at the unannounced inspection on 27th January 2005. Probert Court Continuing Care Home DS0000017198.V259488.R01.S.doc Version 5.0 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.V259488.R01.S.doc Version 5.0 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.V259488.R01.S.doc Version 5.0 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 Service users do not receive written contracts on admission to the home. All service users are assessed before admission to the home. EVIDENCE: Discussion with the manager confirmed that service users do not receive a written contract stating terms and conditions of their stay upon admission to the home. This is an outstanding requirement made at the announced inspection on 22nd July 2004 and again at the unannounced inspection on 27th January 2005. The file of the latest admission was examined and found to contain a written assessment undertaken prior to the individual entering the home. This had been carried out by an appropriately qualified person. Probert Court Continuing Care Home DS0000017198.V259488.R01.S.doc Version 5.0 Page 10 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, 9 & 10 There is not a consistent care planning process in place. This places service users at risk of not receiving appropriate care in relation to their needs. The handling of service user medication is generally good, however minor shortfalls were identified. Promotion of service user dignity is compromised by some care practices that are in need of review. EVIDENCE: The home’s care planning documentation does not have the capacity to be comprehensive. Four service user care plans were examined to monitor compliance with standard seven-service user plan. Although in some cases there was some detailed information recorded in relation to service user need and the delivery of care to individuals this was not consistent in all cases. Some care plans lacked key information in relation to one individuals care. It was documented that the individual had ‘three broken areas that were dressed’, detail as to the location of the wounds, frequency of wound care or treatment was not documented. The daily record stated that photographs had Probert Court Continuing Care Home DS0000017198.V259488.R01.S.doc Version 5.0 Page 11 been taken of the areas, however these were not on the individuals file. A pressure area assessment was left blank. A manual handling assessment was not completed, despite this individual having severe restricted mobility. It was documented that the individual required ‘all care’ with hygiene needs this is not supported by details of what those needs are and how they should be met. Nutritional screening had not been completed and once again the relevant documentation was left blank. Reference that the individual was having problems sleeping was seen recorded in the daily notes. Given that it also documented that the person gets anxious and that they were new to the home, management of this issue did not feature in the care plan. However daily records did confirm that the issue had been addressed and was being monitored. The three other care plans examined were of service users who had lived at the home for sometime. Although as mentioned earlier these were more detailed they had not been reviewed on a monthly basis. All three service users were deemed as having high waterlow scores, two out of the three had not been reviewed since May and June 2005. The third had been reviewed in September 2005, however the review prior to that had last been carried out in June 2005. There was no evidence in care planning documentation to indicate that the care plan had been drawn up with the service user or their representative. Risk assessment for the use of bed rails for one individual had not been fully completed. The home has a high number of service users who have bed rails in situ further discussion to the installation and maintenance of bed rails at the home confirmed that these are carried out by the organisations handy man. The manager was uncertain as to any training he has had in this area. It was suggested that she checks out this information and carries out regular reviews on all service users who have bed rails in situ and documents reviews as they are carried out. Observation of the medicine round was carried out as part of the inspection. This was conducted in line with the homes policies and procedures. Those medication administration records sampled were seen to be completed appropriately. Inspection of the controlled drugs register and an audit of one service users records and stock balance were seen to be satisfactory. It was explained to the inspector that a check at the hand over of each shift of controlled drugs is carried out by two trained staff. Inspection of drugs requiring refrigeration revealed that 4 bottles of eye drops and one tube of cream had not been dated when opened. It was acknowledged by the nurse showing the inspector the medication at the time of the inspection and agreed that this practise must be reviewed. All sharps boxes must have the assembly label completed with all details as per label. Oxygen cylinders stored in the treatment room must be securely changed to the wall to protect the health and safety of the staff. Probert Court Continuing Care Home DS0000017198.V259488.R01.S.doc Version 5.0 Page 12 Discussion with service users confirmed that they feel their privacy and dignity is maintained by staff. Observations of daily routines made by the inspector on the day confirmed that service users are treated with respect. Observations made during the home tour however identified some care practices that compromise an individual’s dignity. These must cease immediately. The use of ‘pooled’ net continence pants and nightwear seen on linen trolleys used within the home and communal toiletries again seen on linen trolleys. Probert Court Continuing Care Home DS0000017198.V259488.R01.S.doc Version 5.0 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): 12 & 15 Opportunities are available to all service users that incorporate individuals being able to exercise choice in the lifestyle they lead. Service users are offered a varied, well balanced diet, which takes into account individual likes and dislikes along with seasonal changes. EVIDENCE: Discussion with service users informed the inspector that a variety of activities are provided within the home and outside. Photographs of a boat trip were seen in the reception area along with a weekly activity programme which includes musical keep fit, flower arranging, foot and hand massage, hairdressing, reminiscing and cards. It was also stated that service users had been enabled to create their own patio tubs, service users chose the flowers to be included or in one case tomato and bean plants! One service user who has a dual sensory impairment has chosen highly fragranced flowers. It was stated by service users and a relative spoken to that the choice and quality of meals was good. A menu is in place and was seen to offer a varied and wholesome diet. Probert Court Continuing Care Home DS0000017198.V259488.R01.S.doc Version 5.0 Page 14 Observation of the lunch-time meal was seen to be relaxed and in pleasant surroundings. Staff were seen to offer assistance where required. Probert Court Continuing Care Home DS0000017198.V259488.