Inspection on 24/05/05 for Windsor Court Care Home

This inspection was carried out on 24th May 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

Windsor Court Care Home 27/06/06

Windsor Court Care Home 11/11/05

Windsor Court Care Home 28/09/04

Windsor Court Care Home 30/07/04

Windsor Court Care Home 06/05/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Windsor Court Bartholomew Avenue Goole East Yorkshire DN14 6YN Lead Inspector Jan Dulieu Unannounced 24th May 2005 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. Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Windsor Court Address Bartholomew Avenue, Goole, East Yorkshire DN14 6YN 01405 763749 01405 765590 kestevengrange@highfield-care.com Highfield Care Homes No 2 Ltd 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) Care Home 77 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (52), of places Physical disability over 65 years of age (52) Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Windsor Court is a modern purpose built care home situated close to Goole town centre. The home has two floors and a safe courtyard garden. There is a local health centre a short distance from the home.The home offers residential care on the ground floor and care for people with dementia in a separate unit on the second floor. Adjacent to this is a unit for people with higher dependency needs. Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of the home was unannounced and took place over two visits. On the first visit two inspectors observed the care practices on two units together with the plans of care for service users. The lunchtime meal service was observed. The manager for the home, Margaret Barton and the operations manager Alison Bentley were present for the inspection. On the second visit one inspector observed the care practices in the evening from 19.10-20.00 and the number of staff on duty. What the service does well: What has improved since the last inspection? Attention is being given to service users basic care needs such as receiving regular baths, most service users are now being weighed and where necessary a plan to address any concerns is being put in place. Staff are receiving training in moving and handling and the manager of the home is a visible presence in the home and is directly supervising the standards of care. Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 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 Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 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) 3 Service users physical care needs are being assessed but not their mental health care needs. EVIDENCE: The service user plans of care contain a range of assessment documentation but significant mental health care needs have not been addressed. These assessments must be undertaken with the service users and their family where possible and the plan must be clearly communicated to all care staff. The plans must be reviewed on each shift and audited monthly to ensure that they accurately reflect service users needs. A requirement to address this issue has been made. Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 Page 9 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 Service users health care needs are not always being identified accurately particularly their nutritional needs leaving their physical health at risk. EVIDENCE: Every service user has a plan of care and those inspected contain a reasonable amount of information assessing service users needs but they are not comprehensive. Examples of this include not identifying service users main reasons for requiring care on the dementia care unit. On the high dependency unit many service users have been weighed and over a four month period have shown that they are losing weight but interventions have not been put in place. One service user on the residential unit whose weight was last recorded in November 2004 as significantly low had not been weighed since that date. An immediate requirement has been issued about this matter. The pressure area assessments have been completed but in some instances they are not accurate. This highlights a lack of skill and recognition of the dependency level of this service user group. One service user likes to receive medication prior to the time it is due to be given. There was no assessment of risk or identified reason within the plan of care, although this was an established practice. Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 Page 10 When the plans of care are put together they must accurately reflect service users basic needs, individual risks and plans to prevent deterioration in their health such as weight loss and the prevention of pressure sores. The documentation in the plans of care is standardised by the company and if used by staff with a depth of understanding would meet the National Minimum Standard. Many service user would benefit from a simpler and more personal plan of care that care staff could follow more readily. Staff are very busy on the units and have little time to spend with service users on an individual basis during meal times or with mobilising them when two staff are required. Following lunch time on the high dependency unit, a queue of service users formed to use the toilet. They all required a degree of assistance, and their dignity is compromised by having insufficient staff to assist them. Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 Page 11 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) 12,13 and15 Service users have a choice of food but presentation of the meals and the nutritional content must be improved. Clear monitoring of service users preferences and nutritional needs to prevent weight loss must be implemented. EVIDENCE: There is a choice of meal available to service users. The meal comes to the units in trolleys and served individually. Service users can choose to eat in the dining rooms or their own room. On the day of inspection many service users left the mashed potato possibly because it looked unappetising. One service user said ‘I just can’t eat it’. Three staff in one unit had eighteen service users to care for including serving the meal, delivering medication and assisting service users with their meal. There was insufficient time for them to do this and give encouragement to service users who were eating very little. Activity workers are employed in the home but there were no activities on the day of inspection. As part of each service users plan of care an assessment of the activities service users enjoy should be included. Service users have visitors whenever they choose and the current management are aiming to build links with the community in a positive way by meeting with care managers, the local GPs and holding events in the home. Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 Page 12 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 The management team have taken seriously and investigated thoroughly all complaints raised about the home to improve the care for service users. EVIDENCE: The home and the Commission for Social Care Inspection have received a number of complaints about the staffing levels and care received in the home in recent months. It is evident that the management of the home are beginning to address the basic standards of care and to create a stable staff group. Recruitment and training is taking place and this is positive for the service users in the home. The manager of the home is open and approachable and her contact with service users and their families is beginning to build confidence and reduce the number of serious complaints received. Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 Page 13 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) 20,23 and 26 Service users enjoy a clean, safe environment with access to a well maintained garden. EVIDENCE: All service users have their own room and if service users choose to have their own key arrangements are made to facilitate this. The rooms are attractively decorated and most service users have ornaments, pictures and personal items in their room. The home is clean and almost odour free with the exception of two service users rooms and one lounge area. They smelled of urine and this should be addressed. All service users are provided with special mattresses, chair cushions,and wheelchairs if they are assessed as requiring them. There are sufficient hoists available to assist service users. The courtyard garden is accessible and well maintained. Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 Page 14 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 Service users receive basic care but current staffing levels are insufficient to promote the health, social well being and dignity of service users in the home. EVIDENCE: The management of the home have successfully recruited care staff since the last inspection and this has reduced the number of agency staff used. This has resulted in greater continuity of care. The home is staffed as follows for up to seventy-seven service users: There are five care staff on duty between 19.30 and 07.30. The home has been required on previous inspections to increase this number but this has not taken place. The management of the home must review the arrangements for staffing the home at night, in particular the reduced staffing level from 19.30. Balmoral: The unit has four staff on duty in the morning and three in the afternoon until 19.30. for up to thirty six service users Sandringham: Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 Page 15 The unit has three staff in the morning and afternoon until 19.30 for up to twenty one service users. Buckingham: The unit has two staff in the morning and afternoon until 19.30 for up to fifteen service users. The staff on duty on the day of inspection worked efficiently and in an organised way but to provide care for the number of service users was challenging. The staffing levels: • leave no margin for staff to accompany a service user to hospital without causing considerable impact on the care of other service users • if a care assistant is absent at short notice it leaves the unit staffed at unsafe levels. • care staff have insufficient time to monitor and encourage service users at meal times. Many service users have lost weight and this is likely to be a contributory cause. • The home must develop a management infrastructure so that responsibility for monitoring service users needs can be delegated by the Home Manager and so that staff can receive supervision and training to develop their role. Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 Page 16 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) 31,32and33 Service users are benefiting from a capable and organised manager. EVIDENCE: The appointment of Margaret Barton to be manager of the home has been very positive. Feedback received from service users, staff and other visiting professionals speak highly of her skills in communicating and shaping the standards within the home. This has resulted in an improvement in the basic standards of care experienced by service users through her focus on directly supervising care staff. This improvement must be consolidated by developing a management infrastructure and improving staffing levels to demonstrate that the home is being run in the best interests of service users. This improvement will be demonstrated by: • Care plans that indicate that a full assessment of needs has been made and updated monthly together with a plan demonstrating how they will be met that involves the service user and their next of kin. Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 Page 17 • • The records of training for staff which will include up to date training in moving and handling abuse awareness, fire safety and dementia care for all staff. A plan to develop NVQ training at level three for senior care staff together with all Seniors receiving medication training and appropriate updates. Supervision records for staff indicating that this is completed on a two monthly basis. Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 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 x x 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION x 3 x x 3 x x 2 STAFFING Standard No Score 27 1 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 2 3 3 x x x x x Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 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 3 Regulation 14 Requirement Timescale for action 1/9/05 2. 8 12 3. 12 16 4. 27 18 The responsible individual must ensure that : service users admitted to the home meet the registration category of the home and that their needs remain under review to ensure that they can be fully met. Service users must have both their physical and mental health care needs assessed together with their dependency level. The responsible individual must 1/7/05 ensure service users weight is recorded together with a plan to address any weight loss factors. The responsible individual must 1/9/05 ensure that all service user have access to regular individually tailored activities.These must be recorded in their plan of care. The shift times which result in 1/9/05 five staff being on duty from 19.30 must be reviewed. The management structure in the home must be strenghthened so that supervision of staff can take place to allow the manager to concentrate on the welfare and consultation with service users J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 Windsor Court Page 20 and their families. Staffing levels must be reviewed and increased to ensure that service users needs can be fully met. 5. 6. 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 15 Good Practice Recommendations The responsible individual should ensure that the Head Cook and the catering team have an up to date understanding of the nutritional needs of this service user group. The responsible individual should ensure that there is a system in place for addressing odours and the causes of them with immediate effect. The responsible individual should ensure the manager of the home completes the application for registration with the Commission for Social Care Inspection. 2. 3. 4. 26 31 Windsor Court J53_J04_S0962_Windsor Court _V225912_240505_stage4.doc Version 1.30 Page 21 Commission for Social Care Inspection Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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