Inspection on 23/05/07 for Queens Court Nursing Home

This inspection was carried out on 23rd May 2007.

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

Other inspections for this house

Queens Court Nursing Home 06/02/08

Queens Court Nursing Home 15/01/08

Queens Court Nursing Home 05/12/06

Queens Court Nursing Home 26/06/06

Queens Court Nursing Home 24/01/06

Queens Court Nursing Home 17/01/05

Queens Court Nursing Home 28/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Queens Court Nursing Home 52 - 74 Lower Queens Road Buckhurst Hill Essex IG9 6DS Lead Inspector Diana Green Key Unannounced Inspection 23rd May 2007 08:30 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 Queens Court Nursing Home DS0000015397.V340886.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. Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Queens Court Nursing Home Address 52 - 74 Lower Queens Road Buckhurst Hill Essex IG9 6DS 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) 0208 559 0620 0208 559 0315 queenscourt@hotmail.com Ranc Care Homes Limited Mrs Rosemary Mathias Care Home 90 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (22), Physical disability of places over 65 years of age (27) Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, aged 40 years and over, who require nursing care by reason of a physical disability (not to exceed 22 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 27 persons) Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 41 persons) The total number of service users accommodated in the home must not exceed 90 persons 26/06/06 Date of last inspection Brief Description of the Service: Queens Court is a purpose built two-storey care home for up to 89 residents. The home has a garden to the rear and a patio area to the front. It is near to the local shops and underground railway system. It has a bus stop nearby, and is within easy reach of the M25 and M11. The home provides personal care to people over 65 on the ground floor. The nursing units on the first floor are predominately for people over the age of 65, but people with physical disabilities above the age of 40 can also be accommodated. The home has a range of information for prospective residents and their representatives. At the time of inspection in May 2007 the fees were £444.45 to £1300. Additional charges are made for private chiropody, toiletries, newspapers and hairdressing. Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was undertaken on the 23/05/07. The report from the previous key inspection of 26/06/06 has not yet been agreed for publication with the Provider. An improvement plan was received from the provider that was taken into account during this key inspection. Two inspectors undertook this inspection that lasted 10.5 hours. The inspection process included: discussions with the registered manager, the deputy manager, the Nursing and Operations Director, the administrator, cook, care staff, five residents, seven visitors and feedback from relatives and health and social work professionals; a tour of the premises including a sample of residents’ rooms, bathrooms, communal areas, the kitchen, the laundry and the sluice-rooms; an inspection of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). The outcomes for people living in the home were inspected against twenty-nine standards and ten requirements and four recommendations were made. The manager and staff were welcoming and helpful throughout the inspection. What the service does well: What has improved since the last inspection? The service user guide and statement of purpose have been updated to include more in depth information. Redecoration of lounges has taken place and new flooring provided on Physical Disability Unit (PDU). Three small kitchens have had new units installed. Kitchen flooring has been replaced as per recommendation by environmental health visit. Relatives said things had improved since the previous key inspection. Efforts had been made to minimise the malodorous smell by purchase of an industrial cleaner and regular cleaning of carpets. The role of the deputy manager, who has been in post since 2003 and an employee since 2000, has changed to that of clinical manager. Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 6 Relatives were positive that the manager and deputy had been more in evidence throughout the home. Residents meetings have been established and a residents committee. Improvement have been made to ensure residents are enabled a choice of food. Care plans have been developed and these together with risks assessments are regularly reviewed. Care staff have been supported by the MacMillan Nurse to develop more of an insight into dealing with death and dying. Additional equipment (four pressure relieving mattresses and twelve profiling beds) have been purchased. Staff training has increased to include continence, infection control, health and safety. Some updated training has been provided in adult protection. A new complaints procedure has been developed and more robust procedures established. New system of quality assurance and auditing has been introduced and a new system of medicine management and assessment of staff established. