Care Home: Glebe Court Nursing Home

What the care home does well Residents have their needs assessed prior to moving in to the home. Residents have their health care needs well met by the staff in the home supported by the multidisciplinary team. Social care is well organised and tailored as far a possible to meet individual needs. Staff had a good knowledge of adult protection procedures and whistle blowing and knew how to action it. Staff are given a supernumerary shift to ensure they are up to date with paper work which is to be commended. The environment is maintained in a clean, homely fashion and residents are encouraged to personalise their bedrooms. What has improved since the last inspection? The requirements arising out of the last site visit had been addressed. Staff had a greater awareness of dealing with and reporting abuse which affords greater protection to residents The home has further developed quality assurance measures to afford greater input into the service. Work with relatives continues with opportunities to meet with manager at any time or speak directly to her as she is on call. What the care home could do better: Supervision of qualified nursing staff needs to be developed to ensure that they receive adequate support and guidance to fulfill their role. Two references must be obtained prior to employment for all staff and the recommendation of three yearly CRB checks continues. All staff should have training on abuse including ancillary staff. Training on abuse should be in line with current guidance and may require more external training to be sought. Key inspection report Care homes for older people Name: Address: Glebe Court Nursing Home Glebe Way West Wickham Kent BR4 0RZ     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: Rosemary Blenkinsopp     Date: 2 2 1 0 2 0 0 9 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 27 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) 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 Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Glebe Court Nursing Home Glebe Way West Wickham Kent BR4 0RZ 02084626609 02084629971 glebecourt@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Glebe Housing Association care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 51 The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Glebe Court is part of the Glebe Housing Association, which provides housing and support through sheltered housing as well as warden assisted bungalows to elderly persons. The Association has one nursing home, which is Glebe Court. This is a purpose built care home for the nursing care of older people. The home is set in its own grounds on Bencurtis Park. There is car parking to the front of the home and a sheltered garden to the rear. The fees in this home are between £ 822.50 and £830.00 for single bedrooms, with extra fees payable for hairdressing, chiropody, newspapers and toiletries. Care Homes for Older People Page 4 of 27 Over 65 51 0 1 8 1 1 2 0 0 8 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 inspection was conducted over a one day period by two inspectors. The visit was unannounced. Prior to the inspection the manager had completed the AQAA and forwarded this to the CQC. The AQAA is a self assessment tool which focuses on how the service meets the standards and requirements. The AQAA contained good information regarding the service. Fifteen comment cards were received during the site visit, including nine from staff and six from residents. Periods of observation were carried out on two floors and included the serving of lunch and part of the medication administration. During the visit we met with several relatives and residents. Care Homes for Older People Page 5 of 27 Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated into this report. A selection of documents were inspected including care plans, staff personnel files as well as health and safety records. Feedback was provided to the manager at the end of the inspection. Other information which has been considered when producing this report and rating, is the information supplied and obtained throughout the year including Regulation 37 reports and complaints. Care Homes for Older People Page 6 of 27 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 7 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are appropriately assessed prior to admission and are provided with information on the service to assist in the decision making process on whether the home is suitable for them. Evidence: At the time of the inspection there were 46 residents in the home. Those relative with whom we met confirmed that the manager from the home had visited them and that either they, or the resident themselves, had visited the home prior to placement. Information is received from the funding authority prior to placement and from which staff can have some information from which to base an initial care plan. The manager conducts pre assessment visit on all prospective residents and completes Care Homes for Older People Page 9 of 27 Evidence: a standard form. The assessments that we looked at provided information about the persons physical, mental and social care needs. Residents told us that once they were admitted both the manager and the activity coordinator made them feel welcome and spent time with them supporting them during the initial stages. Ongoing support was provided by the staff to residents and their families.. Inventories of property and valuables are completed on admission, and items safely stored if not returned home. Contracts are issued which outline the service provided, termination of placement, notice period and fees. Fees are between £ 822.50 - £ 830.00 . The majority of residents in this home are privately funded and are issued with the homes private contract. All others are issued with contracts from the funding authority. Care Homes for Older People Page 10 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that all of their health care needs will be met by staff in the home supported by the visiting multi disciplinary team. Medications are safely managed ensuring residents get the correct medication at the correct time. Evidence: Health care was well addressed. It was evident from the multi disciplinary notes that residents were seen regularly by the GP as well as other health professionals including an aroma therapist. In one care plan there was references to aggression and agitation and this resident had been quickly referred to the GP for a review. Residents told us that they were consulted about their GP, as many are unable to retain their original GP due to distance, and therefore have the homes GP. There was a lot of equipment available including specialized mattresses, hoists and walking aids. Mattresses were fully functioning with the alarms audible and the pressure at the correct level. This is important that the alarm is not put on mute as Care Homes for Older People Page 11 of 27 Evidence: the alarm sounding will indicate that the mattress is not fully operational. Care was provided by staff who were attentive and knowledgeable about residents needs. We did however note that one manual handling practice was not correct