Care Home: Catherine Court Nursing Home

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What the care home does well People using the service are thoroughly assessed prior to admission and have access to a range of written information before moving in, to ensure the service can meets their needs.The health and personal care needs of people living at the home are generally met, promoting health and well-being and ensuring that they receive medication in a safe and consistent manner. Complaints and adult protection are effectively managed to listen to views of people who live at the home and reducing the risk of harm to them. People have contact with their families and friends and some arranged activities are available to provide people with stimulation and interest. The home provides staff cover to meet people`s needs and has needed to rely on agency workers to maintain levels of carers until vacant posts can be filled. Recruitment procedures and staff training are managed well to ensure staff have the skills and competencies to support the people who live there. The management and administration of the home promote continuity for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. What has improved since the last inspection? A requirement made at the last key inspection regarding care plans had been addressed. What the care home could do better: Practice in relation to managing people`s continence needs to be improved in order that their dignity is better promoted by the staff team. The home has been designed to meet the needs of older people but needs improving in some areas to provide a positive environment for the people living there. Staff engagement with service users outside of organised activities needs developing to ensure people have enough stimulation for their overall wellbeing. Mealtimes could be better managed to ensure that these occasions are more enjoyable for people using the service. Some additional input on communication is advised to supplement skills in working with people with dementia. CARE HOMES FOR OLDER PEOPLE Catherine Court Nursing Home Cressex Road Booker High Wycombe Bucks HP12 4QF Lead Inspector Chris Schwarz Unannounced Inspection 09:30 22 & 25 February 2008 nd th 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 Catherine Court Nursing Home DS0000019188.V358730.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. Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Catherine Court Nursing Home Address Cressex Road Booker High Wycombe Bucks HP12 4QF 01494 524850 01494 524914 manager.catherinecourt@careuk.com 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) Community Health Services Limited Ms Ann Hill Care Home 60 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. From time to time service users aged 60 and above may be accommodated in the home. 22nd June 2006 Date of last inspection Brief Description of the Service: Catherine Court Nursing Home is situated a short distance from the town centre of High Wycombe, in a residential area. The town possesses a variety of shops and local amenities and provides access to local and national transport networks. The home is owned by Care UK Ltd and was purpose built for the provision of care. The home provides care with nursing and can accommodate up to sixty older people, some of whom may have diagnoses of dementia. The majority of bedrooms are single with a small number of rooms for two people. All rooms have en-suite facilities and a further four bathrooms and four shower rooms are provided. A qualified nurse is present on each floor of the home 24 hours a day, supported by a team of carers, housekeeping, catering and maintenance staff. Access to healthcare professionals is through direct contact or by referral through people’s general practitioner. Fees for the service ranged from £545.75 to £815.49 per week. Personal items, toiletries and services such as hairdressing and chiropody are at additional cost to the individual. Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection was conducted over the course of two days and covered all of the key National Minimum Standards for older people. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion and comment cards were sent to a selection of people living at the home, relatives and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service, examination of some of the home’s required records and a tour of the premises. Because people with dementia are not always able to tell us about their experiences, a formal way to observe people has been used in this inspection to help us understand. This is called the ‘Short Observational Framework for Inspection’ (SOFI) and involved observing up to 5 people who use services for 2 hours and recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use services, and the environment. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and people who use the service are thanked for their cooperation and hospitality during this unannounced visit. What the service does well: People using the service are thoroughly assessed prior to admission and have access to a range of written information before moving in, to ensure the service can meets their needs. Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 6 The health and personal care needs of people living at the home are generally met, promoting health and well-being and ensuring that they receive medication in a safe and consistent manner. Complaints and adult protection are effectively managed to listen to views of people who live at the home and reducing the risk of harm to them. People have contact with their families and friends and some arranged activities are available to provide people with stimulation and interest. The home provides staff cover to meet people’s needs and has needed to rely on agency workers to maintain levels of carers until vacant posts can be filled. Recruitment procedures and staff training are managed well to ensure staff have the skills and competencies to support the people who live there. The management and administration of the home promote continuity for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. 