Inspection on 19/05/04 for Royal Court

Care Home For Older PeopleRoyal Court Nursing HomeRock Mount King Street Hoyland Barnsley South Yorkshire S74 9EBUnannounced Inspection19th May 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: Promote improvement in social care Inspect all social care - for adults and children - in the public, private and voluntary sectors Publish annual reports to Parliament on the performance of social care and on the state of the social care market Inspect and assess `Value for Money of council social services Hold performance statistics on social care Publish the `star ratings for council social services Register and inspect services against national standards Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Royal Court Nursing Home Address Rock Mount, King Street, Hoyland, Barnsley, South Yorkshire, S74 9EB Email address None Name of registered provider(s)/company (if applicable) Healthmade Limited Name of acting manager (if applicable) Carol Bamforth Type of registration Care Home No. of places registered (if applicable) 40 Tel No: 01226 741986 Fax No: 01226 741986Category(ies) of registration, with (number of places) Dementia - over 65 years of age (9), Old age, not falling within any other category (31) Registration number C060000193 Date first registered 31st July 2002 Was the home registered under the Registered Homes Act 1984? Do additional conditions of registration apply ? Date of last inspectionDate of latest registration certificate 31st July 2002 YES YES 7/1/04 If Yes refer to Part CRoyal Court Nursing HomePage 1 Date of inspection visit Time of inspection visit Name of inspector Name of inspector Name of inspector Name of inspector Name of specialist (e.g. Interpreter/Signer) (if applicable) 1 2 3 419th May 2004 09:00 ­ 17.00 Ms Claire McAuleyID Code088677Name of establishment representative at the time of inspectionN/A Diane Dawes (Senior Care Assistant) Lynn Link (Senior Care Assistant) Amanda Lawson (Senior Care Assistant)Royal Court Nursing HomePage 2 CONTENTS Introduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & Findings National Minimum Standards For Older People: Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management & Administration Part C: Part D: D.1. D.2. D.3. Compliance with Conditions (if applicable) Providers Response Providers Comments Action Plan Providers AgreementRoyal Court Nursing HomePage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI) is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000. This document summarises the inspection findings of the CSCI in respect of Royal Court Nursing Home. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Older People published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: Inspection methods used Key findings and evidence Overall ratings in relation to the standards Compliance with the Regulations Required actions on the part of the provider Recommended good practice Summary of the findings Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The report is based on the findings of the specified inspection dates.Royal Court Nursing HomePage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Royal Court is a care home providing personal care and accommodation for forty older people. Within the home is a separate wing with nine beds for people with dementia. The home is owned by Healthmade Limited. The home is located in Hoyland within the Barnsley area, and is close to the shopping centre and a doctors surgery. The home is a purpose built single storey building. All bedrooms are for single occupancy and have en-suite facilities. There are three lounge areas, dining room and a conservatory that are all comfortably furnished and well decorated. An enclosed garden area is provided. There are car-parking areas.Royal Court Nursing HomePage 5 PART A SUMMARY OF INSPECTION FINDINGSInspectors Summary This unannounced inspection took place on 19th May 2004. It found that some of the National Minimum Standards had been met and that the home was working towards achieving a number of standards not met on previous inspections. Service users spoken to on the visit expressed satisfaction with the care provided. A substantial number of previous requirements are brought forward. However, on the day of the inspection the acting manager was on holiday and therefore not all the necessary information was available for inspection. Therefore some requirements which may have been completed are carried forward. Choice of Home (Standards 1-6) 1 of 4 standards assessed was met. The statement of purpose/ service users guide was not available for inspection, and the senior carer was not aware of the progress of work on the document. The inspector was shown a video box of the statement of purpose/service users guide and therefore would expect that it was complete. Service users spoken to did not say they had received a copy of the statement of purpose/service users guide. There was a signed statement of terms and conditions in each of the service user plans seen. However these did not contain the full range of information. The home had further information on terms and conditions and this should be included in the service users plan. Senior staff spoken to said that full needs assessments had been undertaken for service users. However, on two service user plans seen, there was no assessment, and social work assessments could not be found. There were signed plans of care on the service user plans seen. Health and Personal Care (Standards 7-11) 2 of 4 standards assessed were met The inspector checked four plans of care. These contained a range of information on service users needs. There was evidence of updating on files, reviews, and risk assessments for falls and pressure sores. More information including action taken by staff, leisure needs, dietary needs and food intake, and family/friends involvement was needed. Action was needed to confirm the accuracy of information recorded; as the dietary needs recorded for one service user did not match the actual provision of food. There was also no record of action taken for this service user who had lost a lot of weight. There was a discrepancy on one service users file of the date of admission. Requirements in relation to plans of care are brought forward. Service users could register with a GP of their choice, and the home took advice on continence and pressure sores. Staff had received medication training. Service users spoken to all said that they were happy with the standard of personal care they received. Staff could state measures they took to observe service users privacy and dignity. There was a telephone at the home for service users to use. Care plans seen by the inspector recorded service users wishes in relation to terminal illness. Daily Life and Social Activities (Standards 12-15) 0 of 4 standards assessed were met Daily routines were flexible and varied. A range of leisure activities was provided, including activities which fulfilled religious needs. Activities were not recorded in sufficient detail and not all care plans had details of service users leisure needs. Activities took place mainly in the day centre and there appeared to be little activity which took place in the residential or dementia unit. Relatives and visitors were made welcome at the home. The home did not handle service users finances. Service users could bring in personal items Royal Court Nursing Home Page 6 and furniture to the home. The inspector observed lunch being served. All the food served in the dementia