Care Home: Nelson Court Linked Service Centre

What the care home does well The registered manager was receptive to advice given and demonstrated a commitment to put right any matters needed addressing to improve the service further. Staff spoke enthusiastically about their roles and enjoy working at the home. Residents like living at the home and feel comfortable and safe. Relatives feel reassured by the care and support residents receive from staff. And health and social care professionals are happy with the care and support provided to the residents. Compliments about the service include "Excellent assessment skills, always willing to be creative and look at difficult cases. They are self managing and do not contact care management with small matters"; "They always seem very concerned for their residents and willing to take on advice"; "Staff promptly request assessment when injury or illness effects a client"; "The home provides an individualistic service that encourages diversity and empowerment of the service users"; "The service treats clients as individuals and allows clients to be themselves. Clients are stimulated with activities and staff are very observant of clients` conditions. Families are well Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 supported. They are very aware of the clients` needs and wishes"; "Staff are always polite and professional in their dealings. They always respond to queries and are open and transparent with professionals and visitors. They provide high quality care for their service users and do their best to treat them individually and meet individual needs"; "The service responds to the needs of each individual. Always alert us if there is a problem. Always inform us of any accident, incident or admission to hospital. Whenever one of my clients is offered a placement at Nelson Court I am usually relieved as I know they will be taken care of"; "This home is client led, not service provider led in any way. Staff are analytical in their approach as required. Nelson Court staff assist clients to have control of their lives as much as possible. I always note how relaxed clients are. Similarly it has a really good reputation in the area – by word of mouth and many relatives select Nelson Court first. This is how popular the home is. Manager is very good. She has all the right qualities for the job and is a credit to the home"; "The service cares for its residents and their families really well, giving a friendly approach and making you feel comfortable at all times". What has improved since the last inspection? The uneven paving in one of the secluded gardens has been replaced, making the area safe for residents` use and enjoyment. As part of the home`s improvement programme, some bedrooms have been redecorated, refurnished and re carpeted. Two permanent carers have been appointed, reducing the home`s reliance on bank and or agency staff. For residents` protection some care staff have updated their medication, moving and handling, food hygiene, safeguarding and dementia care training. One of the sitting rooms has been changed into a reminiscence sitting room and furnished accordingly. This is in addition to the existing activities room. More information is obtained by the home`s staff prior to residents being admitted into the home. This supplements the information provided by care management and other care and health professionals. The registered manager has successfully completed her university degree in dementia care studies and there is evidence throughout the home that the knowledge gained is having a positive impact on residents` lives and experiences. What the care home could do better: For residents` safety, doors must be kept shut or kept locked shut where fire precautions dictate this is required. The maintenance of care records does not always provide a coherent picture of residents` current needs and the action being taken. This could present a problem if the information was quickly needed or an investigation carried out. So care staff are fully up to date with caring for residents with diabetes, specific training should be provided. To minimise cross infection risks, hand wash basins should be installed in bathrooms. Details of residents’ end of life wishes and preferences should be obtained and recorded, so that appropriate care is delivered. Survey respondents` comments included "It would be good for service users to be able to go out more, individually or in very small groups"; "Have more access to medical information"; "Have better medical history available"; "Ensure training is adequate for provision of care". No requirements have been made but a number of good practice recommendations have been made throughout the body of the report.Nelson Court Linked Service CentreDS0000036738.V376183.R01.S.doc Version 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Nelson Court Linked Service Centre Nelson Terrace Luton Chatham Kent ME5 7JZ Lead Inspector Elizabeth Baker Key Unannounced Inspection 29 June 2009 09:50 DS0000036738.V376183.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. Nelson Court Linked Service Centre DS0000036738.V376183.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 Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nelson Court Linked Service Centre Address Nelson Terrace Luton Chatham Kent ME5 7JZ 01634 845337 01634 819316 theresa.ward@medway.gov.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) Medway Council Mrs Theresa Ann Ward Care Home 28 Category(ies) of Dementia (0) registration, with number of places Nelson Court Linked Service Centre DS0000036738.V376183.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 only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE). The maximum number of service users to be accommodated is 28. Date of last inspection 6th July 2006 Brief Description of the Service: Nelson Court is a care home providing care and accommodation for 28 older people who are diagnosed with Dementia. Some also have additional needs. The home is owned and managed by Medway Council. The property is located in Luton, a suburb of Chatham and is situated close to local shops, public transport and other amenities. The single storey purpose built home is subdivided into three wings each accommodating up to nine people. Whilst most service users are permanent residents, three places are set-aside for short term or respite care, and a fourth place has recently been designated for emergency use. The home has a large front area, mostly used for parking, and attractive courtyard and gardens at the rear. Fees are currently £419 per week with additional charges for chiropody, hairdressing, toiletries and newspapers. The range of activities includes music therapy, beauty therapy, local walks, chair based exercises, quizzes, cooking and gardening. There is a mini bus for residents use. External trips are made to the coast, garden and shopping centres. Religious services do not currently take place at the home. Nelson Court Linked Service Centre DS0000036738.V376183.