Care Home: Church Court Care Centre

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What the care home does well The home has a number of staff that have worked there for a long time resulting in continuity of care for people who use the service. The home exceeds the recommended 50 percent of care staff with an NVQ 2 or above in Health and Social Care. Which is excellent. People who use the service felt that the standard of food provided is good and the cook is able to make changes to the menu based on the likes and dislikes of the people in the home. The care plans examined were all personalised and had evidence that the person had been involved in the process. In places care plans had been linked to risk assessments, which is good practice. All people and visitors to the home that were spoken with were all very pleased with the standard of care that people receive and all also complimented the staff on being friendly and helpful. What has improved since the last inspection? Several people identified at the last inspection who required specialist equipment to make sure when staff are assisting them with personal care that they are not put at risk, have now been provided with the necessary equipment. A more structured activities programme is in place to help meet the recreational interests of people who use the service. Copies of all complaints correspondence is now stored in the home. All the maintenance and cleanliness issues identified at the last inspection have been addressed. The Registered Manager said the home has reviewed their staffing levels and they are confident that the needs of people are being met. Systems are now in place to make sure staff are being appropriately supervised. Risk assessments are now in place for people who are able to self medicate and these are kept under review. Arrangements for the proper disposal and recording of medication have now improved. What the care home could do better: When any medication is administered to people who use the service it must immediately be clearly and accurately recorded to make sure people receive the correct levels of medication. When a medication is not given for any reason more details about why it was not given need to be recorded.To improve their recruitment practices they must make sure that a full employment history is obtained and any reasons for gaps verified. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Church Court Care Centre Church Street Stroud Glos GL5 1JL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sharon Hayward-Wright     Date: 0 8 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Church Court Care Centre Church Street Stroud Glos GL5 1JL 01453762293 01453753161 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Sally Anne Manby Roberts,Mr Jeremy Walsh Name of registered manager (if applicable) Mrs Rita June Poole Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Church Court is a Grade II listed building dating back to the 17th Century. It is situated next to the parish church in the centre of Stroud and is within easy reach of the shops and local amenities. Church Court is registered to provide personal care for sixteen older people. The accommodation is arranged on three floors, all of which can be accessed by a shaft lift. The communal areas consist of a lounge, a dining area and conservatory. There is one double bedroom with en-suite. There are also twelve single bedrooms, nine of which are en-suite. There is a well-tended, attractive garden, which is accessible to the people who use the service. Care Homes for Older People Page 4 of 27 0 Over 65 16 care home 16 Brief description of the care home Current fees are 390.25 pounds to 530.00 pounds per week. Hairdressing, chiropody, escort and personal toiletries are charged extra. The home makes information about the service, including CSCI reports available to people through a Service User Guide and Statement of Purpose available in the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: One Inspector carried out this inspection over one day in January 2009. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes in to account the views and experiences of people using the service. Prior to this inspection we asked the home to completed an Annual Quality Assurance Assessment (AQAA). We received this on time and it contained detailed information about how the home feels they are performing and any areas that they wish to improve on. Care Homes for Older People Page 6 of 27 We looked at a number of systems the home has in place and this includes randomly selected care records of people who use the service, medication and we followed up the requirements and recommendations from a visit our pharmacist inspector undertook since the last inspection, activities, staff training and supervision, maintenance records. Where possible, people living at the home were spoken with to ascertain their views on the care and services provided. Surveys were sent to the home for people who use the service and for staff prior to the inspection to obtain their views. We received five surveys from people who use the service. Visitors to the home were spoken with during the inspection. The comments received from speaking to people during the inspection and the surveys have been used in the report. The Registered Manager and care staff were spoken with throughout the inspection and were helpful and co-operative. What the care home does well: What has improved since the last inspection? What they could do better: When any medication is administered to people who use the service it must immediately be clearly and accurately recorded to make sure people receive the correct levels of medication. When a medication is not given for any reason more details about why it was not given need to be recorded. Care Homes for Older People Page 8 of 27 To improve their recruitment practices they must make sure that a full employment history is obtained and any reasons for gaps verified. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives are able to obtain information about the service to help decide if it can meet their needs. Evidence: The records for two people who were recently admitted to the home were examined. One person was a planned admission and the other person was admitted as an emergency. In both instances the home had obtained information about their care needs. The Registered Manager confirmed that the family of one person had visited the home prior to their relative moving in. The other person and their family were spoken with and they said the home had been chosen for them by the local Social Services Department but they are happy with the choice of home as they live very close and this enables them to visit frequently. We sent a number of surveys to the home prior to the inspection and in these we asked people if they had received enough information about the home before they moved in so they could decide if it was right Care Homes for Older People Page 11 of 27 Evidence: for them. All 5 people responded yes. Standard 6 is not applicable to this home as they do not provide intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and person care people receive is based on their individual needs and choices. The principles of dignity, respect and privacy are put into practice. Evidence: The care of one person was examined in detail and this included, reading care records, speaking to the