Inspection on 25/09/07 for Royal Court

This inspection was carried out on 25th September 2007.

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

The inspector 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 28/09/09

Royal Court 07/10/08

Royal Court 13/02/07

Royal Court 15/05/06

Royal Court 02/02/06

Royal Court 16/06/05

Royal Court 23/11/04

Royal Court 19/05/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Royal Court Rock Mount King Street Hoyland Barnsley South Yorkshire S74 9RP Lead Inspector Sue Stephens Key Unannounced Inspection 25 September 2007 09:30 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 DS0000006497.V347176.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Royal Court Address Rock Mount King Street Hoyland Barnsley South Yorkshire S74 9RP 01226 741986 01226 741986 admin@royal-court.net None Healthmade Ltd 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) Post Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The total persons who can be accommodated at the home cannot exceed 40 Persons accommodated shall be aged 60 years and above Staffing levels will be determined using the Residential forum for Care Staffing in Care Homes for Older People. 13th August 2007 Date of last inspection Brief Description of the Service: Royal Court is a care home providing personal care and accommodation for 40 older people. The homes registered owner is Healthmade Limited. The home is a purpose built single storey building. All bedrooms are for single occupancy and have en-suite facilities. An enclosed garden area is provided. There are car-parking facilities at the front of the building. Royal Court is located in Hoyland within the Barnsley area and is close to the shopping centre and a doctor’s surgery. The manager said fees from 1 October 2007 range from £341.50 to £410.00 per week. Additional charges include hairdressing and private chiropody. The home supplies basic toiletries. People can get information about Royal Court by contacting the manager. The home will also provide a copy of the statement of purpose and the latest inspection report. The last inspection report is also available in the reception area. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was unannounced; it took place between 9:30 am and 17:30 pm on 25 September 2007. Two inspectors, Sue Stephens and Amanda Lindley, visited Royal Court. During the visit they spent time talking to people who live there, and observed their care. The inspectors spoke to visitors, staff, the manager, Linda Bailey and one of the providers, Sue Pearson. During the visit the inspectors looked at the environment, and made observations on the staffs’ manner and attitude towards people. They checked samples of documents that related to people’s care and safety. These included three assessments and care plans, medication records, and staff recruitment and training records. The inspectors looked at other information before visiting the home, this included evidence from the last key and random inspections, information from people who had raised concerns, surveys, and the homes Annual Quality Assurance Assessment (AQAA). An AQAA is information the commission ask services to provide once a year to show how the provider thinks the home is performing. One person who, lives at Royal Court, eight relatives and two professional visitors responded to our surveys. This was a key inspection where the inspectors checked all the key standards. The Commission for Social Care Inspection pharmacist carried out a random inspection on 10 July 2007 and looked at the homes medication practices. The inspectors would like to thank the people who live at the home, visitors, managers and staff, for their warm welcome and help in this inspection. What the service does well: People live in a home run by committed owners, manager and staff. People gave good feedback about their care and how staff support them. They made comments such as, “I’m ready to go to bed early, so staff take me and I can get up when I want” And “ Staff are very good to me” Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 6 Surveys said the home always or usually met people’s health care needs; and people said staff were friendly and kind. People’s clothes looked well laundered and staff supported them to look presentable and wear safe footwear. People at the home had enjoyed a summer fair and the manager had arranged another event for the autumn. The home had organised a residents, relatives and friends meeting. This gave people the opportunity to be involved in the home and make suggestions. People said they enjoyed their meals; and they had plenty of food and drinks. Mealtimes were a pleasant experience; they were relaxed and sociable. People said they could talk to the staff and the manager. They could raise concerns and staff would take action to help them. People said they were happy with the homes environment. They were happy with their own rooms, and said they were warm and comfortable. People and their relatives said they were satisfied with how staff cared for them. And most said staff were available when they needed them. People could ask the home to look after their monies, the home had a system to keep money safe. The home has a manager with good experience and qualifications. The providers and manager run the home well. What has improved since the last inspection? There was good evidence to show the home had made improvements following the last key inspection. For example the manager was in the process of recruiting a qualified nurse to help staff follow better practices with people’s care plans, medication and moving and handling. The last key and random inspections identified a range of areas where the home needed to improve. The home has made good improvements; this shows that the providers, manager and staff are committed to the care of people who live at the home. