Inspection on 21/05/07 for Zetland Court

This inspection was carried out on 21st May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Zetland Court 04/08/06

Zetland Court 17/01/06

Zetland Court 06/09/05

Zetland Court 31/01/05

Zetland Court 14/07/04

Zetland Court 30/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Zetland Court 128 Alumhurst Road Westbourne Bournemouth Dorset BH4 8HU Lead Inspector Debra Jones Key Unannounced Inspection 21st May 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 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 www.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.V340940.R01.S.doc Version 5.2 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. 4th August 2006 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. The weekly charge for living in the residential area is between £513 and £625. In the nursing and mentally frail area the charge is either £788 or £798. Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 21 May 2007. Debra Jones and Chris Gould were the inspectors who carried out the visit. Tina Beament (Registered Manager), the visiting Regional Business Operations Manager and staff at the home helped the inspectors in their work. Zetland Court has a sustained track record of high performance and residents and other stakeholders give consistently good feedback to the Commission. Recent inspections at the home have looked at the service delivered in all areas of the home. This inspection focussed on the service delivered in the east wing of the home. This is the area that accommodates 18 residents, 5 of whom have dementia or a mental health disorder. During the inspection records were looked at on the east wing. The inspectors spent the majority of the time spent in the home on the east wing, meeting and chatting with residents in their rooms and in the dining area. One requirement was made as a result of this visit. In addition a number of recommendations were made, intended to encourage improvement in an already well-rated service. The management of the home has showed; a good understanding of the areas of weakness and there is a good capacity for the service to further improve. Prior to the inspection the home sent out comment cards on behalf of the Commission to people living in and interested in the service so that they could give feedback about their experience of the home. 12 were returned from residents and 13 from relatives, 2 from care managers and 2 from GPs. All comment cards returned included positive views about the staff and service provided at Zetland Court. Comments included:‘The home has a happy atmosphere and because we have large lounges plenty of space to not feel crowded, besides outdoor space in the gardens.’ (a resident) ‘I am extremely happy in this home it is a very clean and comfortable house and the staff are always very kind and helpful.’ (another resident) ‘I find Zetland Court first rate in every respect.’ (another resident) ‘I believe that Zetland Court maintains a very high standard of care – there is an atmosphere of friendship and love’. (a relative) ‘Excellent. Treat every resident as an individual and allow them as much independence as they are able. Always ready and willing to assist.’ (another relative) ‘I am pleased to have this opportunity to praise Zetland Court residential nursing home. My mother was unwilling to go……… At all times the staff were patient and tolerant and caring to her and me. This has continued during her Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 6 time in the nursing wing. All the staff are warm and all mothers’ visitors are made to feel welcome. The support I receive during this difficult end phase of mother’s life is excellent.’ (another relative) ‘I am extremely happy overall with the care that my mother receives at Zetland Court. The care staff have also been extremely helpful and welcoming to me when I have needed to stay overnight e.g. following my father’s death etc.’ (another relative) What the service does well: When asked what does the service do well relatives answered:‘Zetland Court is a home for life and a home from home. It provides good care by staff who are extremely pleasant and professional. It is good at maintaining links with concerned relatives – like myself who live more than 100 miles away. The activities organiser XX works extremely hard to provide a wide range of stimulating activities for residents.’ ‘Creates a lovely homely atmosphere always smells good (unlike some homes) and I get the feeling its one big happy family.’ ‘The care that my brother receives in the way of nursing and general care appears to be of the highest order.’ ‘Inclusiveness, attention to detail, treating people as individuals.’ ‘The care in looking after my husband is first class.’ ‘Zetland Court is a home in the true sense for the residents. They are involved with what happens there. Birthdays and other important dates are celebrated. There are many ‘concerts’ organised and outings of interest for all. The art group has outings for it’s particular interest.’ ‘To provide entertainment, outings to brighten the residents lives despite their mental incapacity.’ • ‘ they aim to retain personal autonomy for as long as possible, • the management of the nursing staff is very good, • communication with me is of a high standard,’ ‘deals with my mother’s needs in a highly compassionate and caring way.’ Care managers said that Zetland Court did the following well:‘Promotes individual choice and autonomy. Encourages independence, keeps care manager fully informed of any changes in service users’ needs. Good communication.’ ‘Presents a person centred form of care. Good structures in place to enable residents to express their views. Open visiting.’ The following is the Commission’s view as to what the home does well. Prospective residents benefit from the home having a good admissions procedure in place, so that only people whose needs can be met are offered places. Suitable information is available to ensure they are able to make informed decisions about moving to the home. Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 7 Care planning systems provide staff with the information they need to meet the health and personal care needs of residents. The principles of respect, dignity and privacy are put into practice. Residents are encouraged to make choices about how they live their lives and the home provides them with access to social, cultural and recreational activities. The complaints and adult protection procedures reassure residents and their representatives that the well-being and comfort of residents is important to the home and that any concerns raised will be properly investigated and resolved. The home and grounds are very well maintained, comfortable and safe for the residents living there and anyone visiting. The home is kept clean and smells pleasant. The number of nursing and care staff is sufficient to meet the needs of residents. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. The home is well organised and the care, contentment and safety of residents is at the heart of the way the home is run. What has improved since the last inspection? What they could do better: When asked what the home could do better relatives commented:‘I don’t really think it can!’ ‘Employ more permanent staff – dad complains that the agency staff don’t always know what they have to do.’ ‘There is little room for improvement.’ ‘I am not sure how much occupational therapy takes place…….. I have seen carers with cards and craft activities on the odd occasion when I visit so I assume it happens. I know in the residential wing they have regular activities.’ The home has a overall good track record for the services they provide. This inspection focussed on the east wing to see to look at the standard of care for Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 8 the small group of higher needs residents. One requirement was made at the inspection in relation to staff training, particularly in respect of dementia. The east wing houses the nursing area and the dementia unit. The dementia unit is for residential care rather than for any residents in need of nursing. However a nurse oversees the wing and it is all too easy to think of the whole wing as being ‘nursing’ and of the residents in need of dementia care being of higher need than they actually are. The home were agreeable to giving considerable thought as to how the area is managed and the service delivered to ensure that a residential dementia service is provided with residents being offered a stimulating environment and a broad range of social opportunities that meet their needs. The Regional Business Operations Manager, present at the inspection visit, committed to concentrating her monthly visits on the east wing for at least the next 6 months. The operations manager talked of ways the organisation was going to be addressing dementia care and of how they were going to employ an advisor to oversee dementia care for the company. On a more local level Zetland Court will be inviting the manager of another RMBI home who has wealth of experience in dementia care, to look at their care planning, social activities and the environment. A number of recommendations were made as a result of the inspection, mostly centring round the service on this wing, and some particularly concerning the small group of residents who are in receipt of a residential dementia service. Recommendations included updating the statement of purpose in respect of services delivered on the east wing; having better assessments of mental health and dementia care needs and these following through to care plans; clarifying anomalies in medication records and having clear instructions for staff when they have to make decisions about administering medication; looking at ways that residents who are confused or have poor memories are offered choices. It is also suggested that the home looks at the issue of continuity of staff for residents with dementia. All would benefit residents living at the home. In addition it is noted that the home have a number of self auditing systems in place, which is a really good way of continuously assessing the service they deliver to residents. Some weaknesses were found in this system during the course of the inspection and it is suggested that the home review the effectiveness of their auditing systems, looking at ways to keep it ‘live’ to ensure it does not drift into being a paper exercise. Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 10 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.V340940.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. 6 is not applicable to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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: Eleven of the 12 residents who returned comment cards said that they had enough information before they moved in to the home to decide if it was the right place for them. ‘We were also able to take ‘respite breaks’ over 3 years, before we decided to become residents. This allowed us time to discover if we would be able to live in the retirement home and if the nursing annexe provided suitable care as my husband’s condition got worse.’ ‘The care here is excellent. Every effort is made to make one feel ‘at home’.’ Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 12 Files for residents who had recently moved into the home were inspected. These showed that the home has a good procedure in place. Prior to anyone moving to the home a senior member of Royal Masonic Benevolent Institution staff assesses their needs. Files were reviewed for the residents who are living at the home because of their dementia / mental health. Their pre admission assessments were not comprehensive in respect of these particular needs. The Royal Masonic Benevolent Institution (RMBI) has updated their admissions procedure, which now reflects the practice of the home. A form has been introduced for staff to sign to confirm that they have followed the procedure e.g. that the room is ready, the furniture suitably placed etc. This ensures that all the steps are taken to make new residents welcome and have all the things they need to make them comfortable. The home has a statement of purpose that is regularly reviewed. This does not currently include information about the specific services that the home provides i.e. nursing and residential dementia care. Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to provide staff with the information they need to meet the health and personal care needs of residents. The principles of respect, dignity and privacy are put into practice. EVIDENCE: When asked ‘do you get the care and support you need?’ 10 of the 12 residents who returned comment cards prior to the visit replied ‘always’ and 2 ‘usually.’ ‘So far I am reasonably self reliant for my age.’ ‘Nothing is too much trouble and it is wonderful to be able to relax knowing help is at hand if needed’. ‘The physical care is excellent.’ (a relative) Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 14 When asked ‘do the staff listen and act on what you say?’ 11 residents said ‘yes’ and 1 said ‘sometimes.’ ‘Staff are very good, but often very busy as many residents now require extra care however they will always endeavour to resolve problems and be open for discussion.’ Nine of the 11 relatives who responded by comment card said that the home ‘always’ gave the support or care to their relative that they expected or agreed. Two said that this was ‘usually’ the case. ‘They purchased a special bed for her when she came out of hospital after a hip replacement and watched over her day and night at regular intervals to make sure she was OK.’ Relatives were also asked if they felt the home met the needs of their relative. Ten who replied said that this was ‘always’ the case and 1 ‘usually’. ‘My mother has never been happier.’ Relatives also talked generally about the care at the home ‘staff are open and approachable. They are informed and well trained. They are willing to discuss options for care / treatment etc and listen without being judgemental.’ ‘We have always been consulted with about my mother’s care. In addition we have always felt able to ask. We feel that there is a very open system. Nothing is hidden or held back.’ Comment cards sent to local authority care managers asked if the home’s assessment arrangements ensured that accurate information is gathered and that the right service is planned and given to individuals. Of the two care managers who responded one said that this was ‘always’ the case and the other that it was the case ‘usually.’ ‘Very rare to find discrepancy between care needs identified and care delivered.’ The home strives to have care plans of a high standard. In addition to the regular reviews of care plans and assessments care plan documentation relating to each resident is audited monthly by senior members of staff and looked at as part of the monthly visit made to the home by a representative of the Royal Masonic Benevolent Institution (RMBI). Records are kept of the reviews and findings. At this visit plans were reviewed for the residents receiving nursing or dementia care. A broad range of information is collected on the assessment forms and there was evidence to show these were reviewed monthly and updated, however information did not always cross reference leaving the resident at risk of not receiving the care they needed or of concerns and changes not being followed through. The home recognises that particularly in the east wing – the nursing / dementia wing - that they need to get better at being very specific about the details of the care they are to provide. For example one resident has a blister Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 15 on her lower leg but there was no wound chart and the progress of the wound was not consistently recorded. Although 5 people on the wing are there due their need for dementia care the assessments are not strong in this area and this weakness continues through their care plans. Records are kept of the interventions of health professionals e.g. GPs, chiropodists etc. A GP holds a weekly clinic at the home. Residents can choose to visit their Doctor at the community surgery if they prefer. Residents also have access to community services such as chiropodists, dentists and opticians. Where there is concern over how some residents are eating nutrition charts have been put in place. Those seen were being well completed in respect of food but were patchy where fluids were concerned. It was not clear if staff were aware of the need to be recording fluid intake as well as food / food substitutes and if they were to use these charts to do so. All twelve residents who returned comment cards said that they ‘always’ received the medical support they needed. ‘We are fortunate in having the ‘doctor’s clinic’ available to anyone who requires to see the doctor, also if the need arises, he will see us at the Westbourne clinic.’ ‘I am under the heart failure clinic who are available by telephone weekdays. But it has been necessary to have advice ‘outside their hours’ this has been readily available’. Two GPs returned comment cards to the Commission one said that Zetland Court was an ‘excellent home.’ The talked other of their ‘very high standards. Able to look after sick patients. Communication excellent.’ Care managers were asked if individual’s health care needs were properly monitored and attended to by the care service. Both who replied said that this was ‘always’ the case. The medication records held on the east wing – nursing and dementia- were reviewed at this visit. Medication is subject to a monthly audit by home staff. Care plans seen were good in that they have sections on medication, what medication residents take and what it is for, though not all lists were up to date. Medication administration records showed that there were some medicines administered ‘when required.’ Most residents on the wing are able to say when they require medicines of this nature, but some are not. One medicine was to be given for agitation. In both these cases when the medication is administered becomes the decision of the staff, rather than the resident. The circumstances as to when the medicines are administered were not clear in the care plans. Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 16 A number of medicines are listed on the medication sheets as prescribed but are not being administered or the reasons why not being noted. The direction as to which eyes some eye drops were to be used for was not clear, i.e. whether it was for the left, right or both. This was immediately clarified with the GP who was visiting a resident. Staff were seen to treat residents in a respectful and dignified way during the course of the inspection. Relatives commented ‘they are so kind and friendly and treat the residents with respect. They also take great care to preserve their dignity.’ ‘The residents are treated as individuals and their dignity is respected.’ ‘My mother …………has dementia and is always treated with the respect and consideration due to her, notwithstanding her confused condition.’ One care manager commented when asked if the care service provided respected individuals’ privacy and dignity:- ‘my service user and her family felt this was fully upheld. If a long term placement were required this is the only home they would want to use.’ Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are able to make choices about their life style, and are supported to maintain their life skills. Social, cultural and recreational activities meet most individuals’ expectations. EVIDENCE: Zetland Court has a dedicated and proactive activities organiser. 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. Information about activities is displayed on notice boards around the home, in the lift and on a white board outside the residential dining area. Something is on offer every weekday and sometimes at weekends. Activities are open to all residents e.g. from the residential, dementia and nursing areas. 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. Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 18 In addition to the activities arranged in the home a hairdresser is available at the home, the home library service visits and, at the request of residents, a communion service is held monthly at the home. Residents are also able to go out to services if they wish to. Of the 12 residents who returned comment cards 5 said that they it was ‘always’ the case that there are activities arranged by the home that they can take part in, 5 said that this was true ‘usually,’ and 2 said ‘sometimes’. ‘Weekly art classes, ‘seasonal’ craft classes (i.e. making xmas cards, Easter bonnets) musical events – (singers, entertainers) trips to the theatre, visiting library as well as our own, small shop open one morning a week run by the friends. Monthly communion service.’ ‘I do not attend too many, I have asthma, very poor eyesight and very bad hearing problems but as I have lived alone for 50 years I prefer a very quiet life.’ ‘I cannot take part in a lot of activities but it is lovely for my wife to be able to do so’. The general activities programme for the home is advertised all around the home including the east wing. Daily notes seen did not demonstrate that the residents with dementia were taking up opportunities to join in with the mainstream activities. Care planning for the residents with dementia contained little about how the home were to meet their social needs and there was little in the daily notes to demonstrate how this need was being met. On the day of the inspection the activities worker spent time on the unit playing a game with residents in the lounge area. Some residents with dementia and some in receipt of nursing care joined in. Residents on the east wing were asked what there was to do at the home and what they were doing today. Responses included ‘not a lot, watching television.’ ‘Occasional functions and things upstairs we can go to.’ ‘Went to see royal marine band and a couple of lectures about animals.’ ‘My son visits once or twice a week.’ ‘As my mother is senile her intellectual needs are different but staff talk to her and encourage her to be mentally active.’ (a relative) The activities organiser has had dementia activity training and specific activity items have been purchased by the home. The activities organiser said that she had found the most effective activities for the residents with dementia to be of a ‘one to one’ nature. The visitors books confirmed the number and range of visitors to the home. Visitors are welcome at any time. Comment cards to relatives asked if they felt Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 19 they were kept up to date with important issues. Ten relatives who responded said that this was ‘always’ the case. ‘I was phoned at 5.30am to let me know that my mother was on her way to hospital after she had a fall at 5am. I thought that was pretty good!’ Comment cards also asked relatives ‘Do they help your relative to keep in touch with you?’ Eight said this was the case ‘always’. Others felt it was not a relevant question to them. ‘They phone me on behalf of my mother if she wants to let me know something particular. As I visit twice a week, this does not happen often.’ ‘A phone is provided in the room.’ ‘My mother is mentally alert but physically frail. When she is unwell care staff offer to phone me to let me know.’ ‘I am always informed if my brother is in need.’ ‘Not required but if it was the case I am sure they would offer to do so.’ People are encouraged to make choices about how they live their lives at the home. Residents can do as they wish, choose to eat what they like and join in with activities as it suits them. Comment cards to care managers asked if the home supports individuals to live the life they choose wherever possible. The two care manager who responded said that this was always the case. ‘High level of self determination and independence are promoted.’ ‘Very person centred. Individuals are supported to be independent and make their own choices in as many areas as possible.’ Comment cards asked of relatives ‘does the home support people to live the life they choose?’ Nine relatives who responded said ‘always’. ‘ The residents are told to treat the place as if it were their own home. Friends, guests and family are always made very welcome.’ Residents are given the opportunity to meet regularly with managers and at times, senior staff from the Royal Masonic Benevolent Institution (RMBI). This gives residents a real say into the way that the home is run. Minutes are kept of these meetings showing that residents are able to express their views about a range of issues. Copies of menus were submitted to the Commission prior to the inspection visit. These show that residents get variety and choice at all meals. Cooked meals are available at breakfast, lunch and supper. 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 east wing. The manager talked of plans to put a fenced patio outside the east wing dining area to enable residents to east outside safely. The east wing dining room is shared between the residents who are in need of nursing care and those that have residential dementia needs. On the day of the visit there was a mix of Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 20 residents in this room. Lunch was lamb casserole or spaghetti Bolognese with creamed potatoes and garden peas and carrots. Apple and blackberry crumble or yoghurt was for dessert. Residents said that their lunch was very good, but did not necessarily remember what it had been. ‘Food good, balanced diet, plenty of fruit and vegetables.’ All residents are offered choices of meals the day before. On the day of the visit residents were asked at coffee time what they would like to eat the next day. Some residents found this choice more difficult / meaningful than others. Staff spoken to said that they completed the forms for some residents based on what they knew that they liked rather than any choice they were able to express. The home was agreeable to looking at this system of offering choice to the residents on the east wing and particularly to any residents who were confused, to see if the way they are currently offering choice about food is empowering or adding to confusion. In respect of the outcome for residents at mealtimes staff said that the kitchen was very accommodating and residents did get meals they liked from the menu or could have alternatives e.g. omelettes. Residents can have their meals in their rooms should they wish / need to. Two of the 12 residents who returned comment cards said that they ‘always’ liked the meals at the home, with 6 saying that they liked them ‘usually’ and 4 ‘sometimes.’ Comments included:‘We once more have our own catering staff and chefs – the contractors who disappointed everyone with the standard produced means a great improvement has been gained in the quality of product and presentation of meals by having our own staff (under the control of the chef manager and home manager).’ ‘Food not varied enough and seldom served hot.’ ‘Food is good basically.’ ‘The chef is excellent. There is a wide choice and every effort is made to meet individual needs.’ Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. Protection from abuse is promoted. EVIDENCE: The home has a complaints procedure and keeps a record of any complaints made, the investigation of the complaint and the outcome to the complainant. The Commission for Social Care Inspection has received no complaints since the last inspection. The comment cards sent to residents asked the question ‘Do you know who to speak to when you are not happy?’ 12 residents sent back cards. Eleven answered ‘always’ to this question. ‘Our very understanding home manageress.’ ‘Not applicable to us as we are always happy and contented to be here.’ In respect of knowing how to make a complaint 12 residents said yes ‘always’ ‘Method is very clear.’ Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 22 Of the 13 relatives who returned comment cards 11 said that they knew how to make a complaint if they needed to. ‘Never needed to do so.’ When asked ‘has the service responded appropriately if you or your relative have raised concerns about their care?’ Six answered ‘always’ and one ‘usually.’ ‘Not used, no concerns raised.’ ‘I have not had to raise any concerns so far.’ ‘We have never had to raise an issue.’ ‘Friendly approachable staff, always willing to listen to any concerns.’ The home has an adult protection policy and there is staff training in this subject at the home from induction onwards. Since the last inspection an adult protection issue has been raised and investigated at the home. This was handled in accordance with the home’s procedures and involved the local authority and the Commission. Appropriate action was taken and referrals made. One care manager commented ‘Have dealt with one or two adult protection issues and the manager responded in a thoroughly professional manner.’ Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. The east wing environment could be made more stimulating to better promote the well being of the residents with dementia. EVIDENCE: The home has a warm and relaxed atmosphere. The home is well decorated throughout. Lounges and dining areas are comfortably furnished. The main dining room in the residential area has been redecorated since the last inspection. Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 24 The grounds are glorious, providing an outstanding outlook for the home. Residents can enjoy walks around the gardens and plenty of seating is provided. The majority of bedrooms are single occupation. About half the single rooms and all 5 double rooms have en suite facilities. In addition there are a number of communal bathing areas in the home. Since the last inspection the home reported that a new bath and hoist has been installed in the east wing bathroom. Aids and adaptations are available throughout the home e.g. raised toilet seats, grab rails etc - and some residents with particular needs have their own personal equipment to assist with their independence. Residents are able to personalise their rooms with furniture and general belongings as they wish and in agreement with the home. There is a passenger lift in the home, enabling easy access between the floors. There are emergency alarm bells throughout the home, in each bedroom and in communal areas. Areas of the home visited were clean and there were no unpleasant odours. Since the last inspection the main laundry area has been extended and the residential laundry moved to an upper floor. Eleven of the 12 residents who returned comment cards said that the home is ‘always’ fresh and clean, with the other saying that this was the case ‘usually.’ ‘High standard of cleanliness’ A care manager commented ‘This residential care home always appears clean and well tended.’ Improving the dementia area, in line with evolving good practice, was discussed in order for a more stimulating and accessible environment to be provided for people the residents living there. Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient nursing and care staff are employed to meet the needs of residents. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. Plans to improve training and reviewing deployment of staff should result in better outcomes for people using the service. EVIDENCE: Clear staffing rosters are in place that show who is on duty, where, when and what jobs they do. A nurse is always on duty in the nursing area. Kitchen staff, cleaning staff, maintenance men, gardeners, office staff and management, support nursing and care staff in keeping the home running at the high standard it achieves. Residents spoken to at the visit praised the staff. A relative commented ‘My aunt always speaks very highly of the staff. I have always found them polite, friendly and efficient.’ Residents were asked are the staff available when you need them? Six who responded said ‘always’ with 5 saying ‘usually,’ and 1 ‘sometimes’. Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 26 This shows that most people feel that there are sufficient staff but a minority clearly feel that there are not. Residents who commented said ‘the bell is always answered but they are so busy sometimes, two carers for one person, that it is not always possible to have their attention. This I understand.’ ‘Not always available when needed – short staffed!’ One relative commented ‘staff levels are too low at weekends and at night for the number of extremely elderly and frail residents. Residents who need the care provided by the nursing wing can’t always receive the extra help as the nursing wing is always full up.’ For the 18 residents living in the east wing, in the morning there are 4 health care assistants working alongside the trained nurse and in the afternoon 3 health care assistants with the nurse. At night there is one nurse and 2 health care assistants. All care staff work in all areas of the home. They move between the main residential area and the nursing/ dementia wing. This is good in that all staff know all residents and makes cover easy when staff are on leave, training or sick. One relative commented ‘although my parents are in separate wings, due to my mother’s specific needs, all staff know them both well.’ However the downside it that there is less daily / weekly continuity of staff for residents and the home were agreeable to looking at this again especially in regard to the service they provide to their residents with dementia. Well ordered staff records/ personnel files demonstrate the homes’ recruitment procedure in action. The files of four of the latest members of staff to join the home were inspected. All documents that should be on file were. A good system is in place to check that all information is in place before staff begin working at the home. For example CRB disclosures and POVA 1st checks are applied for and received prior to the commencement of duties and references are obtained. The Royal Masonic Benevolent Institution (RMBI) have decided to tighten up on their practice by asking for references to be marked with company stamp and for those giving references to be clear about their positions in the organisation. Records are kept of training that staff undertake. Staff receive induction and foundation training to the industry standard. In addition staff receive 3 days of ‘orientation’ training when they first start work at the home. Each member of staff has a ‘passport’ in which all their training is recorded. Ongoing training is discussed at supervision sessions and where needs are identified these are addressed in the homes ongoing training programme. During the last twelve months staff have had training in manual handling, health and safety, infection control, fire training, first aid and supervision training. Plans are in place for future training in carrying out appraisals, medication updates and dealing with disciplinary issues. Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 27 The Regional Business Operations Manager talked of how the RMBI had made dementia training mandatory, but records at the home showed that only 4 care assistants and 3 of the nursing staff had had training in dementia. This is out of over 50 care and nursing staff. The home agreed to look at this as a matter of urgency so that residents with dementia were being supported by staff who had been appropriately trained, and who have a real interest in the higher / different needs of the residents living there. The regional manager also agreed to look at induction training and if dementia awareness and tissue viability could be added as both are significant to the work of all staff and are not currently covered currently. Clinical supervision – need to record what trained staff are doing to keep themselves up to date and look at ways to share good practice between them. Limited evidence of what trained staff had done. Where there were records training was not recent. There was limited evidence of clinical updating e.g. tissue viability and wound care. The number of care staff with the NVQ level 2 in care qualification is now 62.5 , which is in excess of the 50 target set by the Department of Health. Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well organised and the daily management and running of the home centres round the care and contentment of residents. Good management practice, systems in place, and records kept, confirm the health and safety of all in the home. EVIDENCE: The home is managed by Tina Beament who has successfully completed her NVQ level 4 in management. Ms Beament is a qualified nurse and is registered with the Nursing and Midwifery Council. Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 29 Representatives regularly visit the home from the Royal Masonic Benevolent Institution (RMBI). Reports are made of these visits and copied to the Commission for Social Care Inspection. All records were available as requested at the inspection. An up to date insurance certificate was on display along with the home’s registration certificate. The home sent out and made available comment cards for the Commission as requested prior to this inspection. Those that came back were generally very positive about the home and demonstrated that residents have, and feel free to express opinions. Less positive views and those that related to specific individuals were addressed during the course of the inspection visit. The Royal Masonic Benevolent Institution (RMBI) are employing an external company to carry out their annual quality assurance work. Surveys seen in draft did not distinguish between residents at the home who receive the mainstream residential service, the nursing service or the dementia service. The Regional Business Operations Manager agreed to take this up with the organisation to see if this could be addressed in order to make the feedback more meaningful. The home looks after some money belonging to residents who choose to take up this service. An excellent system is in place to do this. Clear records are kept of expenditure and balances along with receipts. Statements of the history of transactions are readily available. Financial statements for some residents on the east wing were reviewed. All showed that residents had access to personal money, were receiving services e.g. chiropody and hairdressing and were able to purchase any extras they wanted e.g. cigars, newspapers, art supplies. Maintenance records are kept at Zetland Court and the Royal Masonic Benevolent Institution’s regional property operations manager regularly reviews them. Information about recent checks were submitted to the Commission prior to the inspection visit. Where inspections have been carried out by other bodies, and requirements and recommendations have been made to improve the health and safety of the home, these have been complied with. Accident records were looked at. Accident forms seen were well completed. An incidents and occurrences book is also kept. Appropriate notifications about incidents and accidents are made to other bodies. Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 30 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 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 31 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. 1. Standard OP30 Regulation 18 Requirement Staff must receive training appropriate for the work they are to perform e.g. dementia. Timescale for action 01/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations It is recommended that the statement of purpose is revised and includes information about the specialist services delivered at the home i.e. the nursing and dementia services. It is recommended that there is a dementia / mental health assessment tool developed to be used at the pre admission stage and after, to inform the care planning system. It is recommended that the cross referencing in care planning be improved to ensure that plans are clear about the current care to be delivered. Where there are concerns about the nutritional intake of residents charts should be clear about food and fluid intake. DS0000020457.V340940.R01.S.doc Version 5.2 Page 32 2. OP3 3. 4. OP7 OP8 Zetland Court 5. OP9 6. OP12 7. 8. OP14 OP19 9. OP30 Medication lists on residents’ care plans should be kept up to date. • When it is the decision of staff to give medication where residents are not able to say that they are in need of them, the circumstances for administration need to be made very clear in the care documentation. • When medicines are listed on medication administration records as prescribed, why they are not given should be made clear. How to best meet the social and recreational needs of residents with dementia should be further explored and better documented. Plans should be clear and records kept of how needs have been met. The home should look at ensuring that residents with dementia / confusion are offered choices in ways that are individually suitable to them e.g. food choices. The home should look to implement good practice advice in respect of the environment provided for residents with dementia / confusion e.g. to make it more stimulating and accessible. • It is recommended that dementia and tissue viability be added to induction training. And • That the home better evidences that nurses are up to date with clinical practice e.g. tissue viability and wound care. • Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Zetland Court DS0000020457.V340940.R01.S.doc Version 5.2 Page 34 - 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. 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