Care Home: Grove Court Nursing Home

What the care home does well People are provided with good information that assists them with making their choice about moving into the home. People are provided with a good standard of care planning when a care need is identified. The care staff working with people who live in the home are very aware of people`s health care needs and ensure the appropriate health professionals are involved when needed. Staff are aware of the importance of promoting people`s privacy and dignity needs. People are encouraged to get involved with the activity programme that is developed in the home. Those people who are isolated in their rooms are also assisted to have a degree of interaction with activities. The staff have a good awareness of the safeguarding process and this helps to protect people who live there. People are provided with a clean and suitable environment. The recruitment process adopted by the home is robust. The new manager has a good awareness of management systems and processes that help ensure the quality of the care provided is improved. What has improved since the last inspection? Additional resources have been made available in staffing and equipment for the benefit of people, employees and visitors. The activities co-ordinator is now in place, and other additional staff time is available following the increase in care assistant numbers. Refurbishment and redecoration in the hallway, entrance corridors and several bedrooms alongside the provision of new seating for all areas and new dining furniture has improved the environment and reflects the choices of people living in the home. New beds and other aids to daily living have been provided to reflect changing needs. CHESS (End of life care pathway) implementation and the Leeds Care Pathway have been taken forward. Improvements in staff monitoring and liaison between staff with line management responsibility has ensured staff issues are dealt with promptly and effectively. What the care home could do better: Improvement is needed with ensuring people who are identified as being at risk in areas such as falls, nutrition and pressure area care are provided with appropriate riskassessments. This will ensure that those identified as at risk have clear plans of care in place to manage that risk. Improvement is needed to ensure the administration and recording of medications adheres to professional guidelines. Staff involved with moving and handling procedures must ensure that they only use recommended procedures and equipment that helps protect each individual. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grove Court Nursing Home 13-15 Cardigan Road Headingley Leeds Yorkshire LS6 3AE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sean Cassidy     Date: 0 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Grove Court Nursing Home 13-15 Cardigan Road Headingley Leeds Yorkshire LS6 3AE 01132304966 01132242840 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Grove Court Nursing Home Limited care home 38 Number of places (if applicable): Under 65 Over 65 38 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 38 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: Old Age, not falling within any other category, Code OP - maximum number of places 38 Date of last inspection Brief description of the care home Grove Court is a converted and extended property occupying a prominent position on a main road in a suburb of Leeds. It is close to all the main amenities in the area and adjacent to the bus service. The home provides nursing and residential care to 38 older people. Seven beds have now been designated as providing intermediate care. Accommodation is provided on 3 floors there are 38 single bedrooms. The majority of bedrooms have en-suite wc facilities. The ground floor has a choice of sitting areas, and a separate dining room. There are small garden areas to the side and front of the building, which, are well used by people in the better weather. Care Homes for Older People Page 4 of 28 Brief description of the care home The fees charged for this home range from 555 pounds and 53 pence to 601 pounds and 46 pence per week. Care Homes for Older People Page 5 of 28 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 accumulated evidence used in this report has included: A review of the information held on the homes file since its last inspection. Information submitted by the registered provider in the AQAA (Annual Quality Assurance Assessment) Information received from people who use the service, relatives and staff. An unannounced visit to the home, which lasted eight hours. This included a partial tour of the premises. Care Homes for Older People Page 6 of 28 Evidence gained by direct observation, talking with people who use the service and management. Inspection of records including care plans risk assessments, medication administration records,and the homes policies and procedures. What the care home does well: What has improved since the last inspection? What they could do better: Improvement is needed with ensuring people who are identified as being at risk in areas such as falls, nutrition and pressure area care are provided with appropriate risk Care Homes for Older People Page 8 of 28 assessments. This will ensure that those identified as at risk have clear plans of care in place to manage that risk. Improvement is needed to ensure the administration and recording of medications adheres to professional guidelines. Staff involved with moving and handling procedures must ensure that they only use recommended procedures and equipment that helps protect each individual. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are properly assessed and informed before moving into the home. People using the intermediate care service are supported positively with their rehabilitation packages. Evidence: Three care plans were examined. All showed evidence that people were assessed before they were admitted to the home. Discussion was held with the manager regarding the content of the information gained prior to admission. It was recommended more detail in relation to a persons care needs was obtained so that the decision to admit each person was based on thorough information. People told me that they were offered the opportunity to come and look around the home before they were admitted. Care Homes for Older People Page 11 of 28 Evidence: Intermediate care staff come to the home and assist people with their rehabilitation back to their own homes. The documentation was up to date and correct to support this process. People spoken to had a good understanding of what skills were needed to assist this process. They said they received regular training in the rehabilitation needs of people requiring this service. Members of the intermediate care team were spoken to and they provided positive information about how the staff support the people who use this service. Care Homes for Older People Page 12 of 28 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. People living in the home are confident that the staff work hard to ensure their health and personal care needs are met. Risk assessments are not always completed when a risk presents itself and this can potentially compromise the care package. People are not appropriately protected by the medication recording and