Care Home: Island Court Nursing Home

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What the care home does well The home have demonstrated it strengths in relation to person centred assessments and care plans. We found care plans to ensure that every aspect of a persons life is looked at together with strategies in place to meet individuals needs, aspirations and desires. People told us: `I am able to do what I want within my limitations but there are always carers on hand should I need them`. `I feel very happy, settled and contented knowing help is on hand should I need it`. It was pleasing to see care plans in place to meet a persons social, religion and spirituality needs which often gets overlooked. It was positive to see that the home are including clear descriptions of any manual handling equipment that is required for individuals so that staff are able to maintain a persons safety when moving them. We found some good planning in respect of individuals last wishes. For example, last wishes in easy read formats so that individuals who have visual impairments and or difficulties with reading are able to follow their these. This provides further reassurance to people that their choices and preferences will be met at this important time in their lives. The home produces a newsletter so that people are able to read about the events within the home. These include, activities, celebrations, recruitment of new staff and results of resident meetings, where individuals views are expressed in relation to the running of the home together with their preferences. We found that the home have a good programme of activities to enable people living in the home to choose how they spend their days. The registered manager is currently recruiting a second activities co ordinator so that more activities can be arranged outside of the home in the community. Staff told us: `There are also a good variety of activities`. `Good activities and hair done each week`. People told us: `We had Ann Summers party last night and I have never laughed so much`. `We can join in whatever we want to`. The home is clean, tidy, homely and comfortable. There is a programme for further improvements to the homes interior and exterior so that people live in a home that meets their needs. This is confirmed by the registered manager in the AQAA, `Bedrooms have been recarpeted and some bedrooms have been fitted out with new laminate flooring. Bedrooms have been redecorated with a new colour scheme and fitted with new curtains and duvets. This has continued on our rolling programme of work`. People commented that they are impressed with the standards of cleanliness in the home and it has been rewarded for their efforts with a four star rating which is good from the Environmental Health Officer. There have been lots of examples of friendly interaction between staff, people who livein the home, relatives and friends throughout the day. During the visit staff have demonstrated a dedicated approach to their work and they clearly know peoples likes and dislikes together with how to meet their needs. People told us: `I get on very well with staff`. `I find them very helpful and friendly`. It was evident that the registered manager is well respected within the home by people who live there, vistors and staff alike. In the completed AQAA the registered manager demonstrates her commitment to further improve outcomes for people who live at Island Court. We observed in practice that the manager has good knowledge of individuals likes and dislikes and on the day of our visit she assisted a person back to their room noticing their frustrations. People told us: `Excellent matron, brilliant deputy manager and very good carers`. What has improved since the last inspection? The registered manager has implemented the majority of the improvements required at the previous inspection which shows the commitment of the home to work on improving outcomes for people who live there. We sampled training records and found that some staff have now received training in relation to the Mental Capacity Act 2005 so that staff are able to understand their responsibility and roles when supporting people living in the home. The home has improved its practices in respect of ensuring that bedrails are fitted appropriately and audits are in place to regularly maintain bedrails. This means individuals are reassured that their comfort and safety will be protected. Care plans and risk assessments are in place for all equipment used in the home and these are evaluated regularly. Action has now been taken in order to reduce the temperature in the treatment room on the nursing unit. The home now has a thermometer placed in this room which is checked regularly by staff and the radiator is turned off. These actions should ensure that the temperature in this room does not exceed the recommended 25 oC. Meals are thoughtfully and well prepared with menus that offer a range of options for breakfast and lunchtime. The registered manager has sought advice from the local dietician to make sure people are offered a healthier well-balanced diet and or when people require some assistance to lose weight. The home demonstrates a strong commitment to training now having achieved a further increase in its staff who have or are undertaking the National Vocational Qualification, (NVQ), Level 2. What the care home could do better: It is recommended that the home ensures that its statement of purpose and service user guide are available in easy read, larger print and audio format so that individuals who are considering living at the home are able to access this important information tobase their decision on whether the home is the right place for them to live. Daily recordings that we found were rather brief and we recommend that some thought is given to expand the details within these so that staff are able to follow any potential difficulties and evidence is recorded appropriately. Particularly around recording activities participated in by people living in the home together with family and friend contact. Also for staff to have some guidance around the terminology that is used within daily records so that this is respectful to the individual. All prescribed creams and lotions need to be stored in individuals locked drawers or cupboards in their bedrooms so that all people living in the home are safeguarded from any potential harm. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Island Court Nursing Home Bourne Street Woodsetton Sedgley West Midlands WV14 9HN     The quality rating for this care home is:   three star excellent 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: Sally Seel     Date: 2 8 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect 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 36 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Island Court Nursing Home Bourne Street Woodsetton Sedgley West Midlands WV14 9HN 0138470275 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Susan Geary-Campbell Type of registration: Number of places registered: Select Health Care (2006) Limited care home 55 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 to be accommodated is 55. The registered person may provide the following categories 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: Older People (OP) 55 Date of last inspection Brief description of the care home Island Court is a purpose built care home providing nursing and personal care to a maximum of 55 residents age 65 years and above. The ground floor accommodates residents requiring nursing care, the first floor accommodates those requiring personal care. The home is situated a mile and a half from Sedgley town centre. It is on an easily accessible public transport route to local areas, Dudley and Wolverhampton. The home has an experienced manager. A deputy manager is responsible for managing Care Homes for Older People Page 4 of 36 Over 65 55 0 Brief description of the care home care of residents and supervising staff on the first floor. Registered Nurses provide nursing care to those residents who require this service. The home provides single bedrooms only. Each bedroom has an en-suite consisting of a toilet, hand wash basin and shower. Sufficient lounges, dining areas, bathrooms and toilets are available within in the home. The home has a fully equipped hairdressing salon on the first floor. The homes fees for residency are not included in the Service User Guide. Fees do not include extra services such as hairdressing, chiropody, dentist and newspapers. Care Homes for Older People Page 5 of 36 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: three star excellent 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: One inspector undertook this fieldwork visit over a one day period of time. The registered manager deputy manager and staff members assisted us throughout. The home did not know that we were visiting on that day. There were fifty five people living at the home on the day of the visit. Information was gathered from speaking to and observing people who lived at the home. Four people were case tracked and this involved discovering their experiences of living at the home. This was achieved by meeting people or observing them, looking at medication and care records and reviewing areas of the home relevant to these people, in order to focus upon outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and Care Homes for Older People Page 6 of 36 safety records were also reviewed. Prior to the inspection the registered manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us a wealth of information with good examples about the home, staff and people who live there. Improvements and plans for further improvements have been taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. Eleven completed surveys from people living in the home and three completed staff surveys were received. Information from all of these sources was used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. We took this into consideration when case tracking four individual peoples care provided at the home. For example, the people chosen consisted of both male and female and have differing levels of care needs for both the residential and nursing units in the home. The atmosphere within Island Court is inviting and warm and we would like to thank everyone for his or her assistance and co-operation throughout the day we visited What the care home does well: The home have demonstrated it strengths in relation to person centred assessments and care plans. We found care plans to ensure that every aspect of a persons life is looked at together with strategies in place to meet individuals needs, aspirations and desires. People told us: I am able to do what I want within my limitations but there are always carers on hand should I need them. I feel very happy, settled and contented knowing help is on hand should I need it. It was pleasing to see care plans in place to meet a persons social, religion and spirituality needs which often gets overlooked. It was positive to see that the home are including clear descriptions of any manual handling equipment that is required for individuals so that staff are able to maintain a persons safety when moving them. We found some good planning in respect of individuals last wishes. For example, last wishes in easy read formats so that individuals who have visual impairments and or difficulties with reading are able to follow their these. This provides further reassurance to people that their choices and preferences will be met at this important time in their lives. The home produces a newsletter so that people are able to read about the events within the home. These include, activities, celebrations, recruitment of new staff and results of resident meetings, where individuals views are expressed in relation to the running of the home together with their preferences. We found that the home have a good programme of activities to enable people living in the home to choose how they spend their days. The registered manager is currently recruiting a second activities co ordinator so that more activities can be arranged outside of the home in the community. Staff told us: There are also a good variety of activities. Good activities and hair done each week. People told us: We had Ann Summers party last night and I have never laughed so much. We can join in whatever we want to. The home is clean, tidy, homely and comfortable. There is a programme for further improvements to the homes interior and exterior so that people live in a home that meets their needs. This is confirmed by the registered manager in the AQAA, Bedrooms have been recarpeted and some bedrooms have been fitted out with new laminate flooring. Bedrooms have been redecorated with a new colour scheme and fitted with new curtains and duvets. This has continued on our rolling programme of work. People commented that they are impressed with the standards of cleanliness in the home and it has been rewarded for their efforts with a four star rating which is good from the Environmental Health