Care Home: Court Nursing Home

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What the care home does well There is a friendly and relaxed atmosphere at Court Nursing Home and all of the staff we met were pleasant and helpful. People living at the home are afforded dignity and respect. Management and staff all showed a positive attitude towards the people they support. Well over half of the care staff have a national vocational qualification in care and a programme of on-going staff training is led by the home manager. An activities co-ordinator is employed to provide a programme of daily activities to keep people stimulated. Life story books give staff biographical information about the people who live at the home so that they have a better understanding of each individual. The building is clean and well-maintained. A rolling programme of redecoration is in place to make sure that all areas are well presented. A health and safety officer has been nominated and she ensures that all areas are kept safe. There are enough staff to ensure that the needs of the people living at the home can be met. Staff have opportunities to express their views about the service. What has improved since the last inspection? Requirements that were made at our last inspection have all been met. What the care home could do better: There is room for improvement in the care plans so that they provide more detailed information about how people`s needs should be met. Key inspection report Care homes for older people Name: Address: Court Nursing Home 644 New Chester Road Rock Ferry Birkenhead Wirral CH42 1QB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Wendy Smith     Date: 2 6 0 3 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 23 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Court Nursing Home 644 New Chester Road Rock Ferry Birkenhead Wirral CH42 1QB 01516431162 F/P01516431162 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Helmreal Limited care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: 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, Mental disorder, excluding learning disability or dementia - Code MD. The maximum number of service users who can be accommodated is: 31. Date of last inspection Brief description of the care home Court Nursing Home provides nursing care for up to 31 people with mental health needs, including dementia. The home is a three storey detached property situated on a main road close to all local amenities in New Ferry. 1 7 0 4 2 0 0 9 31 31 Over 65 0 0 Care Homes for Older People Page 4 of 23 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: The quality rating for this service is two stars. This means that the people who use this service experience good quality outcomes. We (the Care Quality Commission) visited Court Nursing Home unannounced on 26 March 2010 as part of this inspection. During the visit we spoke with residents and staff. We walked round the building to see all the communal areas and some of the bedrooms. We checked records kept at the home and spent time talking with the manager, the administrator and the home owner. We also looked at any information that we had received about Court since our last inspection there. Before the visit, the manager was asked to complete a questionnaire to give us up to date information about the service. Some residents and members of staff completed survey forms to give us their views of the home. Care Homes for Older People Page 5 of 23 What the care home does well: What has improved since the last inspection? 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. Care Homes for Older People Page 6 of 23 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 7 of 23 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. Peoples needs are assessed before they go to live at Court Nursing Home to ensure that it will be the right home for them and that staff will be aware of the support they require. Evidence: Court Nursing Home provides nursing care for up to 31 people who require care due to an organic or functional mental health condition. On the day we visited there were 25 people living at the home. All except two were over 65 years of age and all except five were men. The admissions book showed that people had come to Court from other care homes or from hospital. Some are people who were considered difficult to manage in other care homes. The manager, who is a registered psychiatric nurse, carries out a pre-admission assessment for anyone interested in going to live at Court. This is a comprehensive assessment that covers every aspect of the persons daily life. The assessment Care Homes for Older People Page 8 of 23 Evidence: includes discussion with family members, advocates, health and social care professionals. We looked at the care plans for the two people who had come to live at the home most recently. We saw details of the assessments carried out before they were offered a place at the home. A nurse we spoke with considered that the managers assessments were very thorough and said we virtually know the person before they come in. All of the people living at the home when we visited were funded by health or social services and the fee is £600 per week. Care Homes for Older People Page 9 of 23 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 personal care needs of the people living at the home are met in the way that suits them. Evidence: Each of the people living in the home has a care plan that records their needs and the care that is provided. During our visit we looked at care plans for three people. We found that the forms had all been completed in full; there were comprehensive risk assessments and needs assessments; detailed daily records were made. In the AQAA (annual quality assurance assessment), the manager told us that All staff are involved on a daily basis assessing and evaluating those needs. Information is gathered and discussed by all staff at the end of each day in order that care plans can be modified where required immediately. There was very little detail in the actual plan for the care of each person. The plans are all written on one sheet of paper as bullet points and are very brief. For example, we looked at the plan for a person who has very complex needs and this contained instructions to maintain Js routine and maintain a safe environment for J, but with Care Homes for Older People Page 10 of 23 Evidence: no explanation of what this routine consists of or what measures are needed to ensure that she is kept safe. The care plan indicted that this person is sometimes aggressive and confrontational towards staff or other residents, but strategies in place for dealing with this were not described. We discussed this with the nurse on duty. She has taken on lead responsibility for the care plans and has been working to improve the format and the way of recording. The care plans included information about when and how people receive health care and support from professionals external to the home. The manager told us that they receive excellent support from medical services, including a consultant psychiatrist who regularly holds a clinic at the home. The local GP practice is also very good and will arrange a visit as often as needed. We looked at the arrangements for the management of peoples medicines. The medicine