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 7 This key inspection found the following improvements. People’s contracts had better information about their fees. People confirmed their hearing aids worked, and they had support to maintain them. People said they could have alternatives to the meals offered, the inspectors saw staff offering people choice during a mealtime. And people said they enjoyed their meals. The manager had nominated a member of staff to oversee the laundry. They checked people had well laundered clothes, and that they returned the right clothes back to the right people. The manager had removed undignified notices from public view. People had better opportunities to enjoy social activities. The providers had made records about the action they took following people or their family’s complaints. The manager had made sure the CSCI (Commission for Social Care Inspection) were aware of any adverse events that happen in the home. And they had a record of accidents. This helps make sure the home follows good practice and improves things if there is an incident. The providers and manager had completed an AQAA (annual quality assurance assessment) this was a start to the home monitoring their quality standards better. And in turn this will help improve services for people who live there. What they could do better: There are three main areas that the home needs to improve to make sure people have good care and are safe from harm. The home has a history of poor moving and handling practices. Their medication practices are not safe and do not follow good practice guidelines. The recruitment procedures don’t follow all legislation (Care Home Regulations 2001) in order to check staff are suitable to work at the home. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 8 In addition to this the home needs to improve the following areas to make sure people get better care and support: The manager needs to remind people she is available to explain the homes fees. Improve the homes assessment tool so that staff can understand people’s needs better when they first come to Royal Court. Make care plans more dignified and person centred. Improve people’s opportunities for day-to-day leisure and social activities, and support them to access outdoors and fresh air. Set a realistic deadline to refurbish the bathroom with the offensive odour. Improve staff training and awareness in the following areas • Safeguarding adults (Adult protection) • Dementia care • Treating people with dignity and respect Make sure new staff have an induction that meets recommended standards and guidelines Carry • • • • out regular monthly visits. And make a report that looks at: People’s opinions about the home Staffing levels and people’s changing needs Where the home needs to improve And what successes Royal Court has achieved. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 9 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 DS0000006497.V347176.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. Standard 6 is not applicable. The quality outcome of this area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. People need to have better assessments from the home; this will help identify better whether the home can meet their needs. EVIDENCE: The manager had reviewed people’s contracts. The contracts included people’s terms and conditions, fees and the kind of service they can expect from Royal Court. (This has improved since the last key inspection). The manager said they had made efforts to keep fee calculations simple for people to understand, this was especially the case for people who had funding from local authorities. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 11 The manager said she told people that if they wanted her to explain the breakdown in more detail she was happy to do this. The inspectors checked this information with visiting relatives. One relative said they were happy with the information; and another relative did not know this and took up the manager’s offer to explain the fees and funding in more detail. Most of the surveys returned said people did not have a contract. The manager said new contracts were due out on 1 October 2007. The inspectors suggest it would be good practice if the manager reminded people, when she sends out the new contracts, that she is available if people want to know more about their fees and funding. The inspectors looked at three care plans, which included assessments. The manager said all people admitted to Royal Court had a local authority assessment first (unless they were someone who self funds). The manager said they look at the local authority assessments to decide if they can offer someone care; and then carry out their own assessment. The manager said the homes assessment tool was basic. However, when the inspector looked at the care plans, these had a profile that would provide a good assessment tool, and help give staff a far better picture of the person coming into the home. Any assessment that included less information than that covered in the profile would be insufficient. A thorough assessment by the home is important especially for people who fund their own care and may not have a local authority assessment. It is important to people because they need to know the home understands and can meet their needs before they agree to live there. The manager said she was recruiting a qualified nurse and this would be part of her role to look at improving assessments. Royal Court accommodates people who need respite care. The inspectors made no distinction between the care and support of people who stay long-term or short-term. At the time of the inspection Royal Court did not provide intermediate care. