Inspection on 03/03/09 for St Leonards Court

This inspection was carried out on 3rd March 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Leonards Court 21/02/07

St Leonards Court 01/11/05

St Leonards Court 19/05/05

St Leonards Court 25/10/04

St Leonards Court 29/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Leonards Court 6 St Leonards Street Mundford Thetford Norfolk IP26 5HG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Shirley Christopher     Date: This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: St Leonards Court 6 St Leonards Street Mundford Thetford Norfolk IP26 5HG 01842878225 01842878238 stleonardscourt@manorcourtcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Manorcourt Care (Norfolk) Ltd care home 25 Number of places (if applicable): Under 65 Over 65 0 25 dementia old age, not falling within any other category Additional conditions: 25 0 25 Elderly people of either sex may be accommodated 25 people of either sex who have dementia may be accommodated Maximum number of 25 may be accommodated Date of last inspection Brief description of the care home St Leonards Court is a care home providing personal care and accommodation for up to 25 older people who have a dementia. St Leonards Court was owned by Manor Court Care, which had other homes and resources within Norfolk. Within the last year it has been bought by Health care homes. There has been no change to its registration or to the staffing. A new manager has been appointed since the last key inspection. The home is situated in the village of Mundford, close to the town of Thetford. St Leonards Court is located on the village green and is in the centre of the village. Care Homes for Older People Page 4 of 27 Brief description of the care home Accommodation consists of 19 single and 3 shared bedrooms. All bedrooms have ensuite facilities. Bedrooms are located on the ground and first floors. There is level access throughout the home and a shaft lift is installed for access between floors. There is ample communal space, including 2 lounges, a period reminiscence lounge and dining room on the ground floor. There is a small sitting area on the first floor. The home has an enclosed rear sensory garden, which is easily accessed by service users. The garden has a ramped pathway and lawns, together with sitting areas and appropriate garden furniture. There is parking space available to the rear of the building. The weekly fees were 410 - 450 at the last inspection. Enquiries about fees should be made directly to the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, The Commission for social care inspection completed an unannounced inspection to the home on the 3 March 2009. The inspection was carried out over a period of six hours. During the inspection we spoke to the staff on duty, the ancillary staff, the manager and the area manager. We spoke with a relative, residents and observed care practises in the home. We joined residents for lunch and watched the interactions between staff and residents. We looked round the home and looked at a number of records the home are required to keep including; staff and residents records, health and safety records and maintenance records. Before the inspection we asked the home to complete a self assessment, which provided us with some numerical data and evidence of how the home are meeting Care Homes for Older People Page 6 of 27 national minimum standards. We looked at the service history, including the last inspection report and notifications, which are a legal requirement. These tell us of any adverse events affecting the well being and, or safety of residents. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is able to meet the needs of the existing client group and complete a detailed assessment before admission to ensure that their needs are known and can be met. Evidence: The home are registered to accommodate people with dementia. The home was owned by Manor court care but was bought out by Health care homes last year. The home has updated their service user guide and statement of purpose. There is a corporate document and one more personal to the home. This can be produced in large print, but is not available in other formats. The home may wish to produce it in a format more appropriate for the current resident group. We looked at one recent pre admission assessment and this was in sufficient detail, but did not give us information about who had been involved in the assessment and Care Homes for Older People Page 10 of 27 Evidence: some information particularly around social history had not been included as part of the initial assessment. The manager said this was working progress and they do work with residents and relatives to gather information about the residents lives and interests. Staff individually and collectively have the skills and experiences to meet residents needs. Staff are experienced and have received specialist training in dementia care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home are able to meet the health and personal care needs of residents. Staff are sufficiently trained and experienced. They work with other health and social care agencies to ensure residents needs are met. Evidence: We looked at one care plan, the initial assessment and spoke to staff and a relative about this persons needs. Documentation was satisfactory but did not include some essential information re family history and where the information from the original assessment came from and who was involved. Care plans should be in more depth and not just state the person needs assistance but clearly describe what they can do for themselves and where they need help. The staff keep a record of residents behaviour which negatively impact of them, or others, recording what happened before the behaviour, what the behaviour was and the consequences of the behaviour. The community psychiatric nurse then helps the staff decide what actions they should be taking to manage behaviour. Staff should be descriptive when describing behaviour and describe what they see rather than state the resident is agitated. Other records Care Homes for Older People Page 12 of 27 Evidence: needed further clarification. Examples being nutritional and sleep records. Language was very subjective. The key stated person ate a small, medium or large meal, which could be open to interpretation by staff and we were not told what the persons normal appetite was like. The sleep records indicated a restless night or a good nights sleep, but there was no description offered re each category. Care plans had been reviewed but records did