unit was pre-plated and there was no discussion that the inspector witnessed with service users as to preference and choice. One staff member was unaware as to the appropriate diet for a service user. A liquidised diet was served with all the items liquidised together. There was no choice of drinks, and orange squash and water was served from large plastic bottles. Service users in the residential unit were not asked their preferences. The inspector was unclear as to alternative choices of lunch, and was informed that service users were able to have salad if they did not like the lunch. Food was served by the cook wearing a dirty overall. A trainee staff member was left on her own with service users. Two service users spoken to said they did not like the food and there was little choice. Two said it was good. All the overalls and towels in the kitchen were stained. Complaints and Protection (Standards 16-18) 0 of 2 standards assessed were met. The senior care staff could not say if the complaints procedure had been given to service users or displayed in the home. The inspector saw a record of complaints which was not up to date and did not record the last complaint fully. The home did not have an Adult Protection Policy and staff had no training on Adult Protection. Requirements are brought forward. Environment (Standards 19-26) 0 of 5 standards assessed were met. The home was suitable for its stated purpose and was clean and reasonably decorated and furnished on the day of the inspection. There was a smell of incontinence on the dementia unit. A number of requirements have been brought forward in relation to the environment from the previous inspections. The garden areas were in need of maintenance. Service users rooms checked were generally comfortable with individual possessions in evidence. All bedrooms were locked during the day. Steradent, E45 and Sudocrem was stored insecurely. This was locked away on the day of the inspection, and risk assessments are to be undertaken. Care plans recorded service users wishes in relation to furniture and fixtures. Lighting and heating was sufficient. Laundry facilities were sufficient. One service user had been able to open their bedroom window and leave the building. Staffing (Standards 27-30) 0 of 4 standards assessed were met A number of previous requirements are brought forward. On the day of the inspection staffing numbers were below those agreed. Four weeks rotas confirmed this had been the case on a number of shifts. On the day of the inspection the home was short of one care assistant, and the acting manager was on holiday. Staff spoken to at the home did not think they were overworked or too stretched. There were ten high dependency service users at the home. Staff at the home had begun to work full shifts on the dementia unit. A number of staff had started NVQ 2 and 3 training. The home was in the process of revising its recruitment policy, but had not completed this. The training programme was also in revision and staff members spoken to confirmed they had received some statutory training. This was not yet completed and other areas of training needed to be identified and provided for. CRB checks were not available for inspection, and two new staff members working at the home had not received their completed CRB checks. Management and Administration (Standards 31-38) 1of 7 standards assessed were met The acting manager was awaiting her fit person interview to register as the homes manager. The inspector was informed that the acting manager had now started her NVQ 4 in Care and Management. Staff spoken to expressed confidence in the acting manager and said she was approachable. The home was in the process of developing quality assurance systems, staff supervision systems, health and safety practices, procedures and training, and new policies and procedures in order to comply with the Care Standards Act 2000. Some of this work had been completed but a great deal still remained to be completed. Royal Court Nursing Home Page 7 Regulation 26 monitoring visits did not take place. The home did not handle service users finances. The homes business and financial plan was not available for inspection. Not all the required information was available to the inspector at the home and therefore all previous requirements in relation to standards 31 to 38 are brought forward.Royal Court Nursing HomePage 8 Requirements from last Inspection visit fully actioned? If No please list belowNOSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard Required actions Timescale for action 1 4, 5, 6 OP1 The home must produce a Statement of Purpose and Service User Guide that includes all details as stated in the National Minimum Standards. Service users plan of care must contain full details of service users needs in respect of his/her health and welfare also what action staff must take to meet the identified needs. The plan must be regularly reviewed and the service users informed of any changes. 31/7/04215OP731/7/04315OP7The manager must review service users plan 31/7/04 of care and where specific health needs have been identified care must be taken to ensure that appropriate professional guidance is sought and detailed instructions are included to enable staff to provide the appropriate care. The service user plan must include: Nutritional screening undertaken on admission, reviewed at least monthly and includes a record maintained of nutrition, including weight gain or loss and any action taken. A planned programme of social activities must be devised and provided that are flexible and varied to suit service users expectations, preferences and capabilities. Staff time and funding must be provided to facilitate this. Details of service users leisure needs must be recorded in care plans. 31/7/04 31/7/04415 17OP7 OP8516OP12616OP1231/7/04Royal Court Nursing HomePage 9 716OP13The policy on maintaining contact with family and friends must be reviewed. Relatives must be given a copy of the policy. Service users files must contain a record of their wishes in relation to the handling of their finances and any advice/assistance given to contact an advocacy service to act on their behalf if they so wish. Service users files must contain details of their dietary needs that include, likes, dislikes, eating patterns and any advice given by a dietician or other professionals.31/8/04812OP1431/7/04912OP1531/7/0410 13 OP15The cooks uniform Whites must be clean and 31/7/04 stain free and changed on a daily basis. Drying cloths used must be stain free and clean. Service users must be given copies of the homes complaints procedure. The homes policy on Adult Protection must be reviewed to take into account the Department of Health Guidance `No Secrets. Staff must receive guidance/instructions on the homes Adult Protection Procedure. A planned maintenance programme must be implemented to ensure the gardens are kept tidy and safely maintained for the service users. A record of the programme of routine maintenance and renewal of fabric and decoration of the building must be kept. The dining area in the dementia unit must be redecorated. The carpet on the dementia unit corridor must be replaced. The stained carpet in the dining area must be cleaned. The toilet (WC 2) on the main unit must be redecorated. 