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 the service is 3 stars. This means the people who use the service experience excellent quality outcomes. On the 29 June 2009 we the Commission carried out the key unannounced visit to the service. The visit lasted just under seven hours. We walked around the home and talked with some residents and staff. We interviewed four residents, two members of staff and one visitor. At the time of compiling the report, in support of the visit, we had received survey forms about the service from five residents, nine social and health care professionals and seven members of staff. As required by regulation, the service returned the annual quality assurance assessment (AQAA) when we asked for it. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The assessment gave us the information we asked for. We have incorporated some of the information gathered from the above sources into this report. Verbal feedback of the visit was provided to the registered manager during and at the end of the visit. Since the last site visit, we have done two annual service reviews and one thematic visit. What the service does well: The registered manager was receptive to advice given and demonstrated a commitment to put right any matters needed addressing to improve the service further. Staff spoke enthusiastically about their roles and enjoy working at the home. Residents like living at the home and feel comfortable and safe. Relatives feel reassured by the care and support residents receive from staff. And health and social care professionals are happy with the care and support provided to the residents. Compliments about the service include Excellent assessment skills, always willing to be creative and look at difficult cases. They are self managing and do not contact care management with small matters; They always seem very concerned for their residents and willing to take on advice; Staff promptly request assessment when injury or illness effects a client; The home provides an individualistic service that encourages diversity and empowerment of the service users; The service treats clients as individuals and allows clients to be themselves. Clients are stimulated with activities and staff are very observant of clients conditions. Families are well Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 6 supported. They are very aware of the clients needs and wishes; Staff are always polite and professional in their dealings. They always respond to queries and are open and transparent with professionals and visitors. They provide high quality care for their service users and do their best to treat them individually and meet individual needs; The service responds to the needs of each individual. Always alert us if there is a problem. Always inform us of any accident, incident or admission to hospital. Whenever one of my clients is offered a placement at Nelson Court I am usually relieved as I know they will be taken care of; This home is client led, not service provider led in any way. Staff are analytical in their approach as required. Nelson Court staff assist clients to have control of their lives as much as possible. I always note how relaxed clients are. Similarly it has a really good reputation in the area – by word of mouth and many relatives select Nelson Court first. This is how popular the home is. Manager is very good. She has all the right qualities for the job and is a credit to the home; The service cares for its residents and their families really well, giving a friendly approach and making you feel comfortable at all times. What has improved since the last inspection? What they could do better: For residents safety, doors must be kept shut or kept locked shut where fire precautions dictate this is required. The maintenance of care records does not always provide a coherent picture of residents current needs and the action being taken. This could present a problem if the information was quickly needed or an investigation carried out. So care staff are fully up to date with caring for residents with diabetes, specific training should be provided. To minimise cross infection risks, hand wash basins should be installed in bathrooms. Details of residents’ end of life wishes and preferences should be obtained and recorded, so that appropriate care is delivered. Survey respondents comments included It would be good for service users to be able to go out more, individually or in very small groups; Have more access to medical information; Have better medical history available; Ensure training is adequate for provision of care. No requirements have been made but a number of good practice recommendations have been made throughout the body of the report. Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 7 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. Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 and 6. 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. New residents move into the home knowing their assessed needs can be met. EVIDENCE: As required by our regulations the home has a statement of purpose and service user guide. These documents inform prospective residents and or their representatives of the services and facilities provided by the home. The documents are printed in standard print fonts. However they would be made available in other fonts, formats and versions if this was required. This also applies to the homes complaints procedure. Many permanent residents previously used the service on a respite basis and made an informed decision to become permanent residents when their condition determined Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 10 they could no longer safely live in the community. Other prospective permanent residents are invited to visit the home before deciding whether to be admitted or not. If their condition prevents them making such visits then their advocates are invited to visit the home on their behalf. Indeed a visitor said she had visited this home on a number of different occasions as well as other care