CARE HOMES FOR OLDER PEOPLE
Zetland Court 128 Alumhurst Road Westbourne Bournemouth Dorset BH4 8HU Lead Inspector
Debra Jones Unannounced Inspection 17th January 2006 12:00 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 Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Zetland Court Address 128 Alumhurst Road Westbourne Bournemouth Dorset BH4 8HU 01202 769169 01202 764980 zetland@rmbi.org.uk arichards@rmbi.org.uk Royal Masonic Benevolent Institution 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) Miss Tina Beament Care Home 63 Category(ies) of Dementia - over 65 years of age (5), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (58) Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home may accommodate a maximum of 13 service users who require nursing care. The home may accommodate up to 5 service users in either category DE (E) or MD (E) at any one time. 6th September 2005 Date of last inspection Brief Description of the Service: Zetland Court is a large care home for older people registered to accommodate up to 13 people who require nursing care and up to 5 people who have past or present mental health disorders or dementia. The home has 63 places altogether. The home is one of 18 run by the Royal Masonic Benevolent Institution (RMBI) and provides accommodation and care for older freemasons and their dependants. The home receives substantial support from their Association of Friends. Zetland Court is situated in the Westbourne area of Bournemouth, close to local shops and transport links to the centre of Bournemouth. The home was originally a summer home for a local landowner and has landscaped gardens leading down to the cliff tops. The communal areas of the home are on the ground floor and include a large and a small lounge, a library and a billiard room as well as a large dining room. The lounge and library overlook and provide access to the rear garden. The home has two pet cats, 2 cockatoos and 2 budgies. The building is on 4 floors with a passenger lift enabling easy access around the home. A call system is installed in all rooms. Meals are prepared on the premises. Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 5 hours on the 17 January 2006 and was the second of the two anticipated inspections of the year. The requirements made at a previous inspection were followed up to see if they had been addressed. They had. The Inspector looked around some of the building and a number of records and related documentation were inspected. Tina Beament - registered manager assisted the Inspector along with the staff on duty at the home. The Inspector went to the residents meeting and chatted with some residents in order to get a feel for what it is like to live at Zetland Court. One resident said ‘we are extremely fortunate.’ ‘They treat you as a person.’ ‘If it can be done, they do it!’ No new requirements or recommendations were made at this inspection. What the service does well:
Zetland Court provides a service for older people in a well decorated home that is furnished to a high standard. The home has a tranquil and relaxed atmosphere and residents are clearly at ease. The home is well organised and the care and contentment of residents is at the heart of the way the home is run. A good admissions procedure is in place that ensures that only people whose needs can be met are offered places at the home. Prospective residents and their representatives have the opportunity to visit the home to see if they like it before they move in. Assessments and care plans are of a high standard. They are thoroughly completed and regularly updated to make sure that staff know how to care for the residents living at the home. Community health professionals support the nursing and care staff in caring for residents. There is a robust system for medication administration at the home. Staff were observed throughout the inspection to be treating residents with courtesy, patience and kindness and residents confirmed that their privacy and dignity were respected at all times. Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 Page 6 Residents are able to do as they wish at the home and join in or not with the activities on offer. There is a good programme of activities on offer at the home. Visitors are always welcome at the home and residents are encouraged to maintain and develop relationships with people in the home, with their families and friends and the local community. Meals are varied and a choice is always available. Through regular meetings with the caterers residents and staff are able to influence the meals provided at the home. Dining rooms are very pleasant and comfortable. What has improved since the last inspection? 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. Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 A good admissions procedure enables prospective residents to make informed decisions about admission to the home and ensures that only residents whose needs can be met by the home are offered places there. EVIDENCE: Two recently compiled pre admission assessments were seen. These showed that the home has a good procedure in place to ensure that prior to anyone moving to the home their needs are fully assessed by a senior member of RMBI staff. It was clear where information had come from and who had been involved in the assessment. Where Prospective residents live a long way from the home an assessor from another part of the country visits them to carry out the assessment. The assessment is then passed to the Zetland Court manager who makes all decisions about suitability of the home. Prospective residents are given the opportunity to visit the home, as are their representatives. Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 and 10 There is a good care planning system in place to make sure that staff have the information they need to meet the needs of the residents. The health needs of the residents are also well met with evidence of good support from community health professionals. The medication at this home is well managed promoting the good health and well being of residents. Residents confirmed that they were treated with dignity and that their privacy was respected. EVIDENCE: Care plans seen are now of a good standard. They flowed from the range of assessments made by the home. Plans were easy to read, to the point and informative about the needs of the resident and how the home was to meet their needs. All information contained in the care plans was up to date with plans being reviewed monthly. Care plans echoed the ethos of the home to provide total care to the person and treat them with respect and dignity.
Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 Page 10 Care plans are backed up by good risk assessments and the action to be taken where risk is identified is clear. Care plans have been identified by the home as an area that they saw needed improvement. Staff have worked hard to bring care plans up to the standard that they have now achieved. Senior staff regularly audit the care documentation to ensure that this standard is being upheld. Daily notes support and evidence the delivery of care to residents. These notes give a good picture of the daily lives of residents and the care that is delivered to them by staff in the home. Records are kept of the interventions of health professionals e.g. GPs and district nurses. A GP holds a weekly surgery at the home. Residents have access to community services such as chiropodists, dentists and opticians. Specialist services are also accessed e.g. Macmillan nurses, dermatology nurses. Nutritional assessments are carried out and residents are regularly weighed to monitor their weight. The day prior to the inspection the regular monthly visit had been made by the responsible individual from the organisation. As part of their visit they had fully audited the medication held at the home and had shared their findings with the staff / management of Zetland Court. Senior staff at the home also regularly audit their medication system and produce a written report of each audit and what action has been taken in response to the findings. A meeting is planned this week for the manager to meet with the home’s visiting GP and the local pharmacist to further improve the system e.g. always noting if any allergies are known or not known on charts, more clarity over the time that medicines are to be given (not just ‘morning’) and getting clearer directions when medications / creams are not to be given routinely. Medication records sampled were up to date and properly completed. Medicines and dressings were tidily stored in appropriate places. The home has made appropriate arrangements for the disposal of medicines that have not been used through a licensed waste disposal company. Residents spoken to said that they felt well cared for, that staff were very good and that their privacy and dignity were respected. ‘They treat you as a person, we get respect from all the girls.’ Staff were seen to be treating residents in a respectful and dignified way during the course of the inspection. Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14 and 15 Residents’ lives are enriched by the social opportunities afforded by their visitors and the stimulating social activities available in the home. Visitors are made welcome at the home and can come whenever it suits the residents. Residents are helped and encouraged to exercise choice in their daily lives at the home. The meals in this home are good offering both choice and variety and are served in pleasant dining rooms. EVIDENCE: Zetland Court has a dedicated activities organiser. Residents and other staff praised her for her hard work and for the range of interesting and enjoyable activities that were on offer at the home. Activities are arranged for groups and 1-1 support is also available. Regular outings are arranged in the home’s minibus e.g. to places of local interest, local shopping centres, theatres etc. On the afternoon of the inspection some residents went to the main shopping centre in Poole. One resident talked of the pantomime they had recently seen.
Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 Page 12 Information about activities is displayed on notice boards, in the lift and on a white board outside the dining area. Records are kept of who joins in with each activity. Hobbies and interests are explored with residents when they first move to the home. A summary of the persons past life is also made. A hairdresser is available at the home four days a week. The hairdressing room is being refurbished and new equipment and basins have been installed. At the request of residents a communion service is held monthly at the home. Residents spoken to said that visitors were always made welcome. Some visitors were having lunch with their relative in the dining room. A guest room is available for visitors to stay. The visitors’ book confirmed the number and range of visitors to the home. People are encouraged to make choices about how they live their lives at the home. Preferences such as when they like to get up and go to bed are noted in the care records. Residents can do as they wish, choose to eat what they like and join in with activities as it suits them. The residents meeting taking place on the day of inspection further evidenced that residents have a real input into the way that the home is run raising issues in a positive manner about a range of issues including how the residents themselves contribute to making the home a happy place to live. Twenty residents attended and were encouraged to express their views. Residents and staff meet regularly with the company that provides the catering at the home to discuss the food. Topics for discussion at the next meeting include menus, quality of meals and general nutrition and suitability of meals for those on the nursing unit. The menus are currently on a five-week rotation. A weekly menu is on each table in the dining room. Residents are offered meal choices the day before. A cooked breakfast is always available in the morning. There is a choice of hot meals at lunchtime or salad. A salad bar is available for residents to choose exactly what they want. Hot and cold puddings are on offer and / or cheese and biscuits. A range of alternatives is available in the evening. The meals on offer on the day of inspection were cottage pie or fish in sauce served with a choice of vegetables. Dessert was stewed apple and custard or yoghurts or ice cream. There was a large bowl of fruit in the dining room for residents to help themselves from. Special diets are catered for e.g. diabetic, low fat. Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 Page 13 Most residents have their meals in the pleasant dining rooms. There are two in the home – one in the residential area and one in the nursing area (east wing). The east wind dining room has recently been refurbished. Residents can have their meals in their rooms should they need to. Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were met at the last inspection. EVIDENCE: None of these standards were assessed on this occasion. Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 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 the following standard(s): Standards 19, 20, 21, 22, 23, 24, 25 & 26 were met at the last inspection. EVIDENCE: None of these standards were assessed on this occasion. Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 &30 were met at the last inspection with 27& 28 exceeded EVIDENCE: None of these standards were assessed on this occasion. Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,36 and 38 were met at the last inspection. EVIDENCE: None of these standards were assessed on this occasion. Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x x Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Zetland Court DS0000020457.V278947.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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