31/7/04 1/9/0411 1222 13OP16 OP1813 1413 23OP18 OP191/9/04 31/7/041512 23OP191/9/0416 17 18 1923 16 23 23OP19 OP19 OP19 OP191/9/04 31/7/04 31/7/04 1/9/04Royal Court Nursing HomePage 10 20 23 21 22 23 OP24 OP22A call system with an accessible alarm facility must be provided in the toilet on the dementia unit next to room 3. The flooring in the identified bedroom must be replaced. The en-suite in the identified bedroom must have a towel rail/holder and towel unless the outcome of a documented risk assessment suggests otherwise. All service users must be offered a key to their rooms. Where a service user does not want a key or lacks the capability to use one this must be recorded in their files. Sufficient staff must be employed to meet the agreed staffing levels Service users dependency levels must be reassessed and sufficient staff provided to ensure all service user needs are met.1/9/0423OP241/9/04 1/9/042312 4OP2431/7/042418OP2731/7/0425 18 26 19 OP27 OP29An action plan must be submitted to the NCSC 31/7/04 stating the training to be provided for those staff identified as working on the dementia unit. The home must operate a thorough recruitment based on equal opportunities and ensuring the protection of the service users. The process must include obtaining two written references, evidence that a CRB check has been obtained and any gaps in employment explored. As part of the recruitment process, all staff must provide evidence of identity including a photograph, birth certificate, passport, and documentary evidence of qualifications 31/7/0427 18 19 OP29 Schedule 2 2831/7/047 Schedule OP29 2 18 OP30The CRB check for the responsible individual 31/7/04 must be available at the home for inspection by the NCSC Three days paid training must be provided for all staff and an individual training and development assessment and profile produced. 1/9/0429Royal Court Nursing HomePage 11 3018OP30The staff induction programme must meet all areas of the National Training Organisation targets. The full range of policies and procedures must be produced and staff made aware of these. Policies that are already in place must be reviewed. An effective quality assurance and quality monitoring system must be put in place, based on seeking the views of service users to measure success in meeting the aims and objectives of the home. The registered provider or named responsible person must visit the home at least monthly unannounced and produce a report covering all areas in this regulation. A copy of the report must be sent to the NCSC. There must be a business plan for the establishment, open to inspection and reviewed annually. Care staff must received supervision at least six times a year. This must include; all aspects of practice; philosophy of care and career development. All care staff must receive statutory training in moving and handling, fire safety, first aid, food hygiene and infection control, also health and safety, care of the sick and dying, care planning and COSHH. The registered manager must ensure that staff receive training in first aid and that there is a qualified first aider on duty at all times. Risk assessments must be completed in all areas of health and safety within the home.1/9/043112OP33 OP261/9/043224OP331/9/043326OP3331/7/043425OP341/9/043518OP361/9/043618OP381/9/043718OP381/9/0438 3913OP381/9/0418OP38An action plan must be submitted to the NCSC 31/7/04 when all care staff will receive statutory training in moving and handling, fire safety, first aid, food hygiene, infection control, health and safety, care of the sick and dying, care planning and control of substances hazardous to health.Royal Court Nursing HomePage 12 4013OP38Records of checks made on portable electrical appliances must be kept at the home.317/04Royal Court Nursing HomePage 13 41Policies, procedures and practices must be implemented/reviewed including: · · · · · · · OP33 OP13 12 24 OP18 OP29 OP38 OP26 · · Adult protection and prevention of abuse. Access to files by staff/users. Accidents to service users and staff. Aggression toward staff. Annual development plan for quality assurance. Service Users absconding/missing from placement. Communicable diseases and infection control including HIV/Aids (Public Health Medicine Environmental Control). Concerns and Complaints. Control of Substances Hazardous to Health. Confidentiality and disclosure of information. Control, administration, self-administration, recording, safekeeping, handling and disposal of medicines including noncompliance. Continence promotion. Code of Conduct. Contact with family and friends. Discharge, including planned discharge and termination at short notice. Disposal of clinical waste. Death of a service user. Emergency admission and detention under the Mental Health Act 1983. Emergency and crises.1/9/04· ·· · · · · · · ·Royal Court Nursing HomePage 14 · · · · · · · · · · · ·Equal opportunities/ethnic minorities. Fire safety. Food safety and nutrition. First aid. Gifts to staff. Health and Safety (Health and Safety at Work Act 1974). Hygiene and Food Safety (Food Safety Act 1990 and Regulations 1995). Moving and Handling. Management of service users money, valuables and financial affairs. Physical intervention, restraint. Pressure relief. Racial harassment occurring between service users; between staff; by staff; or by service users on staff. Record keeping. Recruitment and employment including redundancy. Referral and admission. Risk assessment and management. 1/9/04· · · · 42 18 OP33All staff must receive training in the above policies, procedures and codes of practices as they are implanted and reviewed.Action is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements.Royal Court Nursing HomePage 15 RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations Standard To enable action to be taken of any requirements/recommendations made by the pharmacist who checks the medication systems it is suggested copies of those checks are requested and retained at the home. That the complaints procedure includes information that says the complainant will not be victimised because they have made a complaint. That a rotary iron is provided for the laundry. 50 of staff should be qualified to NVQ Level 2 by 2005. The manager should have NVQ Level 4 in management by 2005.1OP92 3 4 5OP16 OP26 OP28 OP31Conditions of registration that apply (other than numbers and category of service users). The DE(E) registered beds are a separate unit Of the 31 personal care (PC), 2 can be used as nursing care The total persons who can be accommodated at the home cannot exceed 40. Persons accommodated shall be 60 years and above.Met (Yes / No) YES YES YES YESRoyal Court Nursing HomePage 16 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report, which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001 and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard * Requirement Timescale for action 1 5 OP2 OP37 OP3 OP37 The contracts (service users terms and conditions) must be revised to include all the information required by the standards and regulations. Evidence of full needs assessment prior to service users admission to the home must be available for inspection by the CSCI representative. The service user identified must be reassessed, and updated detailed information on that service users dietary needs, health and welfare, and action to be taken by staff to meet those needs, must be placed on the care plan and regularly reviewed and updated. A copy of the revised plan must be sent to the CSCI. 1/9/0421431/7/04312 14OP8 OP371/7/04Royal Court Nursing HomePage 17 The catering systems at the home must be reviewed, including consultation with service users as to their preferences and choices. Menus which provide a choice of two main meals must be provided Menus must be accurately displayed to show what food is being served. There must be a choice of drinks for service users at lunch times and drinks must be served in jugs not in plastic containers Food for service users on the dementia unit must not be pre-plated. Service users must be asked their preference and choices when being served. Service users in the residential unit must be consulted about choice before they are served a meal. Liquidised diets must consist of individual items of food which are liquidised separately and attractively served. Staff must be aware of service users individual dietary needs. Moving and handling procedures and supervision of this must be reviewed and all staff must receive appropriate moving and handling training. The trainee must not be left alone with service users. Wheelchairs must have footplates fitted. Service users must be transferred from wheelchairs to dining chairs. If this is not possible due to health issues or service users choice, this must be recorded on care plans. 