Care Home: Little Court Nursing Home

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What the care home does well Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 The home provides a pleasant atmosphere, and enables residents to carry out their individual lifestyles as far as possible. Comments from residents included: “the home has a happy, friendly and relaxed atmosphere”; “the home does everything well”; and “the staff take good care of me”. Personal and health care is well managed, and staff pay attention to details, such as helping residents to have their choice of bath or shower, and assisting them with good grooming. We spoke briefly with a GP who commented that “the staff are always extremely helpful, friendly and professional.” The home has a wide range of activities and entertainment. This is being further developed by a new activities organiser. Food is well prepared, and is mostly home made. Residents said that there is plenty of choice, and that the food is excellent. Staff recruitment is well managed, and this helps to protect residents from abuse; and gives them confidence in the staff who care for them. There are very good processes in place to enable residents to voice their feelings and opinions; and they are confident that their viewpoints are listened to, and action is taken in line with their ideas. What has improved since the last inspection? Documentation about the home – i.e. the home’s brochure, the statement of purpose and the service users’ guide – have been updated and improved, to add in more information for enquirers. Changes have been made as a result of listening to residents. These include: • • • • • • An organised social evening each week. Communal newspapers. Installing a larger television, and a modern stereo system, in the lounge. Organising more social gatherings, such as afternoon cream teas. More outings to nearby shopping centres. Introducing a light snack in the evenings.The hours for the activities organiser have been increased; and an administrator has been employed. There have been ongoing improvements made to the environment such as the redecoration of some bedrooms. Some new electric profiling beds have been purchased. Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 There have been increased training opportunities for staff in non-mandatory subjects, such as management of diabetes, strokes etc. What the care home could do better: Some aspects of documentation in care plans needs to be improved. This includes: • • • • Ensuring that residents, or their representative, are involved in care planning; and that there is documentation to support this. Ensuring that residents consent to photography for medication purposes and wound care. Giving specific written details to residents or their representative about the use of bed rails, and the risks associated with using these, such as entrapment. Documentation is unclear in regards to the Mental Capacity Act 2005, whereby residents may be assessed as unable to make decisions for themselves (e.g. for resuscitation and end of life care). The records must clearly show who has made decisions on behalf of residents and why; and must be appropriately signed and dated.Medication storage is unsatisfactory, as one of the cupboards is unsuitable. Handwritten entries on Medication Administration Records (MAR charts) must be signed for by two appropriately trained staff. This is to protect residents from being given the wrong medication. Homely remedies purchased for residents must not be given to staff. It would be good practice to record concerns and minor complaints voiced by residents or visitors. This would demonstrate how these issues are dealt with. The providers are planning to carry out some further building work and upgrading of existing areas. This would improve the following areas: additional bathrooms; improved storage facilities; more communal space; and improved laundry and kitchen facilities. The current maintenance hours are not enabling work to be done promptly; and records for some areas of routine maintenance were not found. This includes: • • Not all bedrooms have lockable storage facilities fitted, although we were informed that these have been purchased. Residents should have suitable storage facilities in place. Bedroom doors have fitments to close them, but these are not linked into the fire system. The manager informed us that the fire officer has required this to be done.Little Court Nursing HomeDS0000026188.V376197.R01.S.docVersion 5.2• •Some hot water temperatures have been recorded, but not all hot water outlets are checked for which residents have access. This could endanger their health and safety. We did not find routine maintenance checks for such items as bed rail checks, window restrictors, and wheelchair checks.The application form should be amended to ensure that applicants are asked to provide a full employment history, i.e. from the time of leaving full time education. Key inspection report CARE HOMES FOR OLDER PEOPLE Little Court Nursing Home Roopers Speldhurst Tunbridge Wells Kent TN3 0NY Lead Inspector Mrs Susan Hall Key Unannounced Inspection 24th June 2009 09:15a 24/06/09 DS0000026188.V376197.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. Little Court Nursing Home DS0000026188.V376197.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 Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Little Court Nursing Home Address Roopers Speldhurst Tunbridge Wells Kent TN3 0NY 01892 863414 01892 863454 manager@thelittlecourt.co.uk 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) Mr Peter Francis Gregory Neatbell Limited Mrs. Sheena Elizabeth Hickson Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP) The maximum number of service users to be accommodated is 28. Date of last inspection 27th June 2007 Brief Description of the Service: Little Court Nursing Home is a privately owned care home. It is situated in the village of Speldhurst, which is four miles away from the spa town of Tunbridge Wells. This is the nearest town, and has all the usual amenities. The original building dates back to 1908, but there have been a number of extensions added in recent years. Accommodation is provided on two floors, with a passenger lift providing access between floors. Most rooms are for single occupancy, although there are some double rooms for people who may wish to share. Some rooms have en-suite toilet facilities. The home has mature gardens at the side and rear of the property. There is ample car parking space available at the front of the property and on surrounding roads. As this is a nursing home, Little Court provides nurses on duty at all times. The current fee levels range from £565.00 - £755.00. These are individually assessed according to the nursing needs of each person, and the room being occupied. Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home is assessed as having a rating of good, 2 stars. This was a key inspection, which includes assessing all the information obtained by the Commission since the previous inspection, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us about ongoing developments in the home, and any changes. We received the AQAA back within the specified timescale, and it was well completed. The Commission sent out survey forms, and we received replies from four residents, two health professionals (visiting GPs), and three staff. These were all positive in content, and provided the Commission with a helpful background prior to the visit. The visit to the home commenced at 09:15, and lasted until 3pm. The manager was present throughout the visit. She was appointed to this post in April 2009, having previously been the deputy manager for some years. During the visit, we talked with four staff apart from the manager; one health professional, two relatives, and four residents. We also met several other residents briefly, and observed staff interaction with residents and with each other. We examined documentation such as admission information, care plans, medication charts, staff recruitment and training files, and some servicing and maintenance records. We viewed most areas of the home, and it was clean and fresh in all areas. The providers have recently obtained planning permission for another two storey extension, and have additional plans for carrying out internal alterations. The manager was going through the process of registration with the Commission at the time of the inspection visit. She was subsequently successful at her interview, and has been registered as the manager since 30th June 2009. What the service does well: Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 6 The home provides a pleasant atmosphere, and enables residents to carry out their individual lifestyles as far as possible. Comments from residents included: “the home has a happy, friendly and relaxed atmosphere”; “the home does everything well”; and “the staff take good care of me”. Personal and health care is well managed, and staff pay attention to details, such as helping residents to have their choice of bath or shower, and assisting them with good grooming. We spoke briefly with a GP who commented that “the staff are always extremely helpful, friendly and professional.” The home has a wide range of activities and entertainment. This is being further developed by a new activities organiser. Food is well prepared, and is mostly home made. Residents said that there is plenty of choice, and that the food is excellent. Staff recruitment is well managed, and this helps to protect residents from abuse; and gives them confidence in the staff who care for them. There are very good processes in place to enable residents to voice their feelings and opinions; and they are confident that their viewpoints are listened to, and action is taken in line with their ideas. What has improved since the last inspection? Documentation about the home – i.e. the home’s brochure, the statement of purpose and the service users’ guide – have been updated and improved, to add in more information for enquirers. Changes have been made as a result of listening to residents. These include: • • • • • • An organised social evening each week. Communal newspapers. Installing a larger television, and a modern stereo system, in the lounge. Organising more social gatherings, such as afternoon cream teas. More outings to nearby shopping centres. Introducing a light snack in the evenings. The hours for the activities organiser have been increased; and an administrator has been employed. There have been ongoing improvements made to the environment such as the redecoration of some bedrooms. Some new electric profiling beds have been purchased. Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 7 There have been increased training opportunities for staff in non-mandatory subjects, such as management of diabetes, strokes etc. What they could do better: Some aspects of documentation in care plans needs to be improved. This includes: • • • • Ensuring that residents, or their representative, are involved in care planning; and that there is documentation to support this. Ensuring that residents consent to photography for medication purposes and wound care. Giving specific written details to residents or their representative about the use of bed rails, and the risks associated with using these, such as entrapment. Documentation is unclear in regards to the Mental Capacity Act 2005, whereby residents may be assessed as unable to make decisions for themselves (e.g. for resuscitation and end of life care). The records must clearly show who has made decisions on behalf of residents and why; and must be appropriately signed and dated. Medication storage is unsatisfactory, as one of the cupboards is unsuitable. Handwritten entries on Medication Administration Records (MAR charts) must be signed for by two appropriately trained staff. This is to protect residents from being given the wrong medication. Homely remedies purchased for residents must not be given to staff. It would be good practice to record concerns and minor complaints voiced by residents or visitors. This would demonstrate how these issues are dealt with. The providers are planning to carry out some further building work and upgrading of existing areas. This would improve the following areas: additional bathrooms; improved storage facilities; more communal space; and improved laundry and kitchen facilities. The current maintenance hours are not enabling work to be done promptly; and records for some areas of routine maintenance were not found. This includes: • • Not all bedrooms have lockable storage facilities fitted, although we were informed that these have been purchased. Residents should have suitable storage facilities in place. Bedroom doors have fitments to close them, but these are not linked into the fire system. The manager informed us that the fire officer has required this to be done. Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 8 • • Some hot water temperatures have been recorded, but not all hot water outlets are checked for which residents have access. This could endanger their health and safety. We did not find routine maintenance checks for such items as bed rail checks, window restrictors, and wheelchair checks. The application form should be amended to ensure that applicants are asked to provide a full employment history, i.e. from the time of leaving full time education. 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. Little Court Nursing Home DS0000026188.V376197.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 Little Court Nursing Home DS0000026188.V376197.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): 1-5 (standard 6 does not apply in this home). 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 provides good information to assist prospective residents and relatives in making decisions. There are good processes in place to ensure that the home will be able to meet individually assessed needs. EVIDENCE: The statement of purpose and service users’ guide have been amended since the last inspection, ensuring that they contain accurate and up to date information. They are available for enquirers and prospective residents to read; and a copy is placed in each resident’s bedroom. This enables them to check data regarding the running of the home. Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 11 Both documents contain all the required information, such as the aims and objectives of the home, and details of the providers and manager. The statement of purpose includes details of the admission procedure to the home; the quality assurance processes; and the complaints procedure. The service users’ guide is set out in large print for easier reading, and includes day to day details such as meal times; arrangements for activities and outings; and arrangements for meeting spiritual and cultural needs. Each resident has a pre-admission assessment at home or in hospital, and the manager usually conducts these. We read three pre-admission assessments, and noted that they contained sufficient information to enable the manager to assess the home’s ability to meet the person’s individual needs. The manager has recently designed a new pre-admission assessment format, and this will enable the person assessing to add in more details than on the previous form. All residents are provided with a contract which includes the terms and conditions of the home. We viewed one of these, and it clearly states the fees payable, and payments for extra items such as chiropody and hairdressing. It also states reasons for terminating the contract for both parties, and the conditions which apply to this process. We spoke to one relative who stated that they had found the admission processes to be well managed; and had found the staff helpful. Little Court Nursing Home DS0000026188.V376197.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): 7-11 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 are confident that staff meet their personal and health needs, and that they are well cared for. Care planning is well managed, but needs further improvement in some identified areas. Some improvements are needed with medication management and storage. EVIDENCE: Individual care plans are implemented on admission to the home, using the pre-admission assessment to provide initial information. A separate admission assessment is carried out, which follows all the “Activities of Daily Living”, e.g. breathing, personal care, skin integrity, communication, mobility, continence and nutrition. Additional nursing assessments are carried out to provide detailed information, and these include a moving and handling assessment, Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 13 nutrition assessment, falls risk assessment, pain assessment, and a mental health test. Care plans are then set up according to each person’s separate needs. The home has a computerised system, which prompts nursing staff to include specific details on care plans. For example, moving and handling assessments show the equipment to be used, such as Zimmer frame, walking stick, or a specified hoist and the sling size. Care plans for pressure relief state the type of mattress on the bed, and pressure relieving cushions for chairs. Wound care is well documented, with a separate assessment chart for each wound; clear instructions about the dressing to be applied; and a written record for each time a dressing is changed. Additional charts are used for recording fluid balance, food records, or positional changes, for residents who are very ill. The care staff write daily reports for each resident for day and night care, and nursing staff add any extra comments regarding nursing input. The daily records mostly contain clear and informative data. We viewed four care plan files, and found them to be well completed, with appropriate information about social and family details, as well as nursing needs. Relatives or close friends are invited to help the staff to complete information about the resident’s previous family history and lifestyle. Individual preferences (such as times for getting up and going to bed; having a bath or a shower) are recorded on personal care plans. There is good evidence of input from other health professionals, such as GPs, tissue viability nurse, dietician and optician. One of the doctors who regularly visits the home stated in a survey form that “Little Court provides an excellent service to their clients. The staff are vigilant, and quickly bring