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Inspection on 17/10/06 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 2006.

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 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 atmosphere within the home is warm and friendly and the staff group communicate well with residents. The standard of cleanliness and presentation of the home is good. Several of the people living in the home have problems communicating due to medical conditions and staff appeared to be good at understanding individual wishes and needs.

What has improved since the last inspection?

The inspection that was undertaken in June 2006 had identified shortfalls, which resulted in 15 Statutory Requirements being made of the home. The nurse in charge and staff team have worked hard to attempt to rectify these deficits to improve the service and meet National Minimum Standards. This report identifies that 10 requirements have been achieved and work is clearly in progress to achieve the remaining 5 outstanding requirements. No new requirements were made as a result of this inspection. Documentation within residents care records has improved showing that staff now plan, deliver and review resident`s care on an ongoing basis and identify risks that may be detrimental to each resident. The home has improved the way it records staff training and observations of these records show that staff are provided with a full range of training opportunities specific to meeting resident`s needs. Safer working practices in relation to the safe use of bed rails has been introduced by the home, and evidence was available to show that specific training in the use of bed rails is planned for the 19th October.

What the care home could do better:

During the inspection it was evident that the home had taken steps to achieve compliance in relation to medication storage and in maintaining accurate records for staff and these outstanding requirements were assessed as partly achieved.