5 22 OP16 OP37 OP19 All complaints must be fully recorded with details of action taken. Maintenance of the garden areas and paving must be undertaken so that service users can access the garden areas. 1/07/04 31/7/041/7/041/7/04OP15 4 12 13 16 18 OP27 OP371/7/041/7/041/9/04 1/07/0431/7/0462331/7/04Royal Court Nursing HomePage 18 OP19 7 16 12 OP26 OP37The odour of incontinence must be eradicated from the home. Cleaning programmes and 31/7/04 service users continence programmes must be reviewed and implemented. Bedroom doors must not be routinely locked. Service users must be appropriately supervised so that they do not wander into other service users rooms. Steradent E45 and Sudocrem must be locked away securely unless the service user is risk assessed to take care of it themselves. The Steradent, E45 and Sudocrem was locked away on the day of the inspection and a risk assessment will be undertaken by the home. Service users hairbrushes and combs must be kept clean at all times A restrainer must be fitted to the identified service users window. The members of staff who have not received a CRB check must not work unsupervised.812 18OP2431/7/04912OP24 OP3731/7/0410 1112 23 13OP24 OP2531/7/04 31/7/0412OP29 18 19 Schedule 2 OP37A CRB check must be completed for the trainee. She must not work unsupervised. Staff members CRB checks must be available for inspection by the CSCI representative.31/7/04Royal Court Nursing HomePage 19 RECOMMENDATIONS Identified below are areas addressed in the main body of the report, which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Refer to Good Practice Recommendations Standard * NoneRoyal Court Nursing HomePage 20 PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct observation Indirect observation Sampling Pre-inspection questionnaire Records Care plans / Care pathways Meals Activities Other (Specify) `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total number of care staff employed (excluding managers) Total number of staff with nursing qualifications employed Date of inspection Time of inspection Duration of inspection (hrs) YES YES NO YES YES YES YES NA YES YES NO YES NO NO NO NO NO YES YES YES 5 0 X NO NO YES YES X X 19/5/04 9 00 8Royal Court Nursing HomePage 21 The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Care homes for older people have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No shortfalls) (Minor shortfalls) (Major shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.Royal Court Nursing HomePage 22 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · · 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.Standard 1 (1.1 ­ 1.3) The registered person produces and makes available to service users an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home; and provides a service users guide to the home for current and prospective residents. The statement of purpose clearly sets out the physical environmental standards met by a home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10: a summary of this information appears in the homes service users guide. Range of fees charged From (£) 252.58 To (£) 302.00Any charges for extrasYESHAIRDRESSING If yes, please state what the extras are: 2 Key findings/Evidence Standard met? The statement of purpose and service users guide was still not available. No copy was available for inspection. Service users spoken to did not say that had received copies of the service users guide. However the inspector was shown a video copy of the service users guide (not viewed). (See previous requirements).Royal Court Nursing HomePage 23 Standard 2 (2.1 ­ 2.2) Each service user is provided with a statement of terms and conditions at the point of moving into the home (or contract if purchasing their care privately). 2 Key findings/Evidence Standard met? The home had introduced a new statement of terms and conditions. The inspector saw signed copies of these on four service users plans. These contracts did not include the full range of information, although the home did have the rest of the required information on another form which was not in the service users plan.Standard 3 (3.1 ­ 3.5) New service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. 2 Key findings/Evidence Standard met? The inspector did not see full needs assessments on two of the care plans examined. The staff member in charge stated that service users did have full needs assessments carried out either by a professional social worker or the acting manager and that plans of care were produced on the basis of assessment. Social work assessments on service users were not available for inspection. Standard 4 (4.1 - 4.4) The registered person is able to demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 3 Key findings/Evidence Standard met? Five service users were spoken to and they all confirmed that their needs were met. Four service user files/care plans were checked. The files seen confirmed that a range of specialist services was offered to service users, for example dentist, chiropodist and optician.Standard 5 (5.1 ­ 5.3) The registered person ensures that prospective service users are invited to visit the home and to move in on a trial basis, before they and / or their representatives make a decision to stay; unplanned admissions are avoided where possible. 0 Key findings/Evidence Standard met? This standard was not assessed.Royal Court Nursing HomePage 24 Standard 6 (6.1 - 6.5) Where service users are admitted only for intermediate care, dedicated accommodation is provided together with specialised facilities, equipment and staff, to deliver short-term intensive rehabilitation and enable service users to return home. 9 Key findings/Evidence Standard met? The home did not provide an intermediate care service.Royal Court Nursing HomePage 25 Health and Personal CareThe intended outcomes for the following set of standards are: · · · · · The service users health, personal and social care needs are set out in an individual plan of care. Service users make decisions about their lives with assistance as needed. Service users, where appropriate, are responsible for their own medication, and are protected by the homes 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.Standard 7 (7.1 ­ 7.6) A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. 