Inspection on 23/11/06 for Regents Court Care Home

This inspection was carried out on 23rd November 2006.

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 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

Regents Court Care Home 31/01/09

Regents Court Care Home 16/06/08

Regents Court Care Home 06/11/07

Regents Court Care Home 20/10/04

Regents Court Care Home 30/04/04

Regents Court Care Home 12/01/04

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

CARE HOMES FOR OLDER PEOPLE Regents Court Care Home 128 Stourbridge Road Bromsgrove Worcestershire B61 0AN Lead Inspector N Richards Unannounced Inspection 23rd November 2006 12:00 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 Regents Court Care Home DS0000004151.V319896.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. Regents Court Care Home DS0000004151.V319896.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Regents Court Care Home Address 128 Stourbridge Road Bromsgrove Worcestershire B61 0AN 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) 01527 879119 01527 872631 c.wood@alphacarehomes.com Alpha Health Care Limited Mrs Pauline Vernon Care Home 37 Category(ies) of Dementia - over 65 years of age (37) registration, with number of places Regents Court Care Home DS0000004151.V319896.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Not applicable. Brief Description of the Service: Regents Court was established as a care home in 1984, and is set in the heart of Bromsgrove. When first registered only personal care was provided, then the home was registered to provide both personal and nursing care for a maximum of 30 older people. It was then temporarily closed and completely refurbished, and is now registered to provide personal and social care to a maximum of 37 older people with dementia. The home has been refurbished to a positive standard, with accommodation provided on two floors. Access is provided to both floors by way of either stairs or a central passenger lift. The home is part of a group of homes owned by Alpha Health Care limited. Regents Court Care Home DS0000004151.V319896.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over a period of three hours, and was carried out to assess the home’s performance against key standards within the National Minimum Standards (Care Homes for Older People). A tour of the premises took place and staff and care records were inspected. Due to the nature of the conditions of the residents within the home, it was impossible to ascertain their opinion about the quality of service provided to them. However, opportunity was taken seek the opinion of residents’ relatives, and to observe care interactions and resident responses to the interactions. Since the time of the previous inspection (“Wayside Stourbridge Road”), a new manager has been registered with the CSCI. At the time of inspection, the home was operating at 73 occupancy. The home charges fees ranging from £460.00 per week to £500.00 per week. The fees do not include costs for hairdressing, private healthcare, newspapers, aromatherapy and toiletries. What the service does well: What has improved since the last inspection? What they could do better: Regents Court Care Home DS0000004151.V319896.R01.S.doc Version 5.2 Page 6 Care plans require significant development and staffing levels need to be reviewed to ensure that staffing levels within the home are sufficient to meet the (complex) needs of people using the service. 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. Regents Court Care Home DS0000004151.V319896.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 Regents Court Care Home DS0000004151.V319896.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): 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient effort has been made to develop an admission procedure that ensures there is a proper assessment prior to people moving into the home. This helps to ensure that care needs can be met. EVIDENCE: Individual records are kept for each of the residents, and inspection of the records for three residents had full assessment information recorded. Most residents in the home were unable to comment on the homes ability to meet their needs, due to memory loss problems. However, staff interaction and interventions with residents was observed, leading to the conclusion that the home could effectively engage with and meet the needs of people who can demonstrate some very challenging behaviour. Regents Court Care Home DS0000004151.V319896.R01.S.doc Version 5.2 Page 9 Each care file examined had a contract, which had been countersigned by each resident’s next-of-kin and a home representative. The home does not contract to provide intermediate care. Therefore Standard 6 is not applicable to the home. Regents Court Care Home DS0000004151.V319896.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 adequate. This judgement has been made using available evidence including a visit to this service. The standard of care records within the home is poor. Records are not sufficiently detailed to ensure that individual residents’ needs are met in a consistent manner. Medication was being appropriately managed, and care practice seen confirmed that care needs were being effectively met. EVIDENCE: Three residents’ care files were examined during the inspection. Each resident had a care plan in place, but the quality and content of care plans was poor. Care plans failed to effectively specify how care is to be delivered. The following deficits were noted about care documentation; 1. Care plans had not been formally agreed with and counter-signed by the resident and/or their next-of-kin. This is necessary to ensure that the home (a) works in participation with the individual (rather than working Regents Court Care Home DS0000004151.V319896.R01.S.doc Version 5.2 Page 11 to preclude the individual from the care process), (b) engages the individual within the care process, and (c) ensures that the individual understands and consents to the care provided. 