CARE HOMES FOR OLDER PEOPLE
Queen`s Court 2 Downing Close Bottisham Cambridgeshire CB25 9DD Lead Inspector
Joanne Pawson Unannounced Inspection 1st May 2007 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 Queen`s Court DS0000015097.V338045.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. Queen`s Court DS0000015097.V338045.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Queen`s Court Address 2 Downing Close Bottisham Cambridgeshire CB25 9DD 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) 01223 811905 01223 812517 home.bot@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Mrs Rosalind May Wright Care Home 35 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (35) of places Queen`s Court DS0000015097.V338045.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd May 2006 Brief Description of the Service: Queens Court is in the centre of the village of Bottisham, near the city of Cambridge. Queens Court is a two storey, purpose built home, offering long term and respite accommodation to 35 residents some of whom can have a diagnosis of dementia. The home has five self-contained flats, each with its own kitchenette, dining /sitting room and number of bedrooms. The home also has a day centre operating from the premises, which can be used by residents in the home as well as providing a community facility for older people in the area. Main meals for residents and those attending the day centre are provided from the homes main kitchen and taken to the flats in heated trolleys. Current weekly fees range from £361 to £443 depending on the source of funding and diagnosis. Extra charges are made for private chiropody, hairdressing and newspapers. The inspection report is made available in the entrance area of the home. Queen`s Court DS0000015097.V338045.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on the 1st May 2007 and was conducted by one inspector over seven hours. Methods used for the inspection included speaking to the manager, staff and people who live in the home and their relatives. The inspector also observed care, read documentation and had a tour of the home. Surveys were also sent to people who live in the home, their relatives and the care staff and responses to these surveys are included in this report. What the service does well: What has improved since the last inspection? What they could do better:
Risk assessments must have all parts of the form completed to ensure staff are aware of how to reduce risks to the people living in the home. All staff must receive training on the protection of vulnerable adults to ensure they are aware of the procedures to follow if they suspect anyone living in the home has suffered any type of abuse. Queen`s Court DS0000015097.V338045.R01.S.doc Version 5.2 Page 6 The staffing levels in the dementia unit could place the people living there at risk. Staffing levels have at times been reduced to one carer in the evenings and there is not always a carer present on the dementia unit during the night hours. One relative stated that the home could be improved by ‘an increase in the number of staff to facilitate more effective care’. Staff must have regular supervisions with a manager so that they can discuss any practice or training issues. All chemicals such as cleaning products must be securely stored to reduce risk to people living in the home. Fire drills must be carried out regularly to ensure all staff are aware of the procedure to be followed. 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. Queen`s Court DS0000015097.V338045.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 Queen`s Court DS0000015097.V338045.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): 1,2,3,4,5 Quality in this outcome area is good. Service users have all the information they need to make an informed choice when selecting this home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an up to date statement of purpose and service user guide that is given to all prospective service users. This contains all the information needed to make an informed choice to move into the home. A selection of files of the people that live in the home were inspected. All of them had a contract of care and statement of terms and conditions of residence. Unless it is an emergency admission, prior to moving into to the home the prospective service user has an assessment of their needs carried out by a senior member of the care staff team. If the manager has concerns that the home may not be able to meet the needs of the person she sends a second person to help with the assessment. This is in addition to the social worker assessment and forms the basis for the care plan. As part of this assessment the lead staff member for moving and
Queen`s Court DS0000015097.V338045.R01.S.doc Version 5.2 Page 9 handling makes an assessment of the equipment needed to ensure the appropriate care can be given. The home writes to the person to tell them if they can meet their needs. The home has a link social worker who visits the home fortnightly to hold a social work clinic where any of the people living in the home can discuss any relevant issues with her. Queen`s Court DS0000015097.V338045.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): 7,8,9,10,11 Quality in this outcome area is good. The health care needs of service users are met while maintaining their privacy and dignity and their wishes during final illness and for after death are known and respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All service users have a plan of care. These are reviewed monthly by their key workers and monitored by the senior staff during supervision and at staff meetings. The files of three people living in the home were monitored during the inspection. The key workers are in the process of transferring all of the information into new care plans. The new care plans contained all of the relevant information including personal details with a photograph, personal profile, end of life form, life story summary, hobbies, medical history, current medication and care plans on various living skills such as health promotion, mobility and much more. The care plans identify areas where the people that live in the home may need support but didn’t always then state what action staff should take. The care plans are written in a style that promotes independence. Part of the care plan states whether the person living in the home would like to open their mail themselves, by a relative or by a carer.
