Inspection on 19/03/09 for Queen`s Court

This inspection was carried out on 19th March 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Queen`s Court 23/06/09

Queen`s Court 12/05/08

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Queen`s Court 1 Dedworth Road Windsor Berkshire SL4 5AZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Dickens     Date: 1 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Queen`s Court 1 Dedworth Road Windsor Berkshire SL4 5AZ 01753838450 01753838451 Roseanne.Ince@ccht.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Central & Cecil Housing Trust care home 62 Number of places (if applicable): Under 65 Over 65 62 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 62. 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: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Queens Court opened in December 2007 (and was officially opened by the Queen in February 2008), and is managed by Central and Cecil Housing Trust. It is purpose built and registered to take up to 62 older residents. The home is on three floors which are all self contained with their own dining and lounge areas, 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. There is parking on site and the home is within walking distance of local facilities in the Dedworth area of Windsor. Care Homes for Older People Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was unannounced and took place over 7 hours. The inspection was carried out by Mrs. Helen Dickens, Regulation Inspector, who was accompanied by Mr. Tim Inkson, Regulation Manager, during the morning. Ms. Roseanne Ince, the Registered Manager, represented the establishment. A partial tour of the premises took place, and a number of files and documents, including five residents files and care plans, two staff recruitment files, five staff training records, quality assurance information, and the annual quality assurance assessment (AQAA) were examined as part of the inspection process. Questionnaires returned to CSCI regarding this service were also used in writing this Care Homes for Older People Page 5 of 31 report. The inspector saw and spoke with many residents who were in the ground and first floor dining rooms at lunchtime, and three more residents were interviewed in more detail. Four relatives and a care manager were also interviewed during the inspection. The inspector would like to thank the residents, relatives, care manager, staff and the home manager for their time, assistance and hospitality. Fees at this service range from 364.00 to 1,000.00 per person per week. What the care home does well: What has improved since the last inspection? There have been many improvements since the last inspection and the manager and staff have worked hard to meet the previous Requirements, five of which have been completed in full. Arrangements for monitoring residents nutrition have been put in place and all but the most recently admitted resident had a nutritional risk assessment in place. There are better arrangements for monitoring wounds. The records for one resident being supervised by a specialist community health professional, were very detailed and showed the continual improvement of the wound. The Requirement regarding stocks of medication has now been met and any excess medications were packed up and ready for return to the pharmacist, or for destruction. The two recruitment files selected both had the proforma completed showing that recruitment checks had been carried out. Health and safety monitoring has also improved and there were no new Requirements made at this inspection in relation to safety. More work has been done on care planning, and all residents now have a standard format care plan. There are more activities on offer, and the home has started a monthly newsletter giving details of activities for the coming month, together with quizzes and poetry. Arrangements for meals have improved and those residents and visitors spoken with were complimentary about the food, and the new chef. Several examples of innovative ideas to make residents food more appealing were seen, including some delicious salads, and nutritious finger food for one resident who had difficulty managing cutlery. Care Homes for Older People Page 7 of 31 Whilst the training records Requirement has not been met in full yet, there were significant improvements in the staff training records since the last inspection. The manager has devised a training matrix which includes all permanent staff names, and what training they have done. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. No service user moves into the home without having their needs assessed and being assured these will be met. Evidence: Five service users files were sampled as part of this inspection. It was noted that assessments are carried out by the home and by local authority, and those seen provided a good overview of peoples needs. There was little detail on some areas for example how prospective residents would like their care delivered, and this is discussed in the next section. Most residents at present are funded by local the authority and one care manger from the Royal borough of Windsor and Maidenhead was interviewed during this inspection. She said she had been involved in admitting three residents in the last 12 months, including one 7 days before this inspection. The care manager said all three clients had Care Homes for Older People Page 10 of 31 Evidence: very high care needs before admission but the home had handled this well and all three had improved since they moved to Queens Court. She said the home had been proactive and the manager was Very professional in her approach. The care manager added; Roseanne has come up trumps with the most difficult cases. The care manager said the home had involved the families of residents in their admission and assessments, where residents had a supportive family. The husband of the latest resident to move in to the home was interviewed whilst he visited his wife and he said he was very pleased about the admission process. Asked about his first impressions he said that; Staff are friendly and I was shown around by a very competent member of staff. All the staff seemed very caring, and Roseanne gave me a good reception. He said his wife had been well looked after and he was pleased with how she was settling in. Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning arrangements have improved since the previous inspection but more work needs to be done to ensure all care needs are recorded, and care plans contain details of how people would like their care to be delivered. Residents report that their health needs are met, and there are satisfactory arrangements in place for the administration of medication. Residents are treated respectfully by staff at this home. Evidence: Five service users files were sampled during this inspection, including their care plans. The AQAA states that all residents have individualised care plans and notes they could improve the monitoring system they have for care plans. The AQAA does not state whether the Requirement from the previous inspection, about detailing all care needs and including how residents would like support to be delivered, has been met. Improvements since the last inspection include all care plans have now been transferred to the new Saturn system, which means they are in the same format. The standard format includes a photograph of each resident, together with any allergies, Care Homes for Older People Page 12 of 31 Evidence: and their basic health and medication. There is a consent form to allow staff to give medication and some of those sampled were signed by the service users. There is a section for the social profile, and care plan headings included breathing, eating and drinking, mobility etc, with a space for each persons Goals. Shortfalls on this visit included failure to record what residents could do for themselves, and what help they would need from staff; lack of detail about which slings and hoist to use for one resident; specific individual assessments not being completed or missing including one moving and handling risk assessment, an oral health assessment, and a nutritional risk assessment. There was little evidence of user or family involvement. One relative had drawn up an excellent person centred plan for their spouse relating to their home care prior to admission and this was on file; the manager was asked to ensure that this relative was involved in the new care plan devised by the home. Those plans sampled were difficult to follow as some had been reviewed more than one month ago, a new date set for review, but nothing on file to show whether this review had been carried out. For example one record showed a person could bathe independently, and another said they needed assistance. In some instances the manager was able to go and print off a later version but this would not help staff who were using the paper records to refer to for day to day care. Plans do not appear to be regularly archived and those on file are not necessarily up to date; even when later revisions were printed, some care plans were still overdue for review. Those care plans sampled are still not person centred, some had no staff signatures and little evidence of service user involvement. There is still insufficient detail about how residents would like their support to be delivered. This is particularly crucial as the home still relies heavily on the use of agency staff. A Code B notification was given to the manager in relation to the previous Requirement on care plans which has not been met. In addition to the information above on health care needs, two further areas need to be covered in more detail as they relate directly to Requirements made at the last inspection. One area is the previously poor records of wound management. This has improved significantly and now separate detailed records are kept of wound management. The manager said there are only two residents with pressure ulcers and the records were sampled for one of these. Evaluation of the wounds are carried out by the Tissue Viability Service and there excellent records of the assessment, how to change dressings, and evaluation notes. Improvements in the wound were noted on every subsequent visit by a specialist nurse. The previous Requirement is now deemed to have been met. Care Homes for Older People Page 13 of 31 Evidence: In relation to nutrition, all but one of the five residents files sampled showed nutritional risk assessments are now carried out routinely. Residents weights are also noted. The Chef was spoken with at length and was found to be knowledgeable on special diets and described in depth arrangements for one resident who could only manage finger food. Dietitians are involved as necessary and this is recorded. The one resident without the nutritional risk assessment was a new person living at the home. Though the written risk assessment was not completed, guidance had been given by their family, and their relative who was visiting at lunchtime on the day of the inspection was very pleased with the arrangements in place. The previous Requirement on nutritional risk assessments is now deemed to have been met. One health care professional returned a survey to CSCI and noted things continued to improve at the home, the following being a reflection of their comments; Ongoing but improving problem of poor handover between staff resulting in duplication of requests for visits. End of life status has been an issue, improving but needs to be better - training planned. Generally the nursing staff are very kind. More nursing input needed for some of the complicated dressings required by some patients. The care manager who was interviewed praised the home manager on the issue of end of life care in relation to one prospective resident who the manager had assessed in