Care Home: Palm Court Nursing Home

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What the care home does well The service uses a comprehensive format to record information about prospective admissions that has a dependency rating that gives them a baseline to measure everything they do beyond admission against. They also consider the impact on the people who already live in the home, and the staffing arrangements, etc, before making a final judgement about the suitability of the admission. Care planning is about the person and not just their condition. This is also the approach used during training that is focused on people and the home rather than simply limited to a procedure.The "person centred approach" is not limited to care, it also is adopted in the planning of activities that are aimed at what people say they want as well as what might be "therapeutic" for them. The overall management of the home is very good and the staff should be commended for their team working. The home has produced and provided good documentation that verifies what they do to achieve the standards of care expected of them, and more. What has improved since the last inspection? There has been an ongoing improvement to the fabric of the home that includes replacement of baths, floors and carpets. Recruitment documentation includes equal opportunities questions with the responses being recorded. Staff training is increasingly focused on the benefit to the individual and the home rather than fulfilling a process. CARE HOMES FOR OLDER PEOPLE Palm Court Nursing Home 7 Marine Parade Dawlish Devon EX7 9DJ Lead Inspector Doug Endean Unannounced Inspection 19th March 2008 09:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Palm Court Nursing Home Address 7 Marine Parade Dawlish Devon EX7 9DJ 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) 01626 866142 01626 888580 Palm.court@btinternet.com Mrs Lorraine Jacqueline Greenaway Mr Graham James Greenaway Mr Nigel William Charles Morris Care Home 36 Category(ies) of Dementia - over 65 years of age (3), Learning registration, with number disability (3), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (3), Old age, not falling within any other category (3), Physical disability over 65 years of age (36) Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Registered for maximum of 3 OP Registered for maximum of 3 LD Registered for maximum of 36 PD(E) Service Users aged 65 years and over Registered for maximum of 3 DE(E) Service Users 65 years and over Registered for maximum of 3 MD(E) Service Users 65 years and over To accommodate one Service User (named elsewhere) under 65, in the category of physical disability, may be accommodated for regular periods of respite care 25th September 2006 Date of last inspection Brief Description of the Service: Palm Court Nursing Home is a purpose built establishment located on the sea front of the holiday town of Dawlish. It is within approximately 100 yards of the town’s park, train station, bus stop, and main street, all of which are on the level to the home. The home is built on three levels with a car parking area at the front of the building. There are some seating areas outside and to the front of the home and a Gazebo is erected during suitable weather conditions for the people who live in the home. The home has a large lounge on the second floor that has uninterrupted views over the sea. There are thirty-six single bedrooms, one of which has en-suite facilities. The bathrooms and toilets are all of good size, equipped with modern facilities for the disabled, and are all within a short distance of the bedrooms and communal areas. There is a shaft lift near the main entrance that provides access to each floor in addition to two staircases. A large dining room can be found at the rear of the building on the ground floor. The home is registered to provide personal and nursing care. The current fees are from £370 for residential and £507 for nursing care. There are additional charges for Chiropody and hairdressing, taxis, paper/magazines, and telephone bills, which are variable according to use. Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who use the service experience excellent quality outcomes. This key unannounced inspection took place on the 19th March 2008 beginning at 09:45 hours and lasted 4.5 hours. In that time we toured the home speaking to several of the people who live there and the staff who care for them. We did spend time with 3 individual people and 2 staff talking about their own experiences of being at the home. We compared the information we had collected with that in the case records of the 3 individuals and the 3 staff, this is called case tracking. It verified the care given with the care received by the people who live in the home and information about them as individuals. The staff files verified the information about staff recruitment, training and supervision that we were told about. The Registered Manager prepared the Commission for Social Care Inspection for this inspection by completing the Annual Quality Assurance Assessment, a legal document that informs us about the homes perspective on how they are performing against the National Minimum Standards and the Care Homes Regulations. It also provides facts about the functions of the home and information about staff and the people who live there. The document that was returned was comprehensively filled out and