Inspection on 15/08/05 for Sir Jules Thorn Court and Mary Court

This inspection was carried out on 15th August 2005.

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

Sir Jules Thorn Court and Mary... 14/01/09

Sir Jules Thorn Court and Mary... 10/01/08

Sir Jules Thorn Court and Mary... 21/11/06

Sir Jules Thorn Court and Mary... 09/02/06

Sir Jules Thorn Court and Mary... 20/12/04

Sir Jules Thorn Court and Mary... 10/06/04

Sir Jules Thorn Court and Mary... 15/01/04

Sir Jules Thorn Court and Mary... 21/10/03

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

CARE HOMES FOR OLDER PEOPLE Sir Jules Thorne Court 29-35 Prince of Wales Drive Battersea London SW11 4SL Lead Inspector Janet Pitt Unannounced 15 August 2005 10:00 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 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. Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Sir Jules Thorne Court Address 29-35 Prince of Wales Drive Battersea London SW11 4SL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 7738 0280 Servite Houses Mr KA Mooniaruck Care home with nursing (N) 30 Category(ies) of Mental Disorder, excluding lerning disability or registration, with number dementia - over 65 years of age(MD(E)) of places Dementia - over 65 years of age (DE(E)) Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1- Those being in the category of Elderly Mentally Frail 2- Those Being in the category of Mental Health cannot be liable to be detained under the Mental Health Act 1983. Date of last inspection 20th December 2004 Brief Description of the Service: Sir Jules Thorne provides nursing care for up to thirty people who have mental health needs. The home provides accomodation in single rooms with ensuite faciltiies. Sir Jules Thorne has two floors, the home is divided into four units, known as clusters, which each have their own day room. The home has a large dining area and access to a small garden. The home is situated in Battersea, close to Battersea Park. There are acccessible road and bus links to north and south London. Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection commenced at 10:45 am and concluded at 2:05pm. The inspection was undertaken by one inspector. Care documentation, medications and activities within the home were examined. The inspector spoke with three members of staff and three residents. A brief tour of the premises was undertaken. The inspection focused on activities within the home, mealtimes and care documentation. Standards not assessed at this inspection will be during the inspection year. What the service does well: What has improved since the last inspection? What they could do better: Residents’ dignity must be preserved, particularly at mealtimes and assistance must be given in an appropriate manner. Attention to detail at mealtimes is also required and staff must provide adequate amounts of condiments available to enable residents to flavour their food as required. Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 Page 6 Staff must document the administration of medicines accurately and it must be indicated on the record when a new box or bottle has been opened. Topical creams must have clear direction for use to ensure that residents’ treatment is carried out correctly. 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. Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 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 standard(s) 1,3 and 5 Residents are able to access suitable information relating to the service provided. Care needs are identified through comprehensive assessments, which are undertaken prior to and on admission. EVIDENCE: Residents are provided with information on the home at the time of admission, the manager stated that a welcome pack is given to new residents. The welcome pack contains a copy of the Service User Guide. The Service User Guide gives clear information for residents of what is included in the fee and how large rooms are. Mealtimes and telephone facilities are also detailed. Relatives and friends are encouraged to visit the home at any time, but staff wish to be informed of any late evening visits, to maintain the safety of residents. A copy of the Statement of Purpose was available in the main entrance hall. As a requirement from the previous inspection the Statement of Purpose has been updated to include details of the current regulatory authority and now includes a copy of the complaints procedure. Both documents include details of how Service User Plans are drawn up. Residents assessments examined indicated that a comprehensive assessment of care needs is carried out on admission. Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 Page 9 The manager confirmed that he undertook pre-admission assessments prior to a residents moving into the home, evidence of which were see in residents files, which are stored in an office. Information from other health professionals and social workers was also noted to be held in these files. This enables current information of residents care needs to be kept within files held on the units. Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 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 standard(s) 7,8,9,10 and 11 There must be an auditable trail of medicines held within the home to ensure residents are not placed at risk. Care documentation requires improvement to ensure that actual care given is recorded accurately and all care needs of residents are met. Staff usually treat residents with respect, but improvements must be made to ensure that this is consistent. EVIDENCE: Residents are protected from harm by any allergies being detailed on medicine administration record. (MAR) sheets. All twenty-nine sheets examined had recorded whether there were any allergies to medicines or not. The majority of MAR sheets were completed fully, but on some there were gaps in recording of medicines given. Medicines were signed for when received, but the date the bottle or box was commenced was not noted, therefore there were a few discrepancies in the amount of medicine in stock compared to what had been signed for as given. It was apparent that there was no overstocking of medication, and staff must document when medicines are started, to ensure that there is a clear audit trail. Medicines were observed to be stored correctly. Topical creams did not always have clear directions for use, i.e. the area to which the cream should be applied. This was discussed with the manager and Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 Page 11 he said that he would discuss the situation with the prescribing general practioner. The manager was aware of the need to ensure that clear directions were available to ensure that residents receive correct treatment. There has been improvement in the structure of care documentation since the previous inspection to make information easily accessible. Residents’ wishes in the event of death had been recorded on all four plans examined, which verified that residents and their representatives had been asked about all aspects of care. Residents were noted to be weighed monthly, on the plans examined it was observed that body weights were stable or had increased, which indicates that nutritional intake was sufficient. Residents preferred names were documented and staff ensured that the preferred form of address was used when talking to residents, thus promoting dignity and respect. There were observed episodes of staff not respecting residents’ privacy and dignity, these issues are detailed in the Daily Lives and Activities section, which follows this section. Individualised risk assessments were in place, minimising risk to residents. Examples of risk assessments related to skin condition, eating and mobility. Daily records were noted to be completed routinely, staff entered their designation when completing the entries, however there were no clear details of actual care given, phrases seen included ‘ comfortable afternoon’, ‘all care given’ and ‘fluids encouraged’. One resident had episodes of ‘aggression and noise’ and another resident was recorded as refusing ‘to change’ [their clothes], but there were no interventions documented. Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 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 standard(s) 12 and 15 Residents are able to lead fulfilled lives by the improved choice of activities offered by the home. Mealtimes allow residents choice, but care must be taken to ensure that residents are treated respectfully and with dignity at all times. EVIDENCE: Residents have recently been on a visit to Brighton and one resident had photographs of the outing on their bedroom wall. The manager stated that the home has a new activities co-ordinator and improvements have been made to the variety of activities offered. The inspector heard a visitor commenting on the success of the barbecue held on the day prior to the inspection. One resident was seen after lunch being assisted to the day room, the television was then turned on, but the member of staff did not ask the resident what they wanted to watch. The resident confirmed that they liked to watch the news, but did not always like the content ‘because it [the news] is sometimes miserable.’ Residents were observed in the afternoon playing bingo with staff and two residents were listening to music. Sir Jules Thorne had just acquired a piano for residents to use. Residents have a choice of two main meals at lunchtime and time was spent observing what occurs when lunch was served. The meal portion sizes were adequate and food was well presented. Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 Page 13 Two residents commented that the meal ‘was nice’. The chef confirmed that at each meal he made notes on food wastage to gauge what foods were enjoyed and what foods were not. It was observed that residents had fruit cordial served to them. The residents were not asked what flavour they would like. The manager stated that staff were aware of the residents’ preference and gave them what flavour they liked. Residents were noted to sit where they wanted and were able to eat meals in their rooms if they so wish. There were examples of good practices of assisting residents with their meal. Staff were observed sitting down to assist residents and enquiring whether the resident were enjoying their food and whether it was too hot. However, one member of staff was observed to be standing up when assisting a resident to have a drink. Residents were observed to be enabled to eat independently. Tables were attractively presented by the use of cloth tablecloths. However there were insufficient condiments available for each table. Residents were observed with blue plastic aprons in place of napkins, this was discussed with the manager who stated that it was the residents’ choice. One resident was moved in their wheelchair without footrests being applied, which placed them at risk of being injured. The same resident had to wait for five minutes before being provided with a spoon to eat their dessert. One resident who did not like their main meal was given two desserts and staff stated that this was common for this particular resident. The dining room had been improved with the addition of an air conditioning unit, as the room had a tendency to become too hot. The meal was unhurried and two members of staff were heard asking whether residents had had enough to eat before taking their plates away. Hot drinks were noted to be provided in the day rooms after lunch. Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 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 standard(s) 16 There is clear information for residents and their representatives on how to complain. EVIDENCE: The manager reported that there have been no complaints received in the past twelve months. Residents and their representatives are able to access the complaints policy, a copy is on display in the main entrance and also given to residents on admission. The complaints policy details the procedures to be taken when a complaint is received and the expected timescale for response. This gives residents a clear indication of how their concerns will be addressed. Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: None of these Standards were assessed at this inspection, but will be during the inspection year. Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 A consistent staff team supports residents, to ensure that care needs are met. EVIDENCE: The manager reported that the home had advertised for one staff nurse and two carers’ positions, otherwise the home is fully staffed. There are bank workers who are employed to provide a consistency of service to residents whilst vacant posts are being filled. There were adequate numbers of staff on duty on the day of inspection and staff were visible in the units and dining area when lunch was being served. Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Risks to residents are minimised through storing food correctly and routine checking of hot water temperatures. EVIDENCE: Examination of documentation relating to hot water temperatures indicated that there was a risk of residents being scalded. This was discussed with the manager who stated that thermostatic valves had been fitted to sinks. The records indicated that since this was done, the hot water temperatures had remained within safe limits. Temperatures of fridge and freezers within the home were recorded daily and seen to be within safe limits. One resident was seen being pushed in a wheelchair, without the footrests being in position, which placed them at risk of harm. Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 x x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x 2 Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13 (2) Requirement The registered person must ensure that all medicines administered are recorded as given. The registered person must ensure that there is a clear indication on the medicine record of when a new box or bottle is commenced. The registered person must ensure that topical creams have clear directions for use. The registered person must ensure that there are clear details of actual care given recorded in residents documentation. Interventions to promote care must be recorded. There must be evidence from qualified staff of their input into residents care (previous timescale of 30/3/05 not met in relation to qualified staff input). The registered person must ensure that residents are treated with respect and dignity at mealtimes. If blue plastic aprons are to be used as napkins then this should be documented as being agreed. Staff must ensure that residents have sufficient Timescale for action 30th October 2005 30th October 2005 30th October 2005 30th October 2005 2. 9 13 (2) 3. 4. 9 7 13 (2) 15 and Schedule 3 (3) (k) 5. 10 & 15 12 (4) (a) 30th October 2005 Sir Jules Thorne Court G54-G04 S19122 Sir Jules Thorne V230951 150805 Stage 4.doc Version 1.40 Page 20 6. 38 13 (5) condiments. Staff must ensure that assistance is given in an appropiate manner. The registered person must ensure that when wheelchairs are in use, footrests are used. 30th October 2005 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. 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