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Inspection on 12/05/08 for Queen`s Court

Also see our care home review for Queen`s Court for more information

This inspection was carried out on 12th May 2008.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What has improved since the last inspection?

What the care home could do better:

The manager has already identified that more work needs to be done on some areas and was very amenable to suggestions made at this inspection. A number of Requirements were made in relation to care plans, nutritional risk assessments, the management of wounds, and medication stocks. Recruitment and training records need to be up-dated and health and safety monitoring must be reviewed.

CARE HOMES FOR OLDER PEOPLE Queen`s Court 1 Dedworth Road Windsor Berkshire SL4 5AZ Lead Inspector Helen Dickens Unannounced Inspection 12th May 2008 09:50 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 DS0000071322.V363199.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 DS0000071322.V363199.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Queen`s Court Address 1 Dedworth Road Windsor Berkshire SL4 5AZ 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) 01753 838450 01753 838451 Roseanne.Ince@ccht.org.uk Central & Cecil Housing Trust Ms Roseanne Dianne Ince Care Home 62 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 62. Date of last inspection New service Brief Description of the Service: Queens Court opened (as Dedworth Road) in December 2007 and is managed by Central and Cecil Housing Trust. It is registered to take up to 62 older residents whose main needs are for nursing care. The home is on three floors with each being self-contained and having its own lounge, dining area and bathing facilities. All rooms are single with en-suite facilities. The top floor is for elderly frail residents who do not currently need nursing care. It was re-named as Queens Court and had an official opening by the Queen in February 2008. There is parking within the grounds and current fees range from £364 (for nonnursing care) to £1000 for full nursing care. Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means people who use this service experience adequate quality outcomes. This key inspection was unannounced and took place over 8 hours. The inspection was carried out by Mrs. Helen Dickens and Mrs. Julie Willis, Regulation Inspectors. Ms. Roseanne Ince, Registered Manager, represented the establishment. A partial tour of the premises took place and a number of files and documents, including four resident’s files and care plans, three staff training and recruitment files, quality assurance information, and the annual quality assurance assessment (AQAA) were examined as part of the inspection process. Five questionnaires returned to CSCI from residents, and an assistant care manager, and were also used in writing this report. A letter from a relative was sent to CSCI following the inspection and made a number of positive comments; these too have been included. The inspectors saw most residents at lunchtime and six residents were interviewed in more detail on the day of the inspection. The inspector would like to thank the residents, staff and manager for their time, assistance and hospitality. What the service does well: Queen’s Court offers a pleasant and comfortable environment for residents to enjoy. As this is a new service everything is fresh and clean and residents commented positively on their surroundings. Remarks such as ‘Excellent room’ (describing their bedroom) and ‘I don’t think anything can be improved upon’ were typical. There were no unpleasant odours anywhere in this home. Staff were friendly and helpful and there were a number of compliments from residents, relatives and a local authority worker about the staff and manager – for example one relative noted on their questionnaire to CSCI: ‘Roseanne is a very approachable and caring manager.’ The local authority representative said that when the staff were caring for a dying resident ‘Nothing was too much trouble. They treated the service user with respect and dignity.’ A relative who wrote in to the inspector noted the main reason her mother had settled in so well is ‘because of the many positive things about this home’. Activities for residents have been seen as important by the home and a regular activities programme is already in place including exercises to music, board Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 6 games, reminiscence sessions and aromatherapy. Some staff will be doing the ‘NAPA’ training to enable them to provide well thought out activities for residents. One relative has set up a gardening club and residents were encouraged to work on a mosaic to commemorate the re-naming of the home and the Queen’s visit. The home respects diversity among staff and residents. Those with physical disabilities for example can move around the home more independently because of the layout and the equipment and adaptations in place. Staff are from diverse cultural backgrounds, and, whilst residents are mainly white British, there are some from different ethnic backgrounds whose needs are being met at this home. The home is beginning to have celebrations of different cultures within the home, starting with the polish culture, as two residents are from this background. What has improved since the last inspection? 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 Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s needs are assessed and they are assured these needs can be met prior to them moving into Queens Court. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) completed by the home prior to this inspection stated that pre-admission assessments are carried out in hospital, at the resident’s home or wherever the resident is staying prior to moving in to Queens Court. Prospective residents and their families are encouraged to visit the home in advance and are sent written information about the facilities and care available. Four resident’s files were looked at in detail and found to have a full assessment of need prior to admission to the home. The manager said the staff carrying out the pre-admission assessments also looked at written information from other professionals who have already Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 10 been involved in the prospective resident’s care, for example the Waterlow scores regarding pressure sore risks. Six residents were spoken with in some detail, and none raised any negative issues in relation to their assessments or the way they had been looked after since moving in. One resident who was over 100 years old was asked about their first impressions of the home and said they wanted to be quoted in the report; they told the inspector that ‘They are very nice people here’ and ‘It is all very well organised.’ One resident’s initial assessment did not reveal the full extent of their needs and contained a care manager’s assessment which was out of date. This was discussed with the manager and deputy manager. They felt they had not been given a full picture of this resident’s needs prior to admission and had since discussed the situation with this person’s GP who had now made a referral to a specialist. Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans and arrangements for monitoring people’s healthcare need further work to ensure the safety and well being of residents. Medication administration arrangements are satisfactory though the monitoring of stocks needs to be reviewed. Residents are treated with dignity and respect at this home. EVIDENCE: The AQAA states that ‘All the residents have individual care plans. We have a good working relationship with our GP, district nurses and the social workers that ensure that the residents receive treatment as and when it is needed.’ On the day of the inspection it was noted that the home is in the process of transferring care plans to the new ‘Saturn’ system so there are currently two types of care plans at the home. Three resident’s files were checked for residents who needed nursing care, and all three did have a care plan and these were found to contain basic information e.g. personal and social history, care needs, monthly weights, and body charts etc where appropriate. Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 12 However, those sampled were not detailed or person centred – and did not state how residents would like their support to be delivered. It was also not clear from the records what actions had been taken in relation to changes in circumstances, for example those residents who had been losing weight. There are some risk assessments in place but some more were needed – in particular nutritional risk assessments – the MUST tool is a well recognised nutritional risk assessment, and recommended in the home’s own quality manual but is not currently being used – the manager said staff will need training on this. The inspector also noted the routine use of abbreviations and acronyms on files which is not good practice. Comments from residents and relatives were mainly positive regarding the care at Queens Court and included; ‘The warmth of the staff makes this home a pleasure to live in….having good care, medicines on time and monitored…I am very satisfied and delighted that Mum is in Queens Court ’ (from a relative). And ‘I found the care to be individual and nothing was too much trouble.’ (From an assistant care manager). Only one survey made a negative comment, noting: ‘Lots of reminders have to be given due to shortage of staff.’ This was discussed with the manager who said they always had sufficient numbers of staff, but unfortunately still had to use a high number of agency staff at the home. Three residents who needed nursing care had their files sampled and all had their health conditions and needs recorded e.g. continence needs, weights and nutrition, and wound management. Risk assessments were on file e.g. for falls, and accident reports are kept centrally. Files contained information about specialist referrals e.g. to a psychiatrist and neurologist. Positive comments from residents and relatives were received in relation to healthcare including one relative who mentioned that specific support from a member of staff in relation to weight had been given and their relative at Queens Court now looked and felt much better. One resident commented that other people who needed more help than they did themselves were always well looked after by the staff. A representative of the local authority was spoken to at the home on the day of the inspection and said they were generally happy with the care offered. A relative who wrote to the inspector said her relative at Queens Court got frequent attention from the doctor and, as she suffered from anxiety, staff worked with her to alleviate this - for example by assisting her to get up early in the morning which she preferred. However, nutritional risk assessments were not in place (as outlined above) and it was not clear what action was being taken in relation to some residents whose weight monitoring showed they had been losing weight – the manager agreed that they would review their practice for monitoring weights and nutrition as the inspector said that the current arrangements were not satisfactory. Also, wound care records on one particular client were poor and, Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 13 following discussion with the inspector, the deputy manager drew up a care plan detailing all the necessary information and monitoring in relation to this resident. A Requirement will be made in relation to ensuring that all those at risk of pressure sores or with any wounds, have records and monitoring to this same high standard. The home has a medication policy and procedure in place and the nurses are aware of their responsibilities in relation to the safe administration of medication and follow