home before deciding on choosing this one for her father and she is glad of her choice. Where practicably possible the registered manager or a team leader also endeavour visit prospective residents in their current accommodation to determine whether the home is suitable to meet the residents individual needs. Information is also sought from other agencies such as the local authority and or primary care trust. The information gathered from these sources then helps the home compose a plan of care for the prospective residents. All permanent placements are initially admitted on a four week trial period, after which a review of the placement is undertaken. As the home does not provide nursing care, residents are also subject to care reviews if their condition changes and identifies nursing care is now required. The home assists in the process of finding a suitable nursing home. All five returned surveys from residents indicated they had received enough information to help them decide if this home was the right place for them before moving in and had been given written information about the homes terms and conditions of staying at the home. The home is not registered for intermediate care. Standard 6 is not applicable. Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 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. The social, personal care and health needs of residents are met with evidence of good multi disciplinary working taking place on a regular basis. EVIDENCE: For case tracking purposes we inspected the care records of four residents. Records contained pre admission assessments, Independent Needs Portrayals, contracts and placement letters. The plan of care is made up of Action Plan and Goals and General Information folders. These in turn are supported by risk assessments. Areas covered included mobility, eating and drinking, toilet habits, continence, hygiene, skin care, sensory impairments, smoking, communication, personality, aggressive behaviour, memory, wandering, dental health, foot care and dexterity. Life histories are also recorded and provide good information which reflected our conversations with the residents. Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 12 However where a medical need was recorded it was difficult to obtain a meaningful picture of the care actually required and that being delivered. For example, information about residents with diabetes was inconsistent in that for one resident the care records included specific details of the residents condition whereas another residents care record lacked this level of detail including dietary needs. Both records could have been expanded to include frequency of blood glucose readings. It was identified that nutrition assessments and information of residents food likes and dislikes are kept separately in the kitchenettes attached to each dining room. The ones seen had not been dated. And to support the central care records blood sugar glucose monitoring charts are also kept in another location. The central care records did not inform the reader of this. The daily contact notes for another resident indicated a lot of red areas were flaring up and a topical preparation was being applied. This had not generated a specific care plan component. A body map had not been used to record the actual sites either. The moving and handling assessment for one resident was missing. And for another resident the assessment could have been expanded to include information about the residents amputation. Daily entries in the contact books generally provided a good picture of the residents daily health condition and quality of day experiences. However some carers write meaningless comments such as no problems and appears OK. Potential risks to residents are assessed and this includes smoking. Indeed a number of residents do so. However where the risk assessment highlights a resident is a smoker the form requires an individual smoking risk assessment to be done. The care records did not contain this separate assessment. The visitor confirmed she had been involved in her fathers plan of care and is kept informed of any changes in his condition. Health and social care professional respondents mainly indicated residents social and health care needs are always properly monitored, reviewed and met by the home. A dedicated room is used for the storage of medicines and associated sundries. The room is appropriately equipped and kept in good order. A new drug refrigerator has been acquired since the last visit. However it was identified on this visit that the home does not monitor the temperature of the room and that drug refrigerator temperatures are not recorded. It is good practice to record the temperature of the room and refrigerator on a daily basis. This is because medicines must be kept in accordance with manufacturers instructions so that the efficacy of medicines and creams is not compromised. Medication administration record charts are used and those seen had been completed as required. A number of care records made references to analgesia being prescribed to some residents. However it was identified on this visit that pain assessments are not always used to monitor the effectiveness of analgesia treatments. It is good practice to do so. Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 13 Residents were suitably dressed for the time of day and season, with attention to detail where this is important to them, including their personal appearance. The home has its own hairdressing room and a hairdresser visits the home three times a week. Residents spoken with indicated their dignity is protected when staff assist them with their personal hygiene needs and staff were observed knocking before entering bedrooms. Although details of residents religions were seen in the records inspected, there are currently no care plans covering residents spiritual and cultural wishes and preferences in respect of death and dying. Whilst appreciating this is a sensitive subject, it is an important aspect of care and needs to be addressed. Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 14 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): 13, 13, 14 and 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. Meals and activities offer both choice and variety. Residents are supported in attaining their lifestyle preferences. EVIDENCE: Residents are able to choose from a range of activities some of which are provided within a group setting and others one to one. During the visit some residents were seen in the different sitting rooms reading newspapers, watching TV or chatting amongst themselves. A resident was having one to one care and was enjoying the experience of having her nails done. Residents are encouraged to be involved in bread and cake making and others like to help in the garden. Residents are supported in continuing with their community links, including day centre visits to maintain cultural contact. The home has two activities coordinators who endeavour to provide activities and occupation over six days a week. This includes trips out to a shopping and garden centres, as well as to nearby sea side resorts. Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 15 Because of recent changes in the local church, regular religious services are no longer taking place at the home. However where religion is important, families assist residents in attending services in the community. Residents are encouraged to personalise their bedrooms and those seen had been individualised to the residents own preferences. Visitors are made welcome and can visit at any time. Visitors can also choose to have a meal with the residents and a small charge is made for this. Each of the three units has its own dining area, which residents can use if they want to. Residents spoken with said they enjoyed their meals and get a choice. Although meals were not sampled on this visit, the lunchtime meal was presented in an appetising manner and residents said they had enjoyed it. All surveys returned from residents indicated the home always arranges activities that they can take part in if they want to. Three respondents indicated they usually like the homes meals and two indicated they always like the meals. Residents are regularly weighed and special sit on scales are used for this. As is good practice, the scales are calibrated for accuracy purposes. Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 16 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, 17 and 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 advocates can be satisfied their concerns and complaints are listened to and acted upon. EVIDENCE: A complaints, praise and comments booklet is available in the reception area. This includes contact details of the provider and us. Residents spoken with knew what to do if they had a complaint or were worried about something. All surveys returned from residents indicated there is someone they can speak to informally if they are not happy and that they know how to make a complaint. A central file of complaints is maintained of formal complaints. Since the last visit the home has introduced a system for recording niggles and adverse comments. However this is not being used as intended and may prevent the home in picking up trends for quality assurance purposes. Arrangements are in hand so residents can vote in elections if they wish to. This is good practice. Training details provided at the visit indicate staff have received adult protection training. Staff interviewed described appropriately the action they would take if they suspected abuse had taken place. Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 17 During the visit it was identified that staff have not yet received Deprivation of Liberties Safeguarding training. However the registered manager is booked to attend a two day training course in July 2009. The registered manager will then cascade this knowledge to other staff. This is important as the new safeguards may have implications on the homes current and future residents. Since the implementation of these new safeguards in April of this year, the home has not made any formal authorisation referrals. Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 18 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 and 26. 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. The environment creates an excellent home for residents to live in. EVIDENCE: Our walk around the home identified the home to be fresh, clean, ventilated and tidy. All resident survey respondents indicated the home is always fresh and clean. Outside areas include secluded patio areas with raised beds and a selection of garden furniture for residents to enjoy in good weather. As part of the homes routine maintenance and renewal programme, some bedrooms have been refurbished. And a patio area has been repaved to provide a safe environment for residents to use. Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 19 Radiators are covered and hot water is thermostatically controlled, for residents safety. Corridors are wide and have handrails fitted, enabling residents to move independently and safely around the home. One of the homes sitting rooms has been changed into a reminiscence room and has been furnished and equipped to reflect the 1940s era. To assist residents in finding their own bedrooms, name and number details are conspicuously displayed on doors. The home had tried other methods such as photos, but sadly not all residents were able to recognise themselves and in some cases became distressed. For infection control purposes, staff are provided with protective clothing such as gloves and aprons. The homes laundry room is equipped with washing machines and dryers so residents personal clothes, as well as the homes washing are appropriately washed. Disposable bags are used for the safe washing of soiled linen. And as is required, the laundry has a separate hand wash sink for staff use. However on this visit it was identified that separate hand wash sinks are not available in the communal bathrooms, preventing staff having quick access to facilities to wash their hands after assisting residents with personal hygiene needs. Because of this staff have to access hand wash sinks in other rooms. This is not good practice, as door furniture may become contaminated, presenting potential cross infection risks to residents and staff. It is the providers responsibility to ensure all potential cross infection risks are minimised for residents and staff protection. During the visit it was noted that a self closing door to a dining room was propped open and that a room was unlocked despite a blue fire warning sign indicating it should be kept locked shut. For residents safety only approved devices must be used for propping open doors. And doors must be kept locked shut where the safety sign indicates this. It is the providers responsibility to make sure the home is kept safe at all times. Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. 