Queen`s Court DS0000015097.V338045.R01.S.doc Version 5.2 Page 11 Care plans showed that the people that live in the home are encouraged to do everyday tasks such as clearing the table and a risk assessment had been completed to enable someone living in the home to make their own coffee safely. This is good practice. There is a monitored dosage system of medication administration, recording and storage and all staff have training. Medication records were seen as part of the inspection. The senior staff make daily checks on the appropriate management of medication. In the medication administration records folder each person living in the home also had a medication profile which includes personal details, administration instructions, what the medication is and the reason it has been prescribed All bedroom doors can be locked if the occupant wishes and staff never enter rooms without knocking. The people living in the home confirmed this. There is a policy in place for care in final illness and after death. With the support of the GP and district nurses, people who live in the home can remain there during this time and hospital admission is only sought if it is the best interest of the individual. The manager stated that the end of life care offered is of a very high standard and they always ensure people are supported to die with dignity and respect. If it is not possible for a family member to be with a dying resident then a member of staff is with them constantly. Family members are welcome to stay 24 hours a day with a dying resident and are offered drinks and meals and support form the staff. Queen`s Court DS0000015097.V338045.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): 12,13,14,15 Quality in this outcome area is good. The home has a full and varied activities programme and resident’s needs are met in a flexible way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live at the home are able to make choices in all aspects of daily living and have a variety of activities available to them. There is a daycentre in the home that people living in the home can attend if they wish. During the inspection people living in the home were seen enjoying an afternoon TV quiz. Religious services take place twice a month. Their individual interests and past life history are part of the care plan so staff know how to engage them in conversation and encourage their participation in activities. A local amateur dramatic group rehearses on site and gives a performance of each of their productions to the residents. There are regular outings for pub lunches or visits to garden centres among the destinations. Visitors are welcome at all reasonable times. There is a daily set menu with alternatives available.
Queen`s Court DS0000015097.V338045.R01.S.doc Version 5.2 Page 13 Mealtimes are evenly spaced with lunch being the main meal of the day and tea having a choice of hot or cold food. Drinks are offered at regular intervals. People in the home praised the quality of the food. A poster in the dining room of one unit stated that if the people living in the home didn’t like the main choices of food they could choose from another list of five main dishes and four desserts. The poster also stated if a resident is unwell then the home will try to accommodate any particular wishes. Some of the people that live in the home had decided that they would celebrate one person’s birthday by having a fish and chip supper from the local fish and chip shop. There was also a poster stating that drinks and snacks will be served throughout the day and at any other time on request of the resident. Queen`s Court DS0000015097.V338045.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): 16,17,18 Quality in this outcome area is adequate. Staff are aware what to do if they suspect a person living in the home has suffered any abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a formal complaint procedure for service users or their families to follow. This is contained in the service user guide and displayed on the notice board. A complaint and compliment record book is kept and the manager reviews this. Service users spoken to knew how to raise concerns. All service users are registered to vote and contact with solicitors would be facilitated if needed. A vigorous recruitment procedure ensures only staff suitable to work with vulnerable adults are employed. The requirement made following the previous inspection for all staff to receive training in the protection of vulnerable adults has not been met. This must be completed by August 2007. Staff spoken to were aware of the procedure to follow and stated that if they suspected any person living in the home had suffered any form of abuse they would report it immediately to a manager. Queen`s Court DS0000015097.V338045.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): 19,20,21,22,23,24,25,26 Quality in this outcome area is adequate. Queens Court is clean, safe and well-maintained with sufficient space and facilities to meet the needs of the people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs a general maintenance person for day-to-day repairs and redecorating. There is a team of domestic staff with a key domestic allocated to each flat. Each flat has a lounge/ dining room and one flat has a separate dining room. People who live in the home are able to use the large day centre during the day and join any activities or entertainment arranged if they wish. There is currently a large extension being built which will accommodate another 19 people. The manager stated that the extension work has been
Queen`s Court DS0000015097.V338045.R01.S.doc Version 5.2 Page 16 managed very efficiently by the construction company in order to achieve the least amount of disruption possible for the people currently living in the home. Some of the people living in the home will be moving to the new extension. To limit confusion for the people moving all the people on the unit will move together on the same day and the staff team will remain the same in the new unit. The extension has restricted the access to the grounds for the people living in the home. All of the outside areas will be landscaped on completion of the extension. Although areas of the existing building are looking worn and in need of refurbishment it still has a very homely and comfortable atmosphere. Bedrooms do not have en-suite facilities but there are sufficient toilets and bathrooms to meet the required standard. Any special equipment or adaptations needed by the people living in the home are provided after consultation with community occupational therapists. Some equipment is provided by the local authority/ health care trust on loan or is purchased by the home. Hoists and other moving and handling aids are provided. All staff have moving and handling training. The home has sufficient heating and lighting with all bedrooms having natural light and ventilation. The occupant is able to control the radiator temperature in their rooms by use of a thermostat. All hot pipe-work is covered. Appropriate checks are made regarding hot water temperatures. All new staff have training in infection control as part of their induction training and this is reinforced regularly. The washing machines have a thermal disinfection cycle and sluicing facility. One of the units had cleaning chemicals stored in an unlocked cupboard. All chemicals must be stored securely to reduce risk to the people living in the home. The fire records showed that the fire alarms were being tested weekly. There is no emergency lighting in the home as they have a generator to be used if there is a power cut. There was no record of a fire drill since June 2006. These must be completed on a regular basis. Queen`s Court DS0000015097.V338045.