clinical guidance. The system used for the safe administration of medication is the monitored dosage system. This system reduces the likelihood of medication error and provides an accurate record of administration. Medication is stored securely and the local pharmacist is arranging for the disposal of unwanted medication. The controlled drugs were checked by the inspector and found to be satisfactory. However, stock of one resident’s medication was far in excess of one months supply and the manager said this was partly because the resident had brought in a supply from home; a Requirement will be made on this issue. It was also recommended to the manager that any handwritten additions to medication records made by nurses should be signed and counter-signed, and that written guidance is given to staff regarding the administration of ‘as required’ medication. Staff were observed to respect the privacy and dignity of residents, for example by knocking on doors before entering, and making sure doors were closed when they were carrying out personal care. Residents all have locks on their bedrooms and have a lockable drawer in their bedside cabinet. One local authority professional noted on their survey that they had placed a resident at the home for end of life care and ‘They treated the service user with respect and dignity.’ Residents spoken to on the day of the inspection did not raise any negative issues in relation to their privacy and dignity being respected and comments such as ‘The staff are good and helpful’ and ‘Everyone is very nice here.’ were typical. The inspector noticed that one resident had three large packets of continence supplies on view in their room and discussed this with the manager. Whilst it is recognised that residents need such supplies on hand if they are to use them independently, more discreet storage arrangements need to be made to ensure their privacy is maintained for example when they have visitors in their room. Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 14 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 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A range of activities is offered at Queens Court that provide opportunities for mental and physical stimulation. Residents are encouraged to maintain contact with their family and friends and have the opportunity to exercise some choice and control over their daily lives. Residents should benefit from the recent review of arrangements for meals and menu planning. EVIDENCE: Residents are encouraged to take part in stimulating activities and the home is involved with the organisation ‘NAPA’ who promote good practice in relation to activities for older people in care homes. The AQAA states that the home has organised outings for residents, there are regular visits from the local churches, and there are reminiscence sessions. On the afternoon of the inspection the local vicar arrived with musical accompaniment and residents joined with hymn singing in the lounge. Activities for each week are posted on the board and include for example aromatherapy, gentle exercises, and music sessions. One relative noted on the Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 15 survey to CSCI that the person they visited ‘Plays cards, watches TV and reads. She enjoyed the mosaic class.’ Residents got involved in making a mosaic to commemorate the renaming of the home and the Royal visit; two residents told the inspector that the Queen had visited them in their rooms during her tour of the building. Some residents were observed to be reading their newspapers and others listening to the music player; staff were playing the music which residents enjoy during the gentle exercise classes. Only one of the 4 surveys returned to CSCI said there were ‘always’ activities to take part in, though none of the residents spoken to on the day of the inspection raised any concerns about activities. One relative noted that on two separate visits in the same week the lounge had been ‘packed’ with residents enjoying the activities which was a music session on one day, and a reminiscence session on another. Residents are encouraged to keep in contact with their family and friends and one relative who assisted with the completion of a survey said they were ‘Very satisfied and delighted’ that their relative was in Queens Court. Another relative has started a gardening club for residents and as a result there were some nice pot plants on the balconies and around the home. The AQAA states that community involvement is being encouraged for example links with local churches, and the home has opened their hairdressing service to older people who live in the local community. One relative commented that the home is welcoming to visitors, and that staff are always courteous and attentive to residents and their visitors. The manager said the home does not yet have a written policy on visitors and visiting, and the manager was asked to consider this as set down in Standard 13.5. Residents are given opportunities to exercise some choice and control about their day-to-day lives. For example, they are asked on a daily basis what they would like to eat the next day (from the set menu) and are encouraged to bring personal possessions into the home when they move in. They can choose whether to be in their own room or in one of the communal lounges, and each floor has a quiet area with a few armchairs for those who wish to b alone or see visitors in private. One relative confirmed that her relative at Queens Court had chosen her own room and what personal possessions she wanted around her. However, more work needs to be done on care plans to ensure they reflect the choices and wishes of residents, particularly in relation to how they would like their personal care to be delivered, and this is the subject of a Requirement under Standard 7. Four service user surveys were returned to CSCI prior to the inspection and showed that one person ‘always’ liked