Care Home: Halcyon Court Nursing Home

What the care home does well Everyone has a care plan, which is written in a person-centred way to make sure that people are looked after as individuals. The care plans are regularly audited by the clinical manager, to make sure that they contain all of the information that staff need to provide good care. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Another example of good practice, which helps residents who are involved with their own care plans, as well as staff, is the addition of the visual stickers on the risk assessment documents and the moving and handling plans. The nursing staff work well with other health care professionals, such as the Community Matron, with whom they have developed a good working relationship, thus improving outcomes for the people living at the home. Complaints and concerns are taken seriously, which assures people that they will be listened to. Staff receive training in how to protect people from abuse, including issues about possibly depriving people of their liberty, which means that people’s rights are protected. Staff are well-trained and supported to carry out their respective roles, which means that people get the care they need in a clean and well-run home. The home has stabilised under a stronger management team and many improvements have been made to the day to day operation of the home. This has improved outcomes for people living there, as the quality surveys reflect. What has improved since the last inspection? The home no longer has a contract to provide Intermediate Care beds for the local health care trust and has launched a new 11 place unit for people with Dementia. Staff designated to work on this unit are being trained as Dignity Champions. Written information for relatives, by way of a guide to the home, has been developed by the staff and is available in the reception area. An addition to the care plans is being introduced, the “Some Important Things” document, which gives staff a very good pen picture of the individual, and reflects the diversity of people very well. Food has improved, people saying that there is a good range of choices and it is presented well. Staff have developed a “smoothie” menu, which provides a nutritious alternative or supplement to the meals. One survey said, “Excellent food”. The number of complaints about the home has fallen significantly over the past few months. Parts of the home have been refurbished and now provide a clean, comfortable and odour-free environment for people to live in. Ongoing improvements to the fire safety precautions mean that people also live in a safe environment.Halcyon Court Nursing HomeDS0000055003.V377030.R01.S.docVersion 5.2Improvements in the recruitment and retention rates of staff mean that there has been a significant reduction in the use of agency staff, making for better consistency of care for people. What the care home could do better: The way that nursing staff administer and record medication needs to be improved. This had already been picked up by the clinical manager and raised at a nurses’ meeting. There is a risk that people either don’t get the medicines they are prescribed, or that they might be given again by a different nurse, because the record chart had not been completed. The provision of everyday social activity, and the recording of this, could be improved. One survey said the home could be improved by “having more occupational therapy and entertainment”. Someone said that they would like to be able to go out more often. The home must make sure that, in order to keep some people safe, they do not unnecessarily restrict their rights. This is in relation to the secure garden gate. The accommodation over a number of different floors can mean that staff are stretched thinly, particularly at night. This must be carefully monitored so that people’s welfare is maintained and they are protected from harm. Key inspection report CARE HOMES FOR OLDER PEOPLE Halcyon Court Nursing Home 55 Cliff Road Leeds Yorkshire LS6 2EZ Lead Inspector Stevie Allerton Key Unannounced Inspection 4th August 2009 09:50 DS0000055003.V377030.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Halcyon Court Nursing Home Address 55 Cliff Road Leeds Yorkshire LS6 2EZ 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) 0113 2743006 0113 2307326 penny.fletcher@anchor.org www.anchor.org.uk Anchor Trust Care Home 71 Category(ies) of Old age, not falling within any other category registration, with number (60), Dementia (11) of places Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 28th August 2008 Brief Description of the Service: Halcyon Court is owned by Anchor Trust, a registered charity. Halcyon Court is situated in a residential area of Leeds. The home is registered to provide personal care with nursing for up to 71 people, but in order for everyone to have single rooms, only 58 people are actually accommodated when full. Accommodation is provided on five floors and is split into different zones, all of which are named. The third floor is a self-contained unit for 11 people with dementia. A passenger lift is provided, in addition to the stairwells, which allow access to all floors. Communal bathroom and toilet facilities are provided throughout the building. A number of the rooms have en-suite facilities. There are different lounges and dining areas around the home for communal use. The home has a large parking area. It is within easy reach of the city centre. Public transport is readily available a short walk from the home. There is a wide range of local amenities. The gardens to the rear of the home are accessible and provide a seating area. To the front there is a small garden with planted raised beds and pathway. The current fees range from £417.00 to £620.00 per week; the manager provided this information at the time of this inspection. The home should be contacted directly for up to date information about fees. Additional charges are made for hairdressing, private chiropody and newspapers. Information about the service is available from the home in the form of a Statement of Purpose and Service User Guide. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars good service. This means the people who use this service experience good quality outcomes. The Care Quality Commission (CQC) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk This inspection was carried out by one inspector over the course of a day, from 9:50am until 5:50pm. The purpose of our inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there and in accordance with requirements. Before the inspection we looked at accumulated evidence about the home. This included looking at any reported incidents, accidents and complaints. We used this information to plan the visit. We looked at a number of documents during the visit and visited some areas of the home used by the people who live there. We spoke to people living at the home as well as managers and some staff. We also spoke to health care professionals who have frequent contact with the home. We asked the home to provide some information before the visit by completing an Annual Quality Assurance Assessment (AQAA). We left some survey forms at the home, providing the opportunity for people living there, relatives and staff to comment on the service, if they wished. Information provided in this way may be shared with the provider but the source will not be identified. One relative’s survey was received by the time this report was written and some of their comments are included. What the service does well: Everyone has a care plan, which is written in a person-centred way to make sure that people are looked after as individuals. The care plans are regularly audited by the clinical manager, to make sure that they contain all of the information that staff need to provide good care. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 6 Another example of good practice, which helps residents who are involved with their own care plans, as well as staff, is the addition of the visual stickers on the risk assessment documents and the moving and handling plans. The nursing staff work well with other health care professionals, such as the Community Matron, with whom they have developed a good working relationship, thus improving outcomes for the people living at the home. Complaints and concerns are taken seriously, which assures people that they will be listened to. Staff receive training in how to protect people from abuse, including issues about possibly depriving people of their liberty, which means that people’s rights are protected. Staff are well-trained and supported to carry out their respective roles, which means that people get the care they need in a clean and well-run home. The home has stabilised under a stronger management team and many improvements have been made to the day to day operation of the home. This has improved outcomes for people living there, as the quality surveys reflect. What has improved since the last inspection? The home no longer has a contract to provide Intermediate Care beds for the local health care trust and has launched a new 11 place unit for people with Dementia. Staff designated to work on this unit are being trained as Dignity Champions. Written information for relatives, by way of a guide to the home, has been developed by the staff and is available in the reception area. An addition to the care plans is being introduced, the “Some Important Things” document, which gives staff a very good pen picture of the individual, and reflects the diversity of people very well. Food has improved, people saying that there is a good range of choices and it is presented well. Staff have developed a “smoothie” menu, which provides a nutritious alternative or supplement to the meals. One survey said, “Excellent food”. The number of complaints about the home has fallen significantly over the past few months. Parts of the home have been refurbished and now provide a clean, comfortable and odour-free environment for people to live in. Ongoing improvements to the fire safety precautions mean that people also live in a safe environment. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 7 Improvements in the recruitment and retention rates of staff mean that there has been a significant reduction in the use of agency staff, making for better consistency of care for people. 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. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 4 (standard 6 is no longer applicable to this service) People using the 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 Statement of Purpose and other written information about the home, together with the opportunity for trial stays, gives people enough information to help them decide about going to live there. People are thoroughly assessed for either the general nursing care or dementia care units, to make sure their needs can be met. EVIDENCE: The home has been re-launched since the last inspection. There is no longer a contract for Intermediate Care beds, and one floor has been refurbished and recently registered as an 11 bed Dementia unit. The Statement of Purpose Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 10 has been adjusted to reflect the changes and a copy of the new document sent to CQC prior to this inspection. All of the staff working on that unit have had specific training in Dementia and are Dignity Champions. We saw a really informative document, a guide for relatives, called “A Personal Introduction to Halcyon Court”. This has been developed by the staff in the home, following the Dementia training project. We case-tracked a woman who had been recently admitted. There was evidence in her records that a pre-admission assessment had been carried out by the manager, as well as a full assessment of need by the local authority. The woman came on a week’s trial stay, which was extended into a permanent placement. On admission, a baseline assessment had been completed by the staff over a 24 hour period, which gave rise to the care plan developed for the individual. During the site visit, a family had come to look round the home. They had been given written information about the fees and services at the home, along with a brochure. It was agreed that their relative would come for a two week trial period, on the Dementia unit. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the 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 staff at the home work closely with other professionals to make sure that people’s personal and health care needs are met. Care plans have become more person-centred and individual to each person’s unique circumstances and needs, and staff have received extra training about this. This means that people are more likely to get the care and attention they need in the way they prefer, for their diverse needs. Medication is managed well most of the time, although some of the paperwork needs to improve, in order to protect people from mistakes. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 12 EVIDENCE: The AQAA stated that the service had improved person centred plans, and that nursing staff work closely with the Community Matron & Tissue Viability nurse to ensure good practice. The managers carry out regular drugs audits and nutritional screening. The Community Matron was in the home on the day of the inspection visit. She felt that the home had improved greatly over the past year. She was confident that the nursing staff carried out treatments according to advice given by her and other colleagues and said she had every confidence in the Clinical Manager. The Community Matron spends one day a week at the home, working with the Clinical Manager on nursing care issues. They are currently working together to develop the home’s standards on end of life care. There are currently two people with pressure sores. The Tissue Viability Nurse is closely involved, and the Community Matron was reviewing their progress today. We case tracked three people with a range of needs, their care plans looked at in depth and the findings verified through discussion and observation during the day. We spoke to them where possible, spoke to staff and spoke to other people living there. We observed good attention to privacy (domestic staff knocking on doors prior to entering). There are currently only two people using the service, either permanently or on respite, that come from different ethnic backgrounds to the rest of the people. There are black and Asian staff of different faiths and with a range of language skills, which means that people can be communicated with in their own language. One person on the dementia unit was case-tracked. Staff expressed concern that she was vulnerable to conflict with another resident, had been pushed over twice in the past week, due to walking into other people’s bedrooms. Accident/incident forms confirmed that. They had concerns about keeping her safe and having enough staff to do that, particularly at night. This lady has been assessed by staff as being at risk of malnutrition and records show that she has lost 6 kg in weight in 3 months. She has had high-calorie drinks prescribed, and was seen having one mid-morning. The GP has recently reduced these to one a day, as he feels she will become more reluctant to eat if she relies on these. The staff will be closely monitoring the outcome of this. The care plan records show that she is being monitored by the anti-coagulant Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 13 clinic, and had had a recent adjustment to her dose, which was cross checked with the medication records, and found to have been updated immediately. We looked at the care of a person with general nursing care needs, with a P.E.G. (Percutaneous Endoscopic Gastrostomy) feed in situ, however they can also take small amounts of a soft diet. There was evidence in his care plan of the involvement of the Dietician. Moving & Handling Assessments show that he is moved using a handling belt and walks with a Zimmer frame, wheelchairs for long distances. The care plan was signed by him. It also contained signed permissions regarding the use of his photograph and the staff looking after his medication. The care records included a pre-review questionnaire that had been completed by him. He made some comments about value for money (negative) and issues regarding the food, which the staff were aware of. This questionnaire was not dated and it was unclear from the records when his review was to be held, or if it had already happened. We also case tracked another person with general nursing care needs, who has lived in the home for many years. There was similar documentation, but also specific risk assessments, eg, bed rails. A good addition to the records was the “Some Important Things” document, which gives staff a very good pen picture of the individual. It was particularly good because of the quality of the pictorial symbols used to illustrate each area, eg, what work did they do, what their family’s names are/were, etc. This reflected diversity very well. The manager said that all of the residents will be having these developed. This person is unable to communicate verbally and there was a good guide for staff on how to understand how she communicates with eye contact, etc. A relative has Power of Attorney and handles her affairs on her behalf. This person had signed the care plan on her behalf. General to all of the care plans that were seen: alert forms at the front of the file, alerting staff to immediate changes or issues to note, which is good practice. However, it would be helpful to put the time as well as date on these – they may show up patterns of incidents, or issues regarding staff deployment. Another example of good practice is the regular care plan audits. Those seen were carried out by the clinical manager, deficiencies in the documentation brought to the attention of the named nurse or key worker and timescales given as to when they need to be rectified. This is good practice. The clinical manager monitors weights regularly, to pick up any issues of concern. Accidents and incidents are also monitored and audited monthly, by the business manager. Both of these audit records were seen. Another example of good practice, which helps residents who are involved with their Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 14 own care plans, as well as staff, is the addition of the visual stickers on the risk assessment documents and the moving and handling plans. Medication was looked at, with the assistance of the clinical manager. She had recently done one of her regular monthly audits of the medication records and had highlighted some areas of poor practice from nurses, signatures missed off and other gaps in the records. This had been relayed to the nurses at the meeting they had on the day of the inspection visit. Medication training is being provided by the pharmacist