administration practices of the care staff at the home. Evidence: Three care plans belonging to people who live in the home were looked at. They contained evidence that showed each person was assessed at the point of admission. Evidence was seen that showed people were assessed in all areas where there was a potential care need. When a care need was identified a care plan was written. This is good practice. Care Homes for Older People Page 13 of 28 Evidence: The care documentation contained little evidence to show people had consented to their care. However, the new manager has identified this during her audits and a document has been developed to assist this process in the future. The care files showed some evidence that risk assessments in areas such as falls, moving and handling, nutrition and pressure area care are carried out by staff when needed. However, evidence was seen in some of the files inspected that people at risk of falls, pressure sore development and poor nutrition did not have a risk assessment in place to manage these concerns. One person who was sat in a chair that could be seen as being restrictive had fallen out of it on a number of occasions.Their was no risk assessment in place to manage this risk. The falls risk assessment for this person had not been reviewed after these falls. This placed the individual at further risk. This was discussed with the manager and provider during the inspection. The new manager provided evidence that showed care plans and risk assessments had been audited and that the documentation used to ensure risks are managed correctly are being implemented in the near future. Good evidence was seen in the care files that showed peoples health and personal care needs are properly managed by the staff working in the home. People said, I always get to see the doctor if I need to. They are good in that respect. I have just had an appointment made to see the optician the other day. When mum has been ill the staff have been absolutely lovely. The home have signed up to CHESS which is an end of life care pathway and staff have received training in this area to assit them with helping people appropriately when they rech this stage of their care package. Good evidence was seen during the inspection that showed peoples privacy and dignity are promoted when in the home. Staff were observed to assist people with personal care in a dignified manner. When they communicated with people this was done in a manner that was warm and supportive. People were given time to answer questions. Staff were observed to knock on doors before entering. Those needing assistance at meal times received this in an unhurried and supportive manner. Good feedback was received from people who live in the home and relatives who visit. Comments received were, The staff are great. They try hard to please all the time. They are really quick to respond to the buzzers which is reassuring. The care provided within the home is very good. I recommend people to come here. One relative highlighted some negative concerns about basic care needs. She highlighted that her mother was always a meticulous individual and always liked to be Care Homes for Older People Page 14 of 28 Evidence: well presented. This isnt always promoted by the home. Mums teeth are not cleaned properly. Her nails are in a poor state. Ive asked if this can be Incorporated into the care plan but it never happened. I have brought in toiletries to mum and they always go missing. The person providing the above comments highlighted that she was going to speak with the manager of the home regarding these issues and felt confident that she would have her concerns looked into. I passed these concerns onto the management team. The new manager has carried out a recent audit and has identified a need to train staff in the area of provision of basic care needs. New training is being planned to meet this training need. There are medication policies and procedures in place to assist the safe recording and administration of medication in the home. Evidence was also seen to show audits of the medication take place. The administration and recording procedures were observed during the inspection. Some concerns were raised with the manager in relation to medication administration and recording. One member of staff was still administering the morning medication at 11:40AM. Medications on some charts had stated 8a.m. administration. This evidence indicated that people might not be receiving the therapeutic effect from their medications as they are not administered at the correct times. One member of staff admitted that she signed medications before they are administered. This is poor practice and is not in line with professional guidance. Staff were signing outside the MAR (Medication Administration Record) Sheet. This again is not in line with professional guidance. There were also some unexplained gaps in the MAR charts. These concerns were relayed to the manager and owner at the end of the inspection. Care Homes for Older People Page 15 of 28 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 provided with opportunities to get involved with activities and interests at their leisure. Evidence: Two people are employed on a part time basis to plan and provide an activities programme for the home. The activities person on duty during the inspection was seen as extremely enthusiastic and involved with the people who joined into the activities provided. Each person has a social work book which is filled in by the activities co ordinator. The activities co ordinator was quick to point out that activities are also provided to people who are isolated in their own rooms and evidence was seen that this does take place. People told me about the plans that are in place to access activities both inside and outside the home. The new manager has an identified yearly budget and she is planning the programme for the coming year. There was an Easter party planned which people were aware of. An Easter service had already taken place before the inspection. Care Homes for Older People Page 16 of 28 Evidence: People told me that their spiritual needs were provided for by the arrangements made by the home. A group of volunteers visit the home weekly and provide activity classes. This was observed during the visit and people enjoyed the activity. Easter eggs had been bought for everyone in the home for the coming celebration. Papers are delivered daily and people told me they have other reading material that they can access. A monthly newsletter has been devised to keep people informed of the events in the home. The lunchtime meal was observed and this was seen as a social event. The tables were well presented and condiments were available. Some people were having an aperitif before their meal which they enjoyed. Those that needed assistance were provided with it in a dignified manner by the care staff. The feedback provided from people in relation to food was mixed. Some people gave negative feedback about the food. Some comments made were, The food is not very nice. It is poor quality and is often cold. The scrambled eggs the other night were horrible. The sandwiches arent inviting. The bread is doorstep thick! The food can be lukewarm and cold. There were also positive comments such as, I like the food here, it suits my tastes. You