Care Home: King Charles Court

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• Fairfields Country Rest Home
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What has improved since the last inspection? Care planning has been reviewed and developed and is consequently much more detailed and informative. Resident`s personal choices and wishes are generally included within the care plan now. Continence assessments and management has much improved since the last inspection and should continue so that individual residents needs are managed appropriately. Considerable effort has been made to improve the leisure facilities for residents. A full time activities co-ordinator is employed and the programme of activities continues to be developed and includes some outings and entertainment in the home. We were told and also observed, that several areas of the home have been redecorated and refurbished since the last inspection. At the last key inspection 12 requirements were made regarding breaches of regulation. A random unannounced inspection took place on 11 November 2008. This inspection focused on prioritised requirements set at the last key inspection. It was evidenced that 7 requirements regarding, health care, safeguarding, infection control, registration of the manager, quality assurance, safekeeping of residents valuables, record keeping and health and safety issues had been met. The remaining 5 requirements were regarding staff supervision, care planning, medication and privacy and dignity. At the random inspection we evidenced that work was being undertaken to ensure that these requirements would be complied with but were not fully met at that time. Following this key inspection it is evidenced that these remaining 5 requirements have been met. What the care home could do better: We discussed staffing levels with the registered manager and staff who felt that currently the staffing was adequate. One resident commented that sometimes the call bell takes a while to be answered as the staff are very busy. We observed that staff did appear to be busy and during the afternoon, it was difficult for us as visitors to the home, to locate them. We also observed that residents were sitting in the lounge for periods during the afternoon with no staff available in the area to assist them if needed.King Charles CourtDS0000009186.V375290.R01.S.docVersion 5.2Page 8We asked staff within the surveys prior to the inspection `What could the service do better?` Comments received from staff included `More staff needed to respond to call bells quicker and assist residents to the toilet`, `further work on documentation but this is ongoing and improving all the time`, ` more things for residents to do` and `provide a more nutritional diet`. Unfortunately these surveys were completed and returned anonymously so we were not able to discuss these areas further with the appropriate staff. Discussion and observation on the day did not uphold that there is a lack of activities within the home or that a more nutritional diet is needed. During the inspection we noted that there is limited space for residents to sit outside. This was supported by the expert by experience and their conversations with residents. Their are currently fund raising events taking place to enable the staff team to develop the care park area. We were advised at the last key inspection that the side area at the rear of the home would be developed to provide a private seating area. At this inspection we were told that this was not feasible due to the steepness of the garden. Care plans should continue to be reviewed and developed so that they consistently inform and direct staff of the action they must take to meet individualised care needs. The environment, whilst having improved since the last key inspection, should continue to be updated and refurbished. A maintenance plan and record should be available. Key inspection report CARE HOMES FOR OLDER PEOPLE King Charles Court Marlborough Road Falmouth Cornwall TR11 3LR Lead Inspector Melanie Hutton Key Unannounced Inspection 5th May 2009 09:00 DS0000009186.V375290.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. King Charles Court DS0000009186.V375290.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 King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service King Charles Court Address Marlborough Road Falmouth Cornwall TR11 3LR 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) 01326 311155 01326 319548 kcc@comfortcaregroup.co.uk King Charles Court Limited Ms Suzanne Laura Watson Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (30), Terminally ill (30) of places King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service users to include up to 30 adults of old age (OP) Service users to include up to 30 adults under pensionable age with a physical disability (PD) Service users to include up to 30 adults with a terminal illness (TI) Total number of service users not to exceed a maximum of 30 Date of last inspection 14th May 2008 Brief Description of the Service: King Charles Court is a care home with nursing located in Falmouth. It is situated above the town, although close to the amenities. Many of the rooms have views over the Carrick Road and Falmouth Docks. The home is registered for up to 30 residents who require personal and / or nursing care. There is a qualified nurse on duty at all times. The registered manager and responsible individual are also registered general nurses. Accommodation is provided on two floors with a lift to access the first floor. Two rooms are accessed by a chair lift. A number of bedrooms have en-suite facilities and all the bedrooms have call bells. There is a large dining room, with a lounge area at one end, on the ground floor; this is next to the kitchen. There is a smaller lounge on the first floor. There is a small kitchenette on the first floor where staff can make drinks and serve snacks for residents. There is a very small garden in the grounds at the back of the home; this is not currently accessible to residents. There is limited outside seating for residents at the front of the building. The car parking space to the front of the building is limited. The front door to the home is locked at all times and accessible by a keypad. The visiting arrangements are flexible. Fees range from £530 to £700 per week. This does not include toiletries, newspapers, equipment purchased solely for the benefit of the resident, costs arising from trips and visits outside the care home. The fees payable by service users whose care is commissioned and purchased by the Cornwall Department of Adult Social Care (DASC) or the Primary Care Trust will depend upon their financial circumstances and will be based upon a financial assessment undertaken by DASC. King Charles Court DS0000009186.V375290.