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 Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 8 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 Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 9 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): 3,6 Quality in this outcome area is good. People using the service are thoroughly assessed prior to admission and have access to a range of written information before moving in, to ensure the service can meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a statement of purpose in place which had been revised in January this year and covered all necessary areas. It made clear that no one can be admitted under emergency circumstances and provided useful additional information such as a local advocacy contact. A copy of the statement of purpose was displayed in the foyer plus the welcome pack that is given to all new service users. This provided details of things such as meal times, the keyworker system, arrangements for medical care, activities, meeting religious, cultural and spiritual needs, arrangements for smoking and alcohol, visiting, involvement in care, fire precautions, making complaints and insurance arrangements. Copies of the welcome pack were seen in people’s rooms alongside a copy of the service’s charter of rights and other information. Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 10 A selection of pre-admission assessments was looked at covering people with different care needs. A corporate format had been used to record information on health and personal care needs. Older assessments that were viewed had not consistently been fully completed with details such as relatives and the person’s expectations, information on night time needs/sleep and special needs left blank. More recent assessments provided a more comprehensive picture of the person and had been dated and signed and completed in full. Intermediate care is not provided at this nursing home. Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 11 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): 7,8,9,10 Quality in this outcome area is good. The health and personal care needs of people living at the home are generally met, promoting health and well-being and ensuring that they receive medication in a safe and consistent manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were in place for each person – the home uses a computerised care planning system as well as maintaining a paper copy of each person’s support needs and accompanying risk assessments. Files contained a photograph of the service user, for easy identification, an outline of their personal details such as marital status, ethnic background, preferred name, next of kin, religion, doctor, weight and baseline observations upon admission. Assessments had been written for various scenarios such as risk of developing pressure damage, use of bed rails, moving and handling requirements and risk of nutritional deficits. These had been subject to regular review to ensure information was reflective of people’s current health and abilities. Support plans had been written covering eating and drinking, mobility, hygiene, maintaining a safe environment, work and play, communication, elimination, religious needs, care of the dying and night time care needs. Continence profiles and management of behavioural problems were also seen. In the sample of files examined, each had been signed by the person’s spouse or Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 12 son/daughter. Staff had started to collate information about each person’s life story and obtained photographs and information from their relatives to provide a more rounded picture of people in their care. This information will eventually be incorporated into the care plans. Records of health care appointments had been maintained and showed access to medical staff as required. Two doctors returned surveys, expressing satisfaction with their patients’ care at the home and they were not aware of any complaints or concerns about practice. One additionally commented, “home now runs more efficiently following introduction of new manager.” One of the chiropodists who visits the home was also satisfied with people’s care and raised no concerns about practice. Staff had access to a number of health related policies and procedures such as promoting continence, bowel management, managing challenging behaviour, care of the dying and communication. Feedback to the manager at the end of the inspection included observation that staff were not consistently following good advice in people’s support plans to communicate with them, such as maintaining eye contact, speaking slowly and clearly and using a communication book in one person’s case. Personal care was carried out in private, either in people’s bedrooms or bathrooms – no open doors were observed when people were receiving assistance from staff. Staff used people’s names on most occasions when speaking with them. Some of the people who returned surveys raised concerns regarding people’s dignity. One person said her mother “sometimes has a long wait to be put on the toilet” another said “there are times when we have to push for regular toileting” a third said “there have also been several occasions when she has asked for the toilet and has had to wait for an unreasonable amount of time” and added “she is supposed to wear special stockings but rarely does so.” A recommendation is made to improve practice in relation to managing people’s continence in order that their dignity is better promoted. Medication was being well managed. A look in one of the two treatment rooms showed that the home uses a monitored dose system of medication administration only qualified nurses had responsibility for handling medicines. Medication was being stored in a locked, air conditioned environment and each cabinet and trolley was additionally secure. Medication administration records were being completed accurately and a small supply of controlled drugs was stored and recorded appropriately. Dates of opening had been written on medicines that were not part of the monitored dose system, such as creams, ointments and liquid preparations. A medicines fridge was also available for any items that require cool storage and records maintained of the fridge temperature. Samples of staff signatures had been recorded to identify the person administering medication. A medication policy was in place for staff to refer to for guidance. Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 13 Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15 Quality in this outcome area is adequate. People have contact with their families and friends and some arranged activities are available to provide people with stimulation and interest. Engagement by staff outside of these times needs developing to ensure people have enough stimulation for their overall well-being. Mealtimes could be better managed to ensure that these occasions are more enjoyable for people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two activities organisers are employed at the home and arrange different activities throughout the week, such as dominoes, flower arranging, using the sensory room, going to a coffee morning at the local church, gentle movement with a balloon and showing films. Arts and crafts are also available for people to use. Occasional trips out are arranged, using dial-a ride to transport, but these seemed to take place on an infrequent basis. A church service is held each month, with notices displayed around the home to confirm the date of the next one. A hairdresser visits the home each week, she said she prefers to start at 7.00 am in order to finish early – management should ensure that this arrangement is convenient and acceptable to service users and amend it if it is not. Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 15 Some time was spent observing what people were doing in the lounge before lunchtime. The television had been put on, showing a chat show/magazine style of programme. The volume was loud, resulting in staff raising their voices when speaking to people and a jarring level of noise when the programme’s music came on before and after each commercial break. Staff engaged (loudly) with people in the lounge who were awake, talking with them, using appropriate touch, opening the patio door to let one person get some fresh air and asking if they would like to go out for a walk after lunch. There was not a lot for people to engage with for themselves, such as leafing through magazines or touching objects that were placed in their reach. One person who wanted to touch the curtains was chastised for doing so. The manager described work that is being done within the organisation to introduce ‘activity based care’ at the home which will help staff to think more about providing stimulation for service users and their role in providing opportunities for people to be more engaged in everyday tasks and activities. There is a relatives’ support group and a Friends of Catherine Court which is involved in fundraising for the home. Relatives and other visitors are free to see service users. One relative said “the care home involves relatives well. Our mother particularly commented that she liked that visitors can go in at any time during the day. It took a while to sort out but staff have now accepted that we want to be involved in the care of our mother and work well with us on this. The care home has also provided training for two members of the family to enable us to be more involved. We feel that the management do try to take on board suggestions that relatives make and sort out problems.” Information on advocacy services was displayed in the home. Several comments were made in surveys about the standards of food at the home. A relative said “the food is not up to the standard it was when she first went to the home.” Another said “it has been difficult to establish suitable/liked tea time/supper meals. Some staff have tried but information is not always communicated.” One person commented on the lack of choices for puddings where people require a pureed diet, saying that usually yoghurt is offered as the alternative to the main pudding, without a choice for those who can only eat soft foods. During observation of the mealtime in the dementia care unit, several points were noted. People using wheelchairs were brought around to the dining room from their lounges first of all. As the chairs are large and quite bulky there was additional manoeuvring and re-positioning as mobile service users were escorted in and helped to the table. One person using a wheelchair was moved to a greater degree, and without any explanation or apology by staff before they moved her out of the way each time. When everyone who wanted to come to the dining room was in there, around 23/24 people, the space was tight. The presence of up to eight staff at one point, many sitting next to people to assist with their meal, made the room too overcrowded for comfort. Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 16 People started to be taken to the dining room around 12.20 pm. The people being observed did not receive food until 12.55 pm and one other person in the room who needed staff help did not receive her lunch until 1.20 pm. People who needed plate guards were provided with them, choice of meal had been selected in the morning by service users and they had a choice of fish and chips with two vegetables or a meat pie with mash and two vegetables. There was apple crumble or yoghurt for pudding. Serving of the meal was slow, people naturally progressed with their meal at different rates resulting in those who could manage to eat by themselves finishing pudding whilst others were still coping with the main course. Staff relied on calling out to each other across the room to find out whether everyone had had both courses and a drink. Drinks were not served to each person at the same time, tables had not been set with cutlery or glasses/drinks beforehand but were distributed when needed. There was no music to make the meal time experience relaxing for service users and no reminder of the food options on menus or displayed on a chalk board, for example. People who needed help with their meals were assisted gently by staff in an unrushed manner and they sat down to do this apart from one staff member at one point who assisted two people from a standing position for a short while. There was little or no verbal interaction from staff with the people they were helping. Some recommended action has been made to improve meal times for service users. Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 17 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): 16,18 Quality in this outcome area is good. Complaints and adult protection are effectively managed to listen to views of people who live at the home and reducing the risk of harm to them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a copy of the corporate complaints procedure, whistle blowing procedure and adult protection/safeguarding procedure plus local inter-agency adult protection guidelines. In the pre-inspection self-assessment the manager stated that there had been seven complaints in the past year and one adult protection investigation. The Commission has not received any complaints directly from people using the service or their representatives and has not been made aware of further adult protection issues. The complaints log was looked at and showed that good records are kept of any complaints that are made about the service, and how these have been handled. There was a suggestions box in the foyer for anyone to leave comments. Documents were seen relating to the adult protection matter which showed that the manager had handled this professionally and alerted other agencies as required. Staff training records showed that adult protection/safeguarding training takes place. Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 18 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, 26 Quality in this outcome area is adequate. The home has been designed to meet the needs of older people but needs improving in some areas to provide a positive environment for the people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Accommodation is spread across two floors in a circular design with a central courtyard that has been attractively maintained and has seating areas plus parasols. There is a dementia care unit on the ground floor and a unit for frail elderly people and palliative care on the first floor. Both floors have two lounge areas and a dining room with kitchenette, adapted bathrooms and showers are close by to bedrooms and there is a nurse station/office on each floor. A sensory room has been created on the first floor; plans have been drawn up for a larger sensory room on the ground floor that will be more accessible to people using wheelchairs. Some of the bedrooms that were viewed were modest in size (although met registration standards at the time the building was opened), people had personalised their rooms to different degrees with things such as small pieces of furniture, pictures, ornaments and plants. Some Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 19 people had their own telephone lines installed and one person had a small fridge/freezer. Odour control needed some attention in parts of the building, especially on the first floor, and a recommendation is made to improve this. Some of the carpets were stained and considered by the manager to be beyond shampooing and need to be replaced. Furniture was worn and did not match in some communal areas and gave a negative, shabby, impression. The manager said that a substantial amount of money has been granted by the provider for improvements to the environment but no date for starting or completing the work had been given. This was a source of frustration for one relative who felt that the provider was slow to respond to maintenance issues. It is recommended that an action plan for improved works is submitted to the Commission with clear timescales for starting and completing all identified remedial work. There was good regard for infection control in all parts of the building. Anti bacterial hand mousse was located around the home, staff were seen wearing disposable aprons when serving food and drinks, when assisting people to eat and on entering the kitchen. Gloves were worn to plate up food. One relative who completed a survey said “The smell of urine at times is overpowering.” Another felt that more staff were needed to improve standards of cleanliness and laundry. Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 20 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): 27,28,29,30 Quality in this outcome area is good. The home provides staff cover to meet people’s needs and has needed to rely on agency workers to maintain levels of carers until vacant posts can be filled. Recruitment procedures and staff training are managed well to ensure staff have the skills and competencies to support the people who live there. Some additional input on communication will supplement skills in working with people with dementia. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is staffed with a mix of qualified nurses, carers, catering and domestic staff and an administrator. There were 278 vacant hours for carers at the time of the inspection and the manager and some relatives said that recruitment has been a problem for the home for some time. The provider organisation had reviewed its pay scales to try and attract and retain staff and to offer incentive for those people who achieved National Vocational Qualification. Thirty of the staff team had left the home in the previous twelve months. Agency staff were being used to cover carers until the posts can be filled with a recruitment drive underway at the time of the visit. Rotas showed that six carers plus a qualified nurse cover each floor during the day and at night there are two carers and one nurse on each floor. A selection of recruitment files was looked at to see whether appropriate checks had been undertaken for new staff. All files were in very good order, arranged well and with evidence of work permits where staff were from overseas. Each person had a contract of employment and there was a photograph to identify them. Checks had also been carried out on the hairdresser, chiropodists and a Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 21 student on placement from one of the local hospitals. Training files revealed that staff had undertaken an induction in line with the nationally recognised ‘common induction standards’ and had attended a range of mandatory and specialist courses including care of people with dementia, pressure area management, sight and hearing loss and a good range of health and safety related courses. Staff had received training on protection of vulnerable adults and records showed that this had been extended to staff who were not involved in hands on care provision, which is a good practice. In information supplied by the manager in the pre-inspection self-assessment 