Inspection on 20/02/06 for Royal Court

This inspection was carried out on 20th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Royal Court 17/07/06

Royal Court 12/10/05

Royal Court 14/03/05

Royal Court 17/11/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Royal Court Fiddler`s Green Lane Cheltenham Glos GL51 0SF Lead Inspector Mrs Janice Patrick Unannounced Inspection 20th February 2006 09:15 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 Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 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. Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Royal Court Address Fiddler`s Green Lane Cheltenham Glos GL51 0SF 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) 01242 221853 01242 518827 Bromford Housing Group Mrs Susan Elizabeth Charlton Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (44), Physical disability (4) of places Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. A designated respite flat will be used to accommodate a named person who is under 65 yrs of age & who has a physical disability for periods of respite care. 12th October 2005 Date of last inspection Brief Description of the Service: This Care Home is purpose built and is divided into six units of self contained flats offering independent living for those over 65yrs of age with personal care available as required. The flats vary in size but all contain an inner lobby, bathroom, airing cupboard, lounge and kitchenette. There are communal dining rooms in each unit and one main lounge. A well equipped hairdressing room is also on site. Communal bathrooms are equipped with specialised bath hoists and some adapted toilets. All doorways are wheelchair friendly. In addition there are two passenger lifts giving access to all floors. The forecourt, which has been planted with shrubs and flowers, can be enjoyed in the warmer weather. There is ample, level parking and the local bus route into Cheltenham Town runs outside the Home. There is also a local grocery shop nearby. Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one Inspector between the hours of 9.15am and 3.30pm on 20th February 2006 and between 2.15pm and 3.30pm on 21st February 2006. The Registered Manager and the Deputy Manager were on duty as were other members of the Home team. The inside of the Home was observed during the inspection but a full inspection of the environment was not carried out on this occasion. Pre admission assessments were read along with a sample of residents care plans and other related care documentation. Chosen areas of the medication system were inspected, including related records. Lunchtime was observed and residents’ views on the food sought. A selection of staff training files were seen and a discussion held regarding the Home’s progress with the National Vocational Awards (NVQ) in Care. The general management of the Home was inspected which included systems such as staff supervision and quality assurance. Arrangements for the safe storage and recording of residents’ monies were inspected. Six residents and two relatives were spoken with in detail, several others were asked their views on the food and how they spent their day. What the service does well: What has improved since the last inspection? The Home’s environment has continued to improve according to an ongoing programme of refurbishment and decorating. This has recently included the laundry. There are sufficient cleaning staff to keep the Home clean and extra hours are planned in order to maintain this. Some thought has been given to the quality assurance system and systems that the Home would like to improve on have been identified. Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 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 Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 The assessment process used in this Home ensures that staff are aware of the resident’s needs prior to admission and therefore can adequately meet these once the resident has been admitted. Intermediate care is not provided at this Care Home. EVIDENCE: The pre admission assessments pertaining to the last two admissions to the Home were read. One was carried out whilst the resident was in hospital and the other, during the resident’s visit to the Home. The latter was accompanied by a ‘Care Needs Assessment’, which had been completed by the Hospital, which gave the Home limited information about the resident’s needs. The Manager or Deputy Manager always carry out the pre admission assessments. Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 9 Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 There is an established care planning system in place, but in places this offers limited, individualised information to staff about ‘how’ the person’s needs are to be met. Regular contact with a selection of external health care professionals ensures that the residents’ health needs are met. The system for medication storage and administration are good with clear and comprehensive arrangements in place to ensure residents’ medication needs are met safely. EVIDENCE: A selection of care documentation was read. All care staff record within this documentation and a ‘key worker’ group approach is taken when reviewing or writing care plans. Four care files were read in detail. The care planning was limited in content in places and in one file particularly, the Inspector felt that what was written, did not fully reflect the situation or the needs of the resident. This was explored at the time with the Manager who in this case agreed. Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 11 Another care plan related to a resident that the Inspector spoke with prior to reading his file. Although care plans were in place, they had not been developed with the resident. The Inspector has no doubt that the resident had been spoken to initially about his needs, but during her conversation with the resident he confirmed that he was aware of a care plan as care staff often tell him that they will enter various things in his care plan. He though had never seen this and did not know what was written in it. This resident is keen to keep control of his life and would be more than able and willing to be involved in his own care planning, thus enabling the care plans to be far more individualised and pertinent to him. This resident however, had no complaints with the care he was receiving. This type of approach to care planning had been discussed at the previous inspection and in the case identified then, the persons care plan has since been reviewed with them. The Manager has identified that care planning needs to be more individualised and has included this in her quality assurance action plan, but also said it would be a struggle to find time to do this. Ways of improving the written content without changing the whole system were explored during this inspection with the Manager. It was also identified that residents who have little change in their needs must still have it clearly identified in their care documentation that their needs are being reviewed. In the case of one care plan seen the resident had signed it demonstrating her agreement with the plan. The care documentation demonstrated that residents were receiving on a regular basis, attention from a chiropodist and their GP’s. A Community Nursing Auxiliary visited one resident during this inspection, in order to take some of the resident’s blood. She confirmed that the carer was fully aware of the resident’s condition and what dose of related medication was being taken. Also a Community Nursing Sister visited four residents for various reasons. One resident was poorly and the Home staff had already requested a GP visit that morning. The Community Nurse agreed that the resident’s condition warranted a review by the GP and would advise him of this on her return to the surgery. Both these NHS staff confirmed that the Home staff were always helpful during their visits and were always aware of the condition of their residents. The medication system was inspected in three separate locations. All were stored correctly and were organised with only the stock required at that the time being stored. Records were kept correctly with no gaps in administration. A selection of staff training files were inspected and certificates were seen in accredited training for medication administration. The Manager confirmed that all staff administering medication in the Home, hold appropriate accredited training. One carer confirmed that she held a certificate in this training and had also completed update trainings; these certificates were seen in her training file. Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 & 15 Residents are supported to lead independent lives for as long as they can and to make their own choices. The meals in the Home are good and aim to meet a wide variation in taste and dietary need. EVIDENCE: Residents seen during this inspection clearly vary in their capabilities, but all are supported to remain as independent as possible within their own flats. All have a choice as to whether they join others for meal times or social interaction or not. Those that are frailer are observed more frequently by staff either in the main communal areas or their own flats. A married couple that have very differing needs are supported to live as they would have done at Home but with care and health support when required. One resident admitted fairly recently felt that he had made the right decision coming to the Home, as he has some physical disabilities that he requires support with, but he did not want to lose all his ability to live independently in a domestic setting. He agreed that the flat with care support was ideal for him and he was surprised how well he had settled. He also said the food was Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 13 generally good and confirmed that he could order an alternative to the main menu if he wished. Another resident visited was in the middle of dusting, although the Home staff clean the flat, she liked to dust her ornaments etc. This flat was particularly homely and was obviously enjoyed by the occupant who was carrying out tasks that she would have done in her own home. Several residents were seen socialising with each other or transporting themselves around the Home independently in their own wheelchairs. Every Monday a day centre is held in part of the communal lounge, all the ladies agreed that the food was always well cooked and tasty. On one dining room table residents that were more able were seen helping to pour the water for others or organising the place mats. There was a social feel to the mealtime. Care staff hold training in Food Hygiene and kitchen staff general hold more advanced trainings in the same subject. Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Although the Complaints Procedure has been made available to residents it is not sufficiently obvious in its current location to visitors. Arrangements are in place to ensure that staff are aware of the issues involved in Adult Protection and other related processes help protect residents from abuse in this Home. EVIDENCE: There is evidence of good recruitment practice and ongoing staff supervision which both help to protect the vulnerable person. Training records also show that day and night staff receive training on how to recognise abuse and how to handle such a situation should it ever arise. Group supervision records also show that the less obvious, unintentional misuse of power i.e. carer verses vulnerable resident relationship, has been discussed to help broaden the care staffs’ awareness of peoples perception of what abuse is. Standard 16 was not fully inspected on this occasion but it was noted during this inspection that the Home’s Complaint Procedure was not obvious to those visiting the Home. It was found in a folder titled Royal Court at the back of the main reception table. This does not meet with the agreed action plan submitted to the CSCI by the company following a previous complaint made to the company. The Manager commented that residents did not like it on display in the reception area. She also confirmed that each resident had a copy of the Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 15 procedure. It was also located in the Residents Guide in an upstairs dining area. Alternatives however, should be explored as to the location of the Complaints Procedure, which should be obvious to visitors if they wish to make a complaint without referring to a member of staff. In the majority of other care homes this can be found discreetly placed on the wall in the main entrance, usually alongside the registration certificate. Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The Home benefits from an ongoing programme of refurbishment and decoration, which results in a pleasant environment for residents to live. EVIDENCE: Major refurbishments are planned and budgeted for by the company. This included new boilers and radiators last year. The laundry has recently had work completed on it making it easier to keep behind the large machinery clean and has benefited from a new commercial machine. Many of the flats were recarpeted last year. Flats are redecorated and usually recarpeted during a change of occupancy. If residents wish to have their flat decorated, they are offered another flat to stay in, although several residents do not want the upheaval and do not have their flats totally redecorated. Those seen had some evidence in places of ‘touching up’ as required. The Fire Officer has recently visited the Home and the Manager confirmed that this inspection was satisfactory. Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 17 Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 Staff are well trained to meet the needs of the residents. EVIDENCE: Training given to the staff follows the recognised National Training Organisation for Social Care (TOPPS) guidelines. The Home is doing well towards the required 50 of staff being trained at NVQ Level 2 or equivalent in care. Some of the day and night staff either hold the award or have Level 2 and are progressing to Level 3. Nine care staff have just commenced Level 2. The Manager has also commenced the NVQ Assessors Course, when successful this will give the Home the benefit of two assessors on site. Two of the night staff have been joined by the Manager on their shifts in order to work through some of the units within the award. Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33 & 35 The Home benefits from having an experienced Manager who has a clear vision for the Home and who is well supported by her senior staff. She is aware of where improvements can be made in the interests of the residents and aims to run the Home with their views and opinions being taken into account. This process would be greatly helped if the planned auditing and quality assurance system got underway. Arrangements are in place to keep residents personal monies safe. EVIDENCE: The Manager has managed Royal Court for over 10years, is registered with the Commission for Social Care Inspection (CSCI) and holds the Registered Managers Award (RMA). She is well supported by a Deputy Manager and other staff. She has very clear views as to the standard of care to be provided and where improvements can be made. Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 20 The Manager commented that she is not able to get out of the office as much as she would like and there were a couple of instances where the Inspector would have expected the Manager to be more aware of a residents health history and needs. This problem has been identified and is being addressed by the Manager and two other senior staff ensuring that they each see residents individually on a regular basis in different areas of the Home. It has been noted that all administration is carried out by these key senior staff who would be using their skills more effectively by being more involved with the residents and their care issues. Minutes from the last formal residents meeting dated back to June 2004. The Manager said that these were poorly attended and therefore ceased. A quality assurance questionnaire was sent to each resident last year, but in the last inspection in October 2005 the findings of this questionnaire had not been formally collated. There is a danger that although care staff clearly know their residents and are communicating with them, that a collective view and opinion from the residents is either being missed or is not able to be expressed, particularly if senior staff are also struggling to get out and about and there remains a situation where no resident meetings are being held. The Inspector also noted that residents do see management staff and do not have a problem expressing their views. However, for the Home to improve upon the services offered and for it to be able to measure its standard of care there needs to be a system that measures these areas and which provides a structured action plan and evaluation. The monies held securely by the Home for three residents were inspected. Receipts of any purchases are kept and a record maintained of outgoings and incomings. Second witness signatures were present where staff on behalf of the resident had made purchases and in one case the resident’s own signature, where they had made a withdrawal of money from their ‘in house’ account. One relative confirmed that she looks after her mothers finances for her, the resident agreed that this was easier for her and in another case a resident explained that his relative now manages his finances through a Power of Attorney arrangement and described this as ‘one less worry’ for him. Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 4 X X X X X X X STAFFING Standard No Score 27 X 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 X X X Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The Registered Manager must ensure that the care plan is specific about a residents needs and directs staff on how to meet these needs. The Registered Manager shall make arrangements to gather the views of the residents, representatives and visitors, in relation to the services and care provided within the Home. The Manager must make arrangements to review the quality of care and services offered at the Home. And: Forward a report to the Commission, making the findings available to the residents/representatives. Timescale for action 01/04/06 2. OP33 24(3) 31/03/06 3. OP33 24 (1) & (2) 31/03/06 Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP16 OP28 Good Practice Recommendations The Complaints Procedure should be obvious to any visitor to the Home. The Home should continue to plan towards 50 of the workforce being NVQ Level 2 or equivalent. Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Royal Court DS0000016568.V278281.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!