medical problems to our attention.” Medication is stored in a clinical room which was rather cluttered and untidy. There is one large locked cupboard for storing stock items, but this is not very suitable as the top shelves are too high for most staff to reach; and it is situated behind a door, making it an unsafe area for staff to stand on steps to reach it. The cupboard was full of medication due to a recent delivery, and will not provide sufficient storage space when the home has an additional number of residents in the future. Most medication is administered using a nomad cassette system, and is stored in the medication trolley. This was in good order, and no out of date items were found. One item was found without a pharmacy label. There are two cupboards for storing controlled drugs, and these meet the specifications for controlled drug cupboards. The controlled drugs register was viewed, and entries are well completed by the nursing staff. There are good systems in place for ordering, receiving, and disposing of medication. The drugs fridge and clinical room temperatures are recorded daily and are satisfactory. We viewed all Medication Administration Records (MAR charts), and these are well completed. However, handwritten entries had only Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 14 been signed by one nurse, and must be checked and signed by two appropriately trained staff. We noted that nurses had sometimes supplied homely remedies to other staff (usually analgesia). This practice is not in accordance with NMC guidelines, and they cannot take responsibility for giving medication to staff, for whom they do not have medical knowledge or the right to provide treatment. They are also using medication that has been purchased for residents. The manager stated that this practice would stop immediately; and so an immediate requirement was not issued. Care staff were seen carrying out their duties in a calm and respectful manner. Residents stated that the “staff look after us very well”; “the staff are excellent”; and “they always take care of us very well”. Residents were seen to be well groomed, and dressed with attention to detail – such as including make up and jewellery for the ladies, and men properly shaved. A resident wrote in a survey that “there is a dedicated carer for each resident, which makes us feel at home, and secure”. End of life wishes are documented in care plans, but some of these could be more comprehensive. Residents have an indication on their care plans as to whether or not they wish to have resuscitation in an emergency. However, it is not clear who has made these decisions; or if a decision has been made on behalf of a resident, who was involved, and why. The manager and staff have an understanding of the implications of the Mental Capacity Act 2005 in regards to residents’ ability to make their own decisions, but documentation does not currently support this, and the manager is in the process of implementing it. Documentation is also weak in regards to bed rail assessments, which do not show that the risks directly associated with using bed rails (e.g. entrapment, falling over the sides) has been discussed and agreed. Written consent for photography should also be obtained where possible; and confirmation in writing that residents (or their authorised representative) are involved in their care planning. Some staff have carried out additional studies in palliative care, and the home tries to ensure that residents’ end of life wishes are followed as far as possible, and that they are kept comfortable and out of pain. They are able to have visitors as they wish. Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy an increasing variety of activities, events and outings. Food is well managed in the home, and provides residents with a varied and nutritious diet. EVIDENCE: The home provides a good range of activities and entertainment, and a newly appointed activities organiser is implementing further changes. The activities organiser is taking time to find out what each resident’s individual preferences are, and is quickly becoming familiar their different viewpoints. There is a weekly activities planner in place, but the activities organiser said that she keeps this flexible, as residents sometimes want a different group activity than the one stated on the plan. There is a short daily meeting in the mornings to discuss the newspapers, so that residents can keep up to date with the news. Group activities include items such as quizzes, painting, bingo and craft items such as making collage pictures. The current activities plan included painting mugs (which could be given as gifts); a memories class, when each resident Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 16 brings an item from their room and shares the memories it brings; singing (with a karaoke machine); and cooking small cakes. There is also a weekly exercise class, and this was carried out in the garden on the previous day, so as to enjoy the good weather as well. Residents are encouraged to sit outside, and the pleasant gardens enhance the enjoyment. The maintenance person is assisting with providing a raised gardening bed, for residents who would like to carry out some gardening. The activities organiser spends one to one time with residents who are unable to leave their rooms, or do not wish to do so. This may include playing music, manicures, or reading to them. There are also social occasions such as a special afternoon with Pimms and strawberries to celebrate Wimbledon; a barbecue evening; cinema afternoons (watching a chosen DVD with popcorn or ice-creams); tea parties, and drinks evenings. A summer fete was currently being arranged. Outings are arranged to places of interest such as Penshurst Park, and residents can go out shopping or for pub visits. The activities organiser liaises with nursing, care staff and relatives, to ensure that residents have appropriate support with outings. Visitors are welcome at any time, and there is a designated area in the lounge where visitors can make their own hot or cold drinks. There are good processes in place to enable residents to follow their faith and