2 Key findings/Evidence Standard met? The inspector checked four service users plans. These contained information on service users needs and some action taken by staff to meet those needs. There was evidence of risk assessment and prevention of falls. There was also evidence of updating and reviews taking place. Service users plans seen had been signed by relatives and service users. There were some inaccuracies and omissions in service users plans seen, including a lack of recording of leisure needs, actions taken by staff to meet needs, records of visits (i.e. a visit from the Blind Institute to one service user to offer special equipment. (There was no record of the outcome of that visit). There was a lack of detailed recording of dietary needs food intake, and preferences, and family/friends involvement. One file indicated that a service user had been admitted on 24th March 2004, but her/his admission check list was dated 5th January 2003. The senior care staff explained that this was because he/she had received respite care. There was no indication of this on the plan of care. One file recorded a service users dietary needs as requiring no assistance and able to eat a normal diet. The inspector observed the service user actually receiving a liquidised diet which was fed to him/her. A number of previous requirements are brought forward in relation to plans of care. (See previous requirements).Royal Court Nursing HomePage 26 Standard 8 (8.1 ­ 8.13) The registered person promotes and maintains service users health and ensures access to health care services to meet assessed needs. No. of incidents where service users have been taken to Accident and Emergency during last 12 months No. of service users with pressure sores at time of inspection (from information taken from care notes) 11 22 Key findings/Evidence Standard met? The number of incidents of admissions to Accident and Emergency were taken by the inspector from the accident record. The senior care staff supplied the information on pressure sores. Care plans seen gave some information on nutritional requirements, and service users plans seen indicated those service users were weighed regularly. However, as pointed out in standard 7 one service users plan was incorrect. In addition this service user had lost two stones in weight since March 2004. There was evidence of a GP visit but no indication as to the action taken by the doctor or staff. Service users spoken to confirmed they could register with a GP of their choice. On service users plans seen there were records of health professionals visits, including dental and chiropody. Hospital appointments were recorded. The senior care staff confirmed that the district nursing team nursed service users with pressure sores, and continence advice was sought. The files seen identified whether service users were at risk from falls, or pressure sores, and the acting manager monitored these. (See previous requirements) Standard 9 (9.1 ­ 9.11) The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. 0 Key findings/Evidence Standard Met? This standard was not assessed. The previous requirement was met, and temperatures of the fridge for medication were now recorded. Senior staff administered medication and they had received training.Royal Court Nursing HomePage 27 Standard 10 (10.1 ­ 10.7) The arrangements for health and personal care ensure that service users privacy and dignity are respected at all times, and with particular regard to: personal care giving, including nursing, bathing, washing, using the toilet or commode, consultation with, and examination by, health and social care professionals, consultation with legal and financial advisors, maintaining social contacts with relatives and friends, entering bedrooms, toilets and bathrooms, and following death. 3 Key findings/Evidence Standard met? The inspector spoke to five service users who were all happy with the standard of personal care received. They said that staff cant do enough for you. Service users said they could see the GP and other health professionals in private. Staff spoken to could state measures they took to observe service users privacy and dignity. Each room had a telephone point and there was a telephone in the home for the service users to use. All accommodation at the home was single. Standard 11 (11.1 ­ 11.12). Care and comfort are given to service users who are dying, their death is handled with dignity and propriety, and their spiritual needs, rites and functions observed. 3 Key findings/Evidence Standard met? Discussions with staff demonstrated that the home dealt with terminal illness and death with empathy and treated service users and their families with sensitivity and respect. Relatives were able to stay at the home when someone was dying. Pain relief was sought from appropriate health care professionals. The care plans seen had details of service users wishes in regard to death and dying. The senior care staff spoken to confirmed this information was now on all service users plans. There was information on service user plans seen of spiritual and religious needs.Royal Court Nursing HomePage 28 Daily Life and Social ActivitiesThe intended outcomes for the following set of standards are: · · · · 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.Standard 12 (12.1 ­ 12.4) The routines of daily living and activities made available are flexible and varied to suit service users expectations, preferences and capacities. 2 Key findings/Evidence Standard met? The service users spoken to by the Inspector said that daily routines were flexible and varied. They could choose what time to get up and go to bed and staff had time to talk with them. Those spoken to said there was enough to do at the home. However, the inspector noted that those service users went to the day centre three times a week, and that there was little activity organised within the service users living areas. Some service users did not attend the day centre. There was no evidence of activities organised within the dementia unit. Leisure activities included keep fit, board games, bingo etc. The home did not employ an activities co-ordinator. There was evidence of service users leisure needs, preferences and recorded activities, on two of the care plans seen. Two did not record leisure needs. The senior staff confirmed that the Salvation Army visited once every two weeks, a songs of praise organised by the Reform Church happened monthly and a weekly communion (Church of England) took place. A clothes sale took place every six to eight weeks and an entertainer approximately every two months. Trips from the home took place, including shopping at Meadowhall. (See previous requirements). Standard 13 (13.1 ­ 13.6) Service users are able to have visitors at any reasonable time and links with the local community are developed and/or maintained in accordance with service users preferences. 2 Key findings/Evidence Standard met? Staff indicated that visitors and relatives were always made welcome and could visit at any time. Service users could see their visitors in private. A requirement has been brought forward with reference to the homes policy on maintaining contact with relatives and friends. (See previous requirements).Royal Court Nursing HomePage 29 Standard 14 (14.1 ­ 14.5) The registered person conducts the home so as to maximise service users capacity to exercise personal autonomy and choice. 2 Key findings/Evidence Standard met? The senior care staff confirmed that the home did not handle service users finances. They were not aware if, on admission, checks were recorded in service users files if they wanted to arrange their own finances or not, or if advice was given on how to contact others such as advocates who would act in their interests. The inspector noted that service users were able to bring their own furniture and belongings to the home if they wished. (See previous requirements) Standard 15 (15.1 ­ 15.9) The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements, and that meals are taken in a congenial setting and at flexible times. 