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, 28,29,30 Quality in this outcome area is adequate. The manager recognises the importance of staff training in order provide a quality service. Staffing levels do not always reflect the needs of the people living in the home and therefore people living at the home may be put at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a team of assistant managers who work shifts and two waking night staff who have access to a person on call for emergencies. The home has domestic and catering staff. The afternoon and evening staffing levels for the dementia unit is, on occasions reduced to one member of staff. The staff spoken to on the day of inspection confirmed that two of the people living in the dementia unit need assistance with eating and drinking and two need the assistance of two carers to get into bed. The abilities of the people living in the dementia unit dictate that to effectively meet their needs there should be two members of staff available in the dementia unit during normal waking hours.The night staffing level is not sufficient to ensure the safety and supervision of the residents in the dementia care unit as they are left unattended for long periods when staff are attending to other people. The care plan for one of the people living in the unit states she has ‘drop fall syndrome’ and that this could occur at night. Inspection of the
Queen`s Court DS0000015097.V338045.R01.S.doc Version 5.2 Page 18 accident records also showed that a person living in the dementia unit is prone to falls during the night. The staff working on the dementia unit on the day of the inspection showed a good level of understanding of the specific needs of people with dementia. Staff throughout the home, including the management team were observed interacting well with the people that live there and had obviously built a warm professional relationship up with them. Over 50 of care staff have NVQ level 2 or above. Staff have access to ongoing training and training records are kept. All new staff follow an induction programme. The recruitment process is robust to ensure only those suitable to work with the vulnerable and frail are employed. All staff have an Enhanced Criminal Records Bureau enhanced check and the Protection of Vulnerable Adults register is checked. Staff have to prove their identity and two written references are required. Queen`s Court DS0000015097.V338045.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): 31,32,33,35,36,38 Quality in this outcome area is adequate. The home is run by a strong management team whom the people that live in the home and the staff find approachable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff stated they find the manager approachable and supportive. The people who live in the home and their families know her. There is a quality assurance programme in place where all aspects of the home are regularly audited and questionnaires are sent to service users and their families seeking their opinions of the home and the service it offers.
Queen`s Court DS0000015097.V338045.R01.S.doc Version 5.2 Page 20 The manager has a budget to work to and has budgetary advice available to her. Insurance certificates are displayed and there is a business and financial plan for the home. Any money held for safe keeping for the residents is appropriately stored and recorded. Staff spoken to on the day of the inspection stated that supervisions are not completed on a regular basis. The manager said that she was not aware of this. Because the care plans were being transferred to the new format not all of the risk assessments had been completed. The risks had been identified but the section for the management to agree additional control measures had not been completed. This is very important and must be completed to reduce risk to the people living in the home when possible. The minutes of a recent meeting for the people who live in the home were inspected. Issues such as the day centre and forthcoming events, having name places on the table and what was wanted for a birthday tea were discussed. All of the people living in the unit also signed a card for a resident that had been admitted into hospital. Queen`s Court DS0000015097.V338045.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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 18 2 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 1 X 2 Queen`s Court DS0000015097.V338045.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 OP18 Regulation 13 (6) Requirement All staff must have appropriate training in the Protection of Vulnerable Adults to ensure the well being of people who live in the home. This was a requirement from the last inspection. Failure to comply may result in legal action being taken against the home. There must be fire drills on a regular basis to ensure the safety of the people who live in the home. Suitably qualified, competent and experienced persons must work at the home in such numbers as are appropriate for the health and welfare of service users. Arrangements must be made for staff to receive regular supervisions to help highlight any practice or training issues. All cleaning chemicals must be securely stored. All people living in the home must have risk assessments
DS0000015097.V338045.R01.S.doc Timescale for action 01/08/07 2 OP19 23(4)(e) 01/07/07 3 OP27 18(1)(a) 01/07/07 4 OP36 18(2) 01/07/07 5 6 OP38 OP38 13(4)(a) 13(4)(c) 01/07/07 01/07/07 Queen`s Court Version 5.2 Page 23 completed and these must be reviewed and updated regularly. This will ensure that staff can support people and meet their needs. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Queen`s Court DS0000015097.V338045.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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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