2. Care plans need to be more specific and directive. For example, one care plan relating to the management of “paranoia” cited the care need as “xxx gets very paranoid at times”, the care objective was “To ensure xxx relaxes more and less paranoid” (sic), and the plan of care was simply “To monitor xxx on a monthly basis”. 3. Care plans were not being reviewed in accordance with the frequency specified by the National Minimum Standards i.e. at least once a month. This is important to ensure that (a) any changes to a person’s condition are noted, and (b) the plan of care is amended in response to any change/s noted. 4. Although each file contained a range of risk assessments and health care assessments, some required further development as; (a) one file contained a falls risk assessment indicating that the person had been assessed as being at high risk of falling. No suitable care programme had been developed to address the identified risk and (b) one file contained a moving and handling risk assessment, which cited the individual as being at “moderate risk”. However, no plan of care had been formulated in response to the identified risk. It was noted that medication administration record (MAR) charts had, generally, been accurately completed by staff. There were exceptions to this. For example, manual alterations had been made to the pre-printed MAR charts, but had not been countersigned by two care staff to confirm the authenticity and accuracy of the manual amendment(s). Some residents had been prescribed medication on a variable dose basis. The MAR charts did not always illustrate the actual dose administered when a variable dose medication had been administered. Residents seen appeared content, and were having their care needs met in a dignified and respectful way. Staff were seen providing care sensitively and discretely to residents. Regents Court Care Home DS0000004151.V319896.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. This judgement has been made using available evidence including a visit to this service. Meals are well managed, creative and provide daily variety and flexibility for people living in the home. Residents have opportunities to participate in leisure and recreational activities that meets their needs and expectations. Contact with family and friends is supported, and opportunities for residents to exercise choice over their lives has been maintained to enable them to maximise personal autonomy. EVIDENCE: Menus were inspected and found to be nutritionally balanced and interesting, and mealtime arrangements are also flexible enough to accommodate individual preferences. Catering staff demonstrated a detailed knowledge and understanding of individual residents’ dietary preferences and requirements. The main meal on the day of inspection consisted of braised steak with seasonal vegetables followed by semolina. The chef holds a basic and intermediate food hygiene certificate and has been approached to commence an NVQ Level 2 in catering. This should be actively progressed. Regents Court Care Home DS0000004151.V319896.R01.S.doc Version 5.2 Page 13 Care staff were seen providing direct assistance to people with their lunch in a sensitive and relaxed manner. Residents who possessed swallowing difficulties were offered and enjoyed the same choice of food as residents who did not possess swallowing difficulties. Residents’ weight charts confirmed that residents were not losing weight unexpectedly, and that weights were stable. During the morning and afternoon periods, care staff provide residents with drinks and snacks. During the inspection, some relatives were seen visiting people, and staff greeted visitors politely. Residents are able to receive visitors within the communal areas of the home, or in the comfort and privacy of their own rooms. The individual preferences of residents have been carefully sought, and the activities being undertaken reflect the preferences conveyed by the residents within the home. Regents Court Care Home DS0000004151.V319896.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 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaint management and adult protection within the home is adequate. Complaints are handled objectively and residents are confident that their concerns will be listened to, taken seriously and acted upon. A vulnerable adults procedure is available to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a simple and clear complaints procedure, and the complaint records indicated that this is followed. A register of concerns and complaints has been developed, and records clearly demonstrated the outcomes from the concern/complaint investigations. A copy of the complaints procedure had been given to all residents, and was available to visitors and relatives. A procedure for responding to allegations of abuse is available. Regents Court Care Home DS0000004151.V319896.