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 2 star. This means the people who use this service potentially experience good quality outcomes. This was an unannounced key inspection that was undertaken by two inspectors spending 8 hours in the home. We also received assistance from an expert by experience who spoke with residents and staff during the inspection. People who use the service are referred to as residents in this report to reflect the terminology used within the home. The Annual Quality Assurance Assessment (AQAA) has been completed in detail and returned to us promptly, when requested. At this key inspection we spoke to 8 residents, 4 relatives, the registered manager, several staff and the registered providers. We sent out surveys to residents and staff prior to this inspection visit. We received 6 completed surveys back from staff members and 9 from residents. The comments made within the surveys are included throughout this report. We looked at records, care documentation, policies and procedures and inspected the environment. Case tracking and direct observation were used. The expert by experience provided us with a written report following the inspection. Extracts are included throughout this report and the conclusion of the experts report is as follows: The home occupies a listed ex school building which has been thoughtfully converted. The rooms are decorated in light shades and some of the rooms have amazing views out to sea. There are two lounges where residents can sit and watch television if they choose. Although the home is light, clean and well decorated I was concerned that the residents are not able to sit outside. There is limited outdoor space available and at the moment this is used as a car park. I was told by the manager that £900 has been collected to provide a seating area that would take part of the car park but unless gates are installed this would not be a secure area. Unfortunately the small garden area that is at the side of the building is not accessible, if a way were found to make this accessible it would make a safe and secure area for residents to enjoy the sun. I have experienced living in a flat with no garden and it was the most claustrophobic place I have lived, I could not bare the thought of being shut in a building all day and not able to enjoy the sun and fresh air. This is a time of their lives when being able to enjoy the fresh air is paramount. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 6 What the service does well: Staff were observed to respect resident’s privacy and dignity by knocking before entering private bedrooms. Respect is shown as the staff use the preferred form of address of the resident. Residents told us “the staff are kind and thoughtful” and “Suzanne the manager is very good, she always pops into see me and I could always discuss anything with her” Visitors are made welcome to the home by the staff and observations were made of positive and friendly interactions between the staff and visitors. We spoke with 4 people who were visiting the home to see their relatives. Comments made included ‘my relative is well cared for, although there could be more staff’, ‘My mother is well cared for, fed well and her personal care is provided to a good standard’, and ‘the staff are kind and always nice, the food is fine’. Residents told us that they enjoyed the food provided to them and it was clear that choices of meal are offered at each and every meal. Residents can also choose a different option to the choices detailed on the menu if they so wish. During the inspection we saw that this took place with one resident having a separate choice from the 2 menu choices at the main midday meal. Residents are included in the planning for the home and their views are sought by the registered manager and whenever possible acted upon. A residents meeting takes place regularly. We were able to see evidence where residents choices have been taken into account examples of which include: a cooked breakfast being provided, a suggestions box located within the home and mealtimes altered. Pre admission and admission care needs assessments are detailed and reviewed regularly. This ensures that the home is able to meet the care needs of the resident at admission and any additional or changes to their care needs. Within the staff surveys that we sent out we asked ‘What does the service do well’? Staff commented ‘nutrition, activities and during recent months the home has shown a great drive to meeting care standards’, ‘diets and fluids for residents’, ‘staff work very hard and as a team’, ‘the home provides a caring home for residents that need help, either physical, mentally or general care. Independence is promoted in their every day lives’ and ‘it cares about the individual needs of the resident’. At the end of the staff surveys we asked ‘Is there anything else you would like to tell us?’ and staff commented ‘this is a very good service provision’ and ‘I receive all the help and support I need to do my job’. Residents who completed surveys prior to the inspection made the following comments: ‘It is a very nice home, I am happy to be a part of it’, ‘I am completely happy here, it is my home’, ‘I find the staff are like friends and contribute to the atmosphere of give and take’ and ‘There are some lovely people here’. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 7 A relative completing a survey for their relative said ‘XXXX and all his family are very happy with his care. This is an excellent home with excellent facilities’. What has improved since the last inspection? What they could do better: We discussed staffing levels with the registered manager and staff who felt that currently the staffing was adequate. One resident commented that sometimes the call bell takes a while to be answered as the staff are very busy. We observed that staff did appear to be busy and during the afternoon, it was difficult for us as visitors to the home, to locate them. We also observed that residents were sitting in the lounge for periods during the afternoon with no staff available in the area to assist them if needed. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 8 We asked staff within the surveys prior to the inspection ‘What could the service do better?’ Comments received from staff included ‘More staff needed to respond to call bells quicker and assist residents to the toilet’, ‘further work on documentation but this is ongoing and improving all the time’, ‘ more things for residents to do’ and ‘provide a more nutritional diet’. Unfortunately these surveys were completed and returned anonymously so we were not able to discuss these areas further with the appropriate staff. Discussion and observation on the day did not uphold that there is a lack of activities within the home or that a more nutritional diet is needed. During the inspection we noted that there is limited space for residents to sit outside. This was supported by the expert by experience and their conversations with residents. Their are currently fund raising events taking place to enable the staff team to develop the care park area. We were advised at the last key inspection that the side area at the rear of the home would be developed to provide a private seating area. At this inspection we were told that this was not feasible due to the steepness of the garden. Care plans should continue to be reviewed and developed so that they consistently inform and direct staff of the action they must take to meet individualised care needs. The environment, whilst having improved since the last key inspection, should continue to be updated and refurbished. A maintenance plan and record should be available. 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. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 9 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 King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 10 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 and 6 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. People are provided with information that enables them to make an informed choice about the home providing them with care and accommodation. Care needs assessments are undertaken prior to admission so that the home can ensure they can meet the needs of the service user. EVIDENCE: The statement of purpose and service user’s guide have been updated since the last inspection. The registered manager provided us with the up to date documentation on the day of inspection and told us that each resident and/or their representative has been issued with this information. The guide and statement of purpose given to us on the day of inspection form one document, King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 11 presented in a folder. A copy is also available within the entrance area of the home. Case tracking of the records of the most recently admitted people show that a care needs assessment has been undertaken and detailed records are kept of this. We were told that the registered manager or trained nurse visits each prospective resident prior to admission. At this visit a care needs assessments is completed to make sure that the service is able to meet the needs of the individual. The views of the prospective resident and their relatives or representatives are taken into account during this process. We were told that this service does not provide intermediate care or rehabilitation services. A period of respite care can be available to people when there is accommodation available. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 12 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 and 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. Care plans inform and direct staff as to the action they must take to meet the individual needs of the residents. The privacy and dignity of residents is respected and their health care needs are met. The medication policy and procedure in place is robust. Medication systems follow good practice guidelines and protect residents. EVIDENCE: Each resident has a care plan. The system of care planning has been changed since the last inspection and subsequently all care plans have been completely reviewed and developed. Residents are included within the care planning process and sign to show their agreement with the care plan whenever King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 13 possible. Most of the care plans now inform and direct care staff on how to support the service user’s own capacity for self care and meet their needs. We discussed with the trained nurse on duty and the registered manager some areas within care planning that do not fully reflect the residents personal preferences and choices e.g. whether the resident prefers a bath or shower and how frequently they would like this aspect of their personal care. Care plans incorporate risk assessments including moving and handling issues. It is recommended that detailed information is consistently included regarding the equipment used. For example one care plan identified that a hoist was to be used but not the type of hoist or size of sling to be used. The current staff team do appear to be aware of this information but to ensure the continued safety of residents this should be recorded consistently within the care plan documentation. Residents we spoke with told us they are satisfied with the manner in which their care needs are met and expressed confidence in the staff. Comments included ‘the staff talk through any assistance they are giving e.g. when moving me’ and ‘I have no concerns at all about practice, the staff are always nice and look after me well’. A daily handover takes place for all staff arriving on shift and includes touring the building to see all the residents. A comment in a staff survey stated ‘recent changes in daily handovers have been successful and make it easy for all staff to contribute and participate’. Another staff member returned their survey anonymously and stated that communication is poor – it was not clear what this was specifically referring to within the home. Staff we spoke with during the inspection did not identify that there were issues with communication. Records evidenced that residents are visited by external professionals e.g. General Practitioners, community nurses, tissue viability nurse, dietician, speech and language