Officer. There have been lots of examples of friendly interaction between staff, people who live Care Homes for Older People Page 8 of 36 in the home, relatives and friends throughout the day. During the visit staff have demonstrated a dedicated approach to their work and they clearly know peoples likes and dislikes together with how to meet their needs. People told us: I get on very well with staff. I find them very helpful and friendly. It was evident that the registered manager is well respected within the home by people who live there, vistors and staff alike. In the completed AQAA the registered manager demonstrates her commitment to further improve outcomes for people who live at Island Court. We observed in practice that the manager has good knowledge of individuals likes and dislikes and on the day of our visit she assisted a person back to their room noticing their frustrations. People told us: Excellent matron, brilliant deputy manager and very good carers. What has improved since the last inspection? What they could do better: It is recommended that the home ensures that its statement of purpose and service user guide are available in easy read, larger print and audio format so that individuals who are considering living at the home are able to access this important information to Care Homes for Older People Page 9 of 36 base their decision on whether the home is the right place for them to live. Daily recordings that we found were rather brief and we recommend that some thought is given to expand the details within these so that staff are able to follow any potential difficulties and evidence is recorded appropriately. Particularly around recording activities participated in by people living in the home together with family and friend contact. Also for staff to have some guidance around the terminology that is used within daily records so that this is respectful to the individual. All prescribed creams and lotions need to be stored in individuals locked drawers or cupboards in their bedrooms so that all people living in the home are safeguarded from any potential harm. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 36 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 11 of 36 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 who use the service are provided with good information to assist them in deciding if the home is suitable for their needs. There is a comprehensive assessment and care planning procedure which means people can be confident they are in the right care environment where their needs can be met. Evidence: The home has produced a statement of purpose and service user guide which has been updated since their last inspection. It is recommended that these are now available in large print and audio format so that they are accessible to all individuals considering whether to live at the home. Both the statement of purpose and service user guide provides people with good insights into life at Island Court together with how individuals needs and desires are able to be met. For example, the location of Island Court, what the homes environment is able to offer individuals, what level of care is provided to meet peoples needs, social activities, meals and complaints procedure. Care Homes for Older People Page 12 of 36 Evidence: This wealth of information ensures that people are able to consider whether Island Court is the right home for them. A person living at the home stated, Family members were very impressed by the way the home was run and the friendliness of matron and staff, and another told us, We received lots of information and we were shown around the home by matron. This practice is also echoed in the homes statement of purpose, Offer trial visits to prospective service users and avoid unplanned admissions except in cases of emergency. We found in the four care records sampled that individuals needs were looked at by the home prior to the person moving there. In the completed AQAA, (Annual Quality Assurance Assessment), it states, Service users are admitted to the home once a full assessment of all needs has been considered. The assessment is carried out by the manager or deputy along side family members and professional agencies. We found letters in peoples care records which had been sent to the person confirming whether Island Court is able to provide the right care to meet their needs appropriately. Island Court provides both residential and nursing care. Therefore the staff group consist of both care assistants and registered nurses so that people can be assured that their diverse needs are able to be met by a mixed skilled and knowledgeable workforce. In one questionnaire completed by a staff member it confirmed care plans are regularly updated and all information is passed over during handover at the beginning of every shift and another staff member told us, We are told on hand over and can read the care plans. This shows that peoples needs are reviewed each day with any changes in care shared by all staff so that individuals receive the support and care required at all times. There are currently thirty eight women and seventeen men being cared for at the home, the majority being white British with a person from Asian ethnicity. The staff team reflect the ethnic diversity of the people living in the home and the care needs assessment prior to admission further highlights any particular preferences that need to be catered for. It was positive to see that care plans identify if an individual prefers to be assisted by a male or female. The home currently identifies that it has one male member of staff employed at the present time. Each person who comes to live at the home is provided with a contract which sets out the terms and conditions of their residency within the home together with the fees charged. This ensures that the rights and obligations of the person moving into the home and Island Court are known from the beginning together with who is liable if there is a breach of contract. In the main reception area the home displays its registration certificate and public Care Homes for Older People Page 13 of 36 Evidence: liability insurance for people to view if they so choose. Island Court does not provide intermediate care. Care Homes for Older People Page 14 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Island Court are supported to make decisions about their lives and take risks within a risk assessment framework so ensuring their health and well being. The management of the medication ensures that people receive their