23 of 47 staff had achieved National Vocational Qualification at level 2 or above with a further eight people working towards it. Observation of practice showed that some improvements could be made to staff practice, especially at meal times in the dementia care unit, as described under the section looking at daily life and social activity. Some good interactions between staff and service users were noted, such as speaking to a service user to ask if it was alright to take her to the dining room, covering someone’s legs back over with a blanket when it had come adrift, following the theme of what a service user was saying and taking an interest by asking related questions and one staff member trying to find out more about one person’s cultural and religious needs. Some staff had a tendency to sound brusque and on the harsh side due to the manner in which they sometimes spoke, the level of their voice and not always using plain and simple language with service users. It is recommended that some training be provided for staff to help them develop their communication skills in working with people with dementia. Relatives said in surveys “difficulties in recruiting and retaining good quality staff in this home means use of agency staff. Therefore it is difficult for residents and relatives to maintain close relationships and it is also difficult to implement care plans fully”; “staffing in the home is poor owing, I’m told, to budgets and the fact that a realistic wage cannot be made for the very heavy and hard work involved”; “carers/nurses that are well established often do these things (eg provide soya milk before going to bed, putting bed socks on at night) but a high turnover of staff makes it difficult for the individualised details that make for a better quality of life to be carried out on a regular basis.” Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 22 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): 31,33,35,38 Quality in this outcome area is good. The management and administration of the home promote continuity for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s manager is registered with the Commission, she is a qualified nurse and experienced in care of older people. She was due to leave the service on 29th February; acting management arrangements would be put in place until a new manager is appointed. Some of the people spoken with as part of the inspection were concerned at a change in manager, one person recalled at least three managers working at the home over the space of five years. There was regular monitoring of the quality of care by the provider and reports of such visits were available to read. In the foyer there was a copy of the last Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 23 inspection report, the statement of purpose, the welcome pack, the results of a quality assurance survey in 2006 and other useful information such as a copy of the fire procedure, the complaints procedure, details of an advocacy service, the date of the next church service and a notice announcing the impending departure of the manager. The certificate of registration, employer’s liability insurance and the four weeks’ menus were also displayed. People’s money was being safely managed at the home. Where relatives had chosen to maintain a float of cash for service users, individual wallets and transaction records had been set up with just the home’s administrator and the manager having access to the money. Records had been well maintained with signatures alongside each transaction and a signed routine check of balances by the manager. A sample of six wallets was checked as part of the inspection and found to be in good order with expenditure verified by receipt and balances reconciling with the records. Health and safety was being managed to good effect. Staff had undertaken relevant health and safety training to carry out their roles safely, such a moving and handling, infection control, first aid and food handling and hygiene. There was a current gas safety certificate, evidence of satisfactory electrical hard wiring, baths and hoists had been serviced regularly and electrical appliances safety checked at the end of last year. Servicing reports were available for laundry equipment and there were routine checks around the premises of hot water temperatures, call bells, bed rails and identifying visual hazards. Cleaning products were securely stored so that service users could not accidentally come into contact with harmful substances. The policies and procedures manual contained health and safety guidance for staff to refer to. Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 24 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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 25 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. 1 2 Refer to Standard OP10 OP15 Good Practice Recommendations Practice in relation to managing people’s continence is to be improved in order that their dignity is better promoted. Mealtimes are to be better managed to improve peoples’ experiences of meals, such as reducing the number of people in the dining room at any one time, using music to create a pleasant ambience, co-ordinating serving of food in a more timely manner, setting tables with cutlery and glasses plus drinks, improved pudding choices for people who require pureed diets and through staff engaging with the people they are providing assistance to. An action plan outlining the timetable of improvements to the home is to be submitted to the Commission with the response to the draft report, to show what is being done to create a better environment for people living at the home. Odour control needs to be managed more effectively to ensure that people using the service have a more pleasant DS0000019188.V358730.R01.S.doc Version 5.2 Page 26 3 OP24 4 OP26 Catherine Court Nursing Home 5 OP30 environment in which to live. Training on effective communication is to be provided to staff to help them improve their contact with service users. Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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 Catherine Court Nursing Home DS0000019188.V358730.R01.S.doc Version 5.2 Page 28 - 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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