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good based upon standards 1, 2, 3 & 6 Residents had the information they needed and had their needs assessed prior to moving in to the home. Changing/developing needs were assessed to ensure they were appropriately met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Contracts provide all basic details and the statement of purpose is accessible and available to all residents. Following the last inspection the manager confirmed that all residents had received a copy of the Service User Guide. The Service User Guide and Statement of Purpose have been updated to include more in depth information and are also available in the reception area of the home. Residents spoken with said that they did not have a copy of this document in their room. However they confirmed that their relatives had seen it and had taken it away. Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 9 A standard form of contract for the provision of services and facilities by the registered provider to the service user is available. This document, the Statement of Purpose and the Service User Guide are not available in the home in different languages or formats. However the manager and director of nursing reported that these could be made available should the need arise. The manager undertakes pre-admission assessments. This area was not looked at in great detail however, two residents spoken to remember viewing the home before admission. Although documentation was not looked at in depth, comments from residents and relatives indicate that the standard remains good. Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate based upon standards 7, 8, 9, 10 & 11. The home aims to meet the health and personal care needs of residents through regularly reviewed care planning and monitoring of care practice but inadequate staffing levels at key times mean this is not always achieved. Additional staff training and support from end of life care specialists, provides some assurance to residents they will be treated with care, sensitivity and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new system of documentation had been introduced. This included a person centred care profile, a form for resident’s consent, advocate approval, consent to the Mental Capacity Act and Data Protection, a pre-admission assessment, social care history assessment, risk assessments and nutritional/fluid balance charts. The files of four residents were inspected. All contained risk assessments for daily activities undertaken by the residents. These included risk assessment for falls, moving and handling, continence assessment, skin Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 11 assessment, mobilising. Regular weight monitoring was recorded with evidence that action was taken to provide soft diets and supplements as needed. Daily records were detailed and showed how residents were and what care had been given to them. Feedback was received from relatives that they were not always told when their loved one had been seen by health professional and rarely told of the outcome. The records contained contact details of health and social care professionals involved with the care of the resident and the outcome of visits. These included the GP, community psychiatric nurse, social worker, chiropodist, Macmillan nurse and physiotherapist. Information received from the provider stated that a certificated tracheostomy change assessment process for the registered nurses has been developed in consultation with the respiratory nurse consultant at Whipps Cross Hospital. Relatives raised concerns at delays in chiropody treatment being provided. Information received from the home confirmed that the chiropodist attended the home every four weeks but, due to work commitments is unable to visit more frequently; alternative chiropodists have been investigated but there is an increased cost that relatives are not willing to meet. Residents received annual eye tests at the home and a visiting dentist attended as needed. Records demonstrated monitoring of health care needs. Residents appeared to have their personal care needs met, although staff were rushed when providing care (reference also standard 27). However relatives raised concerns that staff do not provide personal care when changing incontinence pads and there were considerable delays in staff responding to residents’ toileting needs. Concerns were raised that advice with regard to positioning of resident was not actioned. One resident said they were disappointed at the lack of physiotherapy. The home had a policy and procedures for the safe administration of medicines but this was not available in the clinical room for staff guidance. Medication for residents on the first floor of the home was inspected. This was stored in two trolleys (one for each unit) that were secured to the wall of the locked clinical room. There was a controlled drug cupboard and a separate drug fridge. There was an air conditioning unit installed. Systems for monitoring daily fridge temperatures were in place and recorded. Medication was supplied by a local pharmacy in a monitored dosage system and individual containers and checked against residents’ prescriptions by a registered nurse. The home had a contract with a licensed contractor for the disposal of medication as required for a care home with nursing. Stock levels were at an acceptable level. The medication for four residents was checked. Medicines administration records were generally well recorded, but one omission had no reason recorded. Several liquid medications had no date of opening. Eye drops recommended to be stored in a refrigerator were stored in the drug trolley, placing them at risk of deterioration. Photographs of each resident were held with their MAR sheet. Registered nurses administered all medication