Care Home: Glastonbury Court

What the care home does well People thinking of using Glastonbury Court can expect to have their needs assessed before they move in and be given a chance to visit. One relative told us that the home had been recommended to her and she was very pleased by the choice made. `I would recommend it to anyone`. Resident surveys stated that they received enough information about the home before they moved in and therefore could decide if it was the right place for them. One resident said `I knew about the home. I used to visit`. People who use this service were treated with respect and their privacy was upheld. Systems in place around medication ensure safety and a sensitive approach. Carers were very attentive and responded to residents needs immediately in a calm and respectful manner. One resident said `I`m settled here well. The staff are lovely and kind to me`.Glastonbury Court was well designed for smaller group living and had good accessibility throughout for disabled people. The facilities on offer (hoists, assisted bathing, shaft lift, wide door ways, safe accessible garden, all en-suite bedrooms) enable older people to be cared for in an appropriate environment that does not disable them further. Residents tell us the home is always fresh and clean. We visited most areas of the home and found everywhere to be very clean and fresh. Residents health and care needs are met by the staffing levels at this home. Residents are in safe hands because staff are trained to do their job. One resident said `All the staff are lovely, kind and yes there are enough of them`. One relative said `the staff are very good and look after my relative really well. All their clothes are nicely laundered, so quickly`. We also observed staff caring for residents and found they took time with each individual as they needed and every resident was well presented and appeared comfortable, with any request quickly responded to. What has improved since the last inspection? In relation to the previous requirements we were sent information that the lift is regularly serviced. We found that the bath referred to in the previous report has been replaced with a fully assisted bath. This bath is not yet fully operational as a pump is on order to make it function properly. Regular fire training was seen to be undertaken by staff to lessen the risk to residents in the event of a fire. CARE HOMES FOR OLDER PEOPLE Glastonbury Court Glastonbury Road Bury St Edmunds Suffolk IP33 2EX Lead Inspector Claire Hutton Unannounced Inspection 10th July 2008 09:50 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glastonbury Court Address Glastonbury Road Bury St Edmunds Suffolk IP33 2EX 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) 01284 352650 01284 352645 jacqui.davy@acs.suffolkcc.gov.uk Suffolk County Council Vacant Care Home 48 Category(ies) of Dementia - over 65 years of age (29), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (16) Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three Service Users in the category of MD(E) , as named in the application received 5th February 2007, may be accommodated in the home. 30th July 2007 Date of last inspection Brief Description of the Service: Glastonbury Court is situated in a residential area of Bury St Edmunds. It is registered for the care of 16 older people, 29 older people with dementia, and 3 older people with a mental disorder. The service is registered to provide 24 hour nursing care. It is a modern two-storey building that was designed for its current use. All rooms are for single occupation and all have en-suite facilities. The rooms are grouped into units of 8, each with its own lounge, kitchen and dining area. The Home is owned and managed by Suffolk County Council. The current fees are a maximum of £691.00 per week. However please refer to the home for more details. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key inspection, which focused on the core standards relating to care homes for older people. The inspection was unannounced on a weekday, which lasted eight hours. This report has been written using accumulated evidence gathered before and during the inspection, including information obtained from 1 relative, 4 residents and 6 staff ‘Have Your Say’ surveys. The Annual Quality Assurance Assessment (AQAA), issued by the Commission for Social Care Inspection (CSCI) was returned completed by the new manager. This self-assessment gives providers the opportunity to inform the CSCI about their service and how well they are performing. We (CSCI) also assessed the outcomes for the people living at the home against the Key Lines of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with people who live in the home and 4 members of staff. The manager of the home was available during this inspection and fully contributed to the inspection process. What the service does well: People thinking of using Glastonbury Court can expect to have their needs assessed before they move in and be given a chance to visit. One relative told us that the home had been recommended to her and she was very pleased by the choice made. ‘I would recommend it to anyone’. Resident surveys stated that they received enough information about the home before they moved in and therefore could decide if it was the right place for them. One resident said ‘I knew about the home. I used to visit’. People who use this service were treated with respect and their privacy was upheld. Systems in place around medication ensure safety and a sensitive approach. Carers were very attentive and responded to residents needs immediately in a calm and respectful manner. One resident said ‘I’m settled here well. The staff are lovely and kind to me’. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 6 Glastonbury Court was well designed for smaller group living and had good accessibility throughout for disabled people. The facilities on offer (hoists, assisted bathing, shaft lift, wide door ways, safe accessible garden, all en-suite bedrooms) enable older people to be cared for in an appropriate environment that does not disable them further. Residents tell us the home is always fresh and clean. We visited most areas of the home and found everywhere to be very clean and fresh. Residents health and care needs are met by the staffing levels at this home. Residents are in safe hands because staff are trained to do their job. One resident said ‘All the staff are lovely, kind and yes there are enough of them’. One relative said ‘the staff are very good and look after my relative really well. All their clothes are nicely laundered, so quickly’. We also observed staff caring for residents and found they took time with each individual as they needed and every resident was well presented and appeared comfortable, with any request quickly responded to. What has improved since the last inspection? What they could do better: At the last inspection 2007 we found that the monthly monitoring visits to the home by the ‘owners’ – in this case Social Services was not regularly being completed and it was then a repeat requirement from 2006. This had improved, but now has faltered with no visits completed for May and June 2008. The reason for these visits (that should be unannounced) is for the ‘owners’ to speak to people who use the service, look for themselves and form an opinion as to the standard of care being provided. At this inspection we found that the home does not employ nurses though they are registered as a care home with nursing. They had contracted them through an agency but they were unable to provide nurses reliably. We did however conclude that the staffing levels were sufficient to meet the health and care needs of the residents at this home. The manager gave us an assurance that no one at the home required 24 hour nursing care and that any health needs could be met through GP and specialist services. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 7 The Statement of Purpose and Service Users Guide had gaps in it and needs updating to reflect the actual situation to avoid confusion and misunderstandings. We found overall the care plans were informative and relevant for staff to follow, but we found some examples where the changing needs of residents in relation to falls and manual handling needed updating to provide staff with a clearer instruction. The lifestyle of some residents did not meet their expectations and preferences and relatives and staff told us of concerns. Other people were satisfied. One resident spoken with said ‘we have had bingo recently and there is a trip planned to Yarmouth’. The home does not employ a specific person to develop and deliver activities within the home. This was discussed with the manager who said she had been considering this and agreed to look into it. This would go a long way to changing the experience that some people appear to have in relation to activities and daytime occupation. Both resident and staff feedback spoke about the bath out of action in Cedar. One resident said ‘I think it’s about time Cedar Units bath was fitted.’ We spoke to the home about this at our last inspection and a new fully assisted bath had been installed, but was not operational because a vital pump had not been ordered or installed. Residents and staff have been waiting a year for a fully functioning bath in this area of the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Glastonbury Court DS0000037079.V368137.R02.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 Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to have their needs assessed before they move in and be given a chance to visit. However information about this service may not be current and could be misleading. EVIDENCE: The self-assessment told us: ‘Statement of Purpose and Service User Guide in reception, we provide brochure of the home to individuals requesting information in relation to the home. We carry out day assessments prior to admission long term and short term residents. Pre Admission Assessments carried out in their own environment for any residents who are unable to attend the home. Key worker allocated to each individual to ensure full and comprehensive care plans are written and followed. A review is undertaken 6 weeks following admission and then regular 6monthly and Yearly reviews’. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 10 When we arrived at the home there was information about the home available in the main entrance. We were given a copy of the newly revised Statement of Purpose and Service Users Guide. This told us about the new manager who was in place, but the information about the type of service on offer was confusing. In sections of the information it said ‘This section is being revised and will be updated shortly’. This primarily relates to the section on nursing care within the home and how this was provided. The impact of this confusion is commented upon in other sections of this report. e.g. staffing and management. But the conclusion we drew in this section was that the information available at the moment was partly informative, but could be misleading as nursing care was not being provided 24hours a day and the links with the hospital are not