therapist, chiropodist, physiotherapist and optician. Individual records reflected the referrals made to external professionals and the outcomes of their visits. Since the last inspection the trained nurses have developed link nurse roles for specialist areas. The promotion of continence within the home has improved and currently the continence assessments are being reviewed. Those completed are detailed and thorough. Care plans are now more specific regarding the use of continence aids and any specific assistance needed to promote the continence of individual residents. Nutritional assessments are undertaken and work has progressed to ensure that residents receive a diet appropriate to their needs. The home has introduced a system called the blue cup initiative. This promotes and ensures that residents assessed as needing additional calorific content drinks receive these. Menus are available within the home to include these supplements within soups, milkshakes and meals for residents. Pressure relieving equipment is available in the home and recorded within care planning documentation. A chiropodist visits the home regularly. The optician and dentist have made recent visits to the home. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 14 Daily records appear more detailed and informative since the last inspection and reflect personal care provided as well as health issues. A qualified nurse administers all medication and a Monitored Dosage System is used. The quantities of medications received into the home are identified on the Medication Administration Record (MAR), and a separate record identifies any medication leaving the home. MAR sheets were inspected and were observed to be completed appropriately, evidencing why and when any medication has been omitted. Each resident has a photograph held on their medication sheet to ensure their protection during the administration of medication. There are policies and procedures in place. There is a designated fridge to store medication that requires this facility, with temperatures recorded three times a day. The fridge was not locked on the day of the inspection, but is stored within the medication room that is secured by a key pad. There is a Controlled Drugs (CD) cupboard and a CD register. A random check of three controlled drugs identified that the register has been maintained appropriately and was accurate. No residents currently self administer their medication. As the home is being refurbished the new furniture provides a lockable facility in residents rooms. This would enable secure and safe storage of medication should a future or current resident wish to self medicate. Oxygen was stored and in use within the home and appropriate signing in place. It was observed that an oxygen cylinder had been temporarily stored within the clinical room. If this is to be used as a temporary store for oxygen (the main store is outside of the home through the laundry), a warning sign should be in place. The staff were observed to knock on resident’s doors prior to entering. Residents preferred names are recorded on the documentation and the staff were observed to use these and speak to the residents respectfully. One resident told us “the carers are kind and thoughtful and polite”. One resident expressed a preference for some carers but did not elaborate on this or provide information as to their reasons for preferring certain carers to others. Other residents, and their representatives, who we spoke to, said they were generally very happy with the care. Written records are in place to support the residents wishes regarding sharing a room. Screening is provided in the shared rooms. Records also detail the preference of the resident regarding the gender of their carer. The registered manager told us that the duty roster has been reviewed to ensure that there is always at least one female carer on duty. One female resident was very positive in her comments regarding the male members of staff and the manner in which they deliver personal care. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 15 There are currently no people who use the service from ethnic minorities, although it is understood the home would be happy to accommodate people who use the service from other cultures. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 16 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 and 15 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 activities programme caters for the current resident’s leisure and social needs. Visitors are welcomed in the home at a time convenient to them and the resident. Residents are able to make choices regarding their daily lives. Residents enjoy the meals provided. EVIDENCE: The activities co-ordinator was on duty on the day of the inspection. The expert by experience told us ‘I spoke at great length to the full time Activities Organizer who came across as very positive and enthusiastic and has organized numerous outings and entertainment. Given that the residents have varying degrees of mobility and interests it seems that she has quite a task to please them all but appears to be very experienced in arranging a variety of activities, she also has one to one weekly sessions where she talks, sings and reads to them’. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 17 Evidence around the home showed us that social and recreational opportunities are taking place and residents are made aware of these. Records are made of the activity provided, whether the resident chose to attend or not and their enjoyment or participation if they did attend. External entertainers come to the home as well as the activities co-ordinator planning and carrying out activities. A member of the care staff is a trained beauty therapist and provides manicures to some of the residents. Activities take place within groups and also on a one to one basis. e.g. help with a crossword and collection of reading material. The resident’s care plans and assessments contain information about social, leisure, spiritual and recreational interests. The activities coordinator has developed written information including the life story and pen picture of individual redsidents. Visitors are able to visit at any time, information about this is included in the service users guide. 