in the nursing unit: a list of their signatures and initials being maintained for checking against. One resident was self-medicating but there was no risk assessment recorded to demonstrate Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 12 staff had assessed the risk. Lockable facilities were available for safe storage. The manager said that regular audits had been undertaken to ensure standards were maintained. Information received from the provider stated that an external medication assessors training course has been undertaken to enable senior staff to assess and monitor medication. Also an internal trainer had been employed and was developing a training package to ensure staff received updated training. Currently all staff designated to administer medication received training internally and by Boots pharmacy and their competencies were assessed. The home provided care for people at the end of their life and those needing palliative care and specific care plans had been developed for end of life care. Discussions were held with a Macmillan nurse who attended the home weekly to provide advice and to review medication for symptom control of residents with end of life care needs. She stated that the Gold Standards Framework had been introduced with staff training, which is acknowledged to be best practice in care of people with palliative/end of life care needs. A registered nurse with training in care of the dying was the link person on end of life care and a staff support group had been established to provide support to staff following deaths. All staff had been encouraged to attend these meetings. Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is adequate based upon standards 12, 13, 14 & 15. The food has improved however activities in the home are poor. As much as possible residents manage their own affairs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Of the six residents spoken to all said that there was not much to do in the home on a day-to-day basis. One resident commented that they do “nothing all day, just watch TV”. Another that the activities had replaced the physio session and there were not enough of them. On the day of inspection there was little stimulation for the residents. Residents were either in their rooms occupying themselves or in the lounge area watching TV or sleeping. Feedback from residents and their representatives indicated they were rarely taken into the garden and as yet this year, there have been no trips out for the residents. An outside entertainer does visit the home and there are notices up detailing sessions such as bingo, exercise and paws for friendship. Two physiotherapists visit the home and spend 15 hours giving physiotherapy and 15 hours activity time. However relatives said that physiotherapy was not offered but had to be referred through the GP. In one unit staff were seen to make an occasion of a Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 14 forth-coming national football event. Information received from the provider stated that a weekly cookery session had been established that was very popular with residents who took part. However the general outcome for residents is that they still felt that there was little to do. This matter was discussed with the manager. Currently the activities co-ordinator position is vacant and until this post is filled this situation will remain the same. The home is actively trying to recruit to this position however as yet they have not found a suitable person. Representatives of various faiths attended the home as needed and one resident was having communion. The home encourages family visits and on the day of inspection friends and relatives were observed visiting the home. Of those spoken to all said that they felt welcome in the home. Staff were seen to offer friends/relatives drinks and one person commented on how “good” the staff are. Visitors were seen talking in various areas of the home for example in residents’ bedrooms, lounges and in reception areas. Residents spoken with said that they can choose where they spend their time and that generally routines are flexible. For example one resident preferred to eat in their bedroom rather than in the dining room; also they could get up and go to bed when they chose. Residents’ rooms contained their personal possessions and some had their own mobile phones. Residents keep their own money or it is held safely in the general office. There are two visiting hairdressers and residents are enabled a choice. To help improve meals the manager has started a residents’ forum so that the residents review the menus to their own satisfaction. However there is still a mixture of views on the food that is served in the home. For example some said the food had improved and was a little better. Others said it depends on which chef is on as to how good the food is. One resident said that if you wanted food between meals all that was on offer was biscuits. This issue was taken to the manager. The manager reported that other food for example bread and cheese and soup has been placed in the kitchenettes so that staff can make residents a sandwich if they are hungry between meals. It was agreed that this would be communicated to all staff to ensure that they were aware that this facility is available for residents between meals. The inspectors observed lunch. The lunchtime meal was presented well and comprised a choice of cold ham or cheese and mushroom omelette with grilled tomatoes, mashed potatoes or chips and peas but there were no condiments provided to enhance the food. Cold drinks were provided with the meal. One staff member was serving 14 residents with no help. Therefore those that were last to be served waited for some time and there was a possibility that food would be lukewarm by the time they received it. Feedback from relatives indicated this was a frequent occurrence. This was also discussed with the manager who acknowledged that deployment of staff over mealtimes is an issue that they would look at. Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is adequate based upon standards 16 & 18. There is a satisfactory system in place to record complaints and the management are trying to raise relatives and residents confidence that their views are listened to. The management of adult protection is improving. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been complaints received by the Commission for Social Care Inspection about this home from residents, relatives and professionals. The complaints have ranged from poor care practice to staff shortages. There has also been concern raised about the home’s management not listening and acting on matters brought to their attention. Feedback received from a resident indicated they were afraid to complain as previously care staff had intimidated them. Discussion was had with the home’s management about the above issues. To deal with the above matters the management has stepped up the correspondence on complaints. The complaints system has been reorganised, along with accident reports. This is so that complaints and accidents can be better correlated and areas of concern identified within the different units of the home. A staff and residents’ committee has recently started to review care practices and other things such as menus. A relatives meeting has been held recently as well as the director of nursing holding surgeries in the home to make him more available. Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 16 The new system of recording complaints was seen and described the complaint, the investigation and the outcome. The complaints process is displayed in the reception area. However despite all of the above, feedback on the day of inspection still found that communication from residents’ relatives was an issue. In that they felt if they complained about an ongoing problem they did not feel confident that it would be fixed for them. The management of the home were made aware of this opinion and felt that once systems get established communication should improve. There have been two adult protection allegations made since the previous key inspection. The manager had investigated each following appropriate procedures. However one was still ongoing due to the alleged staff member’s sickness. A complaint had been made to the Commission for Social Care Inspection that the manager was slow to act on allegations of abuse. This was discussed with the manager who said she was not aware of the complaint. In the most recent case the management acted quickly to safe guard the resident. From the staff training list, of the 91 staff, 72 had received training on this topic in the last year. To ensure that staff understand abuse and what to do about it, they should have a yearly update. Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate based upon standards 19, 22, 24 & 26. Queens Court is generally clean and aims to provide a safe and wellmaintained environment, but some health and safety risks prevent this always being achieved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A partial inspection of the premises was made that included communal areas, bathrooms, a number of residents’ rooms, the kitchen, the laundry and sluices. Since the previous key inspection lounges have been redecorated, new flooring provided on Physical Disability Unit (PDU) and in the kitchen. Three small kitchens have been updated with new units. The floorboards to the first floor of the home were exceptionally noisy and the inspectors were advised that action was being taken, following a risk assessment for these to be re-screwed to the floor. Notification has been received since the inspection that this has Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 18 been actioned. Ramps were provided to enable access to the garden. Evidence of checks by the fire officer and environmental health officer were seen. The home has dining rooms and lounges in each unit. It was a sunny day and curtains needed to be drawn to shield residents from the sun. Purchase of blinds should therefore be considered. The home had two floors divided into units and accessible by a lift and stairs. There were grab rails, and aids in bathrooms, toilets and communal rooms. The home had assisted baths and shower rooms. Call systems were provided throughout all individual rooms and in communal rooms with leads to enable residents to call for assistance. Pressure relieving equipment was available including mattresses, airwave mattresses and cushions. A good range of equipment to aid daily living was available e.g. perch stools, helping hands etc. and one resident’s room was fitted with an overhead hoist. Several hoists were available to assist staff in moving and handling/transferring residents. Individual residents’ rooms were fitted with locks and keys were provided to those who had made a choice. Lockable facilities were provided for residents’ personal use. The wardrobe in one resident’s room was observed to be too small for a permanent resident and some clothing was stored on