the meals at the home; two ‘usually’ liked them; and a fourth ‘sometimes’ liked them. It was noted that those resident’s on pureed diets had each food item pureed separately to preserve the colour and appearance of the meals. The inspector tasted each item on the main course menu and found the poached chicken to be tender and tasty, with a colourful selection of vegetables. There was also an option of liver and Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 16 onions, or a vegetarian option. Whilst some residents told the inspector they liked the food, with one saying ‘It was quite good….excellent’, there were at least as many who made more mixed comments. Residents commented on the lack of flavour, poor choice of food, and breakfast foods not being available due to delivery/ordering problems. The inspector noted that what was on the menu was not what residents were being given, and in particular, the shortage of potatoes due to delivery problems, meant all residents (except those on soft and pureed diets) had to have rice on the day of the inspection. Several residents did not eat the rice and, when asked, said they would have preferred potatoes. The catering manager was interviewed and a number of issues discussed in relation to meals. He and the manager had already identified a number of problems and had reviewed the menus, arrangements for ordering and delivery, and had the new menu starting at the end of the week. No Requirements will be made as the home has recognised the shortfalls and is taking steps to remedy these – however, a Recommendation will be made regarding involving residents more in the menu planning. Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 17 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 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure and residents are confident to speak up when they have any complaints. The home has policies in place to protect vulnerable adults and residents will benefit from the forthcoming staff training on this issue. EVIDENCE: The AQAA states: ‘We have a complaints policy and procedure which is on view around the home and available to any resident or their relative to access at any time. Residents have the choice to make complaints informally or formally knowing that we will investigate and act upon these in a fair and just way to a realistic time scale in accordance with the policy.’ Residents spoken with during the inspection were able to speak up for themselves and had no hesitation in highlighting any shortfalls to the inspector. Any formal complaints are noted and the AQAA stated that four had been received and all but one had now been dealt with. No complaints have been received about this home to CSCI. It is recommended that the home record even minor issues (perhaps in a separate folder to the more formal complaints records), so that a note can be kept and a record of any actions taken. Concerns including grumbles about the food for example, can then be properly followed up and this shows a more transparent way of dealing with any shortfalls. Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 18 The home uses the local authority policy for safeguarding adults, and the AQAA states that the home ‘Has a policy in place. We ensure that all staff are CRB and POVA checked before starting work within the care home. Personal money audits are randomly checked by outside auditors and are also covered on occasions by the regulation 26 visits.’ A safeguarding issue was raised by the manager to the local authority and reported to CSCI. One of the outcomes is that staff will undergo the local authority training on the protection of vulnerable adults and this has already been booked. CSCI carried out a Thematic Probe within this inspection whereby a series of questions were asked in relation to safeguarding vulnerable adults. This will be reported separately and the results collated nationally. However, it was noted that whilst the manager and staff were clear about their responsibilities in relation to safeguarding vulnerable adults, residents did not know what they should do. It was suggested to the manager that information from either the local authority or Action on Elder Abuse should be obtained and sensitively covered with residents, perhaps at a resident’s meeting. The deputy manager has already obtained a CD on this subject with a view to inviting resident’s to watch the film and discuss the subject in more detail. Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 19 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 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable and accessible environment which is clean and pleasant throughout. EVIDENCE: The AQAA states: ‘We maintain the home to a high standard. The home is a new purpose built facility with large bedrooms that have en-suite facilities. Residents can bring in their own items of furniture and personal items to personalise their rooms.’ A partial tour of the premises was carried out by the inspector who visited the communal areas and three bedrooms. The home is very pleasantly furnished, well maintained and accessible throughout. There is an internal lift between floors and each floor allows easy movement even for those in wheelchairs; some residents in wheelchairs were seen propelling themselves around the home. There are also hoists and lifting equipment for bathing and moving residents. Residents reported being happy with their Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 20 rooms, and one relative noted on a survey: ‘The home is new so obviously looks lovely, but the warmth of the staff make it a pleasure to live in.’ The AQAA notes that: ‘Infection Control is maintained and monitored following practices and measures covered in our policies and procedures. Risk assessments are in place.’ The home was found to be clean and hygienic with no unpleasant odours whatsoever. Three of the four service users who completed surveys ticked that the home is ‘always’ fresh and clean. One relative added: ‘It is always clean every time I come in.’ There were good hand washing facilities throughout the home with soap dispensers, paper towels and hand driers in communal areas. There were also guidelines for staff and visitors about the correct method of hand washing. Some more risk assessments need to be in place and this is discussed under Standard 38 below. Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 21 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 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are sufficient staff on duty to meet resident’s needs, though residents will benefit by more care staff having basic care qualifications. Recruitment arrangements and training records need to be reviewed and up-dated to meet these Standards in full. EVIDENCE: The home has staff rotas in place and on the day of the inspection there were sufficient staff assisting residents. There were a number of positive comments on staff and the care they gave and only one survey commented negatively on the number of staff available. This was discussed with the manager who said they always had the correct number of staff on duty (except in emergencies if someone had gone off sick at short notice) though they still had to use a lot of agency staff. Domestic staff are employed and the home was maintained in a clean and hygienic state. This home has two floors designated for providing nursing care and there is always one registered nurse on each floor, in addition to the care workers. Some care staff have already achieved an NVQ Level 2 qualification in care but the home does not currently meet the National Minimum Standard (28) which recommends that at least 50 of care staff have this qualification – in a home registered to provide nursing care, this excludes trained nurses. The manager Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 22 said she is working on this and hopes to improve on this situation when new staff have completed their induction and go on to start their NVQ training. Recruitment records are held at the Central and Cecil Head Office and a proforma is kept at the service with details on the various recruitment checks including CRBs, POVA checks, and whether a full employment history has been obtained and gaps identified. However, of the three files sampled by the inspector, none had this proforma completed in full, and one was blank. The manager spoke with Head Office and it was agreed the information would be faxed to CSCI within 24 hours. The information arrived the day after the inspection in regard to these three members of staff but a Requirement will be made that in future proformas for all staff are properly completed, kept at the service and made available for inspection. The manager is currently drawing up a training matrix to identify which staff have completed which training courses. Some trained staff have done additional nurse training in relation to issues of relevance in this home, for example the deputy manager is trained in tissue viability. The care staff are also doing additional relevant training, such as NAPA training, which covers activities for older people. The manager said all new staff were following the Skills for Care Common Induction Standards and initial induction records were found on the three staff files sampled. Mandatory training includes health and safety, fire safety and safeguarding adults training. Unfortunately, as the training matrix was incomplete, it was not possible to determine how many staff had completed at least the mandatory training courses. The manager did more work on this which was forwarded to CSCI two days later. Whilst this was an improvement on what was seen at the inspection, there were still a number of shortfalls. The project to complete this matrix, ensure all staff have covered all mandatory staff training, and ensure training and development plans are drawn up for all staff, need to be completed as soon as possible. It was also noted during the inspection that two agency workers were not following best practice in relation to moving and handling – the manager said she would follow this up with the agency to ensure these staff were properly trained for the work they were being asked to do. Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 23 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 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit by the management approach at the home and there are quality assurance measures in place to monitor the service on offer. Policies and procedures are in place to safeguard resident’s finances. Arrangements for monitoring health and safety need to be reviewed to ensure that any shortfalls are identified and dealt with in a timely fashion. EVIDENCE: This home opened in December 2007 and the manager had been in post since the previous July whilst the home was being set up. She is a qualified nurse and was a deputy manager at another home for two years prior to moving into this role. She said she has completed and handed in all her work for the Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 24 Registered Managers Award but is still waiting to hear whether she has passed. There are clear lines of accountability within the home and her job description enables her to take full responsibility for managing the home, for example she has full budgetary control. There were a number of positive comments made about the manager including: ‘I find the manager to b open and willing to discuss issues or concerns raised by service users/family’ (from an assistant care manager); and ‘Roseanne is a very approachable and caring manager.’ There is a pleasant atmosphere within the home and residents and staff benefit by the management approach of the current manager. A relative also wrote in and commented positively on the way the manager and deputy manger were working hard to get things right and were always willing to listen to new ideas. The AQAA states: ‘It is scheduled to hold quarterly residents and relative’s meetings and undertake an annual survey. From the feedback and comments we propose to implement the most appropriate suggestions for our home. We will be monitoring the provision of care quality and the systems we use to work effectively.’ There are a number of measures in place to monitor the quality of the care provided at the home including a regular auditing schedule for care plans, medication, and health and safety. There is little documented feedback from residents and so far the suggestions box has not encouraged anyone to make any suggestions. However, the staff and manager do seek resident’s views by, for example, listening to comments regarding meals; as a result the catering manager has reviewed and re-written the menus at the home. The manager is working on an annual development plan for the home. The manager was receptive to suggestions and comments made by the inspectors and left them in no doubt that she will be following through on any Requirements. Indeed one Immediate Requirement, on wound management, was met whilst the inspector was still on the premises. Residents have locks on their rooms and a lockable drawer to keep money or valuables. No financial records were checked by the inspector on the day of the inspection but the manager confirmed what had been written in the AQAA: ‘The residents financial interests will be safe guarded and will be checked weekly by two senior members of staff and by our Regulation 26 visits. Receipts of all monies in and out are kept for all services given and purchases made on behalf of the residents.’ There are policies and procedures in place to safeguard resident’s finances, and there were no negative issues relating to resident’s finances raised by residents or their relatives during this inspection. There are a number of measures in place for monitoring health and safety, including a 3-monthly health and safety audit. The home is starting to champion certain areas such as care planning, and health and safety. The manager said posters would be placed around the home with staff being given talks on good practice. The company carries out legionella checks on the water Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 25 system and the manager said they monitor the temperature of the tap water on a monthly basis. It was recommended that this be done more frequently, particularly as one resident had tried to bathe themselves without staff supervision. Risk assessments are in place and the service are displaying their current employers liability insurance certificate. The environmental health department have been informed that the home is now open but have not yet carried out an inspection. The manager was asked to follow this up with the local council. More risk assessments need to be carried out including on aggressive behaviour towards staff, the issue regarding one resident who tried to have a bath/shower on their own before staff could check the water temperature, and residents going out into the hot sunshine without a head covering. The inspector also noticed a few injuries on residents and, whilst these had been properly recorded in the accident record, CSCI had not been informed. Any incident or accident which adversely affects the welfare of a service user must be reported to CSCI. A Requirement will be made that the manager review current arrangements for health and safety to ensure any shortfalls are identified and dealt with in a timely fashion. Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 26 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 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 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A 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 OP7 Regulation 12(2) Requirement Care plans must be reviewed to ensure they contain all the necessary detail about care needs, including how residents would like their support to be delivered. A clear system must be in place for assessing and monitoring resident’s nutrition to ensure their nutritional needs are met. A recognised nutritional risk assessment tool must be used as set out in the home’s own guidelines. Arrangements for the proper assessment and monitoring of wounds must be put in place, together with improved record keeping, to ensure the safety and well being of residents. Arrangements for managing the stocks of medication within the home must be reviewed to ensure there are no excess stocks on the premises. Recruitment records must be reviewed to ensure confirmation of all the relevant information (in Schedule 2 of the Care Homes DS0000071322.V363199.R01.S.doc Timescale for action 12/07/08 2. OP8 12(1)(a) (b) 26/05/08 3. OP8 12(1)(a) 26/05/08 4. OP9 13(2) 26/05/08 5. OP29 19 12/06/08 Queen`s Court Version 5.2 Page 28 6. OP30 18(1)(a) 7. OP38 13(4)(a) (b)(c) Regulations) is at the care home and available for inspection. An accurate record of all staff training must be completed, and shortfalls in training (e.g. staff not having completed the mandatory courses) must be remedied as soon as possible to ensure all staff are properly trained for the work they are asked to perform. Training and development plans must be drawn up for all staff. Health and safety monitoring must be reviewed to ensure any shortfalls are identified and dealt with in a timely fashion, for example when more risk assessments are needed as discussed under Standard 38. This is to ensure the safety and well being of residents. 12/07/08 12/06/08 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 OP15 Good Practice Recommendations Arrangements for involving residents in menu planning should be reviewed to ensure they have a greater opportunity to contribute to the process. Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Queen`s Court DS0000071322.V363199.R01.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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