2 residents told us that they frequently have visitors and these visitors are welcomed at whatever time they arrive. The visitors book shows that the home receives many visitors at varied times of the day. The front door of the home is locked for security purposes. Visitors attending the home on the day of inspection were observed to be greeted warmly by the staff. We spoke with a number of visitors to the home who were satisfied with the care that their relative receives. The registered manager told us that currently there are no concerns from the residents regarding any visitors they receive. The home has supported residents in the past when they have voiced that they have not wished to receive certain visitors. Individual choices and preferred routines are generally recorded within the care plan documentation. We observed records and evidence of people getting up at different times and preferences regarding meal times e.g. breakfast. Staff were able to tell us about residents preferred routines regarding getting up and personal care. The kitchen was clean and orderly on the day of inspection and uses the ‘Making Food Safely’ programme. The home provides three varied meals each day with the menu operating on a rolling programme and offers a choice from two options at the main meal of the day and what appears to be many choices at tea time. Food records are kept that show the choices that residents make. Kitchen staff told us “they (the residents) can have what they want really, we tend to give them what they want particularly at tea time”. One survey completed by a relative stated that ‘there are too few options at tea time and not always enjoyed’. This was an anonymous survey and unable to be discussed further and we did not find other evidence to support this on the day of inspection and through talking to and surveying other residents. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 18 Residents told us that they enjoyed the food and confirmed that there was a good choice. Comments made included: ‘the food is lovely, I generally like everything on the menu’, ‘ if you don’t fancy what is on the menu you can always have something else’ and ‘The food is very good, there is always lots to choose from’. We asked residents within surveys if they liked the meals at the home. We were informed: ‘We have very good food, that is nicely presented’ and two people said they would like more variety on the menu. The cook told us that the menus are currently being revised to provide a more seasonal menu. The staff discuss daily choices with the residents. Breakfast, consisting of porridge, cereals, toast and fruit, is served by the care staff from the kitchenette. Residents did not appear to go to the dining room for their breakfast. Following consultation with the residents, a cooked breakfast is now available at least once a week. We observed one person having their breakfast at approximately 10.30 a.m. The staff member told us that this is because they like to get up later and have breakfast once out of bed. The registered manager told us that meal times have been reviewed to ensure that meals are evenly spaced. The main meal of the day is served at approximately 1 o’clock with the tea time meal at approximately 5 p.m. and supper during the evening. The main meal of the day was a choice between roast beef and Yorkshire puddings or salmon with hollandaise sauce. The vegetables available were minted potatoes or creamed potatoes carrots and broccoli. The team time menu included soup, bacon, baked beans, hashed browns, mushrooms and sandwiches. We observed that a chicken had been roasted earlier in the day to be included in the sandwiches at tea time. People were also offered fresh strawberries, raspberries or home made cakes, cheese and biscuits, yoghurts or ice cream. The expert by experience told us ‘There is usually a choice of two meals at mid day. I stayed with four of the residents during the meal and was impressed with the quality and presentation, they were very happy with the food and in my opinion it looked very nutritious. The staff were attentive to the needs of those who needed help with cutting or feeding. Some residents who have mobility problems have their meals in their room’. Fresh fruit and vegetables are available in plentiful supplies. Fresh fruit is offered to residents throughout the day both at meals and from the tea and coffee trolley. The store cupboard was well stocked with food of a high quality in place. Sherry, wine, beer and fruit juices are available for those residents who request this. On the days of the inspection there was the Head Cook and Kitchen Assistant on duty all day. Kitchen staff are provided with appropriate training. Special diets are catered for individually. Kitchen cleaning rotas are in place and adhered to. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 19 The dining room is comfortably decorated and enjoys views across the sea. A daily menu board is in place and was up to date. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 20 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): 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. Residents and their representatives are provided with information on how to complain should they need to do so. Residents are protected from abuse, by the homes policies, procedures and staff training. EVIDENCE: The service users guide includes the complaints procedure for the home, this states if the process is unsuccessful the person can refer onto the Care Quality Commission (CQC) or the Department of Adult Social Care (DASC). During the inspection we observed records relating to 4 complaints / concerns made to the home. Records of the subsequent investigation were available for inspection. One concern raised by a relative was not recorded within the complaints log although full detail of the subsequent investigation by the registered manager was available for inspection. We asked residents within surveys if they knew how to make a complaint. All 8 residents who completed and returned surveys said that they did know how to make a complaint with comments made: ‘I’ve never needed to make a complaint. If I have an odd grumble here and there it is always sorted out right away’ and ‘I have always been very happy here and not needed to King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 21 complain’. Residents we spoke with during the inspection told us that they felt if they had a concern they could speak with any of the trained nurses or the registered manager and that the issue would be addressed. Again none of the residents we spoke with had needed to make a complaint. There is a procedure for the Protection of Vulnerable Adults that includes whistle blowing and is provided to staff. All staff are provided with training on safe guarding adults at induction. The training includes completing a work booklet and question sheet, which is sent to an external company for marking. The responsible individual is also a trainer for Cornwall County Council’s safeguarding training programme and provides support to staff in house. 