1 Key findings/Evidence Standard met? The inspector observed lunch being served. The food served looked nutritious. The inspector observed that all food for service users on the dementia unit was pre-plated and given to service users with no discussion with them about their choices or preferences. One service user in this unit was served a liquidised diet where the items of food were all liquidised together. The staff member feeding her/him thought that this service user was/should be on a normal diet. A service user was seen to be helped to the table for his/her meal in an inappropriate manner (i.e. they were pulled up by the arms). In the residential unit, the inspector observed that there was no discussion with service users as to their preferences on portion size, choice of vegetables, etc. Meals were served up from a trolley and distributed to the service users. The cook serving this meal was wearing a dirty overall. (This was commented upon at the last inspection and the requirement is brought forward). There was no choice of drinks, or jugs on the tables, and orange squash and water was served from large plastic containers. One service user was sat at a table in a wheelchair with no footplates. A trainee (aged sixteen) was left alone with the service users for periods of time. The inspector spoke to the cook and assistant cook and both said that at lunchtime if service users did not want the main meal, salad was always available. The menu board in the dining room had the previous days tea menu displayed. Food to be served at lunchtime was already being plated up and was in the hot trolley at a quarter to twelve, and the cook was cleaning the cooker prior to serving lunch. Two service users spoken to said they did not like the food, and that there was little choice. Two service users said that the food was good. They all said that they could have a drink when they wished. As stated in standard 7 not all service users dietary needs, likes, dislikes, etc were recorded on all care plans. Menus seen covered a good range of food, and there were fresh vegetables and fruit in the storeroom. The cook was aware of diabetic diets. Towels used for drying pots were stained and ragged. (This was commented upon in the previous inspection and the requirement brought forward). All of the overalls/tabards in use within the kitchen were stained. (See previous requirements).Royal Court Nursing HomePage 30 Complaints and ProtectionThe intended outcomes for the following set of standards are: · · · 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.Standard 16 (16.1 ­ 16.4) The registered person ensures that there is a simple, clear and accessible complaints procedure which includes the stages and time-scales for the process, and that complaints are dealt with promptly and effectively. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI Percentage of complaints responded to within 28 days X X X X X X X 1 Key findings/Evidence Standard met? The information on complaints seen by the inspector was not up to date. There may have been other information in the home not available to the inspector. However the complaints book seen recorded the last complaint as 23rd February 2004. This complaint did not record a proportion of the outcome. The senior care staff were not aware if the complaints procedure had been given to the service users. (See previous requirements) Standard 17 (17.1 ­ 17.3) Service users have their legal rights protected, are enabled to exercise their legal rights directly and participate in the civic process if they wish. 0 Key findings/Evidence Standard met? This standard was not assessed.Standard 18 (18.1 ­ 18.6) Royal Court Nursing Home Page 31 The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self-harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policies. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets No. of staff referred for inclusion on POVA lists NO 01 Key findings/Evidence Standard met? The home did not have a procedure on adult protection, aggression toward staff or whistle blowing. The home is working towards producing policies and procedures which meet the requirements of the Care Standards Act 2000. Staff were not trained in adult protection. (See previous requirements)Royal Court Nursing HomePage 32 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · · 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.Standard 19 (19.1 ­ 19.6) The location and layout of the home is suitable for its stated purpose; it is accessible, safe and well maintained; meets service users individual and collective needs in a comfortable and homely way and has been designed with reference to relevant guidance. 1 Key findings/Evidence Standard met? On the day of the inspection the home was in the main clean well decorated and comfortably furnished. It was suitable for its purpose. A number of requirements in relation to the environment have been brought forward. The carpet in the dining area was still stained. The dining room in the dementia area had not been decorated. The carpet on the dementia unit corridor had not been replaced. The toilet had not been redecorated and the bedroom flooring had not been replaced. Senior staff spoken to did not know whether a maintenance and renewal programme had been completed. There was a strong smell of urine in the corridor and lounge of the dementia unit. Areas of the garden had not been maintained, and there were courtyard areas which were not accessible to service users because of the weeds in the paving stones and the unkempt appearance. (See previous requirements) Standard 20. (20.1 ­ 20.7) In all newly built homes and first time registrations the home provides sitting, recreational and dining space (referred to collectively as communal space) apart from service users private accommodation and excluding corridors and entrance hall amounting to at least 4.1 sq. metres for each service user. 0 Key findings/Evidence Standard met? This standard was not assessed.Royal Court Nursing HomePage 33 Standard 21 (21.1 ­ 21.8) Toilet, washing and bathing facilities are provided to meet the needs of service users. 0 Key findings/Evidence Standard met? This standard was not assessed. Previous requirements had been metStandard 22 (22.1 ­ 22.8) The registered person demonstrates that an assessment of the premises and facilities has been made by suitably qualified persons, including a qualified occupational therapist, with specialist knowledge of the client groups catered for, and provides evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of service users. 