prescribed medication at the right time so ensuring their health needs are met. Evidence: We found within the four care records that we sampled that a lot of work had been undertaken to develop comprehensive care plans. All records included a detailed assessment of daily living activities that identified individuals needs and where they required help. These also looked at what people were able to do for themselves together with their likes, dislikes and preferences. For example, in one care plan it stated that the individual was unable to maintain their own personal hygiene. Therefore the action plan for staff to follow highlighted, care staff encourage X to do has much as X can themselves. Adding, X prefers to go to bed late and X likes their family to take them. X likes to wear trousers and jumpers. This information was retrieved easily and assists staff to know what care is to be given but also importantly Care Homes for Older People Page 15 of 36 Evidence: reminds staff of the risks to the individual in relation to loss of independence, privacy and dignity when staff assist them. Family and or other professionals are as far as possible involved in this process. It was evident in the care records that we looked at that care plans were drawn up with both risk assessments, relevant clinical guidelines together with clear evaluations. We found and review processes to ensure that peoples changing needs were highlighted and care or risks were amended for staff to follow on a daily basis. For example, one care plan that we looked at noted that the person had a chest infection so risks were in place for staff to be aware of, such as, reactions to antibiotics and individual developing pneumonia. Staff were also given clear clinical guidelines, administer antibiotics, observe for any reactions for example rash vomiting and diarrhoea. Encourage to deep breathing exercises to prevent pneumonia. Also some practical guidance was given in respect of making sure the person had sputum pot, tissues and a bag. Objective stated, to clear Xs chest infection, prevent temperature rising and observe any reaction to antibiotics. This means staff are able to recognise the signs of deterioration and seek support without delay. The change in peoples needs is also shared amongst staff on a daily basis at their hand over sessions. We observed a hand over meeting where staff on shift share the most up to date information in relation to meeting peoples needs with their colleagues beginning a shift. For example a practice nurse visited the home and provided staff with a leaflet in relation to what side effects to look for when administering a certain type of medicine to a person living in the home. It was confirmed that a care plan will now be completed to include this information. This provides a good insight for staff to follow and ensures any changes in a persons care needs are communicated in a timely manner. We found assessments were undertaken and care plans drawn up for risks, such as, moving and handling, nutrition and risks of skin getting pressure sores and these were reviewed. Some individuals bedrooms were viewed and pressure relieving mattresses together with bedrails were in use to minimise the risk of pressure sores developing and maintaining peoples safety when in bed. Moving and handling assessments provided staff with good details and instructions to follow such as the type of hoist and sling size together with any manufacturers serial numbers that correspond to equipment. This means that staff are able to check that they are using the correct size hoist and sling for the individual. It was positive to see that within care plans it was noted that staff should explain the hoisting procedure with the individual and let them know why the hoist is being used thereby reassuring people. This good practice ensures that people are moved safely as they are transferred from one place to another. Within risk assessments we found staff were reminded to check the equipment used on a daily basis so that individuals and staff are protected from Care Homes for Older People Page 16 of 36 Evidence: injuries due to unsafe working equipment. People living in the home were found to have aids available that were described in the care plans, such as, hearing aids, glasses, dentures and walking frames. Referrals to the dietician to manage weight and high cholesterol were evident. For example, in one care plan it was recognised that the person is on a reducing diet due to being overweight and is administered insulin for diabetes. It stated, to record weight monthly, refer to dietician, inform cook that individual is following a diet, encourage to drink plenty of water, encourage fruit between meals and inform relative to bring fruit instead of sweets and crisps. The objective was clear, try to reduce Xs weight as recommended by dietician. Weight records for all of the care records that we sampled were consistent in their recording and all showed a weight gain. We found in all care records that health care treatments were followed up with outcomes. This demonstrates that any health concerns are recorded and reported to the doctor for follow up. The outcome of the consultation is recorded so that the changing needs of individuals are well managed and records updated for instance one person had seen the chiropodist, dentist and optician. Daily records now require some improvement in relation to how staff record descriptions of people. For example, one daily record stated, X remains moody on two occasions and on a third it was noted, X can still be very moody at times. It is recommended that staff receive guidance to ensure what they record is not an opinion but is a description of events. It is further recommended that daily records consistently reflect the activities people engage in because it means staff can track if the activities fit the persons care plan. The home uses a monitored dosage system. Medicines are dispensed in blister packs. The medicines for the people being case tracked were assessed. All individuals had a medication administration record (MAR). There have been improvements in the arrangements for medication since the last visit. The MAR were well kept. There were no gaps in signing for medication that we checked. Medicines are safely stored in locked cupboards within the homes treatment room. At the homes last inspection it was noted that medications were not always stored at the correct temperatures. Staff told us that the radiator has now been turned off and showed us a thermometer which records