Inspection on 19/07/05 for Rebecca Court

This inspection was carried out on 19th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Rebecca Court 10/08/09

Rebecca Court 20/09/07

Rebecca Court 02/10/06

Rebecca Court 06/12/05

Rebecca Court 06/01/05

Rebecca Court 12/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Rebecca Court 9 Staithe Road Heacham Kings Lynn PE31 7EF Lead Inspector Jenny Rose Announced 19 July 2005 th 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 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. Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Rebecca Court Address 9 Staithe Road, Heacham, Kings Lynn, Norfolk 01485 570421 01485 572910 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Norfolk County Council Ms Glynda Jermy Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Thirty six (36) service users may be accomodated of wither sex who are aged over 65 years. That Norfolk County Council undertakes a review of the windows with a view to replacement of those which are causing discomfort to the service users. The review to be carried out by the end of March 2004 Wheelchair users may be admitted only to rooms of at least 12 sq m, rooms numbered 10, 11, 24, 32, 33, 35, 36, 49, 50, 61, 62, 65, 66, 67 as at 31 March 2003 Date of last inspection 6th January 2005 Brief Description of the Service: Rebecca Court is a care home providing personal care and accommodation for thirty-six (36) older people. The Home does not provide nursing care. It also has two day care places each day of the week, including weekends. The Home is owned by Norfolk County Council-Community Care. The home is located in the village of Heacham, which is between King’s Lynn and Hunstanton. Rebecca Court is a large detached building set in its own grounds. Accommodation is in thirty-six single rooms on the ground and first floors. A small passenger lift is available. Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection taking place over 7.5 hours. The manager, Ms Glynda Jermy was in attendance throughout the day. There was a preinspection questionnaire, 21 completed comment cards and pre-preparation in the CSCI office. A tour of the building was undertaken and records seen. Three service users were spoken to privately, as well as a group of six and a group of four service users and three members of staff privately. What the service does well: What has improved since the last inspection? What they could do better: * Care plans, including those requiring ‘add ons’ for service users diagnosed with Dementia should be completed. * Numbers of care staff should continue to be assessed according to service users’ changing needs. * Although gravel paths outside have been risk assessed, hard paving paths would make the gardens more accessible to service users. Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 Page 6 * There should be a plan for replacing the windows throughout the home. * The patio area next to the dining room needs attention so that it is a safe and attractive area for the service users to sit in. * Hand basins should be provided within each toilet area. * All bedrooms needing redecoration should be completed as soon as possible. * Wheelchair damage to doorways should be repaired and redecorated. * The towel rail in the ‘flat’ used by service users should be removed, or covered to ensure a safe surface temperature * The electric cooker in the ‘flat’ should be disconnected to ensure protection for service users.. 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. Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 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 standard(s) 2,5 Prospective service users and their relatives are able to visit and assess the suitability of the home before making the decision to move into residential care. EVIDENCE: There is a revised Statement of Purpose describing facilities , qualification and structure of the organisation of staff within the home, together with the admission and complaints procedures; the ethos and aims and objectives of the home. Service users spoken to confirmed that they and their relatives were encouraged to visit the home prior to admission and they then move in on a trial basis for one month to 6 weeks, when there is a review meeting, with other healthcare professionals, if required. Many of the service users in the home received day care and periods of short term care before becoming permanent residents. Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 Page 9 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 standard(s) 7,8,9,10 The home had worked hard to improve the care plans, but this needs to be completed to ensure that service users’ needs are met. The policies and procedures for administering medication were in order, ensuring as much protection as possible for service users. EVIDENCE: It was evident that a great deal of work has been carried out on service users’ care plans which are County Council plans. Two were comprehensive and with good detail. There were photographs and a good life history. There were details of preferences and diet, personal care needs and routine, and wishes for funeral arrangements. These were reviewed monthly with the key-worker and signed by a relative. In addition there were nightcare plans, and risk assessments for windows, bath hoist, lift also District Nurse GP visits as well as contact with other healthcare professionals. Room cleaning was also recorded. One care plan was awaiting a photograph, although was complete in other respects and another was incomplete, although the service user had visited the home for day care and short term care before becoming a permanent resident. The Manager said that the care plans would shortly include an ‘add-on’ to the Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 Page 10 care plans for those service users diagnosed with Dementia. There is therefore a requirement that all care plans should be completed and up-to-date. Service users spoken to were appreciative of the care they received in the home, one commented: “I get on well with the staff”. They spoke of the staff treating them with respect and allowing them privacy. The comment cards were positive about the care provided by the home. The medication round at lunch time was observed, being administered by a Care Coordinator, who had attended a pharmacy medication course. The medication was seen to be administered appropriately from an MDS system. The MAR sheets were in order, with photographs of service users. Medication for service users who were in the home for short term care were kept in labelled boxes in the locked trolley. Controlled drugs were kept appropriately in a Controlled Drugs Cabinet. Homely Remedies were recorded separately. There was no one administering their own medication at the time of the inspection, but there is a policy in place for this. Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 Page 11 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 standard(s) 12, 13, 14, 15 There are activities organised which bring interest to service users’ lives. The home is commended for the involvement of service users in decisions in the home and particularly for the variety of food and its presentation in providing service users with a nutritious and appealing diet. EVIDENCE: The service users spoken to were happy with the level of activities provided, they spoke of playing indoor bowls, sing-songs and church services, in which they could participate if they wished. A clothes shop and the local pharmacy visit the home, and there are outings to places such as Sandringham and Hunstanton and also individual accompanied outings, if service users wished. They also spoke of their relatives visiting and taking them out. There is an activities room and there is a regular Bingo afternoon, run by a relative of a service user, which is very popular. One service user has her own mini greenhouse, which she was observed tending. There is good communication of service users’ wishes, evidenced with the naming of two sitting areas . In the redecoration of two toilets, as required at the last inspection, service users had been consulted on colours with local connections, i.e. lavender and sunflowers, both of which are grown locally and Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 Page 12 two members of staff had carried out the redecoration. This control and choice over their lives was also demonstrated by service users choosing to have photographs in the dining room of past events and current events, i.e. a duck and her ducklings, which had been nesting in the patio area. There were also photographs of service users enjoying using the Karaoke Machine, recently purchased, which is popular with many. Service users take their meals in the pleasant dining room, if they wish, but many choose to take breakfast and tea in their rooms. Staff sit with service users at a separate table to help those people who need help with feeding, if necessary. The meal was seen to be appetising and nutritious and attractively presented. There was a good choice of menu, with a vegetarian and salad option every day, as well as special diets, if necessary. One service user was particularly complimentary about the home-made cakes and rolls made by the cook. Service of desserts and tea or coffee to service users was from a trolley, as in restaurant service, with individuals being asked as to their preferences. There have been service users’ meetings with the cook, as a result of which, preference in fillings for sandwiches has been incorporated into the menu. The previous day the Norfolk delicacy of samphire had been served at tea-time, which two service users, in particular, had enjoyed. This is to be commended. Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 Page 13 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 standard(s) 16, 18 There is a clear complaints procedure and complaints were dealt with appropriately ensuring that service users were assured these were listened to and acted upon. Staff training in Adult Abuse Awareness helps to ensure as far as possible that service users are protected from abuse. EVIDENCE: There is a clear complaints procedure and complaints were seen to have been dealt with appropriately, and this was confirmed by one particular service user. Service users spoken to knew to whom to complain, if necessary. All staff spoken to had received training in Adult Abuse Awareness and were aware of the home’s Whistle Blowing Policy. Further training is planned in the next few months. Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 Page 14 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 standard(s) 19, 20, 23 26 There are a number of outstanding requirements and recommendations concerning the environment, which are not in the control of the Registered Manager, which if carried out would make for a more comfortable and safer living environment for service users. The most important and most outstanding of these is to do with the windows. EVIDENCE: There are several sitting areas in the home and the service users have been involved in naming two of these, one with a local connection after the Lavender Fields and these are decorated and furnished in a homely manner. The Dining Room is pleasantly presented with tablecloths and flowers on the tables. As stated elsewhere, two toilets have been redecorated by members of staff in consultation with service users, since the last inspection and all taps have been fitted with regulators. There are spacious gardens surrounding the home, but there are gravel paths, which have been risk assessed, and they are uneven and service users cannot Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 Page 15 access the garden without being accompanied. There is therefore a recommendation that consideration should be given to providing some hard, level paths to provide better access to the garden for service users. There are various requirements and recommendations from the previous report which are repeated. These are beyond the control of the Registered Manager and have been reported to the Property and Procurement Department at County Hall. For example, the recommendations to redecorate bedrooms and repair and redecorate the areas damaged by the use of wheelchairs are repeated in this report. There is also the outstanding plan condition of registration concerning windows throughout the home with a view to replacement. At the point of registration of this local authority home a condition of registration was imposed which required Norfolk County Council to review all of the windows with a view to replacement of those which were causing discomfort to the service users. This should have happened by March 2004. To date the Commission has not received the results of this review (if indeed it has properly taken place) and the Commission has not received