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The quality outcome of this area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. To make sure people have good, and safe, health and personal care, the home needs to continue improving its care practices. EVIDENCE: The inspectors looked at three care plans. These contained some information necessary for staff to support people. For example they included contact details of relatives and health care professionals, risk assessments and they covered people’s care needs. Staff had made a good effort to include people’s needs in the care plans, and it was evident they had made good improvements since the last inspection. The manager confirmed they had worked hard on them. However, the plans were in battered and untidy files, this did not reflect the homes professional approach or show respect for the information about people who the records were about. There were no photographs to help identify Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 13 people. And the format of the plans was complicated and didn’t help make it easy to find information. This means that important information about people could be lost or omitted from the records. The plans did not include people’s personal likes, dislikes and preferences; this means that staff may not always understand things that are important to individuals. A health care professional replied in their survey that they felt that “Records do not always seem to reflect what is happening”. The inspector looked in the plans for an example of this and found that although staff made frequent records, they did not always relate the information to the persons care needs. The inspector pointed this out to the manager. The inspector found that there was good efforts to cover people’s care needs, for example care plans about hygiene, communication, people’s emotions and their mobility. However, this could be improved by making a better link to people’s assessed needs. The homes profile document would cover this well. The inspector spent time with the manager discussing how to improve the plans including using the profile document, and simplifying the care plan format. People told the inspectors they were satisfied with the way staff supported them with their health care needs. People replied in the surveys that the home “always” or “usually” met their health care needs. One visiting health care professional stated that they suspected sometimes people did not always get support to apply topical creams. The inspectors found further evidence of this. Staff had failed to record whether they had applied topical creams to a person. A CSCI (Commission for Social Care Inspection) pharmacist carried out an inspection on the homes medication. Following this, he made requirements and recommendations for staff at the home to improve practices. The inspector, for this key inspection, checked these and the requirements made on the last key inspection. The home had made some improvements, for example the records now showed that refrigerated medicines were at the right temperature. However, the inspector did not find enough evidence to show that the home had improved practices significantly. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 14 For example, • Staff still did not work to current good practice guidelines • Staff had not had an assessment to assess their competence in dealing with medication • Medication records were not accurate; this included missed signatures, and failure to record why staff had administered an ‘as required’ medication • A hand written entry on a medication record did not have signatures to demonstrate staff had checked the instruction was correct • The records didn’t have photos to help staff identify people • There was no supportive guidelines to direct staff about why and when to administer ‘as required’ medication • One person said they had difficulty taking their tablet. They said staff had told them they could only have it broken up if the person broke it themselves. The person said they were too weak to do this and the tablet caused them discomfort after taking it whole. Staff had not sought pharmaceutical advice about this and the approach, from staff, does not support the individual’s comfort, dignity and health needs. When staff had administered ‘as required’ medication they had not recorded the reason for this. For example ‘person complained of headache’. This means that staff cannot monitor people’s health and report this back to clinical professionals accurately. The manager said the new nurse, when appointed, would review the homes medication practices. People said staff treated them with respect and dignity. They said staff were friendly and helpful. The inspectors made observations on the care and support staff gave people. In the main this was good, however on one occasion a member of staff approached someone from behind and dragged their chair back, to move them away from the table, without letting the person know what they were doing. This startled the person; and it was undignified for them. On another occasion two staff tried to help a person put their feet on the footplates of their wheelchair. This looked uncomfortable for the person, but the staff continued with the task, they did not tell the person what they were doing, reassure them, or ask them if it was ok do this. The inspectors informed the managers about these events. And discussed the need for staff to have a better understanding of dignity and positive care approaches. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 15 The home had improved the laundry systems by nominating a member of staff to oversee it. However, some people said they were still not satisfied the laundry was operating at it’s best, and said they would like it to improve further. The inspectors noted the laundry was clean and organised with large storage boxes to transfer people’s laundered clothes. The inspectors also noted that people looked clean and well dressed. They had appropriate and well-fitted footwear. This was good practice, because it respects people’s dignity, and good footwear helps to prevent falls and trips. The manager had removed notices from public view about people’s personal needs. This has improved since that last key inspection. The inspector spoke to one person who used a hearing aid, they said they were happy with the support from staff and had access to batteries. This has improved since the last key inspection. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15. The quality outcome of this area is good. This judgement has been made from evidence gathered both during and before the visit to the service. People follow the daily lives they prefer and the home is improving leisure and social opportunities for them. EVIDENCE: The managers and staff had made a good effort to improve social activities at the home. During the summer Royal Court had held a summer fair. The manager reported that this was very successful, and people’s families and friends had supported the event well. Staff had arranged another event ‘The Pink Day’ to support the breast cancer charity. The manager had organised a residents’, relatives’ and friends’ meeting, where people can discuss what they want at the home and can plan further social events. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 17 The manager discussed with the inspectors other day-to-day social events that might benefit people at the home. These included a residents shop, and themed coffee mornings. One person described what they thought about the homes social and leisure opportunities by saying, “We sit around and chat to each other” and “We went to Barnsley shopping, it was a while ago but I liked that, they (staff) said we can go again, I’m looking forward to it” The manager confirmed the outing happened last winter; and the inspector recommended that the manager should look at more events like this because people said they really enjoyed it. Another person said they don’t get the opportunity to go out in the garden unless their family takes them. And a relative said “we have not seen any residents sitting outdoors during good weather”. The home needs to improve this to make sure people have better access to outdoors and fresh air when they wish to. People told the inspectors they could follow the daily routines they preferred. One person said “I’m ready to go to bed early, staff take me and I can get up when I want”. The manager said people could follow their preferred religion, and gave an example where a vicar calls and offers people a church service. There was evidence that people were more satisfied with their meals. People told the inspectors that the food was good and they had plenty. One person said they had good choice, they said, “I tell them, and yes they do give me choice”. People also confirmed they have plenty of drinks. The inspectors joined people for lunch. The atmosphere was relaxed and lively and people chatted amongst themselves. Staff helped support people, who needed help, to eat their meals and they did this in a dignified manner. The chef helped serve the meals and chatted and spoke to people as he did so. This is good practice because it helps the chef keep in touch with people’s likes, dislikes and changing preferences. The chef said he had good supplies of fresh food, for example they had fresh vegetables delivered twice a week. And he said most people at Royal Court preferred traditional meals, so he planned menus around this. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 18 Each table had a tablecloth, and this gave the room a homely and dignified feel. However, people who needed assistance with their meals did not have a tablecloth on their table. This made the group of people stand out from the rest, and it was less dignified. The previous key inspection also raised this point. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The quality outcome of this area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. People can raise concerns and the home will take action; however, the home’s poor training opportunities do not help safeguard people from abuse. EVIDENCE: Records showed that the providers had taken action when people, or their families, had made complaints. This has improved since that last key inspection. The commission had received information about a concern regarding someone who lived at Royal Court. The providers had looked into this and worked with other agencies and the family to address the concerns. The inspector checked records relating to this, and these were in order. The manager discussed a new recording system that would make recording complaints easier and more consistent; it would also show the action the home had taken much clearer. This would be good practice and the inspector encouraged the manager to further improve the recording system. The complaints procedure was on display in the entrance hall for visitors to see, and people said they felt comfortable about raising concerns with staff or the managers. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 20 Most Surveys said staff listen and act on what people say. One relative replied, “staff have been very intuitive for (family member) and their contentment indicates staff do listen to them”. And another relative said, “we have only to ask the managers or query anything and the outcome is usually satisfactory”. One survey replied that staff do not listen and they said they do not know how to complain. The inspectors recommend that the manager could use the residents and family meetings to remind people about the homes complaints procedure. (See recommendation for standard 33). Staff were in need of safeguarding adult training (adult protection training) to make sure they understand and follow correct procedures if someone became at risk of harm or abuse. The manager had identified training. However, the manager had not set training dates. Safeguarding adult training was a previous requirement. The inspectors advised the manager that they could also apply to use local authority training sessions. These provide up to date information and good practice advice. There is usually no charge for the sessions. Staff interviewed by the inspectors had a good idea about safeguarding practices, however they were unable to explain the homes and local authorities procedures. The home needs to address this so that staff can be confident about how to take the right action to safeguard people. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26. The quality outcome of this area is good. This judgement has been made from evidence gathered both during and before the visit to the service. People live in a comfortable environment that meets their needs. EVIDENCE: People said they were happy with the homes environment and their own rooms. They said they were warm and comfortable and the furniture was appropriate for their needs. People spoke to the inspectors about their own rooms, these were personalised and they said they had all the things they needed. One person described their room as “lovely”, their bed was “warm and comfortable” and they were “happy” with it. Another person said, “I have all my own furniture and I like my own chair”. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 22 The inspectors found the home clean and tidy, in the main areas were well lit, which helped assist people with sight difficulties, and rooms and corridors were free from trip hazards. The managers said they had been successful in a bid for monies to improve areas of the home. They said they planned to replace the entrance and hall carpets and that people who lived there would benefit from this. Staff said they felt the environment was all right and they could go to the manager if anything needed repairs. Two bathrooms had offensive odours. The providers were aware of one bathroom and planned to refurbish the room and floors. However, the providers had no timescale for this. The manager agreed to investigate why the second bathroom also had an offensive odour similar to the other one. One person’s wheelchair was dirty with accumulated dirt and food spills. This did not promote good hygiene standards or respect the person’s dignity. The corridors to people’s bedrooms were long and looked alike. Bedroom doors also looked alike, and it was difficult to tell one door from another. The inspectors advised the manager to think about personalising people’s doors so that it is easier for people to recognise. This would help promote people’s dignity and independence. (Some families had already done this in a dignified way). Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The quality outcome of this area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. People could be at risk of receiving poor or inappropriate care because staff recruitment, induction and training does not meet minimum standards. EVIDENCE: People said about the staff “They are very good to me”, “They are ok and friendly” and “They work hard”. A relative replied in the survey “They have a talent for treating individuals as special; staff work well together”. People said, and this was confirmed in the surveys, that in the main there were sufficient staff available when people needed them. A member of staff acknowledged that sometimes staff sickness meant they were short staffed and one survey said, “There always seems to be a staff shortage”. (See report and recommendation for standard 33). Sixty six percent of the care staff had a National Vocational Qualification in care; this was good practice because it helps staff to understand the principles of good care practices. However, other training opportunities for staff were poor. Staff had received no additional training in relation to the care needs of Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 24 people who live at Royal Court. Previous requirements stated that staff needed dementia care training. The manager had not taken sufficient action to address this. Inspectors found evidence and made observations on staff that demonstrated they could improve their care practices in relation to dignity and respect. (See sections on health and personal care, daily lives and activities and management and administration). Better training opportunities for staff would help increase staff awareness and help promote people’s dignity and individualised care. The home did not have an induction package that linked with the Skills for Care training standards. The induction standards provide a description of the minimum understanding required for social care work. This will help the manager decide the level of training and induction needed at Royal Court. Information about this is available at www.topssengland.net The inspectors looked at a sample of recruitment records. Some records had no evidence that the home had carried out a full Criminal Record Bureau check, not all checks were the required enhanced check. The records did not have staff photos and the manager had not sought written confirmation from staff about their employment gaps. This meant the home could not demonstrate it had taken sufficient action to check that new staff were suitable for the job. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. The quality outcome of this area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. The inspector judged this area as adequate because although the home continues to practice with poor moving and handling procedures there is good evidence the providers and manager run the home well and have made some good improvements. EVIDENCE: The manager holds the relevant qualification, (the registered managers award) and she has at least twenty years experience. The manager was considering applying for registration with the commission and submitted her application following this inspection. Improvements from the last key inspection show that the manager and providers are committed to improving standards in the home. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 26 The manager and providers have completed an AQAA (annual quality assurance assessment) on the home. This forms the basis of a quality assurance system for the home. Previous to this, the home did not have effective quality assurance systems in place. The providers had on occasions carried out monthly visit reports, these look at the views of people who live at the home, staff, the environment and samples of records. When carried out regularly monthly visit reports add to the quality assurance system. They help the home to identify areas for improvement and to recognise good progress and successes. It can also help keep the people who live at the home empowered and involved in the homes development. The inspectors spent time explaining this to the provider and manager and strongly recommend that they use monthly visit reports to help them recognise and make improvements at Royal Court. The inspector checked a sample of people’s finance records. These were records of spending monies held by the home on behalf of individuals. The records were in good order and up to date. There was clear evidence that the manager audited the accounts regularly and the records showed that transactions matched receipts. The inspectors checked a sample of the homes health and safety records, for example the fire records. These were up to date and showed they had done the appropriate checks to keep people safe. Staff had also done fire drills and training following the requirement from the last key inspection. The manager confirmed in the homes AQAA (annual quality assurance assessment) that the home had up to date health and safety maintenance checks. The manager had a record of dates when people had completed safe practice training, the record identified that several staff were nearly due for up date training in several areas. The manager said she was aware of this and would make sure staff received the safe practice training in time. There was evidence to show the home had sent in notifications about adverse events that happened at the home, and the inspector saw a sample of an accident record that demonstrated the home had followed correct procedures. The home has improved this since the last inspection. The home has a history of requirements relating to moving and handling people. The inspectors observed staff carrying out moving and handling techniques to support people to move or walk. Some of these techniques did not look safe for individuals, and the care plans did not have enough information in them to confirm if staff were using the right procedures. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 27 The manager confirmed staff had received training. However, information in the care plans was insufficient to demonstrate that staff had carried out a sound assessment and put in place clear guidelines about how to support a person to move. The inspectors also observed staff using moving belts, some people looked surprised at this, when staff used them. The inspectors fed this back to the manager and suggested that either using belts was not used as often as they should be or staff had not taken enough time to explain to people what they were doing. The moving and handling practices and limited information in care plans puts people and staff at risk of injury. The manager said the new nurse, when appointed, would review the homes moving and handling practices. Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 28 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 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 1 Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 29 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 OP38 Regulation 13.4(5) Requirement This requirement is carried forward from the following dates: 31/08/05, 30/04/06 & 16/10/06 and 31/07/07. The providers must take action to make sure people and staff are safe when involved in moving and handling procedures. This must include: • Staff training sufficient to meet the needs of individuals • Suitable assessments • Clear recorded guidance 2 OP7 15.1 The care plans must include the 31/10/07 following, so that staff have clear and safe guidance about people’s needs. • Clear correlation between plans and people’s assessed needs. • Clear records about peoples health care needs • Records that correlate to DS0000006497.V347176.R01.S.doc Version 5.2 Page 