temperatures in the treatment room to ensure that the temperature does not go above the recommended 25 oC. An audit was undertaken for the people we case tracked and this showed, received medication, administered medication, and remaining medication was in order. All staff that administers medication on the residential unit have completed their accredited training. Records of all medicines received into the home are kept and there are safe systems in place for the returns of all unused medication. We pointed out that all creams and or lotions require the date Care Homes for Older People Page 17 of 36 Evidence: that they were opened noted on their container. This means individuals are having treatments within the appropriate shelf life of the cream. Also descriptions of which part of the body these need to be applied to for all staff to follow. It was also pointed out to the staff member that if individuals have creams and or lotions stored in their rooms these need to be stored appropriately in a lockable draw or cupboard to safeguard the other people living in the home. We were told that staff would ensure that the practice of storing creams in peoples bedrooms would now be looked at so that all people living in the home are safeguarded. People were seen to dress differently to reflect their own tastes and personalities and have different hairstyles. Their clothes were clean and general appearance is good and well groomed. On the day of our inspection we observed individuals having their hair done in the homes salon facility. This shows that people are able to keep up their appearances in a way they choose. Island Court has explored service provision to ensure that issues of diversity are promoted in their practices. The AQAA completed by the registered manager provided many positive examples of how diversity is addressed within the service. This information was sampled during the visit and the inspector confirmed that gender care is assessed and where the resident prefers to be assisted by a male this is specified and in some instances addressed. Also individuals own choice in relation to their religion and spiritual beliefs are included in care plans so that these can be met. The registered manager states in the AQAA, We intend to continue to ensure training is expanded especially equality and diversity to ensure all staff are aware of current issues and changes so we can deliver improved equality and diversity in the most appropriate way. The AQAA tells us that all mail received at the home is opened by the person. All people living in the home are treated with respect and individuals rights to privacy and dignity are maintained in relation to people having access to a telephone to make private calls. All staff address individuals in the manner they request and all medical interventions are conducted in the privacy of their own bedroom. We observed staff promoting peoples privacy and dignity by using individuals preferred names and knocking on bedroom doors. People could have keys to their doors if they so wished. Within the care records that were sampled we found individuals funeral plans so that people can be reassured that their wishes will be upheld at this time in their lives. It was positive to see that some of these plans were completed in easy read formats so that individuals with visual impairments would be able to read further promoting a person centred approach to all aspects of important events in peoples lives. Care Homes for Older People Page 18 of 36 Care Homes for Older People Page 19 of 36 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. Routines are flexible enough to enable the people living in the home to make some choices. Social activities take into account the individual choices abilities and backgrounds of the people living at Island Court. Varied and nutritious meals were provided that take into account the different cultures and medical conditions of the people living there. Evidence: Island Court have a dedicated activities coordinator and are in the process of employing another so that social activities in the community can be further enhanced. In the AQAA the registered manager confirms, By taking the service users out on more outings and enjoy more social events of their own choosing organised by our new activities co- ordinator. This shows that the home are proactive when trying to ensure that there are a wealth of choices in respect of social gatherings and activities on offer for people to participate in both inside the home and community. We found that all forthcoming events and activities are displayed on the homes notice boards in peoples bedrooms and in the newsletter. We sampled the homes activity planners which noted, music and movement, quiz, entertainer, horse racing Pick a Care Homes for Older People Page 20 of 36 Evidence: Winner, news of yesterday and today, songs of praise, craft day, harvest festival, reminiscing with the photo game, bingo, Blackpool illuminations video and quiz, Ireland day, music and memories, bell ringing and Tai Chi exercise in your chair. On the day of our inspection we saw people sitting and chatting with each other some people with their visitors and others were participating in a planned activity. It was positive to note that care plans have been developed by the home to include individuals social stimulation needs. For example, in one we found, X requires assistance with maintenance of social activities. X enjoys all social activities. Concert and quizzes X can not see very well but still tries hard to enjoy themself. Staff were given good indications of the risk to the person if their needs were not met, such as, becoming, withdrawn, depressed, anxiety and isolation. The action plan told staff to, Encourage participation in arranged social activities outings and reminiscence. Encourage family visits. Suggest to X various hobbies suitable to their physical limitations. Encourage X to watch television, to listen to the radio and read daily newspapers. Facilitate frequent keyworker therapy visits. It was positive to see these person centred care plans to meet individuals social needs and that these are not overlooked which can lead to peoples mental and emotional wellbeing declining. The home operates a four weekly menu together with a separate choice of meals for people who eat a vegetarian diet. Vegetarian menu consists of choices, such as, Quorn sausage, poached egg, tomatoes, beans, mushrooms and fried bread or pasta vegetables and bolognese sauce or pizza and salad or chunky vegetable and bean soup