Care Home: Northbourne Court

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What the care home does well All residents were admitted based on a full assessment of need. The assessment information was to a good standard and would provide staff with guidance on what the care issues were and what assistance was needed. An experienced staff team is present in the home. Good support is provided through the multi disciplinary team and GP services.Northbourne CourtDS0000067696.V377325.R01.S.docVersion 5.2The standard of accommodation, both individual bedrooms and communal space is very pleasant. What has improved since the last inspection? Since the last inspection there have been a number of areas where improvements have been made. All of the requirements arising out of the last inspection had been actioned and either been met or staff were working towards this. The records generally were well organised with information easy to access. The manager and the administrator have good systems in place to ensure documentation is well maintained. Residents benefit from a home that is pleasant, well-furnished and spacious environment. Bedrooms all have en-suite facilities. Initial care plans are now prepared for residents at the time of admission to ensure staff have information on which to provide care. Some of the medication requirements had been fully addressed including informing the GP if medications aren`t given. Medication records and stock checks in the main were found to be accurate. The manager is in the process of becoming the Registered Manager through the CQC process. What the care home could do better: The recruitment of staff must continue to ensure a consistent staff team is employed. Daily lives and social are must be organised around individual resident’s needs and preferences. Staff should be more proactive when addressing care looking for resident’s verbal and non verbal communication signs. Care plans need to be comprehensive in content and when issues are identified records of the action taken to address the problem documented. The areas identified in this report under medications must be addressed including appropriate storage cupboards for Controlled Drugs and all medication information must be accurate. Laundry systems could be improved upon. Staff must be familiar with and have sufficient knowledge of addressing adult protection and whistle blowing and this must include referral to appropriate agencies.Northbourne CourtDS0000067696.V377325.R01.S.doc Version 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Northbourne Court Harland Avenue Sidcup Kent DA15 7PG Lead Inspector Rosemary Blenkinsopp Key Unannounced Inspection 12th August 2009 09:45 DS0000067696.V377325.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. Northbourne Court DS0000067696.V377325.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 Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northbourne Court Address Harland Avenue Sidcup Kent DA15 7PG 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) 020 8269 9840 020 8269 9841 susan.ilott@kcht.org.uk www.kcht.org Kent Community Housing Trust Manager post vacant Care Home 120 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age not falling into any other category - Code OP Dementia, over 65 years of age - Code DE(E) The maximum number of service users who can be accommodated is: 120 16th December 2008 2. Date of last inspection Brief Description of the Service: Northbourne Court is a purpose built care home for older people requiring personal care and older people with dementia. The registered care provider is Kent Community Housing Trust, which is a not for profit organisation and the home was registered on 13th September 2006. Accommodation is provided on two floors, all bedrooms are for single occupancy and have en-suite showers, toilets and washbasins and complies with the current environmental standards. The home is divided into four suites each with a named manager and a designated staff team. The suites are further divided into fifteen bed units each with its own lounge, dining room and suitable bathing facilities. Other communal areas include ‘the Piazza’ on the first floor. This area provides a meeting point for residents, a piano bar, a café, a hairdressing salon and internet facilities. Residents and relatives can enjoy a snack and have a drink as the home has a licence to serve alcohol. Outside there is ample parking space and pleasant gardens for residents to enjoy. The current weekly fees ranged from £453.78 to £618.80. Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 5 Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection was conducted over a one day period by three inspectors. The manager facilitated the site visit assisted by the deputy manager and staff on duty. Periods of observation were undertaken in the communal areas. The pharmacy inspector inspected all of the medications during the afternoon of the site visit. Prior to the inspection the manager had completed the AQAA and forwarded this to the CSCI. The AQAA contained good information regarding the service. Twelve comment cards were received during the site visit, including four from residents, two from relatives and six from staff. During the visit we met with several relatives and residents. Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated into this report. A selection of documents were inspected including care plans, staff personnel files as well as health and safety records. Feedback was provided to the manager via the telephone as she was not present at the end of the inspection. Other information which has been considered when producing this report and rating, is the information supplied and obtained throughout the year including Regulation 37 reports and complaints. What the service does well: All residents were admitted based on a full assessment of need. The assessment information was to a good standard and would provide staff with guidance on what the care issues were and what assistance was needed. An experienced staff team is present in the home. Good support is provided through the multi disciplinary team and GP services. Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 7 The standard of accommodation, both individual bedrooms and communal space is very pleasant. What has improved since the last inspection? What they could do better: The recruitment of staff must continue to ensure a consistent staff team is employed. Daily lives and social are must be organised around individual resident’s needs and preferences. Staff should be more proactive when addressing care looking for resident’s verbal and non verbal communication signs. Care plans need to be comprehensive in content and when issues are identified records of the action taken to address the problem documented. The areas identified in this report under medications must be addressed including appropriate storage cupboards for Controlled Drugs and all medication information must be accurate. Laundry systems could be improved upon. Staff must be familiar with and have sufficient knowledge of addressing adult protection and whistle blowing and this must include referral to appropriate agencies. Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 8 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. Northbourne Court DS0000067696.V377325.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 Northbourne Court DS0000067696.V377325.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): 3. 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 subject to robust assessment procedures prior to any offer of placement. This information provides staff with good information on which to provide care. EVIDENCE: All residents were admitted based on a full assessment of need. A full time assessment officer is employed who completes most of the preadmission assessments for homes in the organisation. The assessment officer remains involved with admissions until residents have their first placement review meeting. The manager said the role of the assessment officer worked Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 11 well. Care records including assessments were viewed on several of the units by us. All files seen included a pre-admission assessment of need completed by the assessment officer and some files included a care manager assessment or the panel papers. The Joint Assessment Panel papers contained good information on the resident. The assessment undertaken the assessing officer was also to a good standard covering all aspects of daily living specific needs ad support/care required. The assessment information viewed included good social histories and in particular one which had been obtained from the daughter of a resident was very informative. Information arising out of the pre-admission assessment was incorporated into an initial care plan, which is prepared prior to admission. In addition property inventories and an admission checklist were completed. All beds in the home are contracted to Bexley Council. There was evidence to show that residents received written confirmation that the service could meet their assessed needs. The Statement of Purpose and Service User Guide were seen located in various parts of the home including some bedrooms and communal areas. These documents will need reviewing in light of the change from CSCI to CQC, and to include the new staffing, and the management structure which is due to be changed and implemented by the end of 2009. Other information retained on resident’s files included copies of offer letter from the home and a contract. Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care documentation is not always fully completed and when problems identified not always actioned hence health care is only partially addressed by staff in the home. Records around medications introduce an element of risk to residents’ as they are not always correct. In addition the storage for Controlled Drugs must comply with current regulations. EVIDENCE: Care plans which were inspected were well organised. It was nice to see them written in the first person, i.e. I want, I can do, I prefer etc. All care plans have a photo of the resident on them. Care plans were inspected on two units and found to be to a variable standard. Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 13 The care plans covered daily living activities including personal care, psychological needs and a night care plan. In one care plan, under the heading “Agitation and Confusion”, there was little information on how staff should address the problem simply stating, “To be monitored by staff”. In cases where such problems are identified then comprehensive interventions need to be documented for staff to follow, to ensure a consistent and correct approach are carried out. There was a behaviour motioning chart, which had relevant information recorded such as the type of behaviour precipitating factors and action, but no risk assessment or care plan. In another care plan there was a further example of inadequate record keeping. There was a lot of statements relating to the residents aggression. There was a behaviour monitoring chart which referenced several episodes of aggression although there was no risk assessment and the care plan needed more instructions to staff to ensure a consistent approach. However on another unit the behaviour motioning chart, which was in use, had relevant information recorded such as the type of behaviour, precipitating factors and action. One resident we saw seemed to be exhibiting challenging behaviour. There was a behaviour monitoring chart in place but no risk assessment about how the behaviour should be managed. Risk assessments were in place in the form of a general risk assessment covering areas such as manual handling. Some of the care plans had good social histories incorporated. The social care plans were variable some with good information from which staff could work, others simply asked staff to orientate the resident, this is inadequate The care notes and assessments had good information on the resident’s background and social history although how this was utilised was difficult to assess, as there were no individual activities except the foot massage-taking place. There was some evidence that residents and their relatives had been involved in the care planning process, and they had signed them. There was a separate sheet for records relating to visits made the MTD these Weight charts were checked especially for those residents who had been seen at lunchtime. One resident, was known to be a small eater, although food preferences to encourage them to eat were not recorded. In addition their weight had dropped by over three kilos in seven months yet no action was taken. Another resident had also lost weight every month and again no action taken. It simply seemed as though staff recorded it without giving any thought to it or identifying it as a problem. Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 14 Another resident with obvious mobility problems was wearing slippers with no backs to them and this may have posed a risk to them. The daily events were reasonable in content. Daily notes not always written in black various colours were used including some green and some red. We spoke with 5 residents whose care plans we looked at. Generally the home had been chosen on their behalf. All said that staff were very kind. “Can’t fault them” “anything you want you just ring the bell”. “I can always get an extra cup of tea if I want one” “the hairdresser comes once a week” The Domiciliary Optician was in visiting although not to see everyone. We observed some poor manual handling techniques during the lunch period including a through arm lift. The medications were inspected by the CQC pharmacist. There were still out of stock for some drugs and on those sampled it ranged from one to nine days that medications were out of stock. The home did provide evidence that they had faxed a note to the GP for one of these medicines found to be out of stock although nothing to support the omissions found on the other charts. We did spot checks, and auditing of records against stocks of medications and only found one instance where there was 1 example where the tablet and records did not match. Another issue we identified was that instructions on the label on the packaging were not tying up with that written on the MAR chart. The GP had not made changes to some prescriptions, so medications were coming to the home with old instructions. Staff are giving the right medications, according to the MAR sheet however the prescriptions must be changed so the medications are correctly labelled. A requirement from the last inspection, in respect of informing the GP if medications are omitted had been addressed. The Controlled Drug cupboards must comply with regulations. The current CD cupboards are not attached to solid walls or metal plates. They queried why we did not pick this up at registration or earlier inspections. At registration in 2006, the CD regulations didnt apply to care homes (personal care); however these were changed 2 years ago, so they do need to comply now. At the time of our visit most of the home’s CD cupboards are empty, they are locked, and within locked rooms. Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 15 . Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are limited and do not provide sufficient stimulation for residents to engage in, nor do they provide active leisure periods and fulfilling social lives. EVIDENCE: Periods of observation were undertaken by all of the inspectors. In one unit Keats, tea was served at 11am. The servery assistant did this. She displayed great care and attention when serving the tea and had a gentle manner with residents. The tea came out of the teapot with milk already added hence no one had a choice in this. Biscuits were served with the tea. The activities in Keats lounge consisted of one staff was doing foot massages, which the residents seemed to enjoy. The other care staff engaged much less with residents. Sky news was on the TV and this station repeat the headlines frequently; this was the case during the whole time that we were present in Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 17 the lounge yet no one asked residents what they wanted to watch or attempted to try another way to entertain the residents. Lunch was served two staff and one server did the lunch. Blue aprons and gloves were worn to give out food – this, we were advised is the home’s procedure. During lunch residents were seen to get up leaving their food to get cold. It was obvious one resident wanted the toilet yet her non verbal cues and her verbal requests went unheard by staff. At one point the resident got up and wandered in to the corridor, couldn’t find the toilet, returned and sat down only to become agitated again within a few seconds. No staff member offered assistance or directions to the toilet. One very slender resident made no attempt to eat; one staff verbally prompted them then walked away. The care staff did make the resident tea and toast but they ate only one slice and that was the sum total of their lunch yet no concern was raised. Other resident left food although the “Artic roll” went down well however seconds were not offered. At the end of the food serving a sample was tested and items were cold. A lot of food waste was noted most residents left more than half of their main meal. Plate guards and other feeding aids were not used and these may have assisted people to eat in a more dignified manner and without staff assistance. Engagement between residents was positive and cheerful one assisted another with her meal and the two of them chatted happily through the lunch. Some poor verbal communication between staff and residents was noted, one staff saying, “Sit down you are having you pudding. “ Dining rooms décor was good, but tables very poorly presented and set for lunch by 10:30 am. Tables with just white tablecloth, knives and forks (wrongly set for left handed residents when not left handed), no menu on table no