30 Timescale for action 31/10/07 Royal Court peoples care plans 3 OP9 13.2 This requirement is carried forward from the previous key and random inspections. The providers must take action to make sure medication practices are safe. This must include: • Revise the medication policy to make sure staff work to current good practice Assess staff to check that they are competent enough to handle, record and administer medications safely Maintain accurate and complete records to make sure medicines, and controlled drugs, are given as prescribed and accounted for Hand written entries on the medication records signed and dated by the author Handwritten entries checked and countersigned by a witness 31/10/07 • • • • And from this inspection: • Staff who administer medication must seek pharmaceutical and medical advice when people have difficulty taking their prescribed medicines Staff must make sure that topical creams are applied to people as prescribed • Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 31 And medication records are completed accurately to demonstrate this. 4 OP18 13.6 Staff must have suitable training 31/10/07 and guidance in safe guarding adults (adult protection) to make sure they know how to recognise poor practice and take action if they suspect people are at risk of harm or abuse. The providers must identify a timescale for completing the refurbishment of the bathroom with the offensive odour. Staff recruitment procedures must follow robust checks These must include: • • • • Enhanced Criminal Record Bureau Checks (CRB) Completed CRB checks Staff photos Written confirmation about employment gaps 31/10/07 5 OP26 23.1(a) 23.2(b) 6 OP29 19.4(b) 19.7(b) Schedule 2 31/10/07 This will help make sure people receive care and support from suitable staff. 7 OP30 18.1 (a) 18.1(c) (i) To make sure people receive safe and consistent care that meets their changing, Staff must receive the appropriate training. And they must keep their training up to date. This key inspection found that the following training and guidance was necessary for staff: • Dementia care and awareness Treating people with dignity and respect Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 32 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP2 Good Practice Recommendations When issuing people and their relatives with new contracts, the manager should remind people that she is available to discuss and explain fees and funding further if people want to do this. The manager should improve the homes assessment tool The home’s profile document in the care plans could be used to help give people better assessments and give staff better information about people’s needs when they are first admitted to the home. 3 OP7 The care plans should continue to improve so that staff have clear and safe guidance about people’s needs. This • • • should include: Photos of people to help staff identify them Tidier files, which respect peoples dignity better An easier system so that staff can record and find information better A more person centred approach that includes peoples likes, dislikes and preferences about every aspect of their care and support. 4 OP9 To support safe medication practices the providers should make sure the following recommendations are in place: • Medication that is prescribed as and when required should have supporting guidelines to inform staff under what circumstances these medications should be administered Individual MAR Sheets should have a photo of the resident in the medication file Medication records should have a sample of signatures of staff that administer medication When administering ‘as required’ medication staff DS0000006497.V347176.R01.S.doc Version 5.2 Page 33 2 OP3 • • • Royal Court should record overleaf on the medication records sheet the date, dose and reason why they administered the medication. (For example for a pain relief medication, staff might record ‘person complains of headache’). 5 OP10 Staff practices towards people’s dignity should improve. For example they way they approach and tell people what is happening when they carry out a care procedure. People who need assistance at mealtimes should have their tables set in the same way as other people. For example, by using tablecloths. The laundry systems must continue to improve. 6 OP12 People should have better access to leisure and social activities. This should include better opportunities for people to access outdoor areas and fresh air. The manager should also pursue other activities such as the themed coffee mornings. This will help enhance people’s social and leisure opportunities. 7 OP26 The providers should take action to eliminate the offensive odour in the second bathroom. There should be a regular cleaning schedule for wheelchairs. Staff should clean up spills from people’s wheelchairs as they occur. 8 OP30 To make sure staff are trained and confident to do their job they must have an induction that meets with sector skill council specification. This information is available from www.topssengland.net 9 OP33 The providers should improve the monthly visit reports, and make sure they carry these out every month. The reports should include • • • Royal Court Consulting people about their care Check if they and their relatives are satisfied and know how to raise concerns Identified areas that have improved DS0000006497.V347176.R01.S.doc Version 5.2 Page 34 • • Identified areas of good practice and successes Observations on staff attitudes and staffing levels in line with peoples changing needs Royal Court DS0000006497.V347176.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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