room is of adequate size and was tidy and well organised at the time we visited. The home does not use a monitored dosage system, medicines are dispensed in bottles or boxes. There is a complicated system of ordering repeat prescriptions but it appeared to work successfully and there were no old stocks of medicines in the cupboards. All medication received from the pharmacy is checked in onto a sheet in a folder and this is checked weekly. We looked inside one of the two medicine trolleys and checked this with the medicine administration sheets. Overall the records showed that people receive their medicines as prescribed by their doctor but there were some errors, for example one person had a course of antibiotics that should have been completed over the last week but there were three still left. There were a small number of missed signatures for administration. Where medicines were prescribed to be given as required, there was clear guidance for staff about when they should be given to ensure that this was consistent. Our observation over the course of the day was that people living at the home are supported in a dignified and respectful manner. Some of the people living at the home can be very challenging and staff are encouraged to respect their freedom of choice as much as possible. Privacy is promoted in personal care and curtains have been fitted in all shared rooms. One of the comments cards that we received read The staff are respectful with the residents and are more than able to deal with their individual needs. They can cope with challenging behaviour in a calm and caring manner. Care Homes for Older People Page 11 of 23 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 are able to choose how they spend their time and a programme of social activities is provided to keep people stimulated. Evidence: The home employs an activity coordinator for 25 hours a week. She has been doing the job for three years and has the key role in developing and implementing an activities programme for the people living at the home. She told us that people enjoy karaoke, bingo, painting and pool. She is able to buy the equipment she needs for activities. She knows a couple of other people who do same job at other care homes and they share ideas. She has been trying to increase the opportunities for people to go out and said that more of the care staff are now volunteering to go out with residents. At present two or three groups of two or three residents go out each week. Some people particularly enjoy a bus ride to familiar places. The activities coordinator keeps her own records about what people like to do. Together with the key workers, she has been compiling a life story for each person using information provided by the resident and/or their family. She showed us the life story book for one of the people living at the home and this was excellent, with illustrations from the persons life and plenty of information so that staff know more about her. Care Homes for Older People Page 12 of 23 Evidence: Throughout the day we observed that the care staff were sitting in the lounge with the residents and related well to them. We also observed that people are free to walk around the building and to spend time in their own room if they choose. There is a smoke room, which is supervised by staff, for residents who smoke. In the AQAA the manager told us We strive to maintain an informal atmosphere with no restrictions on visiting times. At present there are very few relatives who are actively involved with the home, however two residents go out with their relative. The dining room is not big enough for everyone living at the home to eat at the same time so meals are served at two sittings. The people who are able to eat their meals without assistance are served at the first sitting, and those who require more support have the second sitting, which means that they are able to take as long as needed. When we looked around the home the dining tables were set for lunch. The days menu was displayed and consisted of fish pie, green beans, carrots, bakewell tart and custard for lunch; sausage casserole, ice cream for tea; pancakes for supper. We were also told that a cooked breakfast is available. The head cooked has worked at the home for 20 years. She told us that she always finds out the likes and dislikes of any new residents and showed us a folder she keeps with information about each of the residents dietary needs and preferences. If people do not wish to have the meal on the menu then an alternative of their liking can always be provided for them. There is a serving hatch between the kitchen and the dining room and people come and ask for a cup of tea, packet of crisps etc at any time of day. Fresh fruit and vegetables are delivered twice weekly and fresh meat weekly. Care Homes for Older People Page 13 of 23 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 living at the home are protected from abuse. Evidence: The homes complaints procedure is displayed in the entrance area. It gives the name of the registered manager, contact details for Action on Elder Abuse and the CQC. One complaint was received during 2009 and we saw records showing that this was investigated and responded to by the home owner. The home provides staff training about protecting vulnerable people from abuse, and all staff are given an information pack when they commence employment containing a copy of safeguarding procedures. All staff attend the safeguarding training courses that are provided by Wirral Social Services. Since our last visit, two safeguarding issues have been referred to the local authority for investigation. Care Homes for Older People Page 14 of 23 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 are provided with a comfortable, safe and clean place to live. Evidence: We were shown around the home by the administrator and visited all areas. All parts of the building were clean and freshly decorated. The home owner told us that a decorating company visits every three months to keep everywhere up to a good standard. Upgrading of the bedrooms has continued since our last visit and bedrooms were personalised to varying degrees to reflect the individual personalities of the people living at the home. There are some shared rooms and all had curtains in place to ensure privacy. There are bedrooms and bathrooms on all three floors. The top floor has six bedrooms. They were all occupied by male residents who were all fully mobile. Some have a lock on their bedroom door and have their own key. Some bedrooms had a portable heater as they were rather cold during the winter. The middle floor is divided into three areas, two four-bedded units for men, and a six bed unit for women. We noticed that one divan bed looked old and shabby and the administrator said that this was due to be replaced. She told us that most of the old beds have now been replaced. There are six bedrooms on the ground floor and these are mainly occupied by people Care Homes for Older People Page 15 of 23 Evidence: who need a high level of support. One person was being looked after in bed. One person has continence problems that are difficult to manage, and although the room looked clean there was some odour of urine. There were no unpleasant smells anywhere else in the building. On the ground