Care Home: Connaught Court Nursing & Residential Home

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What the care home does well People’s needs are looked into properly before a decision is made as to whether they should move to the home. This helps to check that those needs can be met by staff at the home. People like the staff and think that they receive good care. Comments include ‘I can’t speak highly enough of Connaught Court’ and ‘usually very helpful. Everything is very satisfactory’. The home and grounds are well maintained, which enhance the experience of living there. One person said ‘the home is very clean and well looked after with good furnishings and gardens’. Staff are encouraged and supported to attend training so that they have the skills and knowledge to carry out their work. A high proportion have achieved a Level 2 National Vocational Qualification in Care, so that they know what good care is. What has improved since the last inspection? The way medicines are managed at the home is much better and there are now good systems in place to make sure these standards are maintained. This means that there are better records and checks in place to show that people are receiving their medicines according to their prescription. Care planning records continue to be developed so that they more accurately identify people’s individual preferences and how they are to be met. This helps to ensure that people receive care and support according to what they want and not what staff think they want. This work is still in progress. A second activities organiser has been employed so that a greater range of activities, whether in the home or community, can be planned and implemented for the benefit of the people living there. Refurbishment and redecoration at the home is ongoing. For example new baths and walk-in showers have been installed and toilets, which are for communal use, are now all suitable for wheelchair users. A new sensory garden has been established in a courtyard in the dementia care unit. These improvements enhance the experience of living at the home.Connaught Court Nursing & Residential HomeDS0000027959.V377078.R01.S.docVersion 5.2Staffing levels have been re-looked at again to see whether changes would improve life for the people living there. Developing a bank of nurses and carers means there is less reliance on the use of agency staff that people living there don’t know and who are not familiar with people’s individual needs. There are now more robust systems of checks in place so that the manager can more easily satisfy herself that the home is running well. Problems can be now more quickly and easily identified so that issues can be resolved. What the care home could do better: If people are prescribed creams or ointments then the medication chart could state why and where the cream is to be applied. This is especially so where people are prescribed more than one preparation. This would help to ensure the right treatment is provided to the right part of the body. Care staff could be more alert to people not always feeling well enough to look after their own medicines. By taking over this responsibility the home could be more certain that people always receive their medicines as they are prescribed. The home could make sure that care staff always talk to people and explain what they are doing whilst carrying out care practises (In this instance, when using a hoist to assist with moving.) Good communication helps people to know what is happening and shows that people are treated with dignity and respect. Because there has been a wide range of comments about the meals, the home could carry out its own survey to find out what all the people living there think about the food they are served. This would help to decide whether any changes need to be made. Because resident’s meetings are attended by an elected committee of residents the home could continue to make sure that people living there, who may not all have access to a committee member, are still able to influence how the home operates. Key inspection report CARE HOMES FOR OLDER PEOPLE Connaught Court Nursing & Residential Home St Oswald`s Road Fulford York North Yorkshire YO10 4FA Lead Inspector Jean Dobbin Key Unannounced Inspection 09:15 24 and 25th August 2009 th DS0000027959.V377078.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Connaught Court Nursing & Residential Home Address St Oswald`s Road Fulford York North Yorkshire YO10 4FA 01904 626238 01904 611741 mcade@rmbi.org.uk www.rmbi.org.uk Royal Masonic Benevolent Institution Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Margaret Cade Care Home 90 Category(ies) of Dementia (90), Old age, not falling within any registration, with number other category (90) of places Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Dementia - Code DE and Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 90 29th August 2008 2. Date of last inspection Brief Description of the Service: Connaught Court is a care home owned by the Royal Masonic Benevolent Institution (R.M.B.I.) and provides residential and nursing care to men and women who are freemasons, or their dependants. The home has 4 residential areas for people receiving personal care only. These are Ebor, Yorvik, Knavesmire and Fairfax; one of these areas is for people with high dependency needs. A separate area, called Viking, provides nursing care for up to 15 people. In addition, Fred Crosland House is a self-contained unit providing care for up to 10 people who have dementia. The home is situated in Fulford on the outskirts of York, and is within easy reach of major road networks, York city centre and local bus routes. There are extensive and attractive grounds surrounding the home that are accessible to people and there is on-site parking. The fees charged on 24th August 2009 are from £504 - £814 per week. Additional charges are made for hairdressing, chiropody and personal items like newspapers and toiletries. There is no cost for trips out in the minibus though people would pay their own admission charges to places, like anyone else. Information is made available to people about what services the home has to offer and the latest inspection report, written by the Commission for Social Care Inspection, as the predecessor to the Care Quality Commission is displayed in the home and given to people on request. Connaught Court Nursing & Residential Home DS0000027959.V377078.