as clear as was stated. In addition there was a review of the Care Homes Regulations that came into force on 01/04/02. This set out clearly that more information should be available to those who use a service with regards to fees. Information about fees in terms of cost of accommodation, including the provision of food, nursing and or personal care was not set out individually or as a lump sum. Exactly what is included and what is not and how payment should be made needs to be clearly set out to avoid misunderstandings. We looked at the records relating to 4 people at the home and found that an assessment had been completed before an individual moved in. Information was gathered from Social Workers and the manager explained that prospective residents would visit for a day and during that time an assessment would be completed. We saw copies of completed assessments. One relative told us that the home had been recommended to her and she was very pleased by the choice made. ‘I would recommend it to anyone’. All 3 resident surveys stated that they did receive enough information about the home before they moved in and therefore could decide if it was the right place for them. One resident said ‘I knew about the home. I used to visit’. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service were treated with respect and their privacy was upheld. Plans of care were informative, but not always up to date. Therefore consistently good care cannot be assured to everyone. Systems in place around medication ensured safety and a sensitive approach. EVIDENCE: The self-assessment told us: ‘All Care Plans for Elm and Willow have been reviewed and re written. Changes to the daily records to allow any activities that have been participated in to be recorded. Person Centred Care plans are produced with key workers to ensure all personal needs are met and updated’. Majority of our time was spent in the various units within the home observing care and support given. We observed some very good care practice. Carers were very attentive and responded to residents needs immediately in a calm and respectful manner. Personal care was carried out in the privacy of Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 12 bedrooms. We saw good manual handling practices with good use of equipment. When a staff member noticed a skin tear on a residents arm this was immediately reported. We looked at 5 care plans and spoke with 4 residents and 1 relative about their care at the home. In talking to residents they all said they were well looked after by very good staff. One resident said ‘I’m settled here well. The staff are lovely and kind to me’. Another resident explained that they were too frail to remain at home, so they needed the support and care they were able to get at Glastonbury. A relative said ‘all the staff look after my relative very well. I could no longer look after my relative and this is the next best thing’. On the whole the care plans were informative. One plan contained a wonderful life history complete with photographs that would make it easier for staff to communicate about familiar topics for that person. At the front of each plan there was a 24 hour care routine based around the residents preferences and needs. This was very informative. One resident said ‘everything is contained in my care plan’. However for one individual who had recently returned from hospital after breaking their leg key parts of the care plan had not been reviewed. Neither the falls risk assessment nor the manual-handling plan had been reviewed. Both needed to be completed to ensure that directions given to staff were appropriate in terms of manual handling and to prevent a reoccurrence of a fall if at all possible. Staff on duty were aware that the manual-handling plan was out of date and were not clear what equipment they should be using. They said they had raised this issue. Another resident had been at the home for 5 days and the care plan still needed to be completed. Some aspects may take longer to develop, but we would expect the 24-hour care routine to have been developed for staff to follow to offer some consistency. In relation to health care at the home the self-assessment told us ‘Continued support / information given by continence service and District Nurses to ensure that skin integrity and continence needs of each individual are meet. Nutritional screening is undertaken on admission and reviewed regularly. Where possible individuals retain their own General Practitioner, which allows for continuity of care. Full and comprehensive medication policy in place, which is adhered to, and regular audit carried out by Pharmacist and in house procedures. Care plans and regular review documentation. Regular medication and treatment audit sheets. Essential equipment sourced as per assessments completed by District nurses and continence advisor. Medication training at Otley college commenced for all Senior Team and registration completed for Acting Team Leaders.’ Care plans did detail any medical intervention. We saw the District nurse visiting on the day we were there. She came to take a blood sample from one Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 13 resident and came to see to a dressing for another resident. In the morning we were there, there was not a nurse on duty, but this was covered in the afternoon. This is commented upon further in the staffing and management section. One relative told us ‘I have asked to be informed of any doctors visit before the event. Generally I am informed after the event’. In relation to medication management within the home practices observed were very good. Two different members of care staff were seen administering medication. One person was giving out medication to residents who were frail, but able to determine for themselves how they took the medication. Time and observation from a distance was used to ensure medication was taken before staff then signed the records. Another staff member was administering medication to someone with dementia. The staff member took a calm approach and tried differing methods of administration. Suggesting to the resident they would like to pick the pills up for themselves, using a small cup, a spoon and using a syringe for liquid medication. Time was spent to achieve the outcome of the resident still being calm, happy and having taken their pain relieving medication. The system in operation was a monitored dosage system. Medication records were completed and showed that residents received medication prescribed for them. Medication was kept secure. Self-administration risk assessments were in place and had recently been reviewed. Where residents were on medication that controlled behaviours there was written guidance from doctors as to how much and in what circumstances medication was to be given. Systems in place around medication ensure safety and a sensitive approach. Care plans had limited information about the care and expectations of the resident at the time of their death. However one staff member had recently completed a training course on this subject and was planning staff training, had obtained a video and developing care plans with respect to death and dying. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to have many of their expectations and preferences met however cannot be assured that their social needs will be fully catered for. People can expect to receive a good range of food as part of a balanced and varied diet. EVIDENCE: Each of the units within Glastonbury have their own lounge, dinner/kitchen area. This is the focus of the social gathering area, but there are smaller areas for seating that individual people can and did go to if they chose to be on their own or see their visitors in private. One person was seen sitting in the sunshine on a balcony with staff. Each area had a television and a selection of books and activities such as board games. One resident spoken with said ‘we have had bingo recently and there is a trip planned to Yarmouth’. Another resident said ‘I enjoyed the trip to Waverney’. The photographs of this recent trip out were displayed on the wall of the home. Another resident said ‘I like to keep myself to myself’. One resident in their survey said ‘I would like more time with staff for a chat’. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 15 A relative felt quite strongly in their survey and said ‘my relative needs to be paid more attention and not just left to their own devices. Boredom is making them cranky. They require sitting and having a chat on a regular basis, a helping hand to do things or a gentle touch of the hand. A little more attention than “Have a wash”’. Two staff spoken with felt there needed to be more activities on offer. One staff member explained that the home had a minibus but staffing levels meant it was not used that often. On the morning of our visit to the home the Alzheimer’s Society were having a coffee morning at the home, however we did not see any of the residents at the home join this event. One resident did go out to age concern for a period of time and another resident was scheduled to go to a day centre, but they chose not to go and their decision was respected. The home does not employ a specific person to develop and deliver activities within the home. This was discussed with the manager who said she had been considering this and agreed to look into it. This would go a long way to changing the experience that some people appear to have in relation to activities and daytime occupation. The self-assessment told us ‘Units have an individual area to enable drinks and snacks to be provided as and when required. Key workers provide support and assistance to enable the residents to visit the local shops. Outside groups attended by a small percentage of residents. Church visits and services. End of Life Spiritual needs met on an individual basis if required. Regular residents meetings. Retain own General Practitioner. Occasional visits from outside clothing company’s. Trips organised throughout the year for individuals to attend if desired’. We observed a resident request a hot drink and the carer was immediately able to fulfil the request. Lunchtime was observed within 2 units at Glastonbury. Feedback from residents spoken with was very positive about the choices of food available and the quality of food on offer. One resident spoken with who was a vegetarian was able to choose from 21 choices for their main meal of the day. New menus had recently been developed and were on a 4 weekly cycle. The choices of on the menu and meal times were recently discussed at a residents meeting and minutes were available for residents to read. A staff member explained how in the late afternoon they went round to each resident with the menu for the next day and residents chose their main meal. The main meal for that day was sausages and onions in gravy with potatoes and a variety of vegetables. For dessert there was Bakewell tart and custard. There was an alternative each day of a jacket potato with a variety of fillings, different salads or soup and a role. For supper that evening there was cauliflower cheese, but again there were alternatives. Each unit had a bowl of fruit available to residents and a lovely selection of home made cakes. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 16 The self-assessment told us ‘Choice of menu displayed in all dining areas on each unit, and individuals are given the choice of where they would like to sit and eat their meals.’ Three relatives told us that they can visit any time and that the care home always helps their relative keep in touch. We saw relatives visiting when we were there and one said ‘I normally have my set days for visiting, but I decided to change this week. My other relatives, including children will be visiting later’. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service can be confident that their complaints are taken seriously and acted upon. Residents are protected from abuse. EVIDENCE: Residents at Glastonbury Court say they have access to people who will listen to them if they have any concerns. Four residents surveys told us that they know who to speak to if they are unhappy. Two residents both wrote ‘I’m happy here’. All four residents were aware of how to make a complaint if they needed to. One resident spoken with said ‘all the staff are lovely. I would speak to them if I had any problems’. All six surveys from staff say they would know what to do if anyone had a concern about the home. We saw that there were complaints procedures displayed at the home and given to people in the Service Users Guide. However one relative felt strongly and wrote in their survey that ‘when a discussion has taken place the person (client) concerned is ignored even more’. The home had a log of all concerns and complaints made. This showed that concerns were recorded and dealt with. There had not been any complaints received and logged since our last inspection to the home. The leaflet the manager downloaded from the local authority website that related to concerns, Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 18 complaints and compliments had an old address for our organisation on it. As this is a local authority leaflet and not specifically for the home, that did have the correct information, we recommended to the manager that she pass on the updated information. In relation to being protected from abuse we found that all staff records showed that staff are recruited appropriately and that the Protection of Vulnerable Adults national listing was checked along with a criminal records bureau check before staff started work at the home. The home had the local procedure on safeguarding adults from abuse and were aware of the local website where up to date information is available. The home had not needed to use the procedure or referral system since our last visit to the home, but was aware of what to do if and when needed. Staff spoken with were aware of reporting any signs of abuse, but one staff member was unclear about what whistle blowing meant in this context. At our last inspection we recommended that staff have update training on protection of vulnerable adults. We received an improvement plan for the previous manager who said that all staff would receive an update in the next 4 months. We asked at this visit for evidence of this. The new manager was unable to confirm if staff had received this and this had not been part of the handover they had received. The manager was able to confirm that new staff had safeguarding and protection issues covered on the formal induction completed by new staff to the home. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be assured that Glastonbury Court is comfortable, safe, well designed to meet needs and very clean, however replacement of furnishings and equipment can be very protracted. EVIDENCE: Glastonbury Court had a foyer with comfortable seating and relevant information greets people on entering the home. The Statement of Purpose, latest inspection report, compliments and complaints books were all available for residents and relatives to see. Glastonbury Court was well designed for smaller group living and had good accessibility throughout for disabled people. The facilities on offer (hoists, assisted bathing, shaft lift, wide door ways, safe accessible garden, all en-suite bedrooms) enable older people to be cared for in an appropriate environment that does not disable them further. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 20 Four residents tell us the home is always fresh and clean. We visited most areas of the home and found everywhere to be very clean and fresh. There was a view from two staff that ‘dated items such as carpets, décor and curtains in certain areas of the home should be replaced.’ A relative felt that the bedroom their relative had should be decorated and the faulty lamp should have been replaced. We found that certain areas of the home did look tired and needed to be upgraded with a lighter fresher look to them. This was not helped by one section of the home being closed and corridors leading to it had curtains drawn that made it dark. Both resident and staff feedback spoke about the bath out of action in Cedar. One resident said ‘I think it’s about time Cedar Units bath was fitted.’ We spoke to the home about this at our last inspection and a new fully assisted bath had been installed, but was not operational because a vital pump had not been ordered or installed. Residents and staff have been waiting a year for a fully functioning bath in this area of the home. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be assured that staffing levels meet residents health and care needs and that staff are trained to do their job. Overall residents were protected by the homes recruitment practices. EVIDENCE: The staffing levels at this home were examined and discussed with the manager. We found that the home currently does not employ any nursing staff. The nurses were supplied through an agency, but this had proved to be unreliable. In June 2008 we found that 26 shifts had not had a level 1 nurse on duty. In July of the 10 days that had passed at the time of this inspection 10 days did not have a level 1 nurse on duty. The home did however staff the whole home during the day with 10 care staff and there was always a senior carer on duty that had NVQ 3 in care. At night there was 4 care staff and a senior on duty. This was to care for 32 residents who were currently at the home. Discussions were held with the manager of the home about the number and needs of the residents and layout of the home and the manager was satisfied that they were meeting the needs, including any nursing needs that any resident may have. The manager was quite clear that no one at the home required 24 hour nursing care, but that any nursing or medical care could be met by using the district nurses and access to GP’s and medical professionals. Discussions separate to this inspection about this situation have continued to resolve this matter. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 22 Feedback from residents and staff about staffing levels were positive about meeting the care needs. One resident said ‘All the staff are lovely, kind and yes there are enough of them’. One relative on the day said ‘the staff are very good and look after my relative really well. All their clothes are nicely laundered, so quickly’. We also observed staff caring for residents and found they took time with each individual as they needed and every resident was well presented and appeared comfortable, with any request quickly responded to. We saw a committed team of staff meeting peoples needs. They were able to give in-depth accounts of the health and personal care needs of people and new exactly how to look after them. We did have feedback as previously mentioned in the lifestyle section of this report about how the activities and daytime occupation for resident could be improved. We believe this could be improved by employment of staff specifically for this role and the manager agreed to look into it. The self-assessment told us ‘high level of staff qualified to NVQ II with remaining staff committed to starting NVQ II. The home is now committed to complete skills for care folders. Team Leaders carryout in-house mandatory training. Full induction and probation process carried out. Performance Development Reviews completed Annually. Regular supervision undertaken throughout the year. Four week rota in place to try to plan for absences in advance. The home is staffed with a qualified and skilled workforce; there are clear lines of accountability and delegation of individuals within each job description’. In speaking with staff they told us they were well trained in manual handling, medication and food hygiene. Six staff surveys told us that the induction they were given covered everything they needed to know to do the job. One staff member said ‘I was told everything in detail and constructively’. The same six staff said they were given training that is relevant to the job, that helps them understand individual needs and diversity issues and that they were kept up to date with new ways of working. When observing staff we saw they completed tasks such as personal care, manual handling and drug administration in line with current training. Four staff files selected by us showed that the relevant training mentioned above had been completed. Also there was evidence of training in the induction standards for new staff, safeguarding training for some staff and dementia training. The self assessment told us - Out of the 54 care staff employed at the home 46 of them have an NVQ 2 or above. All catering and care staff have a food handling certificate. Also that 50 staff have training in infection control. On assessing all this information we believe that staff at Glastonbury Court are well trained to meet the needs of the people who us the service. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 23 We also looked at the recruitment records for 3 relatively new staff. Overall these were satisfactory and had information such as a full application form with job history, proof of identity, the national register for the protection of vulnerable adults and a criminal records bureau check (CRB) was checked before potential staff started work at the home. Two staff had the two references available for inspection, but one person did not. The manager agreed to look into this, as she believed it had been completed. From the 6 surveys completed by staff all said ‘yes’ the employer did carry out checks such as a CRB and references before they started work. Glastonbury Court DS0000037079.V368137.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be assured that residents health, safety and welfare is safeguarded by the home’s processes however cannot be assured that the owners have been undertaking the necessary monitoring and evaluation of the service. EVIDENCE: We were in the process of registering the previous manager of Glastonbury Court and were informed that they intended to move on from this post, so we did not continue with our processes. We have subsequently received an application to register the new manager and we will interview them in July 2008 to determine if they are fit to be the registered manager. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 25 The new manager was appropriately trained and had good experience at a senior level within a similar care home in the private sector. The manager was helpful throughout the inspection process and there were areas that she was unsure of, because she was new to her post within Social Services. Senior Managers within Social Services have communicated with us since the inspection and express their support of the new manager and their intention to review the Home’s registration which at present is for a care home with nursing, even though at present they do not provide nursing care and do not care for any nursing patients. Glastonbury Court will benefit from a permanent manager to take this home forward. Staff and relatives said that the manager ensured that the home ran smoothly and that she was approachable, but staff would like to see her more often ‘on the floor’. One staff member said ‘I have regular supervision between myself and my supervisor. Though I don’t see much of my manager. I guess she’s kept busy in her office’. Five staff confirmed they received regular formal supervision. Records of 4 staff showed that they received regular formal supervision. Self-assessment told us ‘all financial records are kept in line with Suffolk County Council Polices and Procedures. No staff member is an appointee for any resident. Residents have access to their own records. Residents have their own secure permanent boxes within their own rooms’. In relation to health and safety the self-assessment old us ‘all staff are trained in Manual Handling procedures and refresher training is undertaken regularly. Fire alarm system is tested and serviced to meet guidelines. Fire risk assessment is in place. COSHH is in place and all staff are trained appropriately. All equipment is serviced in compliance with regulations. Risk assessments completed and regularly monitored. Procedure followed for all accidents and incidents’. We sampled servicing records of equipment and found these up to date. We looked at all fire records and found that records relating to fire extinguishers, door closures and fire testing were up to date and recorded appropriately. We sampled hot water in baths and found these to be within safe limits. In relation to quality assurance and seeking the residents views the home holds regular residents meetings and we saw the minutes of these in the lounge areas for residents to see what had been decided. There were various quality checks that were completed routinely within the home such as medication audits that ensure a consistent good quality approach. The manager spoke of a new development of developing a questionnaire specifically for people who were using the home for short-term care to ensure the quality and expectations of people were being met. Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 26 The AQAA (annual quality assurance assessment) the self-assessment we have commented upon through out this document, was completed by the new manager and the information gave a reasonable picture of the current situation within the service. At the last inspection we found that the monthly monitoring visits to the home by the ‘owners’ – in this case Social Services was not regularly being completed and it was then a repeat requirement. This had improved, but now has faltered with no visits completed for May and June 2008. The reason for these visits (that should be unannounced) is for the ‘owners’ to speak to people who use the service, look for themselves and form an opinion as to the standard of care being provided. Matters such as the lack of nursing staff would have been found and potentially resolved before we, the Commission reported upon them. Glastonbury Court DS0000037079.V368137.R02.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 2 X 3 X 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 3 3 X 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 3 X 3 Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 OP33 Regulation 26 Requirement Monitoring visits must be undertaken in accordance with Regulation 26. This is a repeat requirement from July 2006 and from July 2007. The Statement of Purpose and Service Users Guide must set out what is provided by this home and to whom. It must also state information about fees and what is included in the price. This will avoid confusion and misunderstandings. Changing needs of residents in relation to falls and manual handling must be assessed and reflected accurately in care plans for staff to follow. The lifestyle of all residents must be improved with a consultation and then provision of a program of activities, recreation and fitness. The bathing facilities must be available to meet residents needs therefore the bathroom in Cedar must be speedily put into action. Timescale for action 01/09/08 2. OP1 4,5 and 6 01/09/08 3. OP7 15 01/09/08 4. OP12 OP27 16 (n) 01/09/08 5. OP21 23 (2)(j) 01/09/08 Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP18 Good Practice Recommendations Update training should be provided on safeguarding residents from abuse for all staff and this should be documented to demonstrate it has been completed. To improve the environment for residents and staff there must be a proactive program of maintenance and upgrade and not just repair. The recruitment processes must demonstrate that the residents are protected, therefore all documentation must be available for inspection. 2. OP19 3. OP29 Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Glastonbury Court DS0000037079.V368137.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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