hospital with a view to offering them a place at the home. The home manager recognised that the potential client had in fact only a short time to live and it would have been inappropriate to move someone in these circumstances. The client remained in hospital where they died a few days later. None of the residents spoken with raised any concerns about their health care, and the two who returned surveys to CSCI ticked that they always had the medical support they needed. Medication is well organised and the Requirement regarding managing the stocks of medication, made at the last inspection, has now been met. On the day of the inspection the temporary deputy manager was observed giving medication on the top floor. Medication was seen to be kept securely in a locked room and in a locked trolley. The trolley was also kept securely between administrations to each resident. Medication was correctly signed for after it had been given. This staff member was Care Homes for Older People Page 14 of 31 Evidence: noted to be respectful to residents and explained what she was doing as she went to each person. She said she has been auditing medication administration records and dealt with any issues that arose, e.g. unexplained gaps on the administration records. The medication charts sampled had no unexplained gaps. There was no record of a pharmacist visiting and advising the home on medication arrangements and the manager will need to follow this up. The staff and manager at Queens Court were observed to be respectful to residents and their families, and all personal care is carried out in private. Residents can bring their own personal items with them. There are locks on bedroom doors and residents have their own lockable drawer in their rooms. A number of written compliments, sent to the home, are displayed on the board in the reception area, and a number of these confirmed that residents had been treated respectfully. Comments included; Thank you for all the love, care and support you gave to my Mum. You all helped to make her life a little bit brighter. Just like to say thank you for the way you all looked after Mum during her year at Queens Court - she felt safe and cared for and I know she appreciated all you did for her. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home provides a variety of activities for residents to enjoy, and encourages them to be involved with the local community. Residents are given opportunities to make choices in their day to day lives, and arrangements for mealtimes have improved since the last inspection and are now satisfactory. Evidence: The AQAA states that a new monthly newsletter has been started, and that residents are encouraged to keep up with activities they had before moving in. Outings are planned for residents, church services are held, and there is a hairdresser. The inspector looked at the newsletter which contains activities for the coming month including church services, yoga, karaoke, card making, games, the film club, and aromatherapy. There is also regular chiropody, hairdressing three days a week in the hairdressing salon, and the shop is open several mornings per week. They are celebrating a residents 104th birthday with a party on the second floor in the coming month. Outings this month include a trip to Savill Gardens. On the day of the inspection a number of residents were going out to the RAF Museum. Care Homes for Older People Page 16 of 31 Evidence: Residents spoken with were happy with the activities on offer. One resident told the inspector There is a lot going on here. A visitor who was interviewed said the staff did encourage residents to keep up their own interests, for example their relative liked to listen to Radio 4, and has their breakfast taken in to their room. She said the staff at Queens Court Enable her to live the kind of life she would have liked. Residents are encouraged to maintain contacts with the local community and the hairdresser at queens Court also has clients coming in from the local area. Local church contacts are maintained with regular church services held at the home. Outings to local places of interest are arranged as noted above. All four visitors interviewed spoke well of the home and services on offer. All said they had been made welcome. One relative who was a new visitor to Queens Court added that the manager in particular had given them a good reception. Another visitor said that the manager was One of the nicest people, with lovely personal qualities. They added that the home had a friendly atmosphere and was adaptable, to meet the needs of residents. Residents are supported to make choices and there were examples of this in relation to meals and activities. Residents spoken with knew what the choices were, and were asked on a daily basis what they would like to eat. Those who were asked, said they knew for example that if they didnt like any of the choices on the menu, they could ask for something completely different. The home has a number of ways of getting residents opinions and encouraging them to make choices, including at residents meetings, and in their annual surveys. People spoken with noted they had been given choices but care plans did not always reflect this, as discussed under Standard 7 on care planning. The care manager interviewed said that the arrangements for a new resident moving in had been decided entirely between the family and the home, with the home manager going out of her way to ensure there was a smooth transition. The spouse and this new resident had been consulted very fully on the arrangements for moving in and during the early days of the placement. Meals are offered in pleasant surroundings and all three dining areas were visited during the inspection, two during the lunchtime period. Residents commented favourably on their meals, the choices on offer and the new chef. The inspector went to several tables in the first floor and ground floor dining rooms and