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, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Investment within the home continues to ensure that a high environmental standard is maintained, creating a comfortable and safe environment for those living there and visiting. EVIDENCE: Regents Court Care Home DS0000004151.V319896.R01.S.doc Version 5.2 Page 16 Bedrooms within the home are predominantly single occupancy with en-suite facilities. Communal toilets and bathrooms are available throughout the home, and are easily accessible. Separate lounge and dining room facilities are provided on each floor of the home, and systems are in place for the management of infection control. The home was clean, tidy and free from offensive odours. Relatives providing feedback were positive about the physical environment. Each bedroom seen had been furnished with residents’ personal possessions, thereby generating ownership and a sense of autonomy for individuals. The standard of the environment within the home is good, providing residents with an attractive and homely place to live. Hot water temperatures have been risk assessed and had been regulated to prevent people being accidentally scalded when they have a bath, and radiators had been guarded and restricted to prevent people being accidentally burnt through intentional or unintentional contact All the windows located above first floor level had been restricted to prevent people from being injured through falling out of the windows (accidentally or deliberately). Regents Court Care Home DS0000004151.V319896.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. This judgement has been made using available evidence including a visit to this service. Staffing levels and competencies are suitable to ensure that residents’ needs are identified and met. EVIDENCE: There were suitable care staff on duty to provide care and support for the people who were resident in the home at the time of inspection. In addition to care staff, there were also ancillary staff on duty to support service provision. However, opportunity must be taken to review and evaluate staffing levels to confirm that staffing is provided in accordance with the needs of residents using the service. This is particularly important as occupancy levels increase as part of the home’s planned occupancy intentions. At the time of inspection, there were four carers on duty for 27 residents. In addition to care staff there was also an activities co-ordinator, catering staff and domestic staff on duty. It became clear that domestic cover reduced over the weekend period, but the organisation’s area manager said that advertisements had been placed for additional ancillary staff to cover the shortfalls experienced over the weekend period. Regents Court Care Home DS0000004151.V319896.R01.S.doc Version 5.2 Page 18 During the visit, call bells were activated, and staff responded speedily to them. The duty rotas confirmed that the staffing levels were stable, with little evidence of staff being absent through short-term sickness. Three staff files were examined, and documentation available confirmed that the home is operating a robust recruitment procedure to ensure the protection of vulnerable residents. Regents Court Care Home DS0000004151.V319896.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 adequate. This judgement has been made using available evidence including a visit to this service. There is clear leadership; guidance and direction to staff by the home’s manager to ensure residents receive consistent care. EVIDENCE: The registered manager is competent and appropriately qualified and experienced to manage the service. Significant diligence and action has been undertaken to maintain and enhance the positive quality of the service provided by the home since reopening. Regents Court Care Home DS0000004151.V319896.R01.S.doc Version 5.2 Page 20 Relatives clearly expressed their opinion that the home was being run in the best interests of the residents. Staff were being supervised in a positive manner. Although quality assurance is not yet being undertaken, the home is to commence regular quality assurance exercises on various aspects of the homes functioning to ensure that (a) quality is maintained and (b) to improve standards whenever possible – thereby enhancing residents’ quality of life and well-being. The registered manager effectively discharges her duty of care to ensure that the health and safety of residents and staff is maintained and maximised. Regents Court Care Home DS0000004151.V319896.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 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 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 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 Regents Court Care Home DS0000004151.V319896.R01.S.doc Version 5.2 Page 22 N/A 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(1) Requirement Care plans must be developed to include the care required to meet the assessed needs of residents. Care plans must be written to ensure staff understand the care to be provided, and to ensure that care is provided in a consistent manner. Care plans must be formally agreed either with the resident, or with their representative when the resident is unable to provide informed agreement. Care plans’ effectiveness must be reviewed (at least) monthly by a care staff. Care staff must record the actual dose administered on MAR charts for all medication that has been prescribed on a variable dose basis. Manual amendments to preprinted MAR charts must be countersigned by two carers to confirm accuracy and authenticity. Timescale for action 31/12/06 2. OP7 15(1) 31/12/06 3. 4. OP7 OP9 15(2) 13(2) 31/12/06 30/11/06 5. OP9 13(2) 30/11/06 Regents Court Care Home DS0000004151.V319896.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP27 Good Practice Recommendations Staffing levels must be reviewed to ensure that the home is staffed in accordance with the needs of the residents within the home. Regents Court Care Home DS0000004151.V319896.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Regents Court Care Home DS0000004151.V319896.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. 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