2 Key findings/Evidence Standard met? Service users had access to all parts of the home. Grab rails and other aids were in situ in all bathrooms/toilets and in service users bedrooms where needed. Doorways were wide enough to allow wheelchair access. There was still no call system in the toilet on the dementia unit next to room 3. (See previous requirements). There was appropriate storage space for aids and equipment. The home had a portable hoist.Royal Court Nursing HomePage 34 Standard 23 (23.1 ­ 23.11) The home provides accommodation for each service user which meets minimum space as prescribed Total number of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1 April 2003) - single bedrooms below 10 sq.m usable space or additional compensatory space Total number of wheelchair users accommodated for in rooms at least 12sq.m Total number of wheelchair users accommodated for in rooms at less than 12sq.m Total number of shared rooms at least 16 sq.m Total number shared rooms less than 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total number of single bedrooms Total number of single rooms with en suite Total number of double rooms Total number of double rooms with en suite Key findings/Evidence This standard was not assessed. YES NO NO X X X X Standard met? 0 X XX X X XRoyal Court Nursing HomePage 35 Standard 24 (24.1 ­ 24.8) The home provides private accommodation for each service user which is furnished and equipped to assure comfort and privacy, and meets the assessed needs of the service user. 2 Key findings/Evidence Standard met? The inspector checked three service users bedrooms. All had a suitable bed with clean bed linen, curtains, mirror, overhead lighting drawer and wardrobe space, and washbasin. All the rooms were carpeted and had door locks. Service users spoken to said they had been offered keys to their rooms. There was evidence that service users had been offered keys on care plans seen, although it was not clear to the inspector if all service users wishes in relation to keys had been recorded and therefore the previous requirement is carried forward. Care plans seen recorded service users individual wishes in relation to the required furnishings and fittings in their rooms. The inspector noted that all bedrooms including those on the dementia unit were locked during the day. Staff spoken to said this was due to service users wandering and going into other service users rooms. Not all service users are assessed as able to look after their keys. Steradent was found in a service users bedroom, as was E45 cream and Sudocrem. The senior staff member on duty was asked to lock these away immediately until a risk assessment had been completed for the relevant service users. This was done on the day of the inspection. Two bedrooms contained dirty hairbrushes and comb. All had ensuite facilities and were personalised. (See previous requirements). Standard 25 (25.1 ­ 25 8) The heating, lighting, water supply and ventilation of service users accommodation meet the relevant environmental health and safety requirements and the needs of individual service users. 2 Key findings/Evidence Standard met? Service users bedrooms checked all had opening windows. The rooms were centrally heated and the heating level could be controlled within each bedroom with assistance. There were no radiators. Lighting levels were sufficient. Wall lights that were fitted with energy saving bulbs provided the lighting on the corridors. There was emergency lighting throughout the home. Water was provided close to 43°c to prevent scalding. The inspector was informed that one service user had managed to open the window fully and climb out. The window had been locked since then. Standard 26 (26.1 ­ 26.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation and published professional guidance. 2 Key findings/Evidence Standard met? The building was clean on the day of the inspection. However, there was a strong smell of urine in the corridor and lounge of the dementia unit. Laundry facilities were situated away from all food preparation and storage areas. The laundry floor was impermeable and the walls washable. Hand washing facilities were provided. The washing machines had a programme that met disinfection standards. The home had a separate sluice.Royal Court Nursing HomePage 36 StaffingThe intended outcomes for the following set of standards are: · · · · 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 homes recruitment policy and practices. Staff are trained and competent to do their jobs.Standard 27 (27.1 ­ 27.7) Staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed need of the service users, the size, the layout and purpose of the home, at all times. Number of staff /hours in respect of service user needs based on guidance recommended by Department of Health. Personal Nursing Care No. service users High No. staff hours X X X needs allocated No. service users Medium needs No. service users Low needs No. of staff hours required No. of full time equivalent first level registered nurses No. of care staff No. of ancillary staff Key findings/Evidence X X X No. staff hours allocated No. staff hours allocated No. of staff hours provided X X X X X XX X X Standard met? 1Royal Court Nursing HomePage 37 On the day of the inspection staffing levels did not meet the agreed numbers. The home was short of one care assistant, and the acting manager was on leave. The inspector saw four weeks rotas and they showed that staff numbers were at times not at the required level. (This was also the case at the previous inspection and requirements are brought forward). The inspector discussed with the senior care staff the dependency levels of service users and they indicated that all service users in the dementia unit were high dependency and one service user in the residential unit. All other service users were medium or low dependency. The staff spoken to stated that staff members covered for sickness and absence of staff, and that the home did not use agency staff. Staff spoken to said they were happy to cover for absence and did not feel pressurised into covering. They also said that while they had been stretched at times, this had not affected the quality of care offered to service users. The home had a trainee member of staff aged 16. The senior care staff stated that she did not undertake personal care tasks and was always supervised. However, as pointed out in standard 15 she was left alone with service users at lunchtime. All other staff were over 18 and those left in charge were over 21. Staff members now work a complete shift in the dementia unit. One staff member said she was bored when working in this unit. The previous inspection report highlighted the need for staff training in the area of dementia and no progress had been made on this. Therefore the requirement is brought forward The home employed sufficient ancillary staff. (See previous requirements). Standard 28 (28.1 ­ 28.3) A minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved by 2005, excluding the registered manager and/or care manager, and in care homes providing nursing, excluding those members of the care staff who are registered nurses. No. care staff (excluding registered nurses) with NVQ level 2 or equivalent of care staff with NVQ level 2 X X 2 Key findings/Evidence Standard met? The senior care staff stated that a number of staff were now undertaking NVQ 2 and 3 training. (See previous recommendation).Royal Court Nursing HomePage 38 Standard 29 (29.1 ­ 29.6) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 2 Key findings/Evidence Standard met? The home was in the process of revising its recruitment policy, but this had not been completed. The inspector checked three recruitment files and the majority of required information had been added. One did not have evidence of identity. CRB staff checks were not available for inspection. The senior care staff informed the inspector that two new staff members had not received their CRB checks back. The trainee had not had a CRB check undertaken. (Another staff member did not have a CRB check returned at the previous inspection.) The CRB check for the responsible individual was not available for inspection. (See previous requirements). Standard 30 (30.1 ­ 30.4) The registered person ensures that there is a staff training and development programme which meets the National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 2 Key findings/Evidence Standard met? The home was still in the process of revising its training programme and requirements are brought forward. Some staff training had been undertaken and staff spoken to said they had had a range of training including Fire, health and safety, moving and handling. (See previous requirements).Royal Court Nursing HomePage 39 Management and AdministrationThe intended outcomes for the following set of standards are: · · · · · · · · 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 homes record keeping policies and procedures. The health, safety and welfare of service users and staff are promoted and protected.Standard 31 (31.1 ­ 31.8) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. 