Care Home: Christchurch Court

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What the care home does well Service users are fully assessed and involved in the care planning process and this ensures that the care received is appropriate to their needs and enables them to develop their skills and live fulfilling lifestyles as individual members of the community. The service focuses on residents` individual needs. Care Plans are comprehensive and detailed to assist staff to deliver care that fits individual service users care needs. Individual Activities Programmes help residents plan their time, provide stimulation and assist them to work towards their goals. Staff feel well supported in their duties and there is an ongoing training plan that when fully implemented will ensure that staff teams are very well qualified for the work that they do. There is commitment from the staff, the Registered Manager and the overarching management of the home to continue to develop the quality of the service to the benefit of service users. There is a prompt and effective response to any issues arising as areas of potential concern. What has improved since the last inspection? A number of areas have been improved since the last inspection. All areas relating to requirements and recommendations discussed at that time have been reviewed, with better systems being implemented where needed. For example the complaints procedure and the financial procedures have been revised and now serve their purpose to a high standard. Induction and training for staff have been reviewed and further improved and staff feel very positive about the training that they are offered. What the care home could do better: Quality Audit needs to review outcomes and well as input. Medication management was found to have slipped below standard despite the systems in place. Improvements are needed to ensure that the provision of medications is always safe and easily auditable. Staff dealing with medication need to be fully aware of the required standards including the Royal Pharmaceutical Society guidance on the administration of medicines in Care Homes, and need to alert seniors where shortfalls occur. CARE HOME ADULTS 18-65 Christchurch Court 2 Christchurch Road Abington Northampton Northants NN1 5LL Lead Inspector Sarah Jenkins Key Unannounced Inspection 5th November 2007 07:50 Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 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 Christchurch Court DS0000012742.V352211.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 Adults 18-65. 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. Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Christchurch Court Address 2 Christchurch Road Abington Northampton Northants NN1 5LL 01604 639838 01604 631895 enquiries@christchurchcourt.co.uk 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) Marigold Contracts Limited Mr Barrie Amos Care Home 21 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (21) of places Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Christchurch Court care home is registered to provide personal care to male and female service users who fall within the following categories: Mental Disorder (21) The age range of service users is between 19 - 65 years. Christchurch Court can accommodate one named service user who is over the age of 65 and who also has a physical disability. All service users accommodated at Christchurch Court will have an acquired brain injury. The maximum number of persons to be accommodated at Christchurch Court is 21. 13th February 2007 Date of last inspection Brief Description of the Service: Christchurch Court is a care home providing personal care and accommodation for 21 service users with Mental Disorder with all service users having an acquired brain injury. The age range of service users is 19 to 65 years with an additional condition that the home may continue to provide care for one existing named service user over the age of 65 years. The Home is owned by Marigold Contracts Ltd. It is located in a suburb of Northampton, close to a local shopping centre and nearby park, easily accessible by public transport. The premises consist of a two-storey building offering all single room accommodation, with bedrooms having en-suite facilities. There are a choice of lounge areas, a dining room and small lounge smoking area. The Home does not have a lift. There is a courtyard garden area. Fees are £310 per day - this information was provided on the day of the inspection. Fees are all inclusive with no charges for any extras. Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting 2 service users and tracking the care they receive through meeting with the service users, a review of their records, discussions with the care staff and observation of care practices. The Inspector visited during the early morning period to observe practices by staff and to meet with Service Users. Service Users have mental disorders and acquired brain injuries, but most were able to communicate effectively with the Inspector. The Inspector also undertook observations of care practices, and Service Users’ relationships with staff to establish their levels of contentment with their lifestyles and routines. The Inspector spent just over 6 hours in the home from 7.50am. There was no Annual Quality Assurance Assessment (AQAA, a self assessment document filled in by the home) due prior to the inspection and feedback forms were not available at this inspection. The inspector reviewed the recent history of the home and the feedback received from staff and service users at the Inspection, to inform the inspection process. What the service does well: Service users are fully assessed and involved in the care planning process and this ensures that the care received is appropriate to their needs and enables them to develop their skills and live fulfilling lifestyles as individual members of the community. The service focuses on residents’ individual needs. Care Plans are comprehensive and detailed to assist staff to deliver care that fits individual service users care needs. Individual Activities Programmes help residents plan their time, provide stimulation and assist them to work towards their goals. Staff feel well supported in their duties and there is an ongoing training plan that when fully implemented will ensure that staff teams are very well qualified for the work that they do. There is commitment from the staff, the Registered Manager and the overarching management of the home to continue to develop the quality of the Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 6 service to the benefit of service users. There is a prompt and effective response to any issues arising as areas of potential concern. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A thorough assessment process is in place, and is documented, to ensure that prospective service users needs can be met, prior to their admission being agreed. EVIDENCE: Service users expressed complete satisfaction with the admission processes, saying that they had been given the information that they needed and had been enabled to visit the home prior to making a decision. They felt fully supported and welcomed by the homes staff. There was evidence from the records that a full and thorough assessment process is carried out with appropriate liaison with carers and professionals involved in service users previous care placements. Documentation in all relevant areas of care is gathered and information assimilated into care plans. Staff write detailed daily logs which enables the initial assessment to be developed and care delivery to promote the best care for each individual service user. Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The professionalism of the care planning processes leads to good outcomes for service users. Their individual needs and choices are promoted and well met. EVIDENCE: Service users are fully involved in their care plans and are enabled to attend their reviews if they wish. Service users who discussed their care with the inspector were fully satisfied with the processes. Staff spoken with, were knowledgeable about the care and support each service user required. Observations of staff interactions with service users showed that they had a sensitive understanding of the individuals at the home. Service users files are full of relevant and detailed information, which is likely to enhance the quality of care and understanding, and ensure consistent Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 10 approaches from staff. The information is well organized, making the relevant and up to date details easily accessible for staff. Staff were observed to be caring and responsive to service users needs and to use non-confrontational approaches to difficult behaviours. Risk assessments are undertaken appropriately and are updated regularly. Risk is well managed and service users skills and abilities are properly assessed and reviewed in relation to reasonable risk taking. Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users living at the home have the opportunity to lead fulfilling lifestyles, which lead to developing their potential and enhancing their skills and independence. EVIDENCE: An emphasis on service users rights, independence and responsibilities are all included in the philosophy of care, which encourages service users to make informed choices and develop their lifestyles in a manner that suits them best. It was evident from records and from discussion with staff and service users, that service users are enabled to lead active lifestyles with access to the local community, and are helped to get work placements outside the home if they wish. Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 12 Staff said that residents use a range of community facilities including local shops, pubs, the park, and the post office to get their money out etc. At the time of the inspection service users were generally following their written programmes of activities which included trips outside the home and periods of relaxation within it. There was no evidence that any service users were bored or lacking in suitable activity. Service users generally spoke positively about their lifestyles and work placements, although in one instance there was a sense of frustration with the limited personal finance available to support more external individual activities. Regular outings are available and service users are able to express their choices about outings and holidays in the regular house meetings. Main meals are provided by a catering company with a good range of choices and a proper understanding of special diets. Service users spoke particularly positively about the food provision and explained that they also had their own kitchen and were able to make snacks and drinks for themselves whenever they wanted. Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive good personal support with their physical and emotional health needs generally being well met. The medication system needs to be audited and reveiwed and staff reminded of the importance of procedural accuracy. EVIDENCE: Healthcare at the home is generally well supported, undertaken and documented. Service users expressed full satisfaction with the support given by staff in both personal care and general healthcare, and records showed that service users healthcare needs were properly overviewed and reported. Staff have a proper understanding of privacy and dignity issues in relation to service users personal care. Service users emotional needs are well understood and documented on care plans. Good recording in the daily logs enhances and updates staffs ability to understand and support service users. Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 14 The medication system needs full review. There were no serious risks to service users health identified, but the risk factors need to be reduced. The senior staff member available to support the inspection recognized the issues and assured the Inspector that these would be followed up promptly. Matters that require attention are the capacity to audit the system; the correct use of medication profiles; the reduction of unnecessary stocks of repeat prescriptions and the clarity of directions on Medication Administration Sheets. Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident that the staff at the home and the systems for safeguarding promote and protect service users wellbeing. EVIDENCE: New processes are in place in respect of recording complaints made to the home and the follow up of complaints was evidenced. A number of service users expressed the view that they could approach the Registered Manager or any member of staff with their concerns and that these would be followed up appropriately. The Commission has received one complaint since the last inspection. This was connected to the receipt of a weekly timetable by a service user. The complainant referred the complaint to the Responsible Individual and stated at the time of the inspection that no further involvement from the Commission for Social Care Inspection was required. Staff were confident in the procedures and had a good understanding of Protection of Vulnerable Adults issues. Training in this area is ongoing. Advice was given on the need to send follow up reports on some Notifications, where necessary. Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents live in a homely and comfortable environment, and standards of hygiene are very good. EVIDENCE: The home is conveniently positioned with easy access to local facilities and within walking distance of the town centre. There is a regular bus service. The home is bright, clean, comfortable and homely. Service users have a choice of lounge areas, a large dining room, and a garden area. The home is well furnished and decorated and service users have their own kitchenette where they can prepare snacks and drinks. They also have free access to video equipment and a computer. Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 17 Service users were happy with their bedrooms, which they had been enabled and encouraged to personalize. There are central office areas so that service users have easy access to management and staff. A service user expressed discontent with the small smoking area, which can only be accessed by two service users at a time. The Inspector was advised that the management team had looked at this issue but there were no suitable alternative options at the moment. Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are well met by a staff team who are experienced and appropriately trained. EVIDENCE: At the time of the inspection there were six staff on duty including 2 designated seniors, this appeared sufficient to fully meet service users needs. Ancillary staff were also on duty in the home during the course of the morning and management staff were on call and available. Service users who spoke to the inspector expressed content with the staff group who were all seen as caring and helpful. There was general satisfaction in the ways in which issues at the home were dealt with. The training plan was seen by the inspector and it was evident that staff are being encouraged to undertake appropriate training and that the aim is to maintain a highly qualified staff team. Some senior staff are trained trainers Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 19 and much of the training is “in house”. Staff spoke highly of the courses run by the organization, and the support and supervision that they receive. The Inspector discussed the recruitment process with a recently employed staff member and found this to be a fully professional. Records and discussion demonstrated that the home has a good understanding of recruitment issues, and processes have been recently improved to guard against illegal workers. Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed in a manner that promotes and safeguards the health, safety, welfare and rights of residents EVIDENCE: Neither the Registered Manager nor the deputy was available at the time of the inspection and parts of the inspection were conducted with the assistance of an “on call” manager and the Responsible Individual. It was evident that the home is well managed and staff reported that the managers were always approachable and helpful. Service users also reported that they felt they could talk to the Manager or any of the staff and that they would be listened to, and receive a good response. Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 21 They feel involved in the running of the home through the good communication and the opportunities that they have to state their preferences and opinions at house meetings. Records kept at the home were well organized, accessible and easy to use. Policies and procedures are relevant and used by staff. From discussion with service users and staff, and general observations around the home Health and Safety and maintenance issues appear to be addressed properly. No breeches were noted Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 4 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 4 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 x x 3 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 3 x Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 23 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 YA20 Regulation 13 Requirement An audit of the medication system must be undertaken to ensure the system is safe and service users are thereby protected. Timescale for action 14/12/07 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 YA20 Good Practice Recommendations PRN (as required) directions on medications and Medication Administration Sheets should detail what the medicine is for, the minimum period between doses and the maximum dose that may be given in 24 hours. Medication profiles should function as an accurate history of the medicines prescribed for and taken by a service user. Decisions should be taken about the need to reorder prescriptions when there are still adequate on the premises. Overstocking should be discouraged. 2 3 YA20 YA20 Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Christchurch Court DS0000012742.V352211.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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