any plans for removal of the windows. This is now extremely urgent as the home is being operated in contravention of its Conditions of Registration. The Manager said that the towel rail in the ‘flat’ used by service users was to be removed in the next few days, but this requirement is repeated. In addition there are no plans to satisfy the requirement that the patio area next to the dining room receives attention, so that it is a safe and attractive area for the service users to sit in. There are no plans for hand basins to be provided within each toilet area and there are still bedrooms in great need of being redecorated. Many of the bedrooms seen were personalised with service users’ own possessions and were homely and comfortable. There is an unsafe chair in one bathroom, which is not at present being used because of this, and in another bathroom where a shower room is planned, the bath needs attention. It should be noted that at present there are exposed hot water pipes in this bathroom, which need to be covered. There are therefore requirements that both these bathrooms need attention. In a tour of the building it was noticed that an electric cooker, in a small kitchen which some service users use at breakfast time and have personalised, was still connected, although it is not used. There is therefore a requirement that this should be disconnected for safety reasons. Staff have received training in infection control and all areas of the home were seen to be clean and hygienic. Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 Page 16 Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 There has been a recent improvement in the numbers of staff, but this needs to be continuously monitored in order to ensure that the changing needs of service users is met. EVIDENCE: It was evident that staff were enthusiastic and enjoyed their work, although there were some comments that there were occasions when they were under pressure and that there was not always enough time for talking with service users. All staff spoken to spoke of getting on well as a team and that the Manager was very approachable and any problems were tackled by regular supervision. They all felt there was time to discuss matters at the handover of shifts. The Manager explained that there has been an increase recently in the number of staff hours with extra hours for those service users with Dementia. She also reported that she was able to bring in extra staff based on an assessment and review of service users’ needs at particular times of the day or during periods of illness. However, this needs to be continuously monitored and there is a requirement for this. One member of staff expressed her appreciation of the opportunities there were for training, although the numbers of staff with NVQll had not reached 50 , despite 7 members of staff currently undertaking this training. There is much training planned, including Reminiscence and Dementia training, as well as in-house training focussing on life histories and care planning with more Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 Page 18 detailed recording in care plans regarding accidents, to enable monitoring to be carried out more easily, which is to be commended. The staff files seen were seen to include the necessary information and the home follows the County Council’s recruitment procedures. Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 38 There was a quality assurance system in place, which helps to ensure that the home is run in the best interests of service users and the health and safety of service users and staff. EVIDENCE: There had recently been a survey for the service users, relatives and staff. These had not yet been analysed, but the Manager would forward them to the Commission for Social Care Inspection when this had been completed. Service users meetings, as well as staff meetings, are held regularly and from elsewhere in this Report it is evident that service users are consulted on many issues which affect their lives. Both service users and staff spoken to confirmed that the Manager was always approachable. A number of records were examined regarding COSHH Assessments, serviceing of the lift and the Fire Inspection, as well as audits for water Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 Page 20 temperatures, First Aid, Fire Exits and Health and Safety issues and these were seen to be up-to-date and in order. Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 3 2 x x 3 x x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x x x 3 Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The Registered Manager must ensure that the service user plans continue to contain detail about the individual needs of the service users. (This is a repeat requirement) The Registered Person must ensure that there is a plan for replacing windows throughout the home. (This is a repeat requirement) The Registered Person must ensure that the towel rail in the flat used by service users is removed or covered to ensure a safe surface temperature. (This is a repeat requirement) The Registered Person must ensure that the patio area next to the dining room receives attention so that it is a safe and attractive area for the service users to sit in. (This is a repeat requirement) The Registered Person must continue to ensure that adequate staff is provided to meet the changing needs of service users. Timescale for action Immediate and ongoing 2. OP25 23(2)(p) 30 September 2005 31 October 2005 3. OP21 13(4) 4. OP19 23 (2) 31 October 2005 5. OP27 18(1)(9) Immediate and ongoing Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 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. 2. 3. 4. Refer to Standard OP10 OP19 OP19 OP38 Good Practice Recommendations It is recommended that hand basins are provided within each toilet area. (This is a repeat recommendation) It is recommended that the redecoration of the bedrooms be completed as soon as possible (This is a repeat recommendation) It is recommended that any wheelchair damage to doorways be repaired and redecorated (This is a repeat recommendation) It is recommended that the electric cooker in the flat should be disconnected to ensure protection for service users. Rebecca Court I55 s35200 rebeccacourt v232282 1907005 stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 3BN 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. 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