religious needs. A church service is carried out in the home once per month by the local Church of England church nearby, and volunteers will take residents to the church at other times. There is a separate Holy Communion service once per month. Specific faith and cultural needs are discussed during the preadmission process to ensure that the home can meet individual needs. The home has also provided staff with a world religions book for staff to study, to provide them with more understanding. The local community has been involved with various projects within the home; for example, local primary school children come once a month to visit the residents. Residents are encouraged to personalise their rooms according to choice, and are asked for their views about decorating, carpeting etc. for communal areas. The food is managed by a head cook who has been working in the home for several years, and who keeps up to date with residents’ individual likes and dislikes, and discusses menu changes with them. She has completed training in catering, and is enthusiastic about providing residents with a varied menu. She has developed a four weekly menu cycle, which is re-evaluated every six months. Meal times are flexible, and meals can be taken in the dining room, or in residents’ own rooms. The dining-room was attractively laid out with tables for two to four people; and with tablecloths, napkins, fresh flowers, and name cards. There is plenty of space for residents who need transferring with wheelchairs. Staff are on hand to assist residents with eating, and special diets such as diabetic, or pureed foods, are catered for. The cook is assisted by a kitchen assistant in the mornings; and a kitchen assistant carries out the Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 17 preparation and serving for supper times. Residents can have a cooked breakfast on request. There is one main meal at lunch times, but the cook speaks to each resident each morning, to check if they would like something different, and there is always a variety of alternatives available. Afternoon tea is accompanied by home-made cakes; and there is usually a hot dish offered for supper meals, as well as sandwiches, home-made soups etc. Fresh fruit and vegetables are provided every day. In response to a request from residents, coffee is offered after lunch; and a light snack is offered at bedtimes. We viewed the kitchen, and this was clean and well organised. The home has received a gold standard award for hygiene from the Council. Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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 know that any concerns will be listened to and acted on. The management ensure that all complaints are treated seriously; and have procedures in place to produce better outcomes for residents as a result of their investigations. EVIDENCE: The complaints procedure is displayed in the entrance hall, and is included in the service users’ guide. This means that it is easily accessible to anyone. A complaints log is maintained; and reading this confirmed that complaints are taken seriously and are addressed appropriately. All complaints are investigated and responded to within twenty-eight days. The manager stated that most minor concerns (e.g. laundry items missing) are dealt with straightaway. There is currently no record maintained for these issues, and we recommended that minor concerns are documented by the staff, so that there is a clear record of the action taken to address them. Staff are trained in the recognition and prevention of abuse, and this training commences at induction. There are yearly updates for all staff; and a staff training matrix confirmed that all staff are kept up to date with this. The manager is familiar with the protocols for raising suspicions of abuse to the Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 19 Safeguarding Co-ordinator for Social Services; and has a copy of the “No Secrets” documentation available. Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19-22, & 24-26 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. Residents are satisfied with the comfort and general upkeep of the home. There are a number of improvements needed, which the providers are already planning for with future building and refurbishment programmes. Day to day maintenance hours need re-assessing. EVIDENCE: The original building of the home dates back to 1908, but there have been a number of building extensions over recent years. The providers have recently obtained planning permission for another two-storey extension, and have additional plans for carrying out internal alterations. Together, these will provide another six bedrooms, extra lounge space, more bathrooms, improved Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 21 sluicing facilities, more storage space, and a new kitchen. The garden will be landscaped, improving it still further. The gardens are currently very pleasant, but the lawns were waiting to be mown, and there were a number of flower beds with weeds in them. There are currently several communal areas, with two separate lounge areas for those watching television, and those who do not wish to watch; a dining room; and a conservatory. Bedrooms are mostly for single use, and some have en-suite toilet facilities. There are some shared rooms for people who wish to share. The home has two bathrooms on the ground floor with assisted baths, and a shower room on the first floor. The bathrooms are becoming worn, and there are already plans to refurbish these (as well as plans to add more bathrooms), so no recommendation has been made for this. The home has suitable equipment available, such as two standing hoists and a full hoist; grab rails, raised toilet seats and pressure relieving equipment. Some new electric nursing beds have been purchased, and there are plans to continue replacing beds gradually until they are all new nursing beds. There is a nurse call alarm system in each room. Bedroom doors can be kept open with fitted doorstops, but these are not linked to the fire system. The manager informed us that the Fire Officer has already made it a requirement for the home to