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 two star good service. This means the people who use this service experience, good quality outcomes. The Care Quality Commission inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This is what was used to write this report. • • Information about the home kept by the Care Quality Commission. Information asked for, before the inspection, which the manager provides. This is called an Annual Quality Assurance Assessment or AQAA. • Information from surveys, which were sent to people who live at Connaught Court, to staff and to other professional people who visit the home. 10 were sent to people at the home, and 4 were returned. 10 were given to the people so that they could give the survey to someone close to them so they could comment on the home. 4 of these were returned. 6 were sent to healthcare and social care professionals and 1was completed and returned. 5 were sent to staff at the home and 3 were returned • A visit to the home by one inspector, which lasted about 13 hours, over two days. This visit included talking to people who live there and their visitors and to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 6 • Some time was also spent watching the general activity to get an idea about what it is like to live at Connaught Court. Information about what was found during the inspection was given to the registered manager at the end of the visit. What the service does well: People’s needs are looked into properly before a decision is made as to whether they should move to the home. This helps to check that those needs can be met by staff at the home. People like the staff and think that they receive good care. Comments include ‘I can’t speak highly enough of Connaught Court’ and ‘usually very helpful. Everything is very satisfactory’. The home and grounds are well maintained, which enhance the experience of living there. One person said ‘the home is very clean and well looked after with good furnishings and gardens’. Staff are encouraged and supported to attend training so that they have the skills and knowledge to carry out their work. A high proportion have achieved a Level 2 National Vocational Qualification in Care, so that they know what good care is. What has improved since the last inspection? The way medicines are managed at the home is much better and there are now good systems in place to make sure these standards are maintained. This means that there are better records and checks in place to show that people are receiving their medicines according to their prescription. Care planning records continue to be developed so that they more accurately identify people’s individual preferences and how they are to be met. This helps to ensure that people receive care and support according to what they want and not what staff think they want. This work is still in progress. A second activities organiser has been employed so that a greater range of activities, whether in the home or community, can be planned and implemented for the benefit of the people living there. Refurbishment and redecoration at the home is ongoing. For example new baths and walk-in showers have been installed and toilets, which are for communal use, are now all suitable for wheelchair users. A new sensory garden has been established in a courtyard in the dementia care unit. These improvements enhance the experience of living at the home. Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 7 Staffing levels have been re-looked at again to see whether changes would improve life for the people living there. Developing a bank of nurses and carers means there is less reliance on the use of agency staff that people living there don’t know and who are not familiar with people’s individual needs. There are now more robust systems of checks in place so that the manager can more easily satisfy herself that the home is running well. Problems can be now more quickly and easily identified so that issues can be resolved. What they could do better: 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 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. Connaught Court Nursing & Residential Home DS0000027959.V377078.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 Connaught Court Nursing & Residential Home DS0000027959.V377078.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience good quality outcomes in this area. The pre admission assessment ensures that individual care needs can be met at the home and the people receive information and help to enable them to decide whether Connaught Court is the right place for them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Records looked at confirmed that people are assessed properly before moving to the home. This is so that their physical, emotional and social needs can be looked into to check that the home and the staff working there are able to meet those needs. This process also reassures individuals and gives them the Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 10 opportunity to have their questions about the service answered. A senior person from the home, who is a nurse, undertakes this assessment. One person was spoken with who had moved to the home quite recently. They explained that the manager had visited them at their own home and asked them questions about the sort of care and support that they would need if they chose to move to Connaught Court. They were also provided with written information about the home and the services and facilities provided there. They visited the home with their family, were shown the private room they would have and then had a meal and spoke with