get plenty of food and you can have extras if you want. The manager and provider acknowledged that they have had some difficulties with the quality of the cooking and have put plans in place to consult people about their concerns in this area. Care Homes for Older People Page 17 of 28 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 are properly protected by the safeguarding measures used by the home. Evidence: The home has a complaints policy in place which is displayed at the entrance and made available to all in the Statement of Purpose and Service User Guide. The recent complaints made were reviewed and these were investigated correctly. Evidence was seen that showed there was a consistent training programme provided to staff in the area of safeguarding vulnerable people. Staff spoken to during the inspection showed good awareness of this area and what their roles and responsibilities were if they identified a safeguarding incident. Care Homes for Older People Page 18 of 28 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 live in an environment that is well decorated, clean and suits their needs. Evidence: A substantial refurbishment over the last year has improved the appearance of internal areas. A yearly budget is made available for refurbishment which the providers are committed to. No significant comments have been made by external inspectors and any recommendations made have been acted on. Fire and Health and Safety checks are performed as required and recorded. Maintenance and service records are fully completed and up to date and this was evidenced during the inspection. Contracts are in place for servicing of systems, equipment and waste disposal. Residents clothing is well cared for and returned promptly and accurately, there have been no reports of missing or damaged items. A room audit procedure is in place and feeds into management planning. The home was clean and tidy. People gave positive feedback relating to the cleanliness of the home. Care Homes for Older People Page 19 of 28 Care Homes for Older People Page 20 of 28 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. People receive their care packages from a well trained and recruited staff group. Evidence: Staff were observed performing their roles during the inspection. They appeared to be unrushed and had time to sit and chat with people who live there. Generally, positive comments were made about the staff by people living in the home and their relatives. Some comments thought staff were sometimes rushed and had not enough time to spend with people when they were working. The following comments were made during the inspection, The staff are busy but they make time to sit and chat. They have a lot of time to spend with people. The staff are efficient and work well. They dont have a lot of time to sit and chat but I do see them try whenever they can. They are very hard working. they will help me when I need help. There is a training matrix that has been developed to identify the training needs of the staff group. Staff were confident in the induction and training programme offered by the home. Induction training and all required training and updates are provided. Training opportunities are sought and offered to all staff inclusively. Career development training is made available. There is a programme of performance review and Care Homes for Older People Page 21 of 28 Evidence: supervision to inform training and development planning. The provider stated that staff are encouraged to extend their role following appropriate training and development. All new care staff are contractually required to undertake NVQ (National Vocational Qualification) level 2 training and over half of care staff hold qualifications at NVQ level 2 or higher. Three staff hold an NVQ level 4 in management and a registered nurse is undergoing this training. Absences are monitored. The recruitment procedures and processes were reviewed during the inspection and they were found to be robust. Care Homes for Older People Page 22 of 28 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. People receive their care in a home that has good management processes and systems in place. Evidence: The new manager has not been in post long. She is a Registered Nurse with good knowledge and experience in relation to care and care management. She is in the process of registering with the Care Quality Commission and is planning to achieve a management qualification that suits her needs and her regulatory requirements. Evidence was seen that showed the manager has a good understanding of quality assurance and how to implement a quality cycle within the home to achieve improvement. She has already began to audit the care provision and evidence of this was seen during the inspection. These audits have highlighted areas that they are good in and also areas that need more work. These have been highlighted in the evidence written in this report. Care Homes for Older People Page 23 of 28 Evidence: The home does manage some monies belonging to people living in the home. Good procedures are used to protect this service. Monies are always available for people to access if they need small amounts of cash. Regular maintenance checks are carried out on all the equipment used in the home and examples of this were seen during the visit. Fire training and fire records are up to date. Accidents are recorded correctly and audits of these accidents take place. Records showed people receive regular training in moving and handling. However, some staff were observed using unsafe moving and handling practices that placed people at potential risk of harm. The manager took this information seriously and gave assurances that moving and handling techniques would be assessed and retraining given where needed. Care Homes for Older People Page 24 of 28 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 25 of 28 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 8 13 People living in the home must be properly risk assessed in all areas that present possible risks to their wellbeing. This will help ensure potential risks are identified and managed appropriately. 30/06/2009 2 9 13 Staff working in the home 30/06/2009 must ensure the administration and recording of medication is carried out in line with professional guidelines. This will help ensure people receive their medication appropriately and get the appropriate therapeutic effect. 3 38 13 Staff must ensure they use the correct moving and handling techniques and equipment when moving people. 31/05/2009 Care Homes for Older People Page 26 of 28 This will help ensure the risk of harm occurring is minimised. 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 3 The development and introduction of a more robust preassessment document would assist staff to further assure themselves that they can meet the care needs of prospective people. It is recommended consent to care is obtained whenever possible. People living in the home and their relatives should be confident that the basic care needs such as ensuring teeth and nails are clean are planned for and met. The quality of food provision should be reviewed so that any problems and concerns people have in this area are addressed. 2 3 8 10 4 15 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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