floor there is a smoke room, used by a significant number of residents. A bedroom door opens out into the smoke room and we advised the owner to check with the environmental health department whether this is acceptable under smoking regulations. The large lounge was busy and noisy. We discussed with the home owner that it would benefit residents if the choice of a quieter sitting area could be provided, for example by the addition of a conservatory. He agreed with this and intends to add a conservatory when the budget allows. There are some other areas around the building where people can sit down and people are able to go to their own room if they wish to be quiet. The garden at the back of the home has been made secure and a ramp has been constructed to provide access for people with mobility problems. The home has a designated health and safety officer who carries out weekly checks around the building, which are documented. Any repairs needed are brought to the attention of the homes maintenance person. Specialist equipment, aids and adaptations are provided as required for specific individual needs. There are thermostatic controls on all hot water outlets. Covers were being fitted to all radiators, although most are low surface temperature radiators. Windows are fitted with opening restrictors and wardrobes are secured to the wall to reduce the risk of accidents. The previous requirement to ensure adequate bathroom and toilet facilities has been met. Liquid soap and paper towels are provided in all bathrooms and toilets. Care Homes for Older People Page 16 of 23 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 provides enough competent and experienced staff to ensure that peoples needs can be met in full. Evidence: The home employs six registered nurses, three are psychiatric nurses and three general nurses. The home manager, who is a registered nurse, works 50 hours a week from Monday to Friday and these is another nurse on duty 24 hours a day. During the day there are five care staff on duty and their starting times are staggered between 7am and 9am to ensure that people have the support they need in getting up in the morning. There are four care staff in an evening and two at night. This is for 25 residents, but may need to increase if the home achieves full occupancy. The staff rota showed that these numbers are maintained and the staff and residents who completed our survey forms considered that there are enough staff to meet peoples needs. In addition, there is a full-time administrator; there are three cooks and three kitchen assistants; the laundry is staffed between 8am and 3pm every day; a maintenance person works 35 hours a week; an activities coordinator works 25 hours a week; there are three domestic staff. When we visited the home was fully staffed with no vacancies. The administrator said that they do not have any problems with staff recruitment. The home provides work placements for local colleges and recruitment Care Homes for Older People Page 17 of 23 Evidence: often happens as a result of this. All except two of the care staff have NVQ level 2 in care and approximately 50 have level 3. This means that there is a well-qualified team. One of the care staff we spoke with said that she is now doing a Team Leader NVQ. We looked at the recruitment records for the three members of staff who had started working at the home most recently. They all had a Criminal Records Bureau disclosure and two references. These are checks to find out if there is any reason why they may be unsuitable to work with vulnerable people. They had all started basic training to make sure they know how to work safely. There is a comprehensive induction training programme for new care staff that takes 12 weeks to complete. The manager is the training coordinator for the home. She has put together a number of training packs for all staff to complete. The training packs are broken down into small modules so that staff can work through them a bit at a time. The manager told us that training is on-going every day as people have time to spare, and the staff we spoke with confirmed that they have attended training about important aspects of their work to ensure that they know how to work safely. An external trainer provides moving and handling training. Since our last visit, all staff have done food hygiene and infection control training and the manager is developing a nutrition training programme. Care Homes for Older People Page 18 of 23 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. The home is run in the best interests of the people who live there and systems are in place to ensure that they are kept safe. Evidence: The manager is a registered psychiatric nurse and she has been in post for ten years. She showed a positive and caring attitude towards the people who live at the home and this has provided a role model for the care staff. The members of staff we spoke with said that the manager is approachable and supportive. She encourages other staff to develop their skills. We spoke with the nurse on duty, who has worked at Court for a year since qualifying as an RMN. She said that she has brought some new ideas to the home which have been listened to. She has reworked the care plans and made a rota for care plan reviews to make sure they kept are up to date. What she likes most about the home is that people here are treated as individuals. She considered that management works well because they all care about the residents. The manager is supported by a full time administrator who takes a large amount of Care Homes for Older People Page 19 of 23 Evidence: responsibility for the day to day running of the home so that the manager can spend time with residents and staff. The home owner is a qualified social worker and he is actively involved in the day to day running of the home. The management team carry out and record many routine audits within the home. The home has also achieved an external quality award Investors in People. There have been no formal staff meetings recently but communication appears to work well and we were told that all staff on duty meet three times a day including a daily debriefing. Staff have free access to discuss any issues with the home owner, the manager, or the administrator. The AQAA informed us that safety certificates for all plant and equipment were all up to date. A member of staff carries out weekly health and safety checks including the fire alarm and emergency lighting. Fire safety training has been held in October and November 2009 and February 2010. A fire risk assessment had just been completed. An environmental health officer visited in February 2010 and reported that Food safety standards have improved, however there remained some issues to address, which we were told have now been completed. Kitchen cleaning rotas are now in place and the kitchen is closed between 2pm and 3:30pm for cleaning. Care Homes for Older People Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 21 of 23 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 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 Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 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) 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. 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