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17 There is a clear and accessible complaints procedure in place. Service users legal rights are protected. EVIDENCE: The complaints procedure is detailed in the service user guide and on display in the reception area of the home. It was stated by the manager that there had been no formal or informal complaints to the home since the last inspection. One service user relative had offered comments to the home regarding their relatives care. Documentation of this was shown to the inspector who agreed that this did not constitute a complaint. The home however had followed good practise and recorded a meeting that had taken place involving the relative, manager and consultant which was filed on the service user file. Service users legal rights are protected and discussion with the manager demonstrated a clear understanding of her responsibilities under this standard. The manager was aware of advocacy services available to service users. Probert Court Continuing Care Home DS0000017198.V259488.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Service users live in a safe and well maintained environment. The standard of cleanliness is good throughout the home. EVIDENCE: Three recommendations made following the last inspection related to environmental issues. The manager provided an up to date report to the inspector regarding progress made in these areas. Although the recommendations have been acknowledged by Heantun Housing Association they are not yet completed. These will remain as recommendations within this report. During the home tour the standard of cleanliness was satisfactory and all areas were well presented. Staff were observed to be adhering to infection control policies throughout the visit. Probert Court Continuing Care Home DS0000017198.V259488.R01.S.doc Version 5.0 Page 17 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): The association’s recruitment processes are robust and all necessary recruitment checks are carried out before staff commence working at the home. EVIDENCE: The manager was able to demonstrate her knowledge in the associations recruitment process. Staff files are kept centrally at Springvale House. All applicants have relevant pre employment checks, which are vetted by the managers own line manager prior to the offer of any post. Probert Court Continuing Care Home DS0000017198.V259488.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): 31, 32, 33, 35 & 36 The home is managed under the leadership of a committed, trained individual. Her management style creates a positive ethos which is liked by service users and staff. Service users are central to discussions with regard to the home they live in. Service users finances are handled appropriately. Staff are not in receipt of regular formal supervision. EVIDENCE: Probert Court Continuing Care Home DS0000017198.V259488.R01.S.doc Version 5.0 Page 19 The registered manager is a first level nurse and has the experience and knowledge of the service user group. She is currently undertaking the Registered Managers Award. It was apparent through discussion with service users and staff that service users are able to express their views on issues that are important to them. Service users are invited to regular meetings and the manager was praised for her direct involvement and presence throughout the home by service users, relatives and staff. Observations on the day of the inspection showed the managers sensitivity to service users and their relatives and was seen to positively put individuals at their ease in what was seen to be sensitive and personal matters. The requirement made at the unannounced inspection on 27th January 2005 that the registered person must produce an action plan from the quality assurance questionnaire findings remains outstanding. Service users personal monies are held centrally at the head office. Monies required are paid through the petty cash system and then the home is reimbursed. Receipts are kept of each transaction. An audit of the petty cash and record book was carried out by the inspector and manager and found to correct. Staff are not receiving regular formal supervision sessions. This was confirmed by discussion with the manager and examination of supervision records for five staff members. This has been recognised in regulation 26 reports carried out by the responsible individual for the organisation but has failed to be acted on fully by all members of the senior nursing team. This must be addressed as a priority by those who have responsibility for the delivery of supervision. This is an outstanding requirement made at the announced inspection on 22nd July 2004 and again at the unannounced inspection on 27th January 2005. Probert Court Continuing Care Home DS0000017198.V259488.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 2 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 x 3 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 1 x x Probert Court Continuing Care Home DS0000017198.V259488.R01.S.doc Version 5.0 Page 21 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(1)(b) Requirement Each service user must be issued with a contract/statement of terms and conditions. (Previous timescale of 31/12/04 not met) The home must ensure that care plans are sufficiently comprehensive, and reviewed as events require, to meet service users’ needs The home must ensure that assessment and care planning systems, training and skills are in place so that service users’ health needs are met All stored oxygen must be securely chained against the wall All eye drops and creams must state on them the date of opening Sharps boxes must contain completed details of opening, by whom and date of closure The use of pooled net continence pants must cease immediately The use of pooled night wear must cease immediately The segregation of individuals DS0000017198.V259488.R01.S.doc Timescale for action 17/01/06 2 OP7 15 17/12/06 3 OP8 12 17/01/06 4 5 6 7 8 9 OP9 OP9 OP9 OP10 OP10 OP10 13 13 13 12(4)(a) 12(4)(a) 12(4)(a) 17/11/05 17/11/05 17/11/05 17/11/05 17/11/05 17/11/05 Page 22 Probert Court Continuing Care Home Version 5.0 10 OP33 24 11 OP36 18(2) toiletries must be maintained to promote service user dignity at all times The registered person must provide an action plan from the quality assurance questionnaire findings (Previous timescale of 01/03/05 not met) All care staff including trained nurses must receive formal recorded supervision at least 6 times per year (Previous timescale of 19/08/04 not met) 17/11/05 17/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard 21 21 19 Good Practice Recommendations To provide a walk in shower To provide pictures, plants and tile transfers in all the bathrooms To replace the lounge carpets Probert Court Continuing Care Home DS0000017198.V259488.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Wolverhampton Area Office 2nd Floor St. Davids Court Union Street Wolverhampton WV1 3JE 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 Probert Court Continuing Care Home DS0000017198.V259488.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. 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