some of the other people living there, to get their views about the home. Another person moved to the home permanently after having a respite stay at the home last year. Respite stays for planned short stay admissions can be provided if rooms are available. They said staff were waiting to say hello again, when they arrived and they had fresh flowers placed in their room. They said it was little things like that that made a big difference. Written information is provided about the services and facilities provided by Connaught Court by the Royal Masonic Benevolent Institution (RMBI). This however is in a standard format and those people with impaired sight would struggle to read the information. The RMBI should consider providing this information in other formats, like in large print, audiotape or in an easy read version, so that people can learn about the home in a way that is most appropriate to their needs. Surveys completed by three people living at Connaught Court all state that they received enough information about the service before agreeing to move there and all state that they have a contract informing them of their rights and the home’s terms and conditions. Intermediate care is not provided at Connaught Court. Connaught Court Nursing & Residential Home DS0000027959.V377078.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. People get good care, which meets their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Four people’s care plans were looked at as part of this visit. These were from people living in different parts of the home and are in place to describe the care that people need to stay in charge of their lives as much as possible. They are also there for care staff to refer to, so that they can check they are giving the right care and support. Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 12 The pre-admission assessment information contributes to the care plan and audits are now carried out to check that the care planning records are completed within two weeks of the person moving to the home. The manager and her staff have recognised that very personalised care plans help to identify what makes one person very different to the next, so that care can be tailored for that individual. The way the care plans are written are changing so that those differences are now recorded in more detail. For example one care plan described that although the person had glasses, they didn’t like wearing them, and this didn’t appear to affect their communication needs. It stated that the person could wash their own face and choose their own clothes, with prompting. The care plan said they liked a night light on through the night and to keep the head of their bed slightly raised. They had specific music preferences and these were seen in their room. This sort of thing is good practice and clearly identifies what matters to them so that they can be supported in the way that they want. Another person in another area of the home though was described as liking to wear jewellery and was a keen golfer, but there was nothing in their room to suggest these interests were being encouraged or maintained. Their care plan said they needed ‘maximum help’ with all personal cares. People need to be encouraged to maintain small life-skills to maintain some independence and self esteem and care plans need to identify what these small skills are, so that staff don’t take over when individuals can still do things for themselves. Care plans were generally reviewed each month and some signatures were seen to show that these had been discussed with the individual. People spoken with, who were able to respond, knew that they had care plans and what they were for. The care plans looked at had assessments of risk of harm to the individual from, for example, falling, developing a pressure sore or becoming malnourished because of poor appetite or a health problem. Care plans describing how people were to be moved were also evident. Those looked at were generally reviewed regularly though one person had not been weighed for fifteen days, although their plan of care said this was to be done weekly. One very independent person had been visited by the community nurse because they had developed a superficial pressure sore. Whilst the healthcare professional was satisfied with the equipment provided by the home, the individual’s care plan did not detail how staff were supporting the individual to manage this themselves. Whilst staff are keen to promote people’s independence a plan of care is still needed, to say how they are going to monitor a problem to make sure it doesn’t get worse. Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 13 A local doctor visits the home routinely each week and people are also supported to attend the local surgery if appropriate. There were good records of visits from the doctor and other health care professionals, as well as appointments at the local hospital and optician. One health care professional said they had ‘no problem with the standard of care’ provided at Connaught Court and felt one of their strengths was in providing end of life care and support to people and their families. The home has been working closely with a community pharmacist, employed by the Primary Care Trust (PCT) to improve pharmacy practices at the home. Medicines are ordered, stored and administered from the different units within the home. Senior carers, who have received extra training, administer medicines in the residential areas, whilst trained nurses have that role on the nursing unit. Medicines management in three areas were looked at. Staff spoken with showed a good understanding of medicine processes and systems at the home have been improved, with more audit checks being carried out to ensure these improvements are maintained. Medication record sheets (MAR) are now filled in appropriately. Some people living at Connaught Court look after their own medicines and they had been assessed to ensure they were confident and competent to do this. One person spoken with though