extras like condiments, flowers and only paper napkins. This also indicated that the dining area is not available for tabletop activities during day. The small fridges were found to be broken in several units and the bottom tray of one was dirty and broken. This was brought to the Manager’s attention who said staff put large milk containers in this shelf and break them. We saw one server giving out drinks whilst the agency carer told us it was her first day there; she just sat and watched the TV not even watching the server to make sure residents were safe with cups and saucers. As it was her first day we thought it unwise for her to be ‘supervising’ residents on her own with only a server present. In another unit there was no activities taking place expect the TV on (silent) and music playing old war time music, ‘Daisy, Daisy’ and ‘Down at the Old Bull and Bush’ etc… Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 18 The care staff said there is an activity organiser. I asked what was available on the unit and the carer found some puzzles in a corner and knitting wool with one needle for residents when I prompted her. This activity material was stored away on the floor in a corner. We did see one carer with a book of London talking with a resident about the book. This was a single simple example of engagement in this unit. In Chaucer residents were asked how things were and they said “it was boring”. Another practice we observed, which is often seen in care homes is that of residents sitting in usual serried rows and staff showing little sign of engagement, typically the staff are in the room just sitting or standing there as if on guard. Some residents were complaining about the food. One reference to the pastry was “could be used to build a patio”. Other comments included “Meat often tough”, “fed up with mashed potato” “vegetables are hard”. Residents told us “The cook does come to meetings but he doesn’t take any notice” “I have ice cream every day you can’t mess around with that”. No menus were displayed, apparently residents choose the day before. In one of the kitchens the fridge was being defrosted with food still in it while it was happening. This included milk and yoghurt. Food items should have been moved to another one while this was occurring. Also in this unit there was a list stating people’s likes and dislikes regarding food, and those who were diabetic, displayed on the wall is not very dignified. In this unit we observed lunch. Tables had a cloth, drinks, salt and pepper. The food was served from a heated trolley by carers. The food looked satisfactory but the chicken was in big pieces, slices would have been easier to manage. Residents told us it tasted nice. The roast potatoes were very pale in colourBeige. Artic roll was the desert. One resident had a pureed meal. It came from kitchen looking very nicely presented. The carer then put several spoonfuls into a cereal bowl and topped it off with mashed potato and gravy. We suggested that a plate with a plate guard would have been better and may have enabled the resident to eat independently. On another unit we also had related to us mixed opinions about food, some thought it good others said the pastry was no good e.g. particularly in quiches Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 19 and pies. Cottage pie, fish and chips and corned beef hash were popular dishes said the server. We spoke to a resident who was full of praise, “A wonderful place, gorgeous, can’t be faulted’. Another resident with two visitors made similar comments and had no complaints; ‘Staff are very good to mother’. Activities seem limited although we were told that some people were going out for the day. The home has use of mini-bus for ‘bright- days’ (outings). Residents all looked well cared for clean and all were appropriately dressed. The laundry is very large and has the usual facilities including sluicing equipment. There is no sewing machine in the home. Clothes seen were labelled with marker pens and sometimes we were told staff do this. We suggested “Cash” sew in type labels for all residents to be ordered by the home prior to admission. Some damaged and frayed items such as flannels were still in use we advised the laundress to dispose of them. We observed that some clothes were still stained even after washing. Some clothes are donated to the home and used for other residents. Some clothes have gone missing this was according to complaint log we viewed. Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. 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. Information on how raise concerns is made available and complaints are recorded. Staff demonstrated insufficient knowledge when actioning cases of suspected or actual abuse to ensure residents are protected. EVIDENCE: A complaints policy and procedure was provided and included in the Statement of Purpose. A system was in place to record complaints made about the service. The complaints log for the period from 8 January to May 09, showed eight complaints had been received. Two of these were about staff attitudes; one from a GP the details of which were not seen, and one from a distressed relative. Both were investigated by the home, one outcome was as follows “Staff often find it difficult to effectively articulate the message they are trying to convey and this sometimes appears negative”. (This does not seem to reflect the shouting the relative claimed occurred when they raised the complaint). The findings, recommendations and requirements, arising out of Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 21 such investigations must be taken seriously and be addressed with appropriate action to protect residents and relatives. A policy and procedure was provided in relation to safeguarding adults. Staff receive training and induction on both adult abuse and whistle blowing and have updates. Staff’s knowledge of both subjects varied considerably some had insufficient to make sure concerns were reported quickly. As part of staff interviews they were asked on topics such as whistle blowing and abuse. They knew what constituted abuse in general terms and knew they must report although their knowledge of external contacts was limited. One staff member said that she wouldn’t report abuse immediately but would give staff a chance. This must be actioned so that staff have the knowledge skills and confidence to take appropriate action in cases of actual or suspected abuse. Staff on other units were also asked about the two topics. All had an understanding of abuse although were not sure what to do if the manager did not take any notice of their concerns or if the concern was about the manager. In addition staff seemed unsure of where to locate contact telephone numbers; staff must have access to relevant phone numbers and know where to find them. Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable, clean and modern home which benefits from well appointed bedrooms and large communal areas. EVIDENCE: The building is spacious and of good appearance; there are ample communal spaces including reception meeting room, lounges, separate dining rooms, café/bar, and a smoking patio area on the first floor. There is a safe, enclosed courtyard garden. There are several offices including a large clinic room for medications and visiting nurses/doctors but it needs more storage units. A Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 23 ‘Spa’ room is provided which is a parker bath with water nozzles. In addition there is an activity/craft/training room on the ground floor. Home has a small laundry for resident and relatives to use. The following observation were made in respect of the ground floor Each unit has sitting room and dining room / kitchen area. Overall, the home is very well appointed and maintained. The spacious bedrooms all with en-suite facilities. The majority of those seen had been personalised with pictures, ornaments etc. Some residents had brought in items of furniture as well. Pleasant lounges all with widescreen television although it was noted that all of the clocks were wrong in them. The ground floor lounges open out onto the garden; some of the grass still needs cutting- this had been remarked upon in the comment cards. All corridors have handrails and there are nurse’s stations at the end of the units on each floor. The bathroom and toilet facilities all have a picture on rather than a notice these would assist resident’s and orientate themselves to the toilet. We particularly liked the extra small lounges where residents could entertain their visitors. On the upstairs unit there is a smoking area. Generally all areas were fresh and clean although there was some slight odour present in Dickens. All the call bell points I saw were without cords but maintenance man said they are checked and in working order and the push button worked. The call bells had been raised at previous inspections in relation to the use of call bell leads, risk assessments need to be in place if the cords are not needed for individual residents. Bedrooms do not have self-closing devices otherwise fire and safety was found to be satisfactory in bedrooms. Some bedrooms have vinyl floor covering to prevent carpets becoming malodorous. Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are provided in sufficient numbers to meet resident’s needs, they are adequately supervised and are sufficiently trained to undertake the work they do. EVIDENCE: Staff are in the process of being redeployed from another home in the group, into this on, once the other service closes. Northbourne Court is currently in the transition period and this is proving difficult particularly in the area of staffing. The home has been recruiting staff in the last few months. This has proved only partially successful with staff completing the recruitment process then failing to take up post. In addition the lengthy wait for CRB clearance is causing difficulties the manager is reminded of the advice that staff can work under a POVA clearance with supervision until the CRB is received. To fill vacancies agency and bank staff are being used which is not wholly satisfactory. Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 25 Staff rotas were very difficult to read as so many changes were made to them. Staff training needs are identified through a number of avenues including staff supervision sessions. There is a new computer system due to be implemented which will automatically prompt the manager and alert them when mandatory training refreshers are due. Staffing levels are the same for each unit namely two carers to each suite and a team leader overall. We spoke with three members of staff, two of whom were agency. They said that they were in the home frequently and had been working for some time. The permanent staff member was able to tell me about her induction programme and they had gained NVQ level 2. They demonstrated a good understanding of their residents. We met with the housekeeper and discussed employment of Learning Disability people for kitchen, laundry and serving duties. She stated that she needed more time to properly supervise them, although the have a mentor who visits and is very good. One example of the lack of supervision is in the Social Care section of this report relating to the serving of the tea. Three staff files were looked at. All had the information as required under the regulations. It was evident that no one is employed without a CRB, references or identity checks. Pre employment health screening is also undertaken. Training certificates are retained in personnel files. Equal opportunity monitoring is part of our recruitment process. Agency staff are usually supplied through a regular agency and checks are made. Permanent staff are subject to a six months probation period, staff are interviewed and a report made. If this is completed successfully then a permanent contract is offered. The AQAA stated the following: “Due to the higher dependency levels of our residents we would welcome a review of our staffing levels. We train staff to NVQ level. Staff supervision takes place regularly. We have an active in-house training programme. Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 26 Recruitment is based on our equal opportunities policy to ensure the safety of the residents. There is a mix of ethnic minority staff employed in the home, in the event of the resident group reflecting the mixed ethnic make up of the community”. The manager must increase staffing levels as deemed appropriate either by increased resident numbers or increased dependency. Training for the company has been outsourced to ensure staff have sufficient training to do the job they do and ensure mandatory topics are updated appropriate intervals. There is a cascading supervision system which staff are given at two/three month intervals. Staff comment cards were generally favourable of the home saying “Residents are given good care” – “this is a nice place to work” and “staff are cheerful and helpful”. One staff member felt rushed to fulfil her duties whilst another wanted, more induction. Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 27 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, 32,33,35,36 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by an experienced individual supported by a team of well experienced and trained managers. Forums are facilitated to obtain the views of those who use, visit and work in the service. Heath and safety is well addressed providing a safe home for al those living and working in it. EVIDENCE: Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 28 The manger has eleven years experience with this type of establishment and resident population although not this size of home. She has applied to become the Registered Manager and is awaiting her interview with the CQC to confirm her into the role. Certificates confirmed that maintenance and regular servicing were undertaken for items of equipment, including those for electrical gas and fire prevention. Stickers were on all those items used for lifting to confirm six monthly servicing. Resident’s money is all retained safely in the safe. Records of all transactions are computerised. All expenditure have a receipt as proof of purchase. In addition all expenditure has a voucher number for easy auditing and cross referencing. Residents who are able sign for their own financial transactions, it’s recommended to afford greater protection to staff that two staff signatures be n place fro all expenditure. Charges for hairdressing are displayed in the hairdressing room. Minutes of meetings were retained in the staff office. From these minutes we could see that meetings were held frequently. Minutes are taken of all meetings and these are put on general circulation. Relatives are also provided with forums and regular meetings where they can discuss any issues relating to the home. KHCT also produce two newsletters, one which the Chief Executive produces and another produced by the home . Staff supervision is conducted with all staff in the home. This is done via a cascading system where the direct line manager of that staff member addresses their supervision. Appraisals are also conducted with staff. The manager felt both of these issues were not fully understood by staff and this was an issue which had been raised in the comment cards received. The manager intends to raise awareness of the two issues through meetings and regular individual supervision. Fire systems were in good order including weekly checks, fire drills and regular maintenance. The fire panel was being checked on day of our visit. There was evidence that fire equipment was being checked regularly. The visitor’s book being used effectively which is essential should a fire drill Fire training had taken place the day before. The AQAA told us the following: Quality audits take place bi-monthly. The home has clear financial procedures in place. Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 29 There are yearly audits by Head Quarters .We have increased the administration hours in the home. In general health and safety was well addressed in the home Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 30 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 X X 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 x 3 3 x 3 Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? yes 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 Requirement The care plans must be fully reflective of identified needs with comprehensive interventions recorded. Action must be taken when issues are identified and include appropriate supporting records i.e. risk assessments care plans etc, so staff have the full information on which to base the care. Staff must ensure the safe management of medicines, including accurate records and correct storage for all classes of medicines. This requirement is repeated previous time frame 17/11/08 Resident’s social needs must be addressed to include group and individual activities of the resident’s choosing with more active and participative entertainment provided. Activity records must provide evidence that all residents have access to adequate and suitable activities. Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 32 Timescale for action 14/10/09 2. OP9 13 14/10/09 3. OP12 16 14/10/09 4 OP18 13 Staff must be trained 14/10/09 knowledgeable and confident to effectively deal with suspected or actual abuse and evoke whistle blowing procedures when appropriate. They must be aware of the external organisations where to report such matters. 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 OP14 Refer to Standard Good Practice Recommendations The laundry system needs to be reviewed including labelling of clothes, the washing of clothes at a temperature sufficient to remove stains and the system of re-allocating donated clothes. Northbourne Court DS0000067696.V377325.R01.S.doc Version 5.2 Page 33 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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. 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