the door of the en-suite. This was brought to the attention of the manager who said that a suitably sized wardrobe would be provided. The home had its own health and safety policies and guidance. The home was generally clean and hygienic with no malodorous smells, however feedback was received from relatives that rooms were not always cleaned adequately and that the smell of urine in the corridors and in some residents’ rooms had been overpowering. However action had been taken to purchase an industrial carpet cleaner and the director of nursing said that some carpets would be replaced. Hand washing facilities (liquid soap and paper towels) were provided throughout, although some tablets of soap were found in bathrooms. Relatives spoken with said that staff did not always dispose of incontinence pads appropriately but left them on the floor. Some poor practice was observed (used pads left in an open bin, a urine bottle not cleaned between use, dentures not cleaned prior to soaking, inadequate cleaning of hoists and slings). This was discussed with the manager who said that some staff had been disciplined and further action would be taken to address the issues. The laundry room was well organised and fitted with three washing machines and two driers. Systems were in place to minimise risk of infection via the use of red bags for any laundry soiled by body fluids, placed directly in the washing machines; washing machines had the capacity to carry out sluice wash cycles. There was evidence that during a recent outbreak of infection, advice had been sought from the health protection agency and procedures followed as advised. Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate based upon standards 27, 28, 29 & 30. Staffing levels are insufficient at key periods during the day meaning residents have to wait to receive assistance. There is a robust recruitment system. Staff have not received updated training to ensure they are competent in all areas of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of inspection, at peak times of activity there were not enough staff to maintain care at a good standard. For example when inspectors arrived at the home in the morning the staff were very busy attending to residents and answering many call bells. One resident’s call bell rang three times in the space of half an hour. Indicating that staff did not have the time to deal with them at the first or second call. Also at lunchtime there was one staff member to serve fourteen residents in one unit and in another staff were seen to be rushing around. Relatives and residents have also reported that there are times when there is not enough staff available to meet their needs and that the one nurse available in one unit had little time to monitor or supervise care staff. To address this problem the manager is reviewing residents’ dependency levels to find out if more staff are needed and will consider other options for example dining room assistants. Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 20 The home continues to work towards NVQ training for 50 of their staff group. Currently fourteen staff have NVQ level 2, two have NVQ level 3 and seven are nearing completion of NVQ level 2. Four recruitment records were randomly selected and checked. All contained the required documentation and evidenced a robust recruitment procedure. Staff have attended training in subjects such as continence care, palliative care and also access training at St Francis Hospice. An external medication assessors training course has been undertaken to enable senior staff to assess and monitor medication. The manager said that there were plans to establish a link person for continence, dietetics, neuro-rehab and end of life care. However updated training was needed for staff in areas such as fire, manual handling and protection of vulnerable adults. The deputy manager provides health and safety training that includes Control of Substances Hazardous to Health (COSHH) and manual handling training as the designated trainer has recently left employment. It was noted that the laundry assistant had received no training in load management and the deputy confirmed that this was being investigated. There was evidence of skills for care induction training packages for new staff members. Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is adequate based upon standards 31, 33, 35, 36, 37 & 38. A management review and improvements in communication have provided some assurance to residents and relatives that standards will improve. A lack of updated training does not protect the health and safety of residents and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is a registered nurse with a Diploma in Management and has been at the home for 10years. Relatives said that the manager was helpful and always available. However recent staffing issues indicated a lack of adequate monitoring and staff supervision. A deputy manager had recently been appointed and it was expected that with this support, management of Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 22 staff would improve. The deputy manager is also a registered nurse and is undertaking the Diploma in Management. There was evidence of some updated training having been undertaken by both the manager and her deputy. A new system of quality assurance and auditing has been introduced. Information received from the provider stated that registered provider visits required under regulation 26 had been undertaken two weekly following concerns raised since 