was not feeling well and said they were worried that they might not have been taking their medicines properly. Care staff need to be very alert to people’s abilities changing when they are less well and must be pro-active in offering to take back this responsibility at these times. People prescribed creams have a copy of the MAR sheet in their room, so that care staff who apply this cream now sign the form. This is good practice. However when people are prescribed different creams then this sheet needs to clearly record where and when the different creams are to be used. One MAR sheet looked at had three different creams prescribed, but no instruction as to which one was to be used where, and why. This information is needed if they are to receive the most appropriate treatment and so that the doctor can check whether specific creams have been effective. People spoken with said that staff were respectful and kind. One person said ‘I have no problem at all with the staff’. A carer explained how they ensured people’s privacy and dignity was respected. They said ‘I do what they want me to do. I ask them what they want. I ask them what they would like me to call them. I would always knock before going in someone’s room’. Three people were observed being moved with the aid of a hoist on one unit. There was however negligible communication, explanation or permission Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 14 sought by the care staff. Although the manoeuvres were safe they were still a rather negative experience. This was discussed with the manager. Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. People are generally supported to live the life they choose. Mixed views about the meals provided require further investigation. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People living at Connaught Court are generally supported in leading interesting and varied lives and staying in charge of what they do, as much as possible. Recently a second activities person, working part time has been employed to help to make one day different to another. They are going to provide more individualised support to people who may not be able to attend the group activities. Some volunteers also help with the activities. One person commented in their survey though that ‘it is just nice to chat and share time with someone who has time for you when they are not too busy’. Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 16 On the day of the visit there was a movement to music class and a bridge club in the morning, with a quiz in the afternoon. These events are advertised on the board, where people were seen reading the latest notices. Regular sessions take place, including a ‘knit and natter group’ and a ‘gentleman’s club’, which means people can plan and look forward to specific events. Recent events include live music sessions, a summer fete and a teddy bear’s picnic. And some people have been on holiday to Llandudno. The home has a minibus and a car, which can take people in wheelchairs. A ‘mystery trip’ takes place each week, which people can sign up for. A shop is provided weekly by volunteers and there is a well stocked library, to which a number of large print books have been added this year. Three hairdressers and a barber provide their services at the home, so people can have a real choice. Connaught Court has its own chapel, which is always open. The home has its own lay chaplain, who provides a non-denominational service each week. Other services are also provided each month. People spoken with said that they were consulted and allowed to choose what they do and when they do it. A number said they chose to have breakfast in their room, but said they would generally be expected to go to the dining room for their other meals. This was not a problem for them. Another person said they liked their bath on an evening after tea. One person said they had been given a key to their own door, but had handed it back in as they didn’t feel they needed it. The small dementia care unit has a safe, well maintained garden and a recently established sensory garden. People living on this unit attend the same social events and external trips but also have their own dedicated activities and there was evidence of recent craft work displayed there. Residents meetings takes place each month, where appointed representatives meet with the senior staff at the home. Eleven people sit on this committee and those spoken with on the residential units knew who these individuals were and how issues about the home could be raised through them. However some people at Connaught Court are more frail and vulnerable, and may not be able to speak with these representatives. The home needs to be able to show that these people are also being consulted so that they can have a say in how the home runs. Minutes from these meetings are displayed for anyone to read, but these need to be made available for all residents to read, as not all would be able to read them off a notice board. The home uses a four week seasonal menu, which is adapted in consultation with the resident’s committee. There is a hot breakfast available each day and a choice of two main meals, which people choose the previous day. There is Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 17 no vegetarian option on the menu and whilst the cook said that soup is available at lunchtime if requested, as well as at suppertime, this is not offered on the menu. One person said they particularly liked the soups but had forgotten that they could have it at lunchtime. People are offered biscuits with morning coffee and afternoon tea. There is a well-stocked fruit bowl on each unit which people on the residential units said that they helped themselves to. The manager said that fruit is cut up and offered to people who cannot help themselves. There needs to be a way of recording this to show that all the people living there have the same opportunities. At least one person living at Connaught Court has a background that is not British. They were seen