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Inspection on 03/05/06 for Queen`s Court

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

This inspection was carried out on 3rd May 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All service users have a key worker who takes lead responsibility for reviewing and updating the care plans. This is done with the service users at least once a month. The home has a full programme of activities both within the home and trips out. All service users are able to join in with the day centre activities if they wish. All staff have a full induction training package and sign each section to indicate their understanding.

What has improved since the last inspection?

The manager has attended a training course on Protection of Vulnerable Adults (POVA) to enable her to train her staff. A rigorous employment process ensures all staff are suitable to work with vulnerable people.

What the care home could do better:

A letter to confirm the home is able to meet the prospective service users needs is not being sent following their pre admission assessment as required under Regulation 14 Staff had not had training in POVA at the time of inspection. A requirement was made at the last inspection that this should be have been in place by 31/12/05. However the inspector was told that dates for training are in place following the manager attending a training course. Some windows are affected by condensation between the double glazed panes giving them the appearance of being steamed up. This may impair service users views from the window and attention to them is needed.

CARE HOMES FOR OLDER PEOPLE Queen`s Court 2 Downing Close Bottisham Cambridgeshire CB5 9DD Lead Inspector Mrs Jenny Cangy Unannounced Inspection 3rd May 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Queen`s Court Address 2 Downing Close Bottisham Cambridgeshire CB5 9DD Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01223 811905 01223 812517 home.bot@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Mrs Rosalind May Wright Care Home 35 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (35) of places Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th November 2005 Brief Description of the Service: Queens Court is in the centre of the village of Bottisham, near the city of Cambridge. Queens Court is a two storey, purpose built home, offering long term and respite accommodation to 35 residents some of whom can have a diagnosis of dementia. The home has five self-contained flats, each with its own kitchenette, dining /sitting room and number of bedrooms. The home also has a day centre operating from the premises, which can be used by residents in the home as well as providing a community facility for older people in the area. Main meals for residents and those attending the day centre are provided from the homes main kitchen and taken to the flats in heated trolleys. Current weekly fees range from £361 to £443 depending on the source of funding and diagnosis. Extra charges are made for private chiropody, hairdressing and newspapers. Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and commenced at 10.30 am. The inspection was conducted with an assistant manager who was the senior staff member on duty. A review of National Minimum Standards (NMS) not met at the last inspection was undertaken. A review of the key NMS and any standards not inspected at the last inspection was undertaken. A random selection of files were inspected. A tour of the home followed when service user care plans and medication records were seen and staff, service users and relatives were spoken to. The inspection concluded at 4pm following a feed back session with the assistant manager. The home was found to be clean and fresh throughout with adequate staffing. A group of service users accompanied by some staff had gone out for lunch. A requirement from the previous inspection has not been met. What the service does well: What has improved since the last inspection? What they could do better: A letter to confirm the home is able to meet the prospective service users needs is not being sent following their pre admission assessment as required under Regulation 14 Staff had not had training in POVA at the time of inspection. A requirement was made at the last inspection that this should be have been in place by 31/12/05. However the inspector was told that dates for training are in place following the manager attending a training course. Some windows are affected by condensation between the double glazed panes giving them the appearance of being steamed up. This may impair service users views from the window and attention to them is needed. Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have all the information they need to make an informed choice when selecting this home. However currently the home does not confirm their needs can be met formally. EVIDENCE: There is an up to date statement of purpose and service user guide that is given to all prospective service users. This contains all the information needed to make an informed choice to move into the home. A selection of service user files were inspected. All service users have a contract of care and statement of terms and conditions of residence. Prior to moving into to the home the prospective service user has an assessment of their needs carried out by a senior member of the care staff team. This is in addition to the social worker assessment and forms the basis for the care plan. As part of this assessment the lead staff member for moving and handling makes an assessment of the equipment needed to ensure the appropriate care can be given. The registered manager is not writing to each prospective service user stating that their needs can be met before offering them a place. This is required under regulation 14 Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 9 of the Care Homes Regulations 2001. However only service users whose needs can be met are accepted. All service users are offered the opportunity of a visit or a respite stay prior to accepting a place and the first 6 weeks are treated as an extended trial period. Queens Court do not offer intermediate care. Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health care needs of service users are met while maintaining their privacy and dignity. Their wishes during final illness and for after death are known and respected. EVIDENCE: All service users have a plan of care. These are reviewed monthly by their key workers and monitored by the senior staff during supervision and at staff meetings. Four service users records were monitored during the inspection. Although the care plans do not contain great detail they are adequate for new staff to know the care needs and the reviews are signed and dated. All service users are registered with the local GP practice that serves the village of Bottisham The assistant manager stated that there is regular input from district nurses, community psychiatric nurses and a chiropodist although this could not be evidenced in care plans. Referrals are made to occupational and physiotherapy as needed. Nutritional screening forms part of the care planning and all care staff have training in this. There is a monitored dose system of medication administration, recording and storage and all staff have training. Medication records were seen as part of the inspection. No service users currently self administer their medication. The senior staff make daily checks on the appropriate management of medication. All bedroom doors can be Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 11 locked if the occupant wishes and staff never enter rooms without knocking. The assistant manager stated that all personal care is done in the privacy of their bedroom or the bathroom and this was supported by service users spoken to. There is a policy in place for care in final illness and after death. With the support of the GP and district nurses service users can remain in the home during this time and hospital admission is only sought if it is the best interest of the individual. Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Daily life and social activities are according to the service users wishes ensuring everyone has choice and their opinions are heard and acted on. Meals offer choice and a well balance diet. EVIDENCE: Service users are able to make choices in all aspects of daily living and have a variety of activities available to them. Service users supported this during the inspection. They have a daily set menu with alternative choices if they wish.. Religious services take place twice a month. Their individual interests and past life history are part of the care plan so staff know how to engage them in conversation and encourage their participation in activities. Activities are organised by the day centre manager with the support of a three-person activities committee who meet weekly. There are activities planned so all can participate regardless of their frailty can participate. A local amateur dramatic group rehearses on site and gives a performance of each of their productions to the residents. There are regular outings for pub lunches or visits to garden centres among the destinations. Visitors are welcome at all reasonable times. Meal-times are evenly spaced with lunch being the main meal of the day and tea having a choice of hot or cold food. Drinks are offered at regular intervals. Service users spoken praised the quality of the food. On the day of inspection a group of service users were out for lunch at a garden centre. Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 13 Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are dealt with appropriately and service users civil and legal rights are protected. Service users are protected from abuse to some extent but not fully. EVIDENCE: There is a formal complaint procedure for service users or their families to follow. This is contained in the service user guide and displayed on the notice board. A complaint and compliment record book is kept and the manager reviews this. Service users spoken to knew how to raise concerns. All service users are registered to vote and contact with solicitors would be facilitated. A vigorous recruitment procedure ensures only staff suitable to work with vulnerable adults are employed. However Protection of Vulnerable Adults training has not been given to staff and although staff were able to tell the inspector what constituted abuse they were unable to relate the appropriate response to suspected abuse. It should be noted that the manager has recently completed training in POVA and is preparing to train her staff. Training dates are in place. Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a clean, safe, well-maintained home with sufficient space and facilities for their needs. Some attention is needed to the double-glazing. EVIDENCE: The home employs a general maintenance person for day-to-day repairs and redecorating. The major maintenance is contracted to Hereward Housing Society. There is a team of domestic staff with a key domestic allocated to each flat. The grounds are attractive and well kept with access to service users who make use of them in the fine weather. Each flat has a lounge dining room and one flat has a separate dining room. Residents are also able to use the large day centre during the day and join any activities or entertainment arranged if they wish. Bedrooms do not have en-suite facilities but there are sufficient toilets and bathrooms to meet the required standard. Any special equipment or adaptations needed to meet a service users need are provided after consultation with community occupational therapists. Some equipment is Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 16 provided by the local authority/ health care trust on loan or is purchased by the home. Hoists and other moving and handling aids are provided. All staff have moving and handling training. The home has sufficient heating and lighting with all bedrooms having natural light and ventilation. Service users are able to control the radiator temperature in their rooms by use of a thermostat. All hot pipe-work is covered. Appropriate checks are made regarding hot water temperatures. All new staff have training in infection control as part of their induction training and this is reinforced regularly. The washing machines have a thermal disinfection cycle and sluicing facility. Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is only adequate. This judgement has been made using available evidence including a visit to this service. There is an adequate staff team to meet the needs of the service users with the exception of during the night when the staffing levels mean the dementia care unit is left unattended except for routine checks. EVIDENCE: Over 50 of care staff have NVQ level 2 or above. There is a team of assistant managers who work shifts and two waking night staff who have access to a person on call for emergencies. The home has domestic and catering staff and the care staff do the laundry. The laundry was found to be untidy and disorganised and the judgement of the inspector is that this is due to there being no key person to take responsibility. The night staffing level is not sufficient to ensure the safety and supervision of the residents in the dementia care unit as they are left unattended for long periods when staff are attending to other people. The registered person must review this and produce a risk assessment for each resident of the dementia care unit to demonstrate the risk is acceptable. If this is not the case then an addition night staff must be employed to ensure the ongoing safety of those with dementia. Staff have access to ongoing training and training records are kept. All new staff follow an induction programme. The recruitment process is robust to ensure only those suitable to work with the vulnerable and frail are employed. All staff have a Criminal Records Bureau enhanced check and the Protection of Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 18 Vulnerable Adults register is checked. Staff have to prove their identity and two written references are required. Staff have access to regular training and individual training records. Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A very experience manager who has NVQ level 4 registered managers award manages the home to the benefit of staff and service users.. EVIDENCE: Staff stated they find the manager approachable and supportive. The service users and their families know her. There is a quality assurance programme in place where all aspects of the home are regularly audited and questionnaires are sent to service users and their families seeking their opinions of the home and the service it offers. The manager has a budget to work to and has budgetary advice available to her. Insurance certificates are displayed and there is a business and financial plan for the home. Any money held for safe keeping for the residents is appropriately stored and recorded. All staff have formal supervision with records kept. Records are kept as required by the Care Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 20 Homes Regulations. A sample of records were viewed. There is no designated health and safety representative but all staff have training in health and safety And the home has a fire risk assessment.. Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 3 3 X X 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 Regulation 14 Requirement The registered person must confirm in writing to the service user or their representative that following the assessment the home is able to all their care needs. The registered person ensure all staff have appropriate training in recognising abuse of vulnerable adults and the action to take if it occurs. This is outstanding from the last inspection and the requirement date of 31/12/05 has not been met. Any further delay in meeting this requirement will result in regulatory action being taken The registered person must review the adequacy of the night staff numbers to ensure the safety of the service users residing in the dementia care unit. This includes carrying out detailed risk assessments for these service users for during the night-time hours. A review of the laundry provision should also be undertaken to ensure a good service is provided. DS0000015097.V291877.R01.S.doc Timescale for action 30/05/06 2 OP18 13 (6) 30/06/06 3 OP27 18(1(a)) 30/05/06 Queen`s Court Version 5.1 Page 23 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 OP19 Good Practice Recommendations The registered person should seek expert guidance re the double glazed windows that have condensation between the panes and arrange for the repair or replacement accordingly. Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Queen`s Court DS0000015097.V291877.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!