person and their family and speaking to staff. The care records of another person were also examined. Both people had care plans in place for their assessed needs and evidence of ongoing reviews were seen in one as the other person had only recently been admitted to the home. All care plans were personal to each person and contained peoples choices which is excellent. One person has had their medication times altered to fit in with their own choice about what time they like to get up and go to bed. This is good practice. One person had a care plan in place for elimination but this would benefit from more detail about what actual care the staff provide and the home should consider not using the word regularly in care plans and be more descriptive. Ongoing records are Care Homes for Older People Page 13 of 27 Evidence: maintained along with records of external professional visits. A Community Nurse was visiting a person during the inspection and other professionals that visit the home include GP and Chiropodist. Risk assessments are in place for falls, moving and handling, nutrition, the use of bed rails and pressure areas, again ongoing reviews were seen in the one persons care records. One comment we received from a relative at the inspection was This home is very good and the best one he had seen and they have no complaints. We asked people in their surveys do you receive the care and support you need, four people said always and one person said usually. The medication systems used by the home were examined and the requirements and recommendations made by our Pharmacist following their inspection. The staff need to be cautious about where they are positioning the trolley when administering medication as it was in front of a radiator and this could mean the medication is being stored at a temperature above the manufactures guidelines. The Medication Administration Records (MAR) were all examined. Several gaps were found in the recording of some peoples medication and one person had not received their weekly medication but no reason had been added as to why this was. Dates of opening were found on boxed medication and eye drops and this is good practice for auditing and making sure medication is not used past the use by date. Records were seen for medication received into the home, administered with the exception of the above and for medication returned to the local pharmacy. The home now has a procedure in place for medication that needs to be returned. The home at the time of the inspection does not have any people who need controlled medication. One person is self -medicating and a risk assessment was in place and lockable facilities provided in their room. Care plans were seen to be in place for people who use prn or as needed medication, however one person had a care plan in place for pain relief and this would benefit from more directions for staff to follow. A medication reference book and a list of staff initials and signatures is available. People who use the service who were spoken with said they had no concerns about the staff respecting their privacy and dignity. Staff were observed knocking on peoples doors prior to entering and speaking to people in a respectful manner. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their daily life, and now have access to a structured activities programme to help meet peoples recreational interests. Evidence: At the last inspection we raised concerns about the lack of activities for people who use the service. At this inspection posters were seen advertising planned activities and records are being maintained by the care staff. Care staff now undertake activities in the afternoon and on the day of the inspection several people had made some cakes. Several people who were spoken with all said the time passes quickly and they are happy to make their own activities. We asked people in the surveys are activities arranged by the home that you can take part in, three people said always, one person said usually and one person said sometimes. The homes Annual Quality Assurance Assessment (AQAA) states The annual activities plan within the home focuses on festivals and celebrations from a wide range of cultures and religions. These activities are advertised on the weekly activities schedule and any resident wishing to participate is welcome to. If residents wish to visit or be visited by a member of a specific religious order, this is arranged by staff. Members of religious bodies visit the Care Homes for Older People Page 15 of 27 Evidence: home and make themselves available to residents as required. Due to staffing numbers it would be difficult for the home to do ad-hoc outings for example taking people into the local town. Visiting to the home is not restricted and several visitors who were spoken with confirmed this. During the tour of parts of the environment a number of rooms belonging to people were seen and their personal possessions were on display. People spoken with said they are able to make choices about their daily life and this includes where they eat their meals and where they wish to spend their time each day. Peoples choices were also recorded in some of the care plans we examined, which is good practice. Copies of the menus are displayed on the notice board. From discussions with the cook the home will make changes to the menu if the people in the home do not like what is planned. The home has received 4-stars from the local Environmental Health Department. Health and safety checks are taking place the majority of the time as records were seen of these. Detailed food records are now in place but need to include breakfast. A mealtime was observed and it was found to be a very sociable event and where able people were also enjoying a alcohol with their meals. Serving dishes are now used to encourage independence which is good practice. People spoken with during the inspection all said they enjoy the food provided. People were asked the same question in their surveys and two people said always and three people said usually. The meal was tasted by an inspector and found to be very tasty and the meat was very tender. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express any concerns and have access to a complaints procedure. Systems are in place to help safeguard people from possible risk of harm or abuse. Evidence: The home has received one complaint since the last inspection. Copies of the correspondence is held at the home. This complaint was not acknowledged within the 28 days timescale however once it had been acknowledged the complainant received a full response within three weeks. A copy of the homes complaint procedure is displayed on the noticeboard in the main entrance to the home and this procedure was reviewed in August 2008. People were asked in their surveys if they know who to speak to if they were not happy and three people said always and two people said usually. All five people said they know how to make a complaint. The home has policies and procedures in place for safeguarding people who use the service and the Registered Manager said they can access these for staff if they require them. All staff have received in house training in relation to abuse awareness. This training is provided by the Registered Provider. The Registered Manager is due to attend the local Councils training and also has plans to book other staff on to the Councils half day alerters guide training. Care staff spoken with confirmed they have received in house training in relation to abuse awareness and safeguarding people. Care Homes for Older People Page 17 of 27 Evidence: Both the Registered Manager and deputy manager have undertaken training about the Mental Capacity Act and have further plans to attend more training. The Registered Manager said that they have not made any referrals to the local Adult Protection Unit. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a generally well-maintained, clean and pleasant environment. Evidence: A tour of parts of the environment took place, which included viewing some rooms belonging to people who use the service. The home is a grade II listed building and is therefore not a purpose built care home. The home was found to be clean, odour free and generally well maintained. The maintenance issues identified at the last inspection have been addressed. Only one minor area that will need to addressed is that the downstairs toilet in the main entrance does not have a lock and items were being stored in it. The home has rearranged two rooms since the last inspection by moving the dining area to the conservatory and making another lounge where it used to be. One part of the carpet in the conservatory was fraying, however a representative from the Registered Provider said that the flooring is due to be changed. People spoken with said they liked their rooms and one person on the ground floor likes being able to look straight into the garden. The laundry area was examined and this was well organised and a system is in place for managing soiled linen. People spoken with about the laundry said their clothes were looked after well. Care Homes for Older People Page 19 of 27 Evidence: We asked people in their surveys if the home is clean and fresh and all five people said always. Two visitors to the home did express a concern that staff are sitting together in one of the communal lounges when they are sat with their relative and they feel uncomfortable with this. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is confident that the numbers and competency of the staff are meeting the needs of people who use the service. Evidence: At the last inspection we had concerns about the numbers of staff on duty and that the needs of people were not being met. The staffing numbers remain the same at this inspection but the dependency levels of the people who use the service have reduced. The Registered Manager said she felt the staffing numbers and competency of the staff are meeting the needs of people who use the service. People and visitors to the home that were spoken with all complimented the staff in the home. People were asked in their survey if the staff were available when they need them two people said always and three people said usually. Staff that were spoken with all said they enjoy working at the home and several members of staff have been working at the home for a number of years. Staff felt it was a friendly place to work but there are times when they are too busy to have a break. The Registered Manager confirmed that out of the eleven care staff, nine have an NVQ 2 or above in Health and Social Care. This is excellent as it exceeds the recommended 50 percent of staff with this qualification. Care Homes for Older People Page 21 of 27 Evidence: The Registered Manager said that one new member of staff has started working at the home since the last inspection and their recruitment file was examined. All the required checks were in place prior to this member of staff starting work at the home except that their previous employment history was not specific enough as they had used years. A Representative from the Registered Provider said that following this inspection all managers have been reminded about checking employment dates. The Registered Provider has not made any changes as yet to the induction training and proof was seen of a member of staff completing their first day induction at the home and on the one day course provided by the Registered Provider. This member of staff had also completed some in house training on abuse and challenging behavior. The Representative from the Registered Provider said that they are looking to make changes to the induction programme they currently use. The home has a training matrix in place and it is the responsibility of the Registered Manager to make sure staff are booked on to training courses. The Registered Manager said she has plans to book some staff on to courses. Staff spoken with said they have access to training and were able to discuss recent courses they have undertaken. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An experienced person directs the management and administration of the home, and now the home is run in the best interests of the people who use the service. Evidence: There have been no changes to the management of the home since the last inspection. Both the Registered Manager and deputy manager have worked at the home for a number of years. Improvements have been made to the service since the last inspection in relation to medication, activities, staff supervision and some recruitment practices. The Registered Manager said she is looking to start to undertake more auditing herself as per the Registered Providers own policy. Checks were in place for medication and care plans. Regulation 26 visits are taking place and the Registered Provider no longer needs to send copies of these to us. Results of the questionnaires the home sent out in June 2008 are displayed in the main entrance of the home. Care Homes for Older People Page 23 of 27 Evidence: The home has a safe system in place for managing peoples monies. Since the last inspection the Registered Manager has made sure that staff supervision sessions are taking place. A number of randomly selected care staff supervision records were seen and the home is on target to meet the recommended six times per year for care staff. An appraisal was seen for a member of ancillary staff. Maintenance records were examined for safety checks and these included fire checks and water temperature checks. The fire risk assessment was seen but we did not examine the evacuation procedure. Evidence of servicing electrical circuits and large equipment was provided in the AQAA. The only other information not seen was how the home is reducing the risks of Legionella. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 17(1)(a), (3)(a), Schedule 3 (3)(i) When any medication is 03/07/2008 administered to people who live in the home this must always immediately be clearly and accurately recorded. This will help to make sure people receive the correct levels of medication. Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 17 When any medication is administered to people who live in the home this must always immediately be clearly and accurately recorded. This will help to make sure people receive the correct levels of medication. 31/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 The staff in the home should record the actual time and dose given to people who are receiving prn or as required medication. This will help to make sure people receive the correct levels of medication. The needs to look at maintaining food records for breakfast time. 2 15 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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