Inspection on 03/10/08 for Regency Court Residential Home

This inspection was carried out on 3rd October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Regency Court Residential Home Thwaites House Thwaites Keighley West Yorkshire BD21 4NA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sughra Nazir     Date: 0 4 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Regency Court Residential Home Thwaites House Thwaites Keighley West Yorkshire BD21 4NA 01535606630 01535602257 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Fawzia Bibi Pitteea Type of registration: Number of places registered: ADA Care Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Regency Court is located in a rural setting two miles from the town of Keighley. The village of Thwaites is a short walk from the home and there are local bus routes into Keighley town centre. The home provides residential and personal care to people over the age of 65. Care can be provided to a small number of people with dementia. This former farmhouse is an adapted property located in its own well maintained grounds. Care Homes for Older People Page 4 of 28 Over 65 0 16 4 0 Brief description of the care home Accommodation is on the ground and first floors and there are some changes of levels on both with short flights of stairs. Therefore people living in the home need to be fairly mobile. There is a stair lift to the first floor. Communal areas comprise of a lounge and a dining room. In addition, there is a conservatory that is the designated smoking area for people who live in the home. To the rear of the building is a pleasant patio for people to sit and enjoy the views when weather permits. Car parking is provided at the front and rear of the building. The main entrance is at the top of a flight of stairs but there is level access at the rear of the building. Information about services provided in the home is included in the Statement of Purpose and Service User Guide. Copies are kept in the home and can be provided on request. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Information provided by the manager indicated that the current weekly fee for the home depends on the level of need and room size. Additional costs include the provision of extra support by staff, toiletries, hairdressing, holidays, leisure activities and clothes. This is what we used to write this report. We looked at information we have received about the home since the last key inspection. We asked for information to be sent to us before the inspection, this is called an annual Care Homes for Older People Page 6 of 28 quality assessment questionnaire. We sent surveys to people living in the home and some surveys were also filled in by relatives. We visited the home. This visit lasted over six hours and included talking to the staff and the manager about their work and the training they have completed. We also checked some of the records, policies and procedures the home has to keep. We spent time talking with people who live in the home and two relatives. We looked at four peoples care records to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. We focused on the key standards and what the outcomes are for people living in the home. We have reviewed our practice when making requirements, to improve national consistency. In future if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 28 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before they come to live at the home, this means they can be sure that the service will be able to meet their needs. However they do not have all the information they need about the home its staff and services to help them to decide if the home will suit them. Evidence: We saw that the information that should tell people about the home needs to be made uptodate so that people have accurate details for the home, its owners, manager, staff and services. The current registration certificate should be displayed and statement of purpose and service user guide updated. One person told us they had not received enough information about the home before they moved in. A relative said there should be better information for residents and families. Care Homes for Older People Page 11 of 28 Evidence: The document the home sent us tells us that they carry out a full assessment of peoples needs and that people are encouraged to come and look round the home before making a decision about staying. We looked at the care files for four people and saw that each contained an assessment of that persons needs. The manager told us that the home is in the process of reviewing all its documentation. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care people receive may not be based on their individual needs. Care plans and medication policy and practice need to be improved so that people receive the health and personal care they need. Evidence: We looked at the care files for four people. They need to be updated and used by staff to help them care for people. We saw that one persons file said they were deaf in one ear but staff we spoke to did not know this and there was no care plan telling staff how to communicate with this person. We also saw staff helping someone with a visual impairment to move around the building. There was no care plan telling staff what to do to make sure they supported the person safely. We saw two examples of people whose needs had changed according to the daily records but no changes had been made to care plans. We do not know if care staff look at care plans regularly. One relative told us When Care Homes for Older People Page 13 of 28 Evidence: new staff first care for my father, it would help if an experienced staff member could instruct on fathers requirements. He worries that he does the training with regard to his special needs. Another relative said more attention should be paid to residents problems like health and other worries that residents have. Care files showed that people have contact with healthcare services. One relative we surveyed said I often find tablets on the floor when I visit which could be vital to the one who (has) lost it. The home uses a monitored dosage system and receives prefilled boxes from the pharmacist each week. The pharmacist orders medication directly from the gp and items are checked in by the home upon receipt. This is unsafe practice as the home should see what is ordered so that there is no risk of people not getting their prescribed medication. We saw the next weeks supply of medication in the office in a plastic container. We were told that the container is transferred to a locked room once it is checked in and that this usually happens on the same shift. Controlled drugs are kept in a wooden box in the main medication cabinet. The manager is aware that this does not mean current guidelines and is requesting a metal container which will comply. This will mean that there is less risk of medication getting into the wrong hands.There was one error with controlled drugs as previously the home was using the running balance of tablets outstanding to work out whether the person had had their tablets or not. They now use both the medication chart and two staff signatures in a controlled drugs book. The medication policy needs updating to make sure staff have full instructions on how to order, store and administer medication in line with current good practice. The policy should detail the arrangements for people who administer their own medication. We saw a staff member wake up a person in the lounge and give them a shave. This is poor practice as it shows a lack of respect for the persons privacy and dignity. We brought this practice to the attention of the manager to address with the staff member concerned. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples access to activities is limited but improving. More attention to peoples social needs would improve mealtimes. Evidence: We saw that there was an activity plan displayed on the wall. We also heard an entertainer in the lounge and people told us they enjoyed this activity. One relative told us I dont feel they do enough for the old folk and they are bored. There are no magazines, newspapers etc for them to read. Theyre not encouraged to walk about Another relative said Residents need to be stimulated more not just left in front of the tv or left in their room. Activities provided are being improved, but staff need to make sure that they take account of the social needs of people who spend a lot of time in their rooms. People told us that they attend religious meetings outside the home. They are in contact with family and friends. Care Homes for Older People Page 15 of 28 Evidence: The dining room has been refurbished and we saw that people had their lunch in comfortable surroundings. People who needed help received it. However staff could use the opportunity to engage and interact with people more. The staff are starting to include more choice at mealtimes. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People need uptodate information on how to make their views known. More staff training and robust adult protection procedures are needed to make sure people are protected from abuse. Evidence: People do not have access to an uptodate complaints procedure. The procedure displayed in the home still gives the previous owners details. People should be given correct information so that they know what to do if they have a complaint. The information should be made available in a format that suits peoples needs. There have been 2 complaints to the Commission about this home since it was registered under new ownership. Complaints recording needs improvement and the manager is in the process of setting up a record so that she can be sure that all complaints have been responded to promptly. Some staff have had local authority training that tells them about looking for abuse. More staff need this training so that they can help keep people safe and protected from abuse. One survey we had told us about an incident that a person had reported to two staff members. This had not been reported by them to the manager. Procedures need to be made more robust so that the home protects people. Care Homes for Older People Page 17 of 28 Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean environment but bathroom facilities are currently limited. A programme of refurbishment will improve the standard of accommodation. Evidence: The shared spaces in the home were clean. Some carpets we saw were worn. but some bedrooms needed cleaning. Carpets were not vacuumed and surfaces were unclean. A relative said The cleaning of rooms need to improve with a rota for general cleaning and a deeper cleaning structure. Also records of cleaning should be available for residents and families. The manager told us that a new cleaner had been appointed and was due to start work soon. One relative told us some improvements re furnishings needed We saw that the dining room had been redecorated and some bedrooms were being redecorated. We saw a large number of carpets waiting to be fitted. There is a plan in place to refurbish the home. The manager told us that people who live at the home have been asked their views about the changes. Care Homes for Older People Page 19 of 28 Evidence: An assisted bath has been replaced but people feel unsafe on the ramp that leads up to the bath. The manager and owner said that this was being looked at urgently. In the meantime they said they would reinstate the shower and look at ways of using the other bathroom for more people. This is important because a number of people told us that they have not been able to have a bath for a few weeks. One relative told us they pick their relative up to go out and they usually smell and their hair is a mess. They feel more could be done about their personal hygiene The stairlift is due to be serviced and the manager is in the process of finding out about replacing the stairlift. People told us laundry facilities were good. However the limited access to full bathing facilities and drop in cleaning standards may lead to an increased risk of infections. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care needs are met. Staff will benefit from the planned training and support. Evidence: One person said There have been staff changes One relative told us This job needs 100 per cent dedication from the nurses and I don;t feel some of them are. Ive heard abruptness from some of them They need more qualified staff with better experience. The manager showed us papers that confirm that individual staffing issues are bieng addressed. The manager told us that staffing levels have been reviewed and that she will make sure that there are adequate numbers of staff available at peak times. We saw a training plan that showed when staff will be going on courses to help them look after people safely. We looked at recruitment files. The new owner and manager have taken over a running service and staff. Their files show some gaps. The manager is confident that any new staff she recruits will have all the checks necessary to make sure that they Care Homes for Older People Page 21 of 28 Evidence: are safe to work with older people. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and administration of the home must continue to improve to ensure that peoples care needs are met. Evidence: We sent the home a self-assessment to complete and this was not returned until several months after the return date. Relatives told us that the home needs better management and a more robust programme of care There is a new manager in post and she is told us she is in the process of registering with the Commission. Information we received from the home tells us that the manager knows what changes are needed to imrpove the quality of care at the home. During the visit we saw that Care Homes for Older People Page 23 of 28 Evidence: some changes are being made to the environment and polices and procedures are being drafted. More robust procedures are needed for example medication and adult protection. This will mean that people are not put at risk and staff have safe working practices. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 12 Medication policy and 30/01/2009 practice must be reviewed to make sure that the ordering storage and administering of all medication complies with current best practice and Royal Pharmaceutical Society of Great Britain Guidelines. This will help make sure that people get the medication as prescribed by their doctor 2 18 13 A clear and robust adult protection procedure must be put in place This will help make sure that people are kept safe from abuse. 30/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The homes statement of purpose and service user guide should be updated to show the homes current ownership Page 26 of 28 Care Homes for Older People management and staff details. The current registration certificate should be displayed. This will mean that people have accurate information about the home and its services. 2 7 Peoples care plans should be updated to show their full needs and provide staff with clear instructions on how to meet those needs. People should receive personal care in private so that their dignity is not compromised. People should have access to a range of activities and stimulation that is based on their individual needs and preferences. This will mean that peoples wellbeing is maintained. People should be given access to information that tells them who to complain to and how. This will help make sure that the service listens to and responds to peoples views and concerns All staff should receive training on adult protection. This will help keep people who live in the home safe from abuse. The standard of cleaning in bedrooms should be improved to make sure people live in a safe clean environment. The assisted bath should be put to safe use as soon as possible. The shower should be reinstated so that people are able to wash independently. Records, policies and procedures should be revised as planned. This will help make sure that staff have safe working systems and that people are kept safe. 3 4 10 12 5 16 6 7 8 18 19 21 9 38 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 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. 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!