2 Key findings/Evidence Standard met? The acting manager has twelve years experience of working in care homes, including six years as deputy manager. She is awaiting her fit person interview in order to be registered to manage this home. The senior care staff spoken to confirmed that the acting manager had started a NVQ 4 course in Care and Management. (See previous recommendation). Standard 32 (32.1 ­ 32.7) The registered manager ensures that the management approach of the home creates an open, positive and inclusive atmosphere. 3 Key findings/Evidence Standard met? All staff interviewed spoke positively about the acting manager. They said she was approachable and they could discuss any problems or issues with service users with her.Royal Court Nursing HomePage 40 Standard 33 (33.1 ­ 33.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. 1 Key findings/Evidence Standard met? The senior care staff were not aware if the home had a quality assurance system or annual development plan in place. Not all policies procedures and practices required by the standards/regulations were in place. The home was in the process of reviewing or producing, new policies and procedures and quality assurance systems. These had not yet been completed and requirements from the previous inspection are brought forward. The CSCI had not yet received reports of the visits by the registered provider as required by the regulations. (See previous requirements). Standard 34 (34.1 ­ 34.5) Suitable accounting and financial procedures are adopted to demonstrate current financial viability and to ensure there is effective and efficient management of the business. 2 Key findings/Evidence Standard met? Requirements are brought forward. Insurance cover was in place at the home. The senior care staff had no knowledge of the homes business and financial plan. A previous inspection report stated it was kept at the companys head office. (See previous requirements)Standard 35 (35.1 ­ 35.6) The registered manager ensures that service users control their own money except where they state that they do not wish to or they lack capacity and that safeguards are in place to protect the interests of the service user. Number of service users subject to Power of Attorney processes Number of service users subject to Enduring Power of Attorney processes Number of service users subject to Guardianship Orders X X X0 Key findings/Evidence Standard met? This standard was not assessed. The senior care staff confirmed that the home did not handle service users finances.Standard 36 (36.1 ­ 36.5) Royal Court Nursing Home Page 41 The registered person ensures that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice. 2 Key findings/Evidence Standard met? The senior staff spoken to confirmed that not all staff had yet received supervision at the required level. I.e. Six times a year. She confirmed that staff meetings were held at the required frequency. (See previous requirements).Standard 37 (37.1 ­ 37.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 2 Key findings/Evidence Standard met? The inspector checked a sample of the records that the home was required to keep. These were stored securely. Comments and requirements with reference to these are made throughout this report.Standard 38 (38.1 ­ 38.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 1 Key findings/Evidence Standard met? The senior care staff said that notifiable incidents were reported as required. The inspector was unable to check these. Some statutory training had been undertaken by staff members and the senior care staff member spoken to said she had received all statutory training in the last twelve months. The inspector was unable to access any information about the progress of training including first aid training. The inspector was unable to access information about the progress of revision and implementation of policies and procedures or risk assessments. Therefore all previous requirements are brought forward. (See previous requirements).Royal Court Nursing HomePage 42 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition The DE(E) registered beds are a separate unit CommentsComplianceYESCondition Compliance Of the 31 personal care (PC), 2 can be used as nursing care CommentsYESCondition Compliance The total persons who can be accommodated at the home cannot exceed 40. CommentsYESCondition Compliance The total persons who can be accommodated at the home cannot exceed 40. CommentsYESLead Inspector Second Inspector Locality Manager DateClaire McAuley N/A Amanda Lindley 26th May 2004Signature Signature SignaturePublic reports It should be noted that all CSCI inspection reports are public documents. Royal Court Nursing Home Page 43 PART DD.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above unannounced inspection.We would welcome comments on the content of this report relating to the Unannounced Inspection conducted on 19th May 2004 and any factual inaccuracies: Please limit your comments to one side of A4 if possibleRoyal Court Nursing HomePage 44 Action taken by the CSCI in response to provider comments: Amendments to the report were necessary NOComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection reportNONOProvider comments are available on file at the Area Office but have not NO been incorporated into the final inspection report. The inspector believes the report to be factually accurate Note: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. Please provide the Commission with a written Action Plan within 28 days, which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request. You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YES D.2Action plan was received at the point of publicationYESAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action plan Other: Action plan covered the majority of the statutory requirements, however, some of the action to be taken required further discussion. A meeting is to be held on 30 July 2004 to discuss those requirements.NONONOYESRoyal Court Nursing HomePage 45 D.3PROVIDERS AGREEMENT ­ Unannounced Inspection 19.05.04 Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I Mr David Pearson of Royal Court Nursing Home confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or D.3.2 I Mr David Pearson of Royal Court Nursing Home am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons:Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Royal Court Nursing HomePage 46 - 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. 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