enjoying some biscuits from their country of origin and supplied from there, by a family member. Staff at the home should explore whether this person would enjoy other foods more commonly eaten in the country where they grew up as this would help to show that the home is meeting their particular needs. People were observed being assisted with their lunch when necessary in a sensitive, unrushed manner. Staff were observed sitting and talking with individuals whilst they gave this support. People provided a very mixed view of the catering service at Connaught Court. One individual said ‘the food’s good. You get enough and it’s hot enough’. And the survey completed earlier this year by the organisation suggested generally satisfied customers. The home has a dining room comments book which contains many comments from very good to not so good. And either the catering manager or the registered manager is available in the dining room at mealtimes for people to speak with. The three surveys completed for the commission state that two people ‘sometimes’ like the food, with the third saying this was ‘usually’ the case. One person said they ‘couldn’t speak highly enough about the home, except for the meals, which were not so good’. Another person commented in detail in their survey response but (summarised) stated ‘the food is not good’. The manager needs to carry out her own survey and gain all the residents’ views about the food provision at the home. This will help to inform her whether any changes need to be made. The home was given a 4* (good) award by the Environmental Health Officer late last year. This is the local authority hygiene rating for food premises. Prepared foods were seen to be covered and labeled properly so that it was clear when they needed to be discarded, to protect people from potential harm. Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. People’s concerns and welfare are taken seriously, and the right action is taken where necessary to keep them safe from abuse. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home’s complaint’s policy is displayed in the entrance to the home and is included in information given to people and their families when they move to the home. The survey responses all state that there is someone they can speak with informally if they are unhappy about something and also they know how to make a formal complaint. People spoken with were also clear that they would report something that was bothering them and they had confidence that the managers would look into their concerns properly. The commission has received one complaint in the last year. This was about an employment issue, which the company was asked to investigate. The home has received eight complaints in this time. Three of which relate to care Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 19 practises. The home keeps good records to show that these concerns have been investigated and outside guidance has been sought where appropriate to help with addressing people’s concerns. All staff employed at the home attend safeguarding adults training when they start working at the home. They then attend annual refresher training so that their knowledge remains up to date. Three carers spoken with were clear about different sorts of abuse and what their responsibilities are, should they suspect or witness an incident where someone has been mistreated. They recognised that they cannot withhold this sort of information, even if someone had asked them to. This is good practise as sharing information in this way helps to keep people safe from harm. One ancillary worker though, who was clear about reporting any possible allegations of abuse, was not so sure about what to do if they were asked to keep such an incident secret. The manager needs to be satisfied that all staff who come into contact with people living at the home know that any allegation must be immediately reported so that the incident can be looked into properly. The manager has referred five safeguarding issues to the local authority in the past year and one of these has been followed up by the local authority. The manager has informed the commission promptly of these incidents and worked with the local authority to address these concerns properly. One carer explained that there is always a senior manager on duty, or on call and that any allegation can also be reported to a more senior person in the organisation. All staff also should know that they can contact the local authority themselves about an incident of concern, if they do not feel able to speak with someone more senior within the organisation about it. Having a well informed and alert staff group contributes to keeping people safe. Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. People live in a warm comfortable home which has been adapted and equipped to meet their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Connaught Court is a large detached mature house surrounded by attractive well maintained gardens. Maintenance and gardening staff are employed to keep the home and grounds in good condition. It was noted to be clean, warm and comfortable, with no apparent unpleasant smells. All the private rooms have en suite facilities. Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 21 The home has six different units. Viking is for those people assessed as having nursing needs. It is on the ground floor, and has its own dining room, separate communal areas, and specialist equipment to help people to move around and promote their wellbeing. The corridors are wide and uncluttered and rooms looked at contained items that would make the room feel more like home. Fred Crosland is a small safe unit, where people with dementia care needs live. This unit has a well maintained safe garden and a recently-established, attractive sensory garden in a courtyard space. Extra signage helps people to both find their way around and promote their independence. People can help in the kitchen because equipment there, which could pose a risk, is safely stored. The unit has a cat and one of the communal rooms is decorated in the style of an older age, to promote conversation and reminiscing. The remaining units – Fairfax, Knavesmire, Ebor and Yorvick are for people assessed as needing personal care only, although one unit is for people who are assessed as needing extra help. These units are on three floors and have their own small sitting areas, so people can choose where they spend their time. All the units have small kitchens where people or their visitors can make a drink. Corridors throughout the home are wide and uncluttered. A vertical passenger lift enables people to easily move between different levels. The home has a large dining room, where people from the residential units generally have their meals, a large lounge with stage, a library and a chapel. Refurbishment and redecoration in the last year have included six new baths, suitable for people needing assistance, as well as four new walk-in shower rooms. A planned programme is in progress to replace toilets in people’s ensuite rooms. Other parts of the home have been redecorated with new carpets. Some fire safety work has been completed and the organisation is looking at more major building work to bring the mature building in line with current fire regulations, as this will help to protect people from potential harm. One person spoken with was very satisfied with the laundry service at the home. The manager makes sure that appropriate aids are available and used to make sure that people living in the home are protected against infection. Care staff spoken with understood how the way they worked could minimise the risk of cross infection. Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. People are supported by staff, who are recruited properly and who are trained so they know what good care is and how it is to be given. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People told us that the staff at the home were generally very good. One person said ‘the staff vary a bit but the general standard is excellent’. Another said ‘I can’t speak highly enough of the staff and the care provided at Connaught Court. And a third said ‘I have no problem with the staff. I feel perfectly safe with them’. Those staff spoken with were friendly and showed a good understanding of their role. Three of the four survey responses stated that staff ‘always’ or ‘usually’ listened to them and acted on what they said, and were available when they needed them. One person said this was ‘sometimes’ the case, adding that they would like more baths. This comment was discussed with the manager. Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 23 There is always a nurse working at the home. Staff work on specific units, and the home has a pool of bank staff that can fill gaps when necessary. The AQAA tells us that 62 nursing and care shifts have been filled by agency staff in the three months prior to it being completed. The staffing rotas looked at suggest that the home does not routinely use agency staff to fill shortfalls. However one carer spoken with said that their unit had used agency staff a great deal in recent weeks to cover holidays and sickness and this had a detrimental affect on how the unit had operated at this time. One senior carer commented that the shortage of staff had meant that they hadn’t had any supernumerary time recently, so that they could check and update the care records. One person though, living on a different unit, said ‘they don’t use many agency staff’. The AQAA tells us that staffing levels have been looked at since the last inspection a year ago. People spoken with on one of the residential units though identified two times when they felt staffing levels weren’t right. They explained that many people need assistance to go to the dining room at mealtimes, so this process has to start very early, so that everybody can get there for the start of the meal. They also commented ‘the worse time is on (shift) changeover. Those that are going off don’t want to do any more and those due to start don’t want to do anything until after handover. If you want anything then, then you have to wait’. The three staff surveys completed stated that there were ‘always’ or ‘usually’ enough staff working to meet the needs of the people living there. The home employs a training officer, who has undertaken extra training so that her knowledge is current. Outside trainers are used for Safe Handling of Medication training and Safeguarding Adults. More than half the care staff have achieved a National Vocational Qualification Level 2 in Care. This is a nationally recognised award that identifies good care and how it is to be delivered. One staff survey commented that the home provides good training. Good computerised records are kept to make sure people attend refresher training in a timely way. And staff are supported in using distance learning courses to improve their skills and knowledge. The nurses generally attend the same training updates as other care staff. The organisation could consider supporting nurses to attend professional updates, so that they can be confident that the practise of nurses working at the home is up to date. Two recently recruited staff files were looked at. All the checks were in place to show that they had been vetted properly before they were offered a position at the home. Good recruitment processes contribute to keeping people safe. Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience good quality outcomes in this area. People live in a home run by a competent, enthusiastic manager who has their best interests in mind. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager is registered with the Care Quality Commission so is deemed fit to run a care home. She has worked in social care for a number of years and has previously completed extra management qualifications to help her with her Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 25 role as well as completing a more in-depth safeguarding training in the past year. The manager and her deputy and assistant managers are all nurses. The manager leads a management team, which meet each week so that all are kept up to date about things that are happening in the home. People spoken with on the residential unit knew who was in charge and said that they saw her in different parts of the home. They also knew there were other people they could speak with in her absence. Staff also said that the manager was available to speak with and was a visible presence in the home. Connaught Court is a large home and the managers could consider a photographic display of the management structure there, which could be displayed in different parts of the home. This may help people who are not as alert, to understand who different people are and what they do. Audit systems in the home are more robust than a year ago. Monthly statistics on health related issues are gathered and trends are looked for. These are also sent to the organisation so that they can monitor how the home is performing. Medicines audits are carried out each month and spot checks of care records are completed. Health and safety checks around the home are done. All these can now be evidenced to show that they happen. The organisation uses an independent company to carry out a survey each year. These are independently analysed and the results are published and displayed. Action plans are written if necessary. For example when asked about the attitude of staff 61 were described as excellent, and 33 as good. Comments include ‘Connaught Court is a very good place to be when you are old’ and ‘the care is very good’. Another said ‘things could be improved on’ and another commented negatively about the food. The manager should consider surveying health and social care professionals too so that they can give their perspective on how the home is running. Residents meetings are held each month and minutes of these were seen. The management must continue to ensure that people who are not easily able to give their views, because they cannot easily speak with members of the committee because of their frailty, are still consulted and represented at these meetings. And the management team need to be able to show that this happens. A senior manager from the company also carries out unannounced visits to the home each month to monitor how it is running. And staff meetings are regularly held so that information about the home can be passed on properly. Staff also are now receiving regular supervision and annual appraisals, where their work and career development can be discussed and monitored. These Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 26 systems all help to demonstrate that the home is running well and people are being listened to. Finance records were checked and found to be in order. People’s money is safely stored for them and receipts are kept for all financial transactions. Bedrooms contain a lockable space, so that people have a secure place for keeping valuables or things that matter to them. There are a range of health and safety policies and procedures in place. The home has made proper provision to ensure that there are safe working practices by providing staff training in first aid, fire, food hygiene, infection control and safe moving and handling techniques. Hazardous products are stored appropriately and records maintained as required. Monitoring arrangements are in place to ensure the delivery of safe hot water and minimise the risk of Legionella. Gas and electric safety certificates are current. Fire safety checks are carried out properly. A fire drill conducted by an external company earlier in the summer reported a ‘good/satisfactory response. All these processes help to maintain and promote the wellbeing of the people living there and the staff who work there. Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 28 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 OP8 Regulation 13(4) Requirement Timescale for action 30/09/09 2. OP9 13(2) People with an identified health problem, who are looking after this themselves still require a care plan identifying how this support is to be provided and what staff are doing to monitor the problem, to make sure things improve rather than deteriorate further. There must be a system in place 31/10/09 to identify when people who previously looked after their own medicines no longer want, or feel able to look after them. This will ensure staff take back this responsibility in a timely way, so that individuals can continue to receive their prescribed drugs safely and appropriately. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 29 No. 1 Refer to Standard OP9 Good Practice Recommendations When creams and ointments are written on medication record sheets these also need to state where, why and when they are to be applied. This would ensure the right cream is applied to the right part of the body and would help healthcare professionals to assess whether the treatment has been effective. Care staff providing direct care and support to people should explain what they are doing as they are doing it. Good communication both by talking with the individual and with non-verbal signs and gestures helps to show that they are being treated with respect and dignity. The meal provision at the home should be looked at in greater detail to get a more comprehensive view about what people think about the meals they receive. This is so that the manager can be sure that people are satisfied with this service. The managers could make sure that people who do not have access to members of the resident’s committee, either because of their frailty or their inability to communicate well are still able have their views about the home raised at the regular meetings. This will ensure that all people living there can contribute to how the home operates. 2 OP10 3. OP15 4. OP33 Connaught Court Nursing & Residential Home DS0000027959.V377078.R01.S.doc Version 5.2 Page 30 Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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