fit door stops which will respond to the fire alarm, and provide better fire protection for residents. In the mean time, bedroom doors are only kept open in the day times when a resident is staying in their room and particularly requests this. All bedrooms doors are kept shut at night. Not all residents have a lockable facility in their bedroom. The manager stated that these have been purchased, but have not all been fitted yet. There is a requirement to fit these so that residents have suitable storage available. The home currently lacks storage space for equipment (such as the hoists), but this is being included in future planning. There is an ongoing redecoration programme in place; and furniture and furnishings are of good quality. The manager stated that hot water temperatures are checked, but the only records seen were for the kitchen and bathrooms. No documentation was seen for checking hot water temperatures in rooms to which residents have access (e.g. bedroom wash basins, communal toilet wash basins), and this must be carried out to ensure thermostats are working correctly and residents are not at risk of scalding. The manager also stated that there are checks for items such as bed rails and window restrictors, but no records were available. The home currently has only one day per week when maintenance people are available, and there is a recommendation to review the number of maintenance hours, to ensure that ongoing maintenance and routine checks are being carried out effectively. Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 22 The laundry room is situated on the ground floor, and is very small. There are two washing machines and two tumble dryers. There is no space for hanging clothes, and no separate areas for dealing with dirty and clean items. We were informed that the laundry will be extended and improved as part of the planned alterations. There are usually two domestic assistants on duty, but there was only one on the day of the inspection, due to sickness. The home was clean in all areas. The manager is an infection control link nurse, and this was evident, as there are good systems in place for the promotion of good infection control. Residents said that “the home is always fresh and clean”; and the home “is always warm and comfortable”. Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefit from a stable and caring staff team, who are well trained, and competent in their different roles. EVIDENCE: As the home provides nursing care, there are nursing staff on duty at all times. There are usually two nurses on duty in the mornings, with one working on the ground floor, and one on the first floor. In the afternoons, evenings and night duties, there is usually one nurse on duty. This is in addition to the manager, who is also a trained nurse. Sometimes the manager will act as a second nurse for the morning shift. The nursing staff are supported by approximately four care staff throughout the day, and two at night. These numbers may vary according to the dependency levels of the residents. The home also employs cooks and kitchen assistants; domestic cleaning and laundry staff; a part-time activities organiser, and a part–time administrator. The providers are committed to encouraging staff with training, especially NVQ training for care staff. This includes levels 2 and 3 training. There are currently 6 out of 16 carers who have completed training (37.5 ). This is below the Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 24 recommended percentage of 50 , but has occurred due to staff changes. There are two care staff who are currently working towards NVQ 2, and this will bring the percentage back up to 50 when they have completed training. We examined three staff files, and they showed that there are good recruitment procedures in place. This includes checking Criminal Record Bureau (CRB) and POVA First checks; two written references; checks for nurses’ PIN numbers; work permits if applicable; confirmation of training; and a record of the interview. The application forms do not specify that applicants must provide a full employment history (i.e. from the time of leaving full time education), and this should be amended. There are currently no procedures in place for staff to provide a written agreement to inform the manager of any criminal convictions or cautions that they receive after employment commences; and this is recommended. All staff have an induction, and the manager is in the process of altering the induction process to make sure it fully complies with the common induction standards provided by Skills for Care. A training matrix demonstrates that mandatory training (e.g. health and safety, moving and handling, fire training) is kept up to date. Staff are also encouraged to take part in other training opportunities for subjects such as medication management and dementia care. The home is not registered for residents with a diagnosis of dementia, but some older people may be admitted with short-term memory loss, or mild confusion, and this training aids the staff with their care. Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31-33, & 35-38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager ensures that residents and staff are able to share their views, and are involved in the running of the home. There are good administration procedures in place. EVIDENCE: The new manager was appointed in April 2009, having previously worked in this home as the deputy manager for many years. She is therefore familiar with many of the management processes in the home, and is beginning to implement changes to further develop the home. She is currently studying for the Registered Manager’s Award (RMA) and NVQ level 4. Staff members noted Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 26 in survey forms that they “receive ongoing support from the manager”; and one said “communication could sometimes be better”. The manager is working on improving communication. This includes monthly staff meetings, where all staff are welcome to attend and share ideas, as well as receiving updates from the manager. There was good interaction between staff, and between the staff and