spoke with up to 10 residents. All were complimentary about the meals and comments included: Wonderful food.; Good food. Plenty of it.; Good breakfasts.; We get a list so we can select what we like.; All the food is very good here. The inspector observed a variety of meals, including those on the menu (menu card on each table with choices), and other specials, including fresh salads, vegetarian options, and soup being served to a visitor. The chef was interviewed and found to be Care Homes for Older People Page 17 of 31 Evidence: very knowledgeable on residents diets. He said he had observed that one resident coped better with finger foods, and in consultation with staff and the dietitian, adapted the menu accordingly. When he was asked about how much of the food is homemade, he said 12 of the 14 main course options in the coming week were homemade. This is a big improvement since the last inspection where there had been a number of negative comments in relation to meals. The chef was observed to be assisting with serving meals on one floor, and said he makes a point of speaking with residents and staff about the food each day, in this way he picks up any concerns himself and is able to deal with them promptly. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are taken seriously at this home and the policies and practices in place would protect residents from abuse. Evidence: The AQAA states that there is a complaints policy in place, and this is on display and promoted at residents meetings. It says residents have a choice to make an informal or formal complaint with the assurance that we will investigate and act upon and respond to them in a fair way within a realistic timescale. Residents spoken with were able to speak up for themselves if they had a problem, or had family to do this for them. One visitor said their relative would certainly complain if they werent happy, and knew how to do so. Both surveys returned from residents said they knew how to make a complaint. One added, I would talk to the home manager, Roseanne. I have done when I have been unhappy about something. The health care professionals survey returned to CSCI ticked Usually in answer to the question about whether the service has responded appropriately if concerns had been raised. This person added; Appear to listen to concerns and is working towards improving service. Slow to put in much needed computer and connection to improve patient notes. On this last point, the manager said a computer had since been given by the health centre, and external health professionals could now access computerised patient records. Care Homes for Older People Page 19 of 31 Evidence: The home has a safeguarding adults policy in place, and their AQAA states that proper recruitment checks are carried out to protect residents, and all staff have protection of vulnerable adults (POVA) training. A sample of staff training records checked during the inspection including trained staff, care workers, and agency staff, showed they had all had POVA training. The manager and senior staff were aware of the Mental Capacity Act and the Deprivation of Liberty Safeguards guidance from the Department of Health, and senior staff had been on the relevant training courses. The manager said Central and Cecil had also issued guidance to staff on this subject. Four safeguarding adults issues have been raised at Queens Court, and the home has reported these in a proper way to the relevant authorities and then co-operated in the subsequent investigations. At the time of writing, three of these matters have been satisfactorily resolved, and the fourth, which is the most recent, is still being dealt with. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit by being in a pleasant and comfortable environment, which is clean and hygienic throughout. Evidence: The AQAA states that they maintain the home to a high standard. Paint work is carried out in rooms as needed. We have a member of staff who assists in minor repairs and Windsor Housing respond very quickly when reports of faults are made. A partial tour of the premises took place and included dining rooms, living rooms, three bedrooms, the kitchen, the purpose built hairdressing salon and the reception area. The home is new and has large rooms and a spacious feel. It is pleasantly furnished and comfortable throughout. The home is very accessible for those with disabilities due to wide door ways, plenty of room for wheelchairs, and passenger lifts between floors. There are hoists and lifting equipment provided as necessary. The reception area and staff are welcoming, and there were no complaints from residents about their rooms. One issue at the previous inspection regarding the time taken to carry out minor repairs seems to have been overcome. One visitor described the home as A new building. Bright and light. Another family Care Homes for Older People Page 21 of 31 Evidence: were interviewed in the bedroom of the person they visited, and the resident said they were happy with their room. The manager and staff create a homely and friendly feeling and this was commented upon by both residents and visitors, one wrote; We were impressed with the care, and the very clean and happy environment. The AQAA states infection control is maintained and monitored following practices and measures outlined in our policies and procedures. During the inspection it was observed that the home is kept clean and fresh and there were no unpleasant odours. Good hand washing facilities were seen throughout, with soap and hand towel dispensers as well as hand gel being easily accessible. Due to incomplete training records it was not possible to confirm that that all staff had done infection control training and this is discussed further under the next set of Standards. Both service users who returned surveys ticked Always in answer to the question about whether the home is kept fresh and clean. One added; Yes it is kept very nice and clean - my room is always kept nice. The other wrote; Lovely. Clean and tidy. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs are met by the staff at the home, and recruitment arrangements have improved since the last inspection. More work needs to be done to ensure care staff have qualifications in care work, and better staff training records must be kept. Evidence: There is a staff rota in place and a mix of trained staff and care workers, as well as domestic and kitchen staff. The manager said there is always one trained nurse on each of the two nursing units on each shift. There are more staff at busy times. There were many compliments about the staff including on surveys; Staff dress me if need I get the support I ask the staff for.;Generally the staff are very kind and considerate.; Overall, I am very satisfied with the care.; Staff are good. I like all the staff. A relative said staff had arranged to take her mother for a hospital appointment and that Staff are very good to Mum. However, some residents commented on having to wait for things. One (on a survey) said they had to wait for their breakfast, and added There are days when there dont seem to be enough staff on duty - they can be rushed off their feet. This person said they sometimes cannot have a bath if there arent enough staff on duty. A resident in the dining room said they were happy at Queens Court, but The girls are run off their feet. This was discussed with the manager who said that they were well staffed, given Care Homes for Older People Page 23 of 31 Evidence: the home was not full. As this is a care home with nursing, there is a trained nurse on each of the two nursing floors on each shift so there are always qualified staff on duty. However, it is expected that care staff who are not trained nurses will also take qualifications in care work and the National Minimum Standards suggests that at least 50 of care staff should have an NVQ Level 2 qualification or above. On the AQAA the manager stated that only 4 of the 15 permanent care staff have gained this qualification so far. Recruitment arrangements have improved since the last inspection. A proforma is in place covering important aspects of the recruitment process for example whether two references have been sought and verified, the CRB number, and whether a POVA check has been carried out. It notes whether a full employment history had been given and any gaps verified. Original documents are then kept at head office. At the previous inspection one of these checklists had not been completed. At this current inspection the proformas on both files were checked and found to be completed; therefore the previous Requirement is now considered to have been met. However, there were some anomalies which the inspector will need to check and get back to the manager about. For example, who authorised the agreement that Central and Cecil could fill in the proforma - rather than have the actual records available at the home. It was also noted that the manager, not the HR department, had signed to say a full employment history had been sought and checked, yet when asked, the manager did not appear very clear about what a full employment history is i.e. it must start from when the person left school. One of the two files sampled did have the application form on file, and this form asked only for a ten year employment history. More information will be sought and the inspector will liaise with the manager about any further action that needs to be taken. Staff at this home are given induction training, including agency staff are given an induction when they first come to work at the home. Staff training arrangements have improved significantly since the last inspection. The manager has worked hard to create a training matrix which enables management to see at a glance which staff have done which training courses, and when refreshers are due. The AQAA states, in response to the statement Our evidence to show that we do it well, we Maintain our training matrix thereby keeping staff training up to date. However, the matrix on the wall was incomplete, as was the alternative computer version shown to the inspector. The inspector chose, at random, 3 RGNs, 1 care worker, and 1 agency worker, and asked to see evidence that they had all completed training on the following subjects; Health and Safety; Moving and Handling; First Aid; Care Homes for Older People Page 24 of 31 Evidence: Food Hygiene, POVA and Infection Control. This took a long time and eventually included going through staff files in search of missing records. Only 2 of the five staff had documentary evidence that they had completed all these courses. The agency staff training record was faxed across from the agency during the inspection, but the home should have had their own record of this training. One person who was booked on the next first aid course had no record of them ever having had first aid training in the past, and another who had no evidence of having done first aid training was not booked on the course at all. The previous Requirement to have accurate training records has not been met and a Code B notification was given to the manager in this regard. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit by being in a home which is run by a person who is qualified and competent, though more management support and resources are needed. Quality assurance arrangements need to be reviewed to ensure the service that residents receive is properly planned and reviewed. Arrangements are in place to safeguard residents financial interests, and to promote their health, safety and welfare. Evidence: The AQAA states that the home remains resident-focused....We listen, and act on feedback from our residents, social services and CSCI. Residents are free to see the duty manager or home manager at any time. The current manager was in post prior to the home being opened in December 2007 and is a qualified nurse who has now also gained her Registered Managers Award and attended leadership training since the last inspection. There are clear lines of accountability within the home, and on surveys returned to CSCI, and during Care Homes for Older People Page 26 of 31 Evidence: interviews with the inspector, residents and relatives knew who to go to if they had a concern. Many complimentary remarks were made about the manager that are noted elsewhere in the report. These comments included mentioning the friendly atmosphere within the home, as well as her exceptional personal qualities. There have been significant improvements since the last inspection which are noted under What has improved since the last inspection at the beginning of this report and the manager should be commended for bringing about those improvements under quite difficult circumstances. The manager has lost her deputy since the last inspection and, though a senior person was drafted in to offer support, they have also left the home due to health reasons. The management arrangements have been reviewed and a new person was recruited and due to start in February, but this person has since made other arrangements and the home is readvertising. A temporary deputy is now working at the home for three days per week and the manager said she can stay as long as she is needed. Whilst the current manager provides a really good role model for her staff, and she has been open, honest and very committed during this and the previous inspection, there are still a number of shortfalls. There appears to the inspector to have been insufficient resources available to the manager in terms of senior staff to assist with the crucial areas for example with regard to care planning and managing training. The home is still reliant on significant numbers of agency staff which is likely to increase the responsibility and burden for the permanent staff, and leave fewer senior people for the manager to delegate work to. A community nurse visiting the premises believed that in relation to the shortfalls on care planning, more clinical input and monitoring was needed. Whilst the manager stated that the organisation has recognised this and they are recruiting more staff, including someone in a management position, the shortfalls in care planning and training records were Requirements from 10 months ago and should have been prioritised. Some quality assurance processes are in place at Queens Court including following the policies and procedures of the provider, and monthly Regulation 26 visits on behalf of the provider. There is also some auditing of records, for example in relation to medication administration records. The home has monthly residents meetings, and relatives meetings every 6-8 weeks. The AQAA states that the manager or duty manager are available to residents at any time. There is an annual satisfaction survey for residents, and the manager spends Care Homes for Older People Page 27 of 31 Evidence: some time with residents during activities, and one to one sessions to ensure she gets direct feedback from the people who live at this home. Residents are given opportunities to participate in running some activities, including the shop and the film club. However, at the previous inspection it was noted that the manager was working on an annual development plan. In the AQAA completed before this current inspection, it was stated that there was no annual development plan. It was also the conclusion of this inspection that there were either insufficient or unsatisfactory audits, for example in relation to care plans, and the home should review its quality assurance arrangements to ensure they fit with Standard 33. The AQAA states that records of residents personal monies are kept, and Personal money audits are randomly checked by outside auditors, and are also covered on occasions by the Regulation 26 visits. Receipts are kept for expenditure on behalf of residents, and there are policies and procedures in place to safeguard residents finances. Residents are encouraged to be independent as possible in this regard and they have locks on their rooms, and a lockable drawer to keep their own money or valuables. Health and safety arrangements have improved since the previous inspection and the manager confirmed she had reviewed health and safety monitoring following shortfalls found at that time. She said more risk assessments had been carried out for example in relation to residents heads being covered when going out in the hot sun. Examples seen by the inspector included nutritional risk assessments which had improved and now all but one recently admitted resident had the recognised MUST nutritional risk assessment score. Other health and safety measures in place, as set out in the AQAA, include service reports, risk assessments, COSHH sheets, fire checks and servicing, and contracts are in place for gas and electricity safety, and for hoists and lifts. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 12(2) Care plans must be reviewed 12/07/2008 to ensure they contain all the necessary detail about care needs, including how residents would like their support to be delivered. An accurate record of all staff 12/07/2008 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. 2 30 18(1)(a) Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 33 24 The arrangements for 18/05/2009 monitoring the quality of the service should be reviewed to ensure residents receive a service that is properly planned and kept under review. For the welfare of service users. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 The manager should follow up with the health authorities, whether arrangements need to be made to have a community pharmacist visit the home to look at medication arrangements and to offer any advice. Care Homes for Older People Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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