2 members of staff told us that they were due for update training regarding safe guarding adults and were aware that a date is being arranged for this training to take place in the near future. The expert by experience told us ‘In total I spoke to four residents who were happy with the care they received and had not experienced bullying or insensitivity from the staff’. Since the last inspection there have been 4 safeguarding issues identified at the home relating to the care of residents. DASC and the health trust have been involved in safeguarding meetings and resolving these issues. A final meeting is due to take place in June – the registered manager told us that all actions have been taken and issues addressed to resolve the issue. She believes it is the intention for the safe guarding to be closed at this next meeting. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 22 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): 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 home provides a physical environment that meets the needs of the resident’s currently living there, although residents safe access to outside space is limited. Records show that checks and maintenance have been carried out. The home is clean and hygienic and on the day of inspection free from odours. EVIDENCE: The home is located in Falmouth overlooking the harbour, there is a car park to the front of the home. Some rooms have sea views. The residents we spoke with told us that they liked their accommodation. The environment is generally King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 23 comfortable and homely. There is a lounge/dining room on the ground floor, which enjoys pleasant views of the sea and a cosy lounge on the first floor. We were able to observe that a number of the bedrooms and communal areas have been refurbished since the last inspection. The registered manager appraised us of the areas that are prioritised for refurbishment. Some carpets e.g. in the entrance hall appeared stained and some paintwork e.g. skirting boards were scratched and damaged. Staff make a note for the maintenance person of any daily issues e.g. changing of light bulbs or emergency repairs. The maintenance person is shared with the sister home. It is recommended that a programme of planned maintenance and refurbishment is produced and implemented with records kept. A member of the domestic team keeps cleaning records. Alarms are fitted on external doors and the front door of the home is locked. The garden is at the rear of the home and currently not accessible to residents. It is accessed via a number of steps and the grass area is overgrown. The manager told us that following residents meetings, plans are being made and funds raised to develop the area at the front of the home to make it more useable to residents. Currently there is seating for 2 people outside the front door for use when the weather is fine. One resident told the expert by experience that they would very much like to be able to sit outside in the sunlight when the weather permitted. Resident’s rooms were observed to be clean and comfortable in appearance. It is recommended that residents are able to lock the doors to their room if they wish to and if their risk assessment is appropriate. Lockable facilities are now becoming available to residents in their own rooms, with the provision of the new furniture when rooms are refurbished. The expert by experience told us ‘The rooms were warm and light and care has been taken to make the surroundings pleasant. I observed one room where the resident was chair bound so a mirror had been hung in such a way that she could see the amazing sea view through the window. When the rooms become vacant they are tastefully decorated for the new resident’. We made recommendations at the last inspection that the bathrooms be made less clinical. This has been achieved in the bathrooms and plants and pictures are in place. The shower / wet room on the first floor should be reviewed as it does not appear to be user friendly e.g. the light switch is behind the door, there is no soap or paper towels or toilet roll. We discussed this with the registered manager who stated that this is generally an area where residents are assisted by staff but agreed to address these issues. Additional toilets are located near the communal areas of the home. Random checks of hot water outlets found them to feel satisfactorily close to the recommended temperature of 43 degrees centigrade. There were not thermometers in each area to accurately check these temperatures. We were told that there are King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 24 thermostatic controlled valves on all hot water outlets. It is recommended that these are checked at regular intervals, to ensure they are providing water at the current temperature, with written records maintained to evidence this procedure. There are two sluices in the home. Both sluices were observed to be difficult to access due to large clinical waste bins in front of them. The sluices appeared to be in use despite this. Commodes were in use in a number of bedrooms and were clean in appearance and free from odour. Since the last inspection the registered manager has developed a cleaning system and rota for commodes, which seems to be adhered to. The home appeared clean, hygienic and free from odours during this inspection visit. One resident told us ‘the cleaners work hard and it is always lovely and clean here’. Residents who completed surveys said that the home was always or usually fresh and clean with an additional comment ‘It is a very nice home, I am happy to be part of it’. The expert by experience commented ‘I observed a steam cleaning machine that is used on a regular basis to clean the carpets and curtains and the rooms that I observed were clean and odour free’. Some ventaxias / air extractor fans were observed to need cleaning, these may cause a risk of fire. This was noted at the last inspection also. The laundry room has two industrial washing machines with a sluice facility and three tumble driers. A system is in place to separate soiled and clean laundry and red bags are used for soiled linen. Individual baskets are provided to each person. Resident’s clothes appear well cared for. General laundry e.g. sheets and towels are contracted to an external laundry for washing and plentiful supplies were observed within the linen cupboards around the home. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 25 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): 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. There is a duty rota in place that identifies the members of staff on duty and amendments are made to the duty rota based on the care needs of the residents. Residents are safeguarded by the recruitment procedures. Records show that care staff are trained, competent and appropriately supervised so that they can meet the resident’s care needs. EVIDENCE: On the day of inspection, the duty roster accurately reflected the staff on duty. The staffing levels are as follows: • Morning shift – 2 trained nurses and 5 carers • Afternoon shift – 1 trained nurse and 3 carers • Twilight shift – 17.00 to 20.00 1 additional carer • Night 1 trained nurse and 2 carers up until 00.30 then 1 carer until 06.00 when another carer arrives. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 26 The registered manager told us that a dependency tool has been used to determine the staff levels. Other members of staff told us that additional staff are rostered according to the needs of the residents. The trained nurse on duty told us that the staffing levels are satisfactory to meet people’s current needs. We discussed with the registered manager the staffing levels and advised that during the afternoon of inspection we found it difficult to locate a member of staff within the communal areas of the home. The lounge did not seem to have a member of staff available for the needs of residents during this period. We were told that staff carry radios so that they can communicate with each other easily and observed these in use. One resident told us that they often have to wait for a period of time for their call bell to be answered, as staff are often busy. Staff commented within the surveys prior to the inspection ‘on the whole staffing levels suffice’, ‘5 care assistants in the morning is not always enough to provide all care’ and ‘we have a high level of dependency here and sometimes residents wait a long time for breakfast’. The registered manager told us that the staffing levels are reviewed very frequently and she will continue to do so. The AQAA told us that 11 out of 18 staff have completed National Vocational Qualification training at level 2 or above. This equates to 61 of the care staff. A generally robust recruitment procedure is in operation. A number of new staff have been recruited since the last inspection. New staff complete an application form, written references and an enhanced Criminal Records Bureau check are obtained. There is evidence of an interview assessment. Evidence of registration is sought from the Nursing and Midwifery Council (NMC). It is recommended that the registered manager ensures that written evidence is held of each check made with the NMC. All staff are provided with terms and conditions of employment. No volunteers work in the home. It is recommended that consideration is paid to the references obtained as in one staff file only one written reference was available. The regulation states there should be 2 written references and it is recommended that 1 of these should be from the last employer. The member of staff concerned had been working at the home for over a year and the registered manager stated that 2 references had initially been sought. The home’s induction training has been reviewed and staff surveys informed us that this is a three day induction training course provided internally. One member of staff told us that their induction had only been 1 day in total. Written induction checklists are in place. Further induction training is provided via workbooks that the registered person has purchased from an external company. According to regulation, staff need to receive training regarding fire prevention, food handling (if they handle food), first aid (i.e. there needs to be King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 27 at least one ‘appointed person’ on duty), infection control and manual handling. Records of training are kept, supported by an up to date training matrix. This did not however correlate with records on individual files. The registered manager said she would check this, and there are plans to issue certificates for courses delivered internally. However training appeared thorough, and staff receive training required according to regulation. Registered nurses are supported to undertake training to ensure that they remain up to date, with details of forthcoming training displayed clearly on the office wall. There was also records of clinical training that nursing staff had received in their files. All staff who completed surveys prior to the inspection said that they are given training which is relevant to their role, helps them understand and meet the individual needs of service users and keeps them up to date with new ways of working. An additional comment made was ‘I have attended plenty of study sessions’. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 28 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): 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 is managed on a day to day basis by the registered manager in the best interests of the residents. Resident’s money and property is fully protected by the staff. The health, safety and welfare of the staff and resident’s is protected. EVIDENCE: Since the last inspection the current manager was approved for registration with the Commission for Social Care Inspection. The registered manager is a King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 29 registered nurse and has considerable management and clinical experience – as detailed in the statement of purpose. Staff and residents were positive about the management of the home and improvements were noted by us regarding the management systems in place and the orderliness of the home. The expert by experience told us ‘I met the manager who came across as a very positive and friendly person full of new and useful ideas. She has only been at the home for a year but is already making changes to benefit the welfare of the residents. I met and observed other members of staff who appeared to be caring and helpful’. We have received records of a Regulation 26 visits carried out by one of the directors. Staff appeared positive and confident in their roles and the support they have received from the registered manager. Comments were made, by staff members, that the ethos and philosophy in the home has changed. This was confirmed by a visiting professional to the home on the day of inspection. We did not evidence an annual development plan for the home. Regular residents meetings, which are attended by some residents and sometimes their representatives is an excellent initiative. Meetings are held regularly and discuss a wide range of issues affecting people living in the home. The registered manager told us that the annual survey is being prepared to be sent out to residents and interested parties. An insurance certificate is displayed within the entrance hall and is up to date. The registered manager told us that very little personal monies are kept for the residents. The monies and valuables that are held are stored securely and written records identify any transactions made on behalf of or by the resident. Not all residents have lockable space provided for them to keep their valuables safely. This is however, being addressed by the provision of new furniture as part of the refurbishment programme. A programme of supervision has been developed. Staff know who their supervisor is. Supervision records were in place in individual files. It is recommended that regular supervision takes place for all staff, some files showed that supervision is not as regular as others. When asked within staff surveys if their manager meets with them to give support and discuss how they are working, 3 staff members said regularly, 1 often and 2 sometimes. Additional comments made were ‘the role / working of the manager is more than satisfactory’ and ‘regular meetings are held’. Records are stored securely in a locked office – this is accessed by a master key held by staff. There is a visitor’s book in the reception area of the home. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 30 The accident book in use is compliant with the Data Protection Act. At the last inspection a communication book was in use that did not comply with the data protection act, this has been removed and a satisfactory system has replaced this. An external company visited the home in December 2008 to complete an audit of health and safety standards. Standards were generally deemed satisfactory. The registered persons have completed health and safety risk assessments, and these should assist in ensuring any risks to staff and residents are minimised as long as appropriate remedial action is taken. Risk assessments identify that thermostatic controls are fitted within bathrooms and showers and that water has been tested for legionella. The registered manager and director were able to show us evidence of maintenance and servicing of equipment within the home e.g. hoist servicing, laundry machines, passenger lifts, nurse call system, and regarding the electrical circuit (hard wire circuit). Portable electrical appliances have also been tested and deemed safe. Records inspected showed that fire training and emergency equipment testing has taken place as required. King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 31 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 2 3 3 2 2 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 32 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 OP20 Regulation 23(o) Requirement It is required that the registered provider ensure that external grounds which are suitable for, and safe for use by, service users are provided and appropriately maintained. It is required that a report be provided to CQC to outline how this will be achieved. It is required that the registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitable person are working at the care home in such numbers as are appropriate for the health and welfare of service users. It is required that following the next regular staffing review conducted by the registered manager, CQC be provided with a copy of the outcome. Timescale for action 30/06/09 2. OP27 18(1)(a) 30/06/09 King Charles Court DS0000009186.V375290.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that the registered person ensure that care plans continue to be reviewed and developed to ensure that consistency is achieved so that each care plan informs and directs care staff of the action they must take, to meet the identified personal care and health needs of the individual service user. It is recommended that the complaints log is maintained to reflect each complaint / concern raised within the home. It is recommended that a programme of planned maintenance and refurbishment is produced and implemented with records kept. It is recommended that the shower / wet room on the 1st floor be fully furnished with toilet roll, soap and paper towels. It is further recommended that the light switch be easily accessible to residents. It is recommended that the bedrooms continue to be refurbished so that all residents are provided with lockable storage and provided with the key unless the reason is explained in the care plan. It is recommended that doors to accommodation be fitted to an overrideable lock accessible to staff in emergencies. It is recommended that the thermostatic valves be checked at regular intervals to ensure that water is provided at the correct temperature, with written records maintained to evidence this procedure. It is recommended that all ventaxias / air extractor fans are cleaned regularly. It is recommended that two written references, including one from the previous employer, are obtained for staff members in addition to character references / testimonials. DS0000009186.V375290.R01.S.doc Version 5.2 Page 34 2. 3. OP16 OP19 4. OP21 5. OP24 6. OP25 7. 8. OP26 OP29 King Charles Court Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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