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 receive care and support from a happy, enthusiastic, caring and trained workforce. EVIDENCE: As well as care staff, staff are employed for cooking, activities, cleaning, laundry, maintenance and administration. The home is staffed 24 hours a day, including three awake staff at night and a rota is kept. Throughout the visit staff were seen carrying out their duties in an unhurried manner and being attentive to residents in a reassuring and non-patronising way. All returned surveys from residents indicated they always receive the care and support they need and that staff are always available when they need them. Two respondents added I have never had any problem in getting hold of members of staff and the staff are very good. Ninety-seven percent of carers are now trained to NVQ level 2 care or equivalent. This is an excellent achievement. Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 21 There have been no new employees since the last visit, although two new carers have just been appointed. However until such time as the organisation receives satisfactory references and Criminal Record Bureau check clearance they will not commence working at the home. This is good practice. For residents protection, staff are required to re-do their Criminal Record Bureau check every three years. The organisation has changed its application form to make sure staff record full employment history details. Our regulations require this information is sought and where any gaps are identified that explanations are recorded. This is for residents protection. Training details provided at the visit indicated staff have received training on various subjects including health and safety, manual handling, bullying and harassment, managing aggression and violence, adult protection and medicine administration. Staff interviewed said they had received training including fire, moving and handling, infection control and dementia care. Most residents at the home have dementia and staff receive appropriate training for this condition. However staff are not always provided with appropriate training for medical conditions such as diabetes. A number of the homes residents have this condition. And a member of staff said they would like to receive training for this as some of the residents in her care have diabetes. Whilst recognising the registered manager has attempted to source this training, it is the providers responsibility to ensure staff are appropriately trained to meet the all assessed needs of the homes current and future residents. Two staff respondents added the home could do better by ensuring training is adequate for provision of care and keep staff training up to date. The home is just introducing a new in-depth induction programme which follows the Skills for Care model, as well as incorporating the providers values. The newly appointed staff will be expected to commence on the programme following their initial induction. Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 22 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, 32, 33, 34, 35, 36, 37 and 38. 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 benefit from a well run home. EVIDENCE: The registered manager has worked in social care for about 22 years and been the registered manager for Nelson Court for almost five years. The registered manager has attained the NVQ level 4 in Care and Management and has just completed a degree in dementia care at Bradford University. Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 23 Residents, visitor and staff spoke openly during our visit about their experiences of living, visiting and working at the home. The registered manager and team leaders promote an open door policy. Residents, relatives and staff appreciate this. Staff interviewed said they receive supervision and can discuss any matters with the registered manager or their team leaders at any time. Supervision records were seen in the staff files inspected. Staff respondents indicated their manager regularly or often gives them enough support and meets with them to discuss how they are working. The home has its own quality assurance programme which includes seeking the views and opinions of the service from residents and or their advocates. The results are analysed, recorded and made available. The providers representative visits regularly and provides the home with a record of the findings. Meetings and forums are facilitated for residents and staff. So staff have sufficient notice of the meetings, dates are made available and distributed on a yearly basis. Night sessions are included for the convenience of staff. Records for residents and staff are kept with due regard to confidentiality. However as stated previously, the maintenance of care records made it difficult to obtain a coherent picture of residents individual problems and action being taken. This could cause a problem if an investigation into allegations of poor care needed to be carried out. The returned AQAA indicates the home has policies and procedures for staff to refer to when carrying out particular duties. Most were reviewed in 2007, 2008 and 2009. However, the policy and procedure for the control, storage, disposal, recording and administration of medicines is recorded as last being reviewed in 2005, which might not reflect the subsequent medicine guidance our predecessors issued and made available to providers on their website. For residents convenience the home holds some of their money which is then used for the payment of services or items obtained or purchased on their behalf. The balances are kept collectively. Individual records of the transactions are kept and details submitted to the provider on a weekly basis for checking purposes. Disappointingly, records inspected identified cash balances in excess of £100.00 being held for two clients. Our agreement with the provider for the retention of collective cash balances is that the sum of £100.00 should not be exceeded. We expect the provider to comply with this. The AQAA also indicates that the homes equipment is tested and serviced in accordance with the manufacturer or other regulatory body recommendations. Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 24 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 4 3 4 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 3 3 3 2 4 Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Nelson Court Linked Service Centre DS0000036738.V376183.R01.S.doc Version 5.2 Page 26 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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