who supplies the prescribed drugs. On the dementia unit, medication is administered by the Team Leaders (care staff rather than nurses). The clinical manager was not happy with the depth of knowledge they had gained from the training so far, and has asked for some more in-depth input. There are another three dates arranged for August, then she will check their competence before they can be signed off. There are two medication rooms, newly created, with sufficient space for other clinical equipment, dressings, etc. The medication room on the 3rd floor, was extremely hot, however, and needs ventilation. The Area Manager said that a portable air conditioning unit would be put in place until a permanent solution to the problem can be afforded. The storage and recording of Controlled Drugs was inspected, with no issues noted. The anti-coagulant medication was looked at for one of the people who was case-tracked. The record chart had been updated and signed, reflecting the change in medication instructed a few days previously. The clinical manager expressed some frustration with the re-ordering of medication. The two nurses who normally take the lead on this were on leave, and the nurses on duty had waited until the last couple of tablets before saying that they needed re-ordering. This was also raised at the nurses meeting. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is making efforts to provide a range of activities for people, but this appears to be reliant on the activities co-ordinators and other staff are not as involved. Care staff need to view this as an essential part of their role in order that people feel more fulfilled. Care records also need to reflect the day to day activities enjoyed by people, not just the formal, organised ones, as these are just as important for well-being. Food has improved since the last inspection and people say they have good choices and enjoy the meals. Staff are thinking of more imaginative ways to present a nutritious diet, particularly to the people with dementia. EVIDENCE: There are two Activities Co-ordinators employed at the home and there are generally activities taking place at least five days a week, sometimes every Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 16 day. The activities notice board in the reception area displayed a range of activities and events, produced monthly. One person who was case tracked said they would like to get out more often. Another person said that their religious belief was very important to them and they would like it if they could speak to a priest regularly. However, they could not remember whether one came to the home. The AQAA stated that there is a religious service held every month and the manager confirmed that a priest does visit regularly. One relatives’ survey returned commented that the service could improve by having “more occupational therapy and entertainment.” There were currently only three people, plus a respite client, residing on the dementia unit, so staff were seen to have plenty of time to sit and talk to people and some warm and friendly exchanges were observed. Two areas have been developed on this unit that it is intended will trigger memories of life in the past: a garden, complete with gnome and a washing line with items pegged on it, and a beach with sand, shells, bucket & spade and two deckchairs. Outside, there is a secure garden area that everyone has access to. The home was successful in being granted a sum of money from Leeds City Council to fund a sensory garden in this area. Care plans could be further developed in the area of social interests and activity; people with high physical and nursing care needs tend to have care plans that concentrate on these aspects and there was little in the way of social activity being recorded. Even such things as sitting talking to someone, doing a manicure, reading out bits from a newspaper should be recorded, as they are valid activities that can fulfil individuals’ needs. The manager acknowledged that the care staff often left the social aspect of care to the activities co-ordinators, and often did not recognise that social activity does not always have to be “organised”. Meal provision was felt by management to have improved enormously over the past year. The chef has done training with Anchor that led to gaining a qualification and is producing a good standard of home-made food. In-house surveys were seen which reflected this improvement. 1 relatives survey returned to CQC said “Excellent food”. The four-week rotating menu was seen. The main meal is provided in the evening, apart from Sundays, lunch consisting of a choice of sandwiches, soup and a hot dish. There was a good range of choices on offer. Staff described how they offer choice to people at the time, rather than asking people to preorder. One person on respite stay often has an alternative if they don’t fancy the choices for that day. The chef liaises with the person and produces an acceptable alternative. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 17 Menus are on the table in the dining rooms, along with a “smoothie” menu. This idea came from the staff, following the dementia project training, as a good way of getting fruit into peoples’ diet. Two of the people case-tracked have PEG feeds, one having nil by mouth and the other able to take small quantities of liquidised food. This person prefers to come to the dining room for this, but then makes unfavourable comparisons with what other people are having. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and concerns are taken seriously, which assures people that they will be listened to. Staff receive training in how to protect people from abuse, including issues about possibly depriving people of their liberty, which means that people’s rights are protected. EVIDENCE: Spoke to some staff who were in the home on the day of inspection, having a training session, followed by a nurses’ meeting. Some raised a concern they have about the numbers of night staff currently on duty each night, and their worries about the safety of people, particularly those with dementia who are vulnerable to assault from others. Staff surveys were left, for them to make comment and one person said they were going to raise it at the nurses meeting. The clinical manager later confirmed that it had been discussed, and they were able to tell those at the meeting that four more night staff had been recruited and were just awaiting CRB (Criminal Records Bureau) checks before they could start work. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 19 We looked at feedback books, where people can make comments about various aspects of the home. We also looked at the complaints records. The number of complaints has fallen significantly since the last inspection. A complaint was made on the day of inspection, from the occupant of a neighbouring property, complaining about noise from the bins outside the kitchen early on a morning. The Area Manager said she would follow this up and visit the complainant. A survey returned by a relative said that they knew how to make a complaint, but had never had cause to. There had been a recent complaint and subsequent safeguarding referral made by hospital staff following the admission of a lady with bruising. Accident/incident forms were seen, documenting a series of falls, including some where the lady fell on top of her Zimmer frame. According to the records at the home, CQC were not notified, and we have no records that they did. Discussed this with the clinical manager – the hospital closed the case and told her they had no issues to report to safeguarding, hence they had not let us know. She was advised that these type of incidents should be reported to us anyway. The manager has a good awareness of the Mental Capacity Act Deprivation of Liberty Safeguards and we discussed these in relation to the locked garden area. We agreed it was not a deprivation, but a restriction. The CQC Registration Inspector had advised a secure gate because of the people with dementia in the new unit that was being registered. It is unusual to have a key on a chain to unlock a padlock. The home agreed to keep this under review. Deprivation of Liberty Standards training had been arranged for the following day. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Parts of the home have been refurbished and now provide a clean, comfortable and odour-free environment for people to live in. Ongoing improvements to the fire safety precautions mean that people also live in a safe environment. The arrangements for the security of the garden for people with dementia, may mean that other people are being restricted and this must be kept under close review. EVIDENCE: Information on the AQAA stated that there was an ongoing refurbishment plan throughout, for all bedrooms; new carpets in communal areas; an odour free and clean home and thorough detailed cleaning schedules, with audits. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 21 A tour of the building was carried out, accompanied in part by the clinical manager. The main gate to the reception is padlocked, a notice instructing how to gain entry with the key, which is attached to a chain. This is an unusual way to secure a garden, and the manager was advised to follow this up with the Fire Officer. She said that the Fire Officer has seen this on visits to inspect safety work that has been carried out, and made no comment. The top floor is the main lounge and dining room; this has been out of use for the past six months, whilst fire safety work has been carried out, now almost completed (a refuge at each end of that floor has been created, behind extra fire doors). People have had use of the dining room on the ground floor, but many have opted to take their meals in their own rooms. The newly created 11 bed Dementia unit is on the 3rd floor, and has its’ own sitting room and dining room. A new shower room and bathroom has been installed for this unit. People’s bedrooms were seen in passing and one lady on the Dementia unit invited me to see hers. Rooms are big enough to be personalised and are well furnished. A lot of carpets have been replaced since the last inspection. The home had no unpleasant odours and staff also said that this had improved greatly. There is a designated smoking room on the ground floor, though only 1 person currently uses this. The kitchen was not inspected. The laundry has been recently moved to the basement, and the construction of a dirty laundry chute is currently in progress. A new floor has been laid and there is a logical flow through the laundry area from dirty to clean. Red bags are in use and there is a disinfection cycle on one of the washing machines. The whole area looked organised and was very clean. A laundry assistant works from 8am until 4pm each day. The manager said that the NHS had carried out an Infection Control audit the previous week and they had received good feedback, with only a couple of recommendations. One of the nurses has received training as a Fire Safety Co-ordinator, and one of the Team Leaders will also be trained; this will enable them to cascade training to the rest of the staff team. There are 2 Health & Safety Coordinators on the staff team – the maintenance man and the hospitality team leader. There is currently one Back Care Co-ordinator, providing moving & handling training in-house; this was being done on the day of the inspection visit. Appropriate risk assessments were seen to be in place for safe moving & handling, the use of bed rails, etc Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in the recruitment and retention rates of staff mean that there has been a significant reduction in the use of agency staff, making for better consistency of care for people. Staff are well-trained and supported to carry out their respective roles, which means that people get the care they need in a clean and well-run home. The accommodation over a number of different floors can mean that staff are stretched thinly, particularly at night. This must be carefully monitored so that people’s welfare is maintained and they are protected from harm. EVIDENCE: The AQAA stated that there had been a large reduction in the use of agency staff. They had robust recruitment procedures in place and all new staff have probationary periods. NVQs (National Vocational Qualifications) are free to staff. Regular staff meetings take place, also questionnaires & surveys. Staff receive supervision and have opportunities for e-learning. The home plans for more staff to receive the five day training to become dignity champions. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 23 We looked at the personnel records for two recently recruited staff. These showed that the recruitment process is thorough and that the correct background checks are being carried out. There was evidence that staff are employed subject to a successful probationary period of up to 6 months. Induction training leads to ongoing training for all job roles. The staff rotas showed where in-house training sessions had been booked in, eg, Back Care update on the day of inspection, Deprivation of Liberty Standards the following day. Care practice workshops are also held, covering person centred care, key working and “back to basics” refreshers. On the day of inspection the following staff were on duty: two nurses, plus the Clinical Manager, eight care staff up until 12:00 and six carers until 8:00pm. The full-time shifts are 12 hours 8:00am – 8:00pm. There is a separate kitchen rota, including domestic support, and a housekeeping rota which shows two or three domestic staff working in the home. A new post of Team Leader has been created for the Dementia Unit, which is social care, rather than nursing. The Manager said that the use of agency staff had been greatly reduced. The night time rota shows one nurse and three carers for the 35 people currently accommodated over five floors. Staff expressed concern about this and intended to raise it at the nurses’ meeting. The manager said that as soon as the CRB checks were back, four new staff can start, which will increase the night staffing to one nurse and four carers. Staff of various job descriptions were met during the day: reception and administrative staff, the Business Manager (Registered Manager), Clinical Manager, chef, nurses and care staff. The receptionist spoke about the importance of good customer service at the front of house and there was evidence that staff are being trained in these skills Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 People using the 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 has stabilised under a stronger management team and many improvements have been made to the day to day operation of the home. This has improved outcomes for people living there, as the quality surveys reflect. Records, policies and practices promote and safeguard the health, safety and well-being of people living at the home, improving their quality of life. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 25 EVIDENCE: Looked at a sample of operational and regulatory records, including: care plans, accident records, medication records, fire safety records, health & safety records, maintenance records, staff personnel records, staff rotas, staff training records, menus, kitchen hygiene records, complaints records, financial records, minutes of relatives’ meetings. Anchor carries out a “Safe Site” Health & Safety audit periodically, which the manager said was due shortly. Certificates confirming the safe systems in place in the building were up to date and available for inspection. The Business Manager is in the process of registration with CQC. She had just had her Personal Development Review. She is an experienced and qualified Manager. She was doing a live interview on local radio on the morning of the inspection, talking about the new Dementia unit. She and the Clinical Manager are both shown on the rota as being available Mon – Fri during the day. They are supported by designated staff working on reception and administration. The Manager had produced an action plan, which has been updated as things are put in place. The action plan is based on CQC’s KLORA (Key Lines of Regulatory Assessment), which is good practice. Some issues are still ongoing, but it can be seen what action was taken and by whom and what is still to be worked on. The home carried out some quality surveys in the previous month. The report on the survey outcomes of 6 months ago was also seen. It was clear that people are experiencing better outcomes now. Comments from the most recent survey included: (from a GP) “care staff are always helpful”, “the nurses are very good”, “the senior nurses are first rate and I trust their judgement completely”, “the general care has improved greatly”. The survey for people who live at the service, entitled “Let’s Talk”, showed a common theme in that many people did not know their key workers. We discussed ways of giving this more prominence Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 26 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 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X 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 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement All medication must be properly recorded when given, or an explanation recorded why it has not been given. This is to safeguard people, make sure that their medical conditions are treated and prevent other staff from making errors. Ventilation to the medication storage room on the 3rd floor must be improved. This is so that medication and clinical supplies are kept at the right temperature, as well as protecting staff working in that room from becoming overheated. Timescale for action 04/09/09 2 OP9 13(2) 04/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 28 No. 1 Refer to Standard OP12 Good Practice Recommendations Everyone should have their personal interests recorded, along with a plan of how the staff aim to promote these, and a record of how these needs are being met on an everyday basis. This is so that people are helped to live fulfilling lives. The security arrangements for the garden gate should be closely monitored. This is so that any issues about depriving or restricting people of their liberty are fully discussed; and also that the current arrangements do not create a problem in the event of a fire evacuation. The manager should keep the staffing ratios under close scrutiny whilst the home is admitting more people. This is so that the staff numbers increase accordingly and everyone’s needs are met, day and night. 2 OP19 3 OP27 Halcyon Court Nursing Home DS0000055003.V377030.R01.S.doc Version 5.2 Page 29 Care Quality Commission Yorkshire and Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. 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. 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