not state who had been involved in the review. Other assessments relating to risk, skin care and falls were good and had been evaluated monthly. The weight record seen was adequate but there was no record of weight on admission or a regular weight record. During the inspection staff were observed talking to residents in an appropriate way, but there were a few examples when interactions were inappropriate, such as staff pulling residents chairs away from them whilst telling them to stand up. Face to face interactions were not always used. Staff were overheard using language which was demeaning to residents. This was not used in front of residents but could have been overheard. We did see some examples of positive interactions and staff patiently explaining a task. One resident has requested a key code to her room to give her privacy. The staff explained that some residents will go into each other rooms without consent and the staff monitor this. The home are able to meet the health care needs of residents. The are good links with other health care agencies particularly the local doctor and mental health care services. The district nurses visit as required. The home have good systems in place to meet the palliative care needs of residents. They use a pathway, which help and support staff in identifying appropriate ways to support residents. The Senior staff member stated that they do not have any one with pressure sores and have been successful in maintaining the skin integrity of residents through good care planning and ensuring residents health care needs are met. Some residents are on individually prescribed dietary supplements and are regularly weighed to monitor weight loss, which is discussed with other agencies. The medication supplies were checked and records were accurate. There were clear descriptions for (PRN) prescribed when necessary medication. There are sample signatures for drug key holders, and staff administering medication are trained. Some residents require their medication crushed but this is agreed with the consent of the family and the doctor. Medicines were stored at the correct temperature and there was a clear audit of medications received by the home and returned by the home. Care Homes for Older People Page 13 of 27 Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provide a range of social activities for residents but these are limited in scope. Evidence: Throughout the day a number of visitors came into the home and the home have an open and inclusive atmosphere. It is more difficult for the home to actively engage with the local community. Reasons for this include poor access for residents with mobility difficulties. The local church has steep steps. There is no main bus route and the village has only a local pub and shop. The manager had approached the minister and asked them to assist in meeting residents spiritual needs. The home have also approached the local schools. They do a little fund raising and have a programme of activities. At least once month they have an activity, either in the local community or in the home which relatives are invited too. On the day of inspection the activities coordinater was spoken to. She told us that there are three members of staff who share the role of providing activities, along side their other roles. They work for 6 hours each. The lady spoken to has completed a course in social care and a hand massage course. She would like to do a dementia care course. Some of the other staff had either completed a course or were booked on a course. She had a file in which she Care Homes for Older People Page 15 of 27 Evidence: recorded residents likes and interests and how these are facilitated. Activities are evaluated to see if they were worth repeating. The staff member said there was usually something going on every day. On the day of inspection the activities coordinator was engaging with a small group of residents doing a picture, the theme was spring time and flowers, and poems were used. One relative said that residents spent alot of time unoccupied and staff engagement was vital but the home were limited in meeting peoples social needs. Relatives have been written to and asked to provide as much information as possible about residents social history, to assist staff with engaging with residents and understanding their behaviour better. A list of forthcoming activities were on display and there were photographs around the home. There was a separate quiet room where residents can reminisce. The television was on in this room but no one was watching it. In the other main seating area modern music was on which was not appropriate. We were invited to join residents for lunch. A choice of two main dishes were provided and staff were attentive. The food was good. We questioned why residents choice was limited. No salt and pepper was on the table and drinks were handed out rather than jugs being put on the table. This restricted choice was applied to everyone, although we saw one person being asked if they would like salt. The same situation occured at breakfast when toast was handed around rather than being put on the table. Marmalade was already on the toast and we did not see residents given a choice. Some residents were sat at the table for a long time after finishing their meal. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has adequate systems in place to protect residents from harm. Evidence: The home has an accessible complaints procedure. Staff have received training on the protection of vunerable adults. The home has not received any formal complaints but do keep a record of any concerns and these are recorded. The home are pro active in informing the CSCI of any event affecting the well being of residents. We were notified recently of an issue involving staff misconduct and this was dealt with appropriately. