Inspection on 20/09/07 for Rebecca Court

This inspection was carried out on 20th September 2007.

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

Other inspections for this house

Rebecca Court 10/08/09

Rebecca Court 02/10/06

Rebecca Court 06/12/05

Rebecca Court 19/07/05

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 Rebecca Court 9 Staithe Road Heacham King`s Lynn Norfolk PE31 7EF Lead Inspector Mr Pearson Clarke Unannounced Inspection 20th September 2007 10:40 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 Rebecca Court DS0000035200.V351335.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. Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rebecca Court Address Rebecca Court 9 Staithe Road Heacham King`s Lynn Norfolk PE31 7EF 01485 570421 01485 572910 rebeccacourt@norfolk.gov.uk www.norfolk.gov.uk Norfolk County Council-Community Care 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) Ms Glynda Jermy Care Home 36 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (36) of places Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. 2nd October 2006 2. Date of last inspection 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. Rebecca Court is a large detached building set in its own grounds located in the village of Heacham, which is between Kings Lynn and Hunstanton. This is a non-smoking home for residents. Accommodation is in thirty-six single rooms on the ground and first floors. A small passenger lift is available. The current fees are £368.72 a week as stated in September 2006. Additional costs include chiropody at £8, plus hairdressing, newspapers, magazines, toiletries, clothing and the payphone at varying costs. Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from previous inspections, information from the providers ,the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home and this report gives a brief overview of the service and current judgements for each outcome. What the service does well: What has improved since the last inspection? Although the timescales for improvements to the building have not been fully met the Provider has committed to and started on significant improvements to the building, which will enhance the quality of life of those living there. There have been improvements to the homes pre-admission assessments work on which is on going. Care plans have improved including the development of a night care plan. Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 Page 6 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. Rebecca Court DS0000035200.V351335.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 Rebecca Court DS0000035200.V351335.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): 1 and 3 Quality in this outcome area is ( good.) That the service helps ensure that appropriate admissions are made through the use of sound assessments and prospective residents have the information they need to make an informed choice in respect of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit the inspector looked at the paperwork associated with recent admissions to the service and talked to the care co-ordinator leading the shift about the homes approach in this area. From this it was clear that the home has an appropriate approach to the admission of new residents. In addition to social work assessments, staff carry out their own documented assessment including a visit to the prospective resident wherever possible. These assessments are then used to compile a care plan which will be further enhanced as more information becomes available. During the visit the Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 Page 9 inspector was shown a new assessment format which is being introduced and should further enhance the quality of the process. The services Annual Quality Assurance Assessment indicated that care is taken to ensure that people considering admission receive all necessary information to help them understand what the home has to offer. As such people are encouraged to read the last inspection report and service user guide and are given information about how they should bring medication to the home. Discussions on the day confirmed the picture given in the Annual Quality Assurance Assessment. Rebecca Court DS0000035200.V351335.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): 7,8,9 and 10 Quality in this outcome area is ( good). Residents benefit from an agreed plan of care, a well managed medication system and staff who respect their privacy and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The services Annual Quality Assurance Assessment described improvements to the homes care planning system which have been introduced during the past year and these include the creation of a specific night care plan, improved plans relating to skin condition and fracture risk assessments used in the context of a falls prevention strategy. During the site visit the inspector looked at five care plans and found them to be well maintained, clear and comprehensive. As such risk assessments were in place, there was evidence of review and residents had signed to indicate acceptance of the plans. The plans evidenced a comprehensive approach to meeting the healthcare needs of residents with clear documentation of medical visits and treatment. The home Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 Page 11 uses the Malnutrition Universal Screening Tool and as indicated above is working with community staff to try and prevent falls. A visiting district nurse told the inspector it was a good home, the best in the area and that there was good communication with staff regarding residents care needs. The arrangements for the storage and medication of medication were inspected during the site visit. Part of the medication round was observed and appropriate practice was witnessed. The service has secure storage and an air conditioning unit is to be fitted in the drug room to reduce temperatures which at present can become too high. Good quality medication records were seen and the service carries out regular medication audits. A number of service users and visitors were spoken to, and in addition written comment was received. From this the inspector could see that staff are valued and felt to offer good care with respect for peoples dignity. Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is (good). That residents enjoy a relaxed lifestyle with good quality food and opportunities for stimulation and activity, although these are sometimes affected by shortage of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion with residents and visitors and observation during the site visit, confirmed a picture of a relaxed home in which people are able to exercise choice and control in their daily lives. There continues to be a good level of satisfaction with the food served and the service has implemented nutritional screening to help reduce any possible risk of malnutrition. There is evidence of good levels of regular structured activity planned. Including significant input from those who live in the home. However it was clear from conversation with staff on duty that on occasions staff shortages are compromising the ability to deliver what is planned. Written comment received Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 Page 13 showed that relatives feel that the home offers good care and that they are kept up to date with what is happening. One area of concern relates to the apparent arrangements for smoking available to the two current residents who smoke. As understood by the inspector this involves smoking in the open air some distance from the building which appears to be a highly unsatisfactory situation. In the light of this the provider must review this situation and a requirement to this effect is made. Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 Quality in this outcome area is ( good). That the service helps to protect residents through a sound complaints system and a robust approach to safeguarding. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Inspection of complaints records and discussion during the site visit confirmed the picture of a service which has a sound approach to complaints and safeguarding. The provider has well established policy and procedure for the protection of vulnerable adults and staff employed at the home have received safeguarding training. Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is (adequate). That residents are benefiting from improvements to the building with more necessary work planned for the near future. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The services Annual Quality Assurance Assessment listed a number of areas of improvement to the building undertaken since last inspected and these were confirmed by a tour of the building during the site visit. Previous inspection has lighted the environment as poor with a particular need to replace outdated and draughty windows. It was clear at this visit that work has begun to address areas of concern and notices were prominently displayed confirming all windows would start to be replaced in the near future and that a shower room Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 Page 16 was to be created. Discussion with staff on the day confirmed that more accessible toilets with easier access and hand washing facilities will also be created in the near future. All areas seen were clean and there was no unwanted odour. Residents spoken to confirmed that this was how the home was normally kept. Given the firm plans for work to be undertaken there are no repeated requirements relating to the premises, however the provider needs to keep under review possible future improvements to the building as areas such as the heating system and lift are not in line with current standards, with the former not allowing residents any individual control of the temperature in their rooms and the lift having heavy lattice gates. Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is (adequate). That residents benefit from well trained, competent and caring staff, however shortage of staff and the effect that this has on staff morale maybe compromising ability to deliver the care needed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the site visit the home had reduced staffing levels as a result of staff sickness and the inability of the home to obtain agency cover. Prior to the inspection the inspector received written comment from relatives which raised this issue as a concern. This was discussed with staff on duty at the time of the visit and from these discussions it was suggested that this has been a consistent problem for some time. This was impacting on the morale of the staff spoken to, which the inspector found to be worryingly low. However the inspector was not able to ascertain if this was an extensive issue as it was not possible to gain the managers views and the numbers of staff spoken to was relatively low. There was a strong perception that dependency levels have got higher and higher and that staffing levels have not adjusted in line with this. In the inspectors opinion the issue of shortage of staff and inability to cover shifts is a concern which the provider must monitor and where necessary Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 Page 18 address in order to maintain the usual good standard of care that the service offers. It is also of concern that when shifts are covered staffing levels may not be sufficient to meet need. On the day of the site visit the home was not full, however when full the home can take 36 people with 8 of those having dementia. The normal rota pattern will allow for 4 care staff on duty on an early shift and 3 or 4 on a late. Given that the building is large and on two floors it is possible that this is impacting on the ability to offer residents an individualised service. Indeed when asked, the staff spoken to felt that although they were meeting peoples basic needs, this was often in a rushed manner. As such there was little or no time to give individualised care and recently things such as the provision of activity had suffered. Again the provider needs to satisfy themselves that staffing levels are sufficient to ensure good quality care delivery. From observation and the views of residents, the staff are hard working, caring and good at their jobs, however the low morale encountered has the potential reduce their effectiveness. Training records show that people are well trained and the provider’s employment process is sound and this was confirmed by discussion on the day. Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is ( good). Residents benefit from a well run home where their interests are to the fore, however the management team needs to consider how best to support staff and address issues of poor morale This judgement has been made using available evidence including a visit to this service. EVIDENCE: The last inspection of the home found a well managed service with an effective management process in place. The site visit on this occasion coincided with the service manager being on annual leave and as such it was not possible for the inspector to hear her views on particular issues such as staffing. However from inspection of records and receiving the views of others the inspector believes Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 Page 20 that the home is still effectively managed. Despite this the issue of addressing staff morale is an important management challenge and it was the perception of the inspector that there is a danger of the staff team as a whole losing unity with the potential for this to effect service delivery. Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 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 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x 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 x 18 3 2 x x x x x x 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 x 3 x 3 x x 3 Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 Page 22 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 OP27 Regulation 18 Requirement That the provider considers ways in which the regular shortage of staff can be addressed to ensure a more consistent service. That the provider review core staffing levels in the home in relation to the numbers cared for and their dependency. That the provider review the current arrangements for residents to smoke to ensure that they can do so in a reasonable setting. Timescale for action 31/10/07 2 OP27 18 30/11/07 3 OP12 13 (4) 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 Page 23 Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Rebecca Court DS0000035200.V351335.R01.S.doc Version 5.2 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!