3/04/07 and reports were available. A staff meeting was also held on 26/04/07 to discuss the issues raised. Staff were funded to attend and 50 attended. Policies and procedures were regularly reviewed. Quarterly audits of the home have been undertaken that included staffing, training, records and document, food, care and the environment. Bi monthly and annual facilities audits are undertaken. Health and safety audit and quality audit are also undertaken. Residents’ meetings and a residents’ committee has been established. Residents have their own money wallet, which is held, in a safe place. Four records were checked. The balance for each was correct. All items purchased are evidenced with a receipt. There are clear records of money received in and money taken out. Currently staff are not receiving supervision six times a year. The manager is aware of this and is introducing appraisals for all staff with regular supervision to follow. The manager and Director have undertaken spot checks at night resulting in several staff being disciplined. Training/development opportunities have been offered to staff. Records held on behalf of residents were kept up to date and stored safely in secure facilities in a locked office in accordance with the Data Protection Act 1998. Records viewed at this inspection included: the statement of purpose/service user guide, fire records, electrical safety, medication, care plans, medication records, hoist and equipment maintenance, policies and procedures, accident records. The home had a new policies and procedures manual that included health and safety policy and procedures for staff guidance. The infection control policy contained a procedure to be followed in the event of an outbreak of infection Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities (e.g. gas, electricity certificates, lift, hoists, annual PAT testing etc.), and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g. checks on fire equipment and door closures, fire alarms and emergency lighting, hot tap water temperatures, etc.). Accident records were monitored monthly and trends identified and action taken and then information used for dependency reviews. Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 23 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X 3 X 2 X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 1 3 2 Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 24 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 OP8 Regulation 12(1)(a) Requirement Timescale for action 30/07/07 2. OP9 13(2) 3. OP12 16(2)(m) Residents must receive personal care when incontinence pads are changed to prevent infection and the risk of pressure sores developing. 1. Staff must clearly document 30/07/07 the reasons why medicines have been omitted to ensure residents receive medication as prescribed. 2. All medicines with a limited shelf life must be dated on opening medicines and must be stored in accordance with the manufacturers’ recommendations to ensure they have not deteriorated. This is a repeat requirement. Timescale of 14/08/06 & 1/02/07 not met. 3. Risk assessment must be recorded where residents selfmedicate to demonstrate risks are minimised. 1.Residents must receive 30/08/07 sufficient stimulating activities to enhance their daily lives. 2.Staff must receive training in the provision of activities for older people to ensure they are DS0000015397.V340886.R01.S.doc Version 5.2 Queens Court Nursing Home Page 25 4. OP15 16(2)(i) 5. 6. OP16 OP18 32 13(6) 7. OP26 13(3) 8. OP27 18(1)(a)(c ) 9. 10. OP36 OP38 18(2)(a) 18(1)(c)(i) skilled. This is a repeat requirement. Timescale of 14/05/06 and 01/09/06 not met. 1.Staff must be made aware that food is available between meals for residents. 2.There must be sufficient staff to serve residents their food to ensure they do not have to wait. Staff must feedback complaints to ensure that these are acted on. All staff must receive updated training on adult protection to ensure residents are safeguarded. This is a repeat requirement. Timescale of 1/09/06 not met. Infection control practices must be improved to ensure residents are not placed at risk of infection. Staffing levels must be reviewed to ensure that there are sufficient numbers of staff throughout the day to meet residents’ needs. This is a repeat requirement. Timescale of 01/09/06 not met. All staff must receive regular supervision to ensure they are competent in their practice. The registered person must ensure that all staff receive updated training in fire safety and moving and handling This is a repeat requirement. Timescales of 1/12/06 & 1/05/07 not met. 30/07/07 30/07/07 30/09/07 30/07/07 30/08/07 30/09/07 30/09/07 Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 26 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. 2. Refer to Standard OP1 OP8 Good Practice Recommendations The statement of purpose should be developed to include the end of life care services provided at the home. The registered person should consider increasing the physiotherapy hours, so that more residents can be provided with active rehabilitation. The purchase of blinds should be considered for the dining room to provide shade from the sun for residents. The registered person should ensure that a minimum of 50 of care staff achieve NVQ level two in care. 3. 4. OP20 OP28 Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Queens Court Nursing Home DS0000015397.V340886.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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