with crusty bread. An example of one days meal options: Breakfast - porridge selection of cereals cooked breakfast which consists of bacon sausage egg and tomatoes with tea, coffee or fruit juice Lunch - Ham leek and potato bake or Cornish pastie with diced herby potatoes carrots and swede. Dessert - jam or lemon sponge or spotted dick and custard. Teatime - Sardines on toast or selection of sandwiches and rolls with a dessert of coconut cake. Supper - sandwiches cheese and crackers fresh fruit with tea coffee fruit juice Horlicks or drinking chocolate. We joined people for their lunchtime meal in the nursing unit which was a relaxed and social occasion with individuals chatting to each other and sharing their experiences of last nights social occasion, Ann Summers lingerie. People sitting on the table with the inspector shared their own experiences of meal choices and what they valued about the staff who worked in the home. Some of the comments made were, Staff are very hardworking. Sue is lovely and very caring. You can have whatever choice of meal you want. Care Homes for Older People Page 21 of 36 Evidence: The home have considered how the involvement of family and representatives of people living in the home could be maintained. This has been successfully promoted via the use of a newsletter. It is stated in the November/December edition that people living in the home had a meeting in July where they were able to make suggestions for changes they would like to see in relation to the food offered at the home. For example, some people would like to see gammon and pineapple and more cheese and toast on the menus. Comments from people about the menus were food remains good to excellent. The newsletter also announces any celebrations that have happened in the home such as birthdays and information is given about any new staff recruitments made. This ensures that people are able to have information about the home and all forthcoming events together with changes that may affect individuals lives within the home. Everybody is able to make a contribution to the newsletter if they wish. Island Court hope to build on these initiatives to seek relatives views and contributions for developing the service. The home also promotes peoples own religion and spiritual beliefs. These are developed into care plans so that individuals religion and spiritual needs are not overlooked. Church services are held at the home and on the third Thursday of each month Holy Communion is offered if people want to participate. It was positive to see that Island Court is continually looking at meeting individuals cultural needs and striving to improve the range of activities offered to people. Staff had good knowledge of promoting independence, such as, people choosing the time they get up go to bed managing their medication and finances. People living in the home said that routines were flexible they opened their own mail and were supported to vote in elections. Comments made earlier in this report regarding religion and culture show that the service has been flexible and strives to meet individual needs. Care Homes for Older People Page 22 of 36 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. Arrangements are in place to ensure that peoples views are listened to and acted on. People at Island Court are protected from abuse, neglect and self-harm. Evidence: We were told that the home have received no complaints since its last inspection. There is a complaints procedure, which has been given to all people who live in the home. The procedure is well documented and is contained in the service user guide and statement of purpose. The home confirms in its AQAA that their complaints procedure is displayed in the reception area of the home as well as on display on the residential floor. Individuals are asked on a monthly basis if they have any complaints this recorded on a complaints log. It was positive to note that complaints are also audited via the monthly Regulation 26 visits, copies of which are sent to the Commission for Social Care and Inspection, (CSCI). This further enhances the protection of people living in the home whilst ensuring that the systems are in place to deal with any complaints as they arise. Several people described their experiences in relation to complaints. One person commented, There is always matron or someone available to speak to if needed. Another person said, I do not know how to make a complaint but as things are I shouldnt imagine I will need to do so. Care Homes for Older People Page 23 of 36 Evidence: One safeguarding incident was reported to CSCI by the local authority in July 2008 and this matter was fully investigated. The outcome was that the concerns were not upheld and the matter was closed. CSCI have also received a concern made by Island Court which was shared with the local authority and fully investigated under adult protection procedures. There was lack of evidence to support who had taken the residents monies that were held by the home for safe keeping. Therefore the provider reimbursed all individuals monies and the matter is now closed. The registered manager informed us that the homes policies and practices regarding holding individuals monies is now more robust to ensure that this does not happen again. Staff training records show that most of the staff had training in Adult protection and Abuse. The registered manager also states in the AQAA, A copy of the publication, No Secrets is available for all staff to read. Staff had a good understanding of what abuse is and how it can happen. They recognise behaviour that may indicate abuse is occurring and know the procedure for reporting these concerns. Staff comments were, I would try to reassure the person and pass it on to manager. and another said, ,To ask the manager. The procedure for reporting concerns to CSCI is understood and we have received a consistent level of notifications in relation to incidents that may affect the welfare of people who live in the home. This shows that the home are proactive in relation to reporting concerns with competence in this area further safeguarding individuals from potential harm. Care Homes for Older People Page 24 of 36 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. The home is comfortable, clean and well maintained. Facilities meet the visual hearing and mobility needs of people so that they are able to enjoy living in a safe and homely environment. Evidence: A partial tour of the home was carried out during which the communal areas toilets and bathrooms and some