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides comfortable and well maintained accomodation which is fit for purpose. Evidence: The home is well maintained and the home is in good state of decoration. It is nicely painted. The home is carpeted throughout apart from the dining room which has wooden flooring. Some of the skirting boards were scuffed. The home was cleaned throughout, with no unpleasant odours. The home is an old building which has a certain amount of charm. Long, narrow corridors and narrow stairs. One of the stair wells is closed off so residents cannot use it. This is for their safety. The home notified CSCI of an incident of a resident leaving through the front door after a visitor. This is being looked at to see if the current access arrangements could be made safer. A number of residents bedrooms were seen and some were well decorated and well presented. Other bedrooms were basic and the furniture was shabby. One bedroom had uncovered radiators and the bed was against the radiator. The toilet seat was broken and there was exposed pipe work.The home does have a maintenance person but this is a shared position with a number of other homes. We raised concern about the uncovered radiator and a radiator cover in the lounge which had the protective cover touching the radiator. The home assured us that new radiators covers were Care Homes for Older People Page 18 of 27 Evidence: being fitted and would be in place by the end of the week. Other environmental issues included poor plumbing which was being addressed, but because it was an old building there were some difficulties with this. One of the bathrooms upstairs was not in use, but again we were assured that this would be brought back into use. The home has a large, secure garden. A work shop is being built which the staff hope they can use to provide another area for activites for residents. The ancillary staff were spoken to and the staff showed a good understanding and had received training in infection control and manual handling. Staff are issued with gloves, aprons and alcohol spray for their hands. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employ staff in sufficient numbers and staff have the skills and experience to meet residents needs as demonstrated through induction and training records. Evidence: The home is staffed by experience staff and has a strong management presence. Most staff have worked at the home for a long time and there is very little staff turn over. The staff on shift were spoken to and they were able to give a good account of residents needs and how they were able to manage difficult behaviours sometimes exhibited by people with dementia. Staff had received appropriate training, both specialist and mandatory and most had experience, and training in dementia care. Two staff files were audited and we were concerned that staff had been employed before all the necessary checks had been put in place. The manager stated that when staff are first employed as the date given on their employment contract they complete a five day induction. This is completed away from the home. When they are first on shift they are shadowed by more senior staff and then complete a twelve week induction course following a recognised induction programme passport to care. The manager must ensure there is a tighter audit trail so she is able to demonstrate that Care Homes for Older People Page 20 of 27 Evidence: staff are not working before the required documentation has been received. One staff application form we saw gave years of previous employment and not months. This made it diffcult to look at potential gaps in employement. Another members of staffs references were poor and it may have been good to source a third reference. Training records were seen and were satisfactory. The staffing rota must include staff surnames. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and there are systems in place to ensure the home complies with current legislation. Evidence: The home manager has been in post for eighteen months and was promoted from a seniour carer. Staff spoken to expressed confidence in her ability to manage the service and felt that she was very supportive and operated an open door policy. The manager did state that staff support is provided on a daily basis and staff were given formal supervision, but she recognised that this was an area requiring further development. The manager is supported by a head of care and there are four permanent seniour staff and four bank seniour staff who are able to cover staff holidays and staff sickness. Care Homes for Older People Page 22 of 27 Evidence: There are no formal relative, residents meetings. Staff meetings are held frequently and minutes for these were seen. We did not look at the homes financial or buisness plan. The manager told us that they do not deal with residents finances or hold money on their behalf. This is dealt with by family or an appointed person. The home has a maintainance person, but they work in a number of care homes owned by Health care homes. a number of maintainance issues were identifed including: unguarded or unsafely guarded radiators, exposed pipe work, poor plumbing, broken toilet seat in one residents bathroom and some scuffed woodwork. These issues were being addressed and we were satisfied that the home was in a good state of repair and well maintained. We noted that fire extinguishers were on the floor and not on the brackets. We were told that one resident was responsible for this. We looked at some maintainance records including fire records. The manager told us that there was a fire at the home last year. The home has a detailed evacuation plan and an emergency plan to deal with events which could affect residents safety. Servicing records for the hoists and lift were satisfactory. The manager confirmed that the last food hygeine visit was completed in February 2008. The manager is regularly audited by her manager on a monthly basis and she completes a report. The home completes an annual quality assurance assessment in which they ask the views of relatives about the service they provide. Results are published. The home completes a number of audits particularly around, accidents, incidents and falls. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 19 13 The home must ensure that 30/04/2009 all areas of the home are well maintianed and hazards from exposed radiators, uncovered pipework and broken equiptment such as toilet seats are dealt with quickly. This is to ensure residents are safe. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be sufficiently descriptive to ensure that all staff know what the residents assessed needs are and how they should be met. The home must be able to demonstrate that they have consulted with the resident or appointed person about any review or assessment of need. This will ensure a consistent approach. 30/05/2009 Care Homes for Older People Page 25 of 27 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 10 12 Staff must be respectful of residents and be mindful of confidentiality at all times. The home should review how they offer choice to residents and be able to demonstrate how residents individual tastes and preferences are reflected. The frequency and the way staff supervision is recorded should be reviewed. 3 36 Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!