CARE HOMES FOR OLDER PEOPLE Probert Court Continuing Care Home Probert Road Oxley Wolverhampton West Midlands WV10 6UF Lead Inspector Rosalind Dennis Key Unannounced Inspection 17th October 2006 10:00 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.V308570.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.V308570.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 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.V308570.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th June 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. Individuals are generally referred via a consultant, with fees paid via the Primary Care Trust. Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced at 10.15 and was conducted by one inspector over a period of around 6 hours. The purpose of the inspection was to focus on the requirements made at the last inspection to Probert Court in June 2006 and to monitor progress against an action plan submitted by the provider in response to those requirements. It is pleasing to note that the home has achieved or in the process of achieving requirements. Time was spent observing staff working, looking at documentation and speaking with residents, visitors and staff. The inspector found the home functioning well and all residents seen during the inspection appeared well cared for and staff attentive in meeting their needs. A nurse has taken the responsibility for leading the staff team until the appointment of a new manager with the assistant director visiting the home frequently to provide managerial support. What the service does well: What has improved since the last inspection? The inspection that was undertaken in June 2006 had identified shortfalls, which resulted in 15 Statutory Requirements being made of the home. The nurse in charge and staff team have worked hard to attempt to rectify these deficits to improve the service and meet National Minimum Standards. This report identifies that 10 requirements have been achieved and work is clearly in progress to achieve the remaining 5 outstanding requirements. No new requirements were made as a result of this inspection. Documentation within residents care records has improved showing that staff now plan, deliver and review resident’s care on an ongoing basis and identify Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 Page 6 risks that may be detrimental to each resident. The home has improved the way it records staff training and observations of these records show that staff are provided with a full range of training opportunities specific to meeting resident’s needs. Safer working practices in relation to the safe use of bed rails has been introduced by the home, and evidence was available to show that specific training in the use of bed rails is planned for the 19th October. 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. The summary of this inspection report can be made available in other formats on request. Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 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 Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 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. 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 admissions 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: This inspection identified that the home has improved the way it uses the information obtained at the time of a person’s admission to Probert Court. Three care files that were examined in detail showed that needs identified during the assessment process form the basis of care plans and these were found to be individually relevant to each resident. Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 Page 9 Each file contained a ‘personal orientation profile’ drawn up from information given by the resident, family and friends, and these profiles provide staff with a history of the individual before their illness and their likes and dislikes. Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. Improvements to the care planning process means that staff are provided with the information they require to meet residents’ needs. Evidence of regular review and good multidisciplinary working ensures that the health and personal needs of residents are met. The administration of medication is generally good, however the storage of medication is not satisfactory which could impact on the effectiveness of the drugs and put service users at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents were generally very positive regarding the care they receive and during the inspection staff were observed responding to residents requests appropriately. The home has worked hard to implement processes to effectively plan, review and evaluate each resident’s care on an ongoing basis. Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 Page 11 Three care files that were looked at in depth, contained short term and long term care plans including detailed care plan records for some of the complex medical conditions experienced by the people case tracked. Daily entries made by staff into residents care records describe the actual care given, which corresponded to the residents care plan and provides evidence that the care plans are ‘working documents’. Moving and handling risk assessments and care plans contained detailed information to provide staff with the information they need to safely move individuals and all other risk assessments seen were complete and regularly reviewed. The recording of wound care has improved and the senior nurse discussed her intentions to further develop this area to ensure accurate monitoring of wounds. Bed rail risk assessments were seen in files and fluid intake/positional charts were seen in the rooms of those individuals identified as at risk. Staff were positive about the changes implemented, commenting that they are now evaluating care on an ongoing basis to ensure that residents are getting the care they need. The senior nurse has worked hard to implement and develop the new care planning processes, and although some amendments were discussed these were in respect of good practice guidance for staff in respect of record keeping. At this inspection the medication room was found unlocked and the door ajar. Although the medication room is located in a designated ‘staff area’ of the home where access is restricted via a ‘key code’ lock, it is not considered safe practice to leave areas for the purpose of storing medication unsecured. This concern was discussed with the senior nurse and regional manager during the inspection. Since the last inspection in June the home has started monitoring and recording a daily temperature of the medication room. It was observed that there remains some inaccuracies with the recording of the drugs fridge temperatures and requires further clarification with staff to confirm their awareness of the required temperature range. The CSCI pharmacist inspector may visit at some stage to conduct a more indepth inspection of medication practices and procedures. Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 Page 12 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. Daily routines are flexible with residents being offered a choice of varied activities. The home provides meals that offer variety and cater for different cultural and nutritional needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The organisation of individual activities is provided by staff on a daily basis, and since the last inspection the home has improved the way these activities are recorded. Residents that were able to speak with the inspector confirmed that sufficient activities are provided although one individual did comment that they would like access to some large print or ‘talking books’ and their request was communicated to the nurse in charge. Most residents that were spoken with were happy with the meals provided, confirming that choices are available and that staff assistance at mealtimes and with feeding is good. One resident felt that some improvements could be made with the presentation and type of food served, commenting that choices Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 Page 13 for individuals who can chew were limited and that food served on cold plates was not appealing, these comments were brought to the attention of the regional manager. Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. The home has a satisfactory complaints system that ensures that residents and/or their representatives concerns are listened to and acted upon. The arrangements for the protection of residents from abuse is satisfactory. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is detailed in the service user guide and is also on display in the reception area of the home. The nurse in charge informed that there had not been any recent complaints and CSCI have also not received any complaints in respect of the home. Since the last inspection contact details of the adult protection team have been made available for staff should a concern arise that requires the team’s intervention. The training matrix has been updated and shows that staff have received adult protection training, and two staff members that were spoken with were able to describe relevant procedures to safeguard adults. Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. The standard of the environment is good providing residents with a comfortable place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A random selection of individual bedrooms and communal rooms were observed to be clean and without unpleasant odour. The home has sufficient communal rooms, such as lounges to provide ‘quiet areas’ for residents and visitors to access if they wish, these rooms were observed to be well equipped, warm and welcoming. Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 Page 16 The home has improved the processes for caring for people with specific infections, care plans seen were clear and provided staff with sufficient information and guidance to ensure good standards of infection control are maintained. Observations of staff working confirmed that staff followed appropriate guidance to reduce the risk of cross-infection. The nurse in charge is aware of where to access up to date guidance in respect of infection control and key staff are due to attend meetings with the local infection control team. Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. Training opportunities within the home are satisfactory which ensures that staff are appropriately skilled and competent to carry out the duties for which they are employed. Staffing levels appear sufficient to meet the needs of the current residents. The home has improved the way it provides information in respect of the staff group, which provides confirmation that the home has a robust recruitment procedure and protects residents from the employment of inappropriate staff. . This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion with the nurse in charge and observation of staffing rotas confirms that staffing levels within the home remain at; 1 Nurse and 6 carers in the morning, 1 Nurse and 4 carers pm and at night there is 1 Nurse and 2 carers. The nurse in charge confirmed that she receives supernumerary time. Three visitors and four residents that were spoken with during the inspection felt that the staffing levels were generally sufficient. The home has not appointed any new employees recently, however observation of two staff files shows that the home has audited staff files to Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 Page 18 address previous recruitment deficits, including providing evidence of criminal record bureau disclosures and suitable references. Training certificates were available for staff which showed attendance at a range of courses including fire safety, moving and handling, catheter care, hearing aid care, updates in clinical practice and the nurse in charge confirmed that further training and updates are planned in infection control, food hygiene, falls risk, palliative care and food hygiene. The proportion of staff with NVQ Level 2 or equivalent exceeds the required level and information was available which confirmed that staff have access to formal supervision. Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 Page 19 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, 33, 35 and 38. Quality in this outcome area is adequate. Service users and staff are benefiting from the interim management arrangements in place and the staff group are appropriately skilled which ensures that the health, safety and welfare of residents is promoted. The home monitors and reviews processes to ensure that residents receive a range of quality services This judgement has been made using available evidence including a visit to this service. EVIDENCE: The regional manager has taken on the role of ‘acting manager’ with the nurse in charge leading the team on a daily basis. The regional manager reported Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 Page 20 that the home is in the process of recruiting a new manager for Probert Court and once appointed this individual will need to submit an application for registration with CSCI. It must be said that the nurse in charge has worked hard to initiate and implement improvements in a short space of time and, in particular in respect of care documentation. The home operates a quality assurance system based on seeking the views of residents where capable and/or their representatives and senior management conduct comprehensive unannounced visits of the home, and a copy of this report is sent through to CSCI. Records pertaining to the maintenance and servicing of equipment were not observed on this occasion, observations during the inspection confirmed a safe environment and equipment such as hoists and wheelchairs appeared well maintained. Bed rails that were observed in use were fitted correctly and the company has devised a system for monitoring bed rails to ensure that they are fitted correctly and evidence was available to confirm that training in the safe fitting of bed rails is due to be provided to ‘key staff’ on the 19th October 2006. Financial records for residents were checked at the inspection in June 2006, where it was identified that the home has robust systems in place to safeguard resident’s financial interests, including the undertaking of regular audits of financial records to confirm accuracy. Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 Page 21 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 2 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 X 3 X 3 3 X 3 Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13(2) Requirement All stored oxygen must be securely chained against the wall. Timescale for action 01/01/07 (Partially met. Previous timescale of 17/11/05 and 1/08/06) 2 OP9 13(2) of 01/08/06). The temperature of the drugs fridge must be maintained at between 2 and 8°C and the registered person must ensure that staff are aware of the required temperature range and of the procedure to follow should the temperature fall outside this range. The temperature of the treatment room must also be monitored to ensure it does not exceed 25°C (Partially met-Previous timescale The registered person must ensure that information and documents as required by Regulation 19 Schedule 2 are retained on each staff file. 01/01/07 3. OP29 19 01/01/07 (Assessed as work clearly in progress to ensure all documents are available within the homePrevious timescale of 1/09/06). Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 Page 23 4. OP37 17 Up to date records must be maintained in the home for residents and staff as identified in Schedules 3 and 4 (Assessed as work clearly in progress to ensure all documents are available within the homePrevious timescale of 1/09/06). 01/01/07 5. OP38 18 13(4)(c) Staff who are responsible for 01/01/07 selecting, fitting and checking bed rails must receive appropriate training and bed rail assemblies should be included on a planned maintenance schedule (Partially met-training due on 19/11/06. Previous timescale of 01/09/06). 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. Refer to Standard OP8 Good Practice Recommendations Photographs should be used as a method of monitoring wounds, treatment and outcome unless the resident’s consent cannot be obtained. (Assessed as work in progress) It is recommended that staff write in care records in black ink and that staff sign and date all documents. 2 OP8 Probert Court Continuing Care Home DS0000017198.V308570.R01.S.doc Version 5.2 Page 24 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 © 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.V308570.R01.S.doc Version 5.2 Page 25 - 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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