bedrooms were sampled. All of the bedrooms are single with ensuite facilities ensuring that peoples independency, privacy and dignity are maintained. We looked in some of the bedrooms and found them to be clean and reflected individuals personalities, tastes and gender. For example, individuals had photographs of families, friends, pictures and ornaments. On each door was a picture and the persons name. The pictures were chosen by each person and reflected their particular interests, such as, football, racing, flowers and animals. In each bedroom there are call systems so that people can alert staff if they need to. In the AQQA it confirms, Bedrooms have been recarpeted and some bedrooms have been fitted out with new laminate flooring. Bedrooms have been redecorated with a new colour scheme and fitted with new curtains and duvets. This has continued on our rolling programme of work. The home have two main dining areas, one on each floor where dining tables and Care Homes for Older People Page 25 of 36 Evidence: chairs are arranged in small groups to enable social interaction to take place whilst people enjoy their meals. There are also separate lounges with comfortable seating where people are able to relax and socialise as they wish. The home have lawns to the rear and side of the home together with a patio area where people are able to sit weather permitting. The maintenance log book was viewed and demonstrated that a variety of house hold jobs and general maintenece is being undertaken consistently along side major redecoration and refurbishment. Anybody is able to place their comments in this book including people who live in the home visitors or staff. This shows that the home is consistently being well maintained. The aids and adaptations throughout the home appeared to meet the needs of the people living in the home and these included a passenger lift, level entrances and exits, grab and hand rails, assisted bathing and toilet facilities, emergency call system and there were mobile hoists on site for use as necessary. The home have been awarded a four star quality rating from their recent environmental health visit. This means that people who live in the home can be assured that hygenic standards and kitchen cleanliness is good at Island Court so that individuals are protected. The AQAA states, An extension has been proposed to extend the home to accommodate four new bedrooms, a new laundry and the treatment room moved to a larger storage area. The managers office to be made larger and to move the administration office from downstairs to upstairs. A conservatory is to be added to the downstairs dining area. Plans have been drawn up and approved and are awaiting a start date. This further shows the homes commitment to complete improvements to the enviorment so that people live in a well maintained home where improvements are constantly sought. People told us: Room and bathroom are cleaned daily. I like my room. Staff told us: Provides a warm homely environment for the service users. Care Homes for Older People Page 26 of 36 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. A diverse staff group of both registered nurses and care assistants ensure that individuals needs are competently met. Robust recruitment practices provide the homes commitment to keeping people safe and protected from harm. Evidence: From discussions with individuals, sampling of records and observation of care practice it is evident that people are supported by a well-trained and competent team of established staff that have a good understanding of their individual needs. For example over 50 of the staff team have or are working towards NVQ level 2. This exceeds the expectation and ensures the staff team is equipped to undertake their role in a skilled manner. The registered manager has continued to look at what is needed within the home in relation to the staff team and looking at the changing needs of the individuals. We observed that individuals were supported throughout the day and their needs met in a timely manner which reflects the statement made by the registered manager in the AQAA, A rota of all staff who are on duty at any time during the day and night and in what capacity is kept. We adhere to the Health authority guidelines of rotaring of staff. Staff skills match with the needs of the people in the home ensuring staff are able to offer the support needed. There is a matrix which showed mandatory training Care Homes for Older People Page 27 of 36 Evidence: completed, such as, fire training, food hygiene, infection control, moving and handling, first aid and health and safety Specialist training which is relevant to the individual needs of people living in the home included, Mental Capacity Act, symptom control, adult protection, challenging behaviour, dementia awareness and holistic needs which enables staff to gain a good understanding of how to meet and support a persons individual needs. Also the home have booked training in deprivation of liberty safeguards which has been introduced in the Mental Capacity Act 2005 and is to be implemented in April 2009. This provides further protection for people with dementia who are unable to make their own choices with regards to the care they receive. This reflects the commitment that the home have in enabling all staff to receive regular ongoing training so that people can be confident that they will receive care from a knowledgeable and skilled staff team. Island Court has a recruitment procedure that safeguards service users and meets the regulations and the national minimum standards. Four staff files were sampled all had evidence of identification a completed application form two written references and a Criminal Records Bureau check to include, Protection Of Vulnerable Adults (POVA) Check. Staff files showed that induction had been undertaken. This means that staff have a good understanding of the principles of care and what standards are expected from them ensuring that the care delivered to people in the home is of a good standard. The registered manager has worked hard on developing the improved format in relation to information being easily retrieveable in relation to an index and organisation of staffing files. This demonstrates that the recruitment procedures are robust and protect vulnerable people. Staff meetings are undertaken and these provide a forum to improve communication and promote teamwork. Staff spoke positively of the registered manager and deputy manager and felt they were approachable and listened to their concerns. They