residents, on the day of the inspection. One staff member said that they are “impressed with the contact that takes place between the staff and relatives”. And one of the relatives said that “there is good communication with relatives, and all the staff are very approachable”. The manager has just implemented a formal structure for one to one staff supervision. This is delegated to different departments, and nurses will each take responsibility for some of the care staff. One to one supervision will be carried out every two months, and there will be an annual appraisal. Residents are enabled to feedback their feelings in a variety of ways. Several commented that they each have a carer as a key worker, and this is helpful, as they can speak directly to their key worker for day to day changes. The home has formal residents/relatives meetings every three months, and the last one was attended by twenty-two residents. The minutes of these meetings are distributed to each resident, and to relatives/representatives as appropriate. There are also informal meetings over meals; with the activities organiser, or just sitting outside together; and these provide an informal and ongoing opportunity to share concerns and ideas. All residents or their representatives are given a quality assurance questionnaire every six months. These are easy to complete, with tick boxes for “poor, adequate, good or excellent” in answer to different questions. These forms are analysed, and the results are given out. Action is taken in response to this feedback. The manager has an open door policy, and is easily accessible to staff and residents. The home does not look after money for any residents. If they are unable to manage their own finances, the home will ensure they have an authorised representative. Additional payments for items such as hairdressing and chiropody are invoiced to the relevant person. Policies and procedures are kept up to date, and the staff are notified of any changes. Documentation is generally of a good standard, and records such as care plans are stored with awareness of maintaining confidentiality. We viewed a number of servicing records (e.g. fire alarm system, emergency lighting checks, hoist servicing, lift servicing and PAT testing), and these correlated with the information supplied on the Annual Quality Assurance assessment (AQAA). We have already highlighted concerns about routine maintenance checks in the section on “environment”. The servicing records viewed were all up to date. Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 27 Accidents and incidents are recorded on the correct forms in accordance with the Health and Safety Executive (HSE), but were being filed in residents’ care plans. This contravenes the Data Protection Act, as staff addresses are then available to other people. The manager said that she would rectify this with a different filing system, so a recommendation has not been given. The home reliably informs the Commission of legal notifications. Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 28 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 2 3 X 2 2 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 X 3 3 3 2 Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15 (2) Requirement Care plans must show that decisions made about residents’ health and welfare are discussed with the resident or their authorised representative (as appropriate). This applies to the following items: • Decisions made in regards to resuscitation and end of life care, must show who has made decisions and why, and must demonstrate compliance with the Mental Capacity Act 2005. Bed rails assessments should show that residents or their representative have been informed of the risks associated with using bed rails. Timescale for action 31/08/09 • 2. OP9 13 (2) Medication management must be 31/07/09 improved in the following areas: The registered person must ensure that there are suitable Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 30 storage cupboards for all medication. Handwritten entries on Medication Administration Records (MAR charts) must be signed for by two appropriately trained staff. Homely remedies purchased for residents must not be given to staff. A lockable facility must be fitted for each resident in their bedroom, so that they have suitable storage available for personal items. The registered person must ensure that routine checks and maintenance are carried out satisfactorily. This includes ensuring that hot water outlets which are accessible to residents, have temperature checks to ensure that thermostats are working correctly. 3. OP24 23 (2) (m) 31/08/09 4. OP38 13 (4) (c) 31/07/09 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 consent is obtained in writing for taking photographs for medication charts and other reasons, such as wound care. It is recommended that concerns and minor complaints are recorded by staff; and records show the action that has been taken to address these matters. 2. OP16 Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 31 3. OP19 It is recommended that closures for bedroom doors which respond to the fire alarm system are fitted as a priority; following the instructions from the fire officer. It is recommended that maintenance hours are reviewed, to ensure there are sufficient hours available to carry out all required checks and day to day maintenance. It is recommended that the planned upgrade for the existing premises takes place, so that bathroom and laundry facilities are improved. The application form should clearly state that applicants are required to provide a full employment history (i.e. from the time of leaving full time education). It is recommended that a procedure is put in place for staff to provide a written agreement, whereby they will inform the manager of any criminal convictions or cautions that they receive after employment commences. 4. OP19 5. OP19 6. OP29 Little Court Nursing Home DS0000026188.V376197.R01.S.doc Version 5.2 Page 32 Care Quality Commission The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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. 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