and this needs to be monitored as staff need to handle residents safely. Relatives said that they were kept informed of any developments in respect of their loved ones and one person in particular felt that the home had been very good at communicating issues. Care plans in this home use the Standex system which is a comprehensive format for addressing care. Care plans had photographs attached although were without a full description. The care plans in the main reflected the care residents required although there were areas which needed to be addressed. It was evident from care plans that the resident population had high levels of dependency. The interventions were comprehensive and would provide staff with the information they need to carry out care. The care plans outlined activities of daily living had associated risk assessments and supporting documentation such as turn charts, food and fluid balance and weight records. These were well completed. Those records seen relating to weights, showed no significant weight loss. Reviews were in place. On the ground floor we found one care plan that reflected residents needs although a wound to the left heel was without a care plan. The Registered Nurse seemed vague about this although the manager was clear that this had healed some time previous. Other care plans we sampled did include care plan for dressings. Another care plan needed updating to reflect the resident was now nursed in bed and not mobile as the care plan indicated. Signatures of the residents or their advocates were omitted in some of those care plans viewed, as was that of the nurse who completed the care plan. This needs to be actioned. Residents looked well cared for with attention to hair nails and moth care evident. Spectacles are individually labeled to ensure the correct people wear them. Medications. Medications are well managed, resident receive the correct medication on time. Care Homes for Older People Page 12 of 27 Evidence: Medications were safely stored and those with a short shelf life had the date of opening recorded. Records for medications received and those disposed of were retained. The clinical room temperature and that of the fridge were recorded daily. The medication administration charts were well completed with codes to identify the reason when medication was not taken. The medication administration that we observed, was safe and the correct procedure followed. Those medications that are hand transcribed need two signatures to ensure that the information recorded is correct. Staff told us that the are trained in medication procedures and are updated annually. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have choices in the way they spend their day and are encouraged to be as independent as possible. Organised activities are age appropriate, and address the needs of those who require individual attention as well as group sessions. Evidence: The home employs an activity coordinator who works 16 hours a week. She organizes external entertainment as well as in house group sessions. For those residents who cannot participate in the group activities individual time is provided. There was a lot of information available about what was planned for residents. The home also has eight volunteers who work closely with the activity coordinator. There is a separate budget for activities and the home trains staff to do activities. There is also a fund raising committee who raise funds for the home generally. There were records about the activities and these indicated who had taken part and who had not. Most residents had TVs and radios in their bedrooms and there were TVs in communal areas. Daily newspapers and a selection of magazines were also available as were games. The activities person was seen to have a very caring manner with residents and spent time talking with individuals as well as organizing entertainment. One relative commented that the activity person spent a lot of time with them and Care Homes for Older People Page 14 of 27 Evidence: their relative, when they were first admitted. Residents told us that they were free to do as they liked, choosing rising and retiring times and where to spend time during the day. Residents told us that they enjoyed their food and there was always a choice. One resident did not want the dishes offered on the menu so was provided with a salad. Omelettes are always an alternative. Relatives were seen to come and go throughout the day and residents said that there were no restrictions on visiting. Many residents have their own telephones in their bedroom which they fund themselves. Choice was evident throughout the day and residents were encouraged to be as independent as possible. Lunch when served was nicely presented. Tables were set up in preparation with menus ,condiments cutlery and serviettes. Lunch was unhurried and there were enough staff to assist those residents who needed it. Staff were relaxed and engaged with residents when assisting them with their meal. Residents made the following comments Its not bad at all here, and in relation to food the resident said, Its a case of you cannot please all of the people all of the time. Comment cards were positive about the care and activities provided and indicated some staff were outstanding. Comments included they cannot do anything better. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that any complaints will be taken seriously. Staff are trained to take action on actual or suspected abuse to ensure residents are protected from harm. Evidence: The information on how to make a complaint was available throughout the home and included in the Service Users Guides which were in every bedroom. The complaints file showed that there were 24 recorded complaints/concerns, ranging from fairly minor issues to care practices. All complaints are investigated and the records retained of the investigation. The outcomes, whether the complainant was satisfied or not was also recorded. Care staff including the activities person and the ancillary staff were asked about reporting abuse. Staff had a good knowledge of what to do and were aware of how to find the numbers for external contacts such as the Local Authority. Staff felt that all concerns were taken seriously and that they could approach members of management as well as those at head office. Staff told us that the manager has an open door policy and will make time to listen to concerns. Staff were also familiar with how to action whistle blowing and understood that it was not confined to abuse but also included issues such as poor practice, staff attitudes, Care Homes for Older People Page 16 of 27 Evidence: routines etc. This is good and ensures that residents are protected not only from the different types of abuser but also practice issues. The manager advised us that staff are updated internally on abuse and whistle blowing. It is recommended with all of the changes in this field that external training be sourced. One domestic said they were unable to recall training on abuse. The ancillary staff must be included in training on abuse and whistle blowing routinely as they work closely with residents and need to be aware of the action to take in cases of suspected or actual abuse. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home which is well maintained, clean and comfortable. All equipment is provided to meet their needs. Bedrooms are comfortable and residents are encouraged to personalize them. The home retains a domestic feel without being too clinical despite the equipment in use. Evidence: The home is located close to West Wickham and you can get their by public transport . Parking is provided to the front of the building. The home is a modern building set over three floors. There is a large reception area at the main entrance and two administration offices close by. The communal dining area and large lounge are located on the ground floor. The areas were bright, homely and had comfortable seating provided. There are a number of communal areas which provide quieter areas for those that need it. The home was fresh and clean and free from hazards. Equipment was safely stored although as in every facility more storage space would be of benefit. Bedrooms were personalized and many residents choose to spend their day in them as opposed to communal areas. Care Homes for Older People Page 18 of 27 Evidence: There was evidence of fresh flowers and plants in many bedrooms. Residents had call bells at hand , or in a pendent form worn round their necks, for easy access. Call bells were answered quickly. Bedrooms had fresh water provided . Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels provide sufficient staff to address the needs of residents. Staff have training to enable them to perform their work competently. Recruitment procedures are in place to ensure staff are safe to work in the home. Evidence: The home has good staffing levels to meet residents needs The skill mix ensures that there are enough qualified staff to direct the care and supervise staff in general. Staff with whom we met confirmed that in their opinion there were enough staff to meet residents needs. Staff told us that they received enough training to their jobs and had refresher training on the mandatory topics. A new staff member indicated that they had received a comprehensive induction over a two week period. The staff member said that all staff had been helpful and supportive. The home is fully committed to Equal Opportunities Staff records were to a good standard generally although some areas needed Care Homes for Older People Page 20 of 27 Evidence: attention. Records were securely stored. The files included the application form, references, identity checks as well as health declarations. In some files the second reference was missing. Staff need to have two references in place prior to employment, one of which must be from their previous employer in care where applicable. There were some files where the CRB had been received from the previous employment. The guidance in relation to CRB clearance has now changed and CRBs can be brought from a previous employment. The recommendation that they are done every three years stands. There was one file of a potential employee, where the CRB was dated 2005. The employee was due to start within a week. The recommendation is that CRBs should be repeated every three years and this should have been actioned earlier as the employee was due to start the following week with a four year old CRB. Staff were knowledgeable when asked about topics relating to the work they do including infection control health and safety and medication. Staff surveys told us that residents received good care and care plans were followed. Staff said that they were supported and equipment was provided. One staff wanted more training although did not say on what topics. Overall positive comments were included in the surveys. One staff when asked about her work replied,I love it here. Supervision is not addressed regularly with the Registered Nurses although an annual appraisal is conducted. All staff need supervision six times a year and this needs to be implemented. Staff who do receive supervision told us it was an open discussion where work and training issues was discussed. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by an experienced individual supported by the management committee. Health and safety issues are well addressed ensuring the home is safe to live and work in. Quality assurance measures seeks out the view of those persons living and involved with the home and uses the information to improve the service. Evidence: The home is managed by a qualified nurse who has experience in this type of setting. Ms Davis is an RGN and has a Post Graduation Certificate in Management. The home is supported by a full time administrator and a full time receptionist. Health and safety is well addressed by regular servicing and ongoing maintenance. A sample of service certificates were selected for viewing including those for the lift, Care Homes for Older People Page 22 of 27 Evidence: electrical, gas and lifting equipment, all were found to be in good order. Fire records showed weekly alarm testing and emergency lights routinely checked. Fire maintenance records showed fire serving had been done 15 October 2009. Fire training is conducted regularly and staff are sent a memo to ensure that they attend sessions at least twice a year. The fire risk assessment had been reviewed August 2009. Quality assurance measures showed there to be regular meetings with all grades of staff. Regulation 26 visits are conducted monthly, unannounced. The annual quality assurance survey , which incorporates the views of residents, relatives staff and all stakeholders was still in the process of collecting feedback. Residents money is safely stored along with any valuables. There are records for transactions and receipts are issues for all expenditure. The hairdresser and the chiropodist issue one receipt with individual payments identified on it . This is retained for audit purposes. Care Homes for Older People Page 23 of 27 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 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 13 Ancillary staff should be 30/12/2009 included in training on abuse and whistle blowing routinely To afford residents protection 2 7 15 Care plans must be current and reflective of all the residents needs . Staff need to use the care plan to deliver the care without updated information the correct care may not be provided. 3 28 19 Staff must be subject to robust recruitment procedures including two references To ensure that staff are safe to work in the home. 30/11/2009 30/11/2009 Care Homes for Older People Page 25 of 27 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 7 18 28 36 Descriptions for identity purposes should be completed on the residents care plan External training on abuse should be provided to ensure all staff are updated in current practice. CRBs should be addressed every three years and a new one obtained on commencement of employment Staff should receive regular supervision,six times year, in order that they can have a forum where work and training issues are discussed. Care Homes for Older People Page 26 of 27 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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