also described many improvements that have taken place which have had significant outcomes for the service users. This included consistent staff levels, good communication systems and clear targets for further improvements. People told us: I get on very well with staff. I find them very friendly and helpful. The carers listen and help in any way they can. Staff told us: We could do with a staff room. We all have regular supervisions. This gives us the opportunity to talk about any problems we have or any problems management have. Care Homes for Older People Page 28 of 36 Care Homes for Older People Page 29 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements ensure that the home is run in a way that benefits the people living there and promotes their best interests. Staff have good direction and appropriate supervision, which means they meet the needs of the people. There have been sustained better outcomes for the people who live at Island Court due to the skilled leadership of the home. There are good arrangements to ensure that the health safety and welfare of people living in the home is promoted and protected. Evidence: Susan Geary- Campbell is the manager of Island Court, is registered with the CSCI and has nine years experience of running the care home. Mrs Geary-Camplbell is a registered nurse and has completed her Registered Managers Award (RMA), National Vocational Qualification (NVQ) Level 4 and is experienced in caring for older people. Mrs Geary- Campbell is supported by a qualified deputy manager. Care Homes for Older People Page 30 of 36 Evidence: Respectfully and affectionately staff, people living in the home, family members and regular visitors prefer to call the registered manager by the title of matron. It is evident that through the determination of the management staff have clear role definitions which enables them to understand what their responsibilities and duties are. The improvements of care plans and risk assessments ensures that all care practices are, person centred, can be monitored more effectively and any shortfalls rectified. This means that people living at island Court can be confident that the home is led by proactive leadership with the ethos of providing the best possible outcomes for people and staff alike. This shows that the registered manager has the best interests of people liviing in the home at heart. One staff member commented, I think the home is very well managed and everybody works very hard to meet the needs of service users. Staff supervision records show that staff have regular formal supervision sessions to ensure that they are performing their job role. Also staff training and development needs are identified and they are able to meet the needs of the people living in the home. This ensures that the quality of life for the people who live there is kept under review. Prior to the inspection the Registered Manager had completed an AQAA and returned it to us. This gave us some information about the home staff and people who live there improvements and plans for further improvements which was taken into consideration. Throughout this report we have included information gained from the AQQA supplied to us. The manager must ensure that all the information supplied within the homes completed AQAA is correct. This is because we found that the safeguarding incidents were not included in the AQQA. A good level of communication and transparency is provided to the commission via regular monthly Regulation 26 audits that are sent by the providers. These are fairly comprehensive and informative and the latest one sent to CSCI for November 2008 shows that views of the people who live at the home are sought. This demonstrates that good efforts are being made to include the views of people and staff alike in order to make changes to the service. The arrangements for the safekeeping and financial transactions of peoples personal monies have now been tightened up to prevent any further incidents of theft and or financial abuse. Health and safety and maintenance checks had been undertaken in the home to ensure that the equipment was in safe and full working order. Maintenance checks are completed on the fire system and equipment so that people should be safe in the Care Homes for Older People Page 31 of 36 Evidence: event of a fire occurring. The reporting procedures for accidents and incidents to the commission have remained consistently good. The registered manager has shown throughout our visit and within the completed AQAA that she is determined to make further improvements to the home so that people living there have good quality outcomes. This is not only in relation to leading a diverse staff group but also maintaining her own training. Mrs Geary-Campbell had made this quite clear in the AQAA, To continue to gather more knowledge in the care of the elderly by completing a palliative care course. This shows that the registered manager has the best interests of the people who live at Island Court at heart. Care Homes for Older People Page 32 of 36 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 33 of 36 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 33 24 The registered manager needs to ensure that all information suppplied in the AQAA is factual and up to date. This will ensure that all information within the completed AQAA is relevant to the service and complies with the regulation 29/01/2009 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 To ensure that the statement of purpose and service user guide are available in larger print and audio formats so that all people considering moving to the home are able to access information upon which to base their decisions. Where prescribed creams and lotions are stored in individuals bedrooms these must be kept in locked drawers or cupboards to protect all people living in the home from any potential harm. All prescribed creams and lotions must have the date they are opened on their containers together with what part of the body staff are applying these to. 2 9 3 9 Care Homes for Older People Page 34 of 36 4 10 Staff should receive guidance with regard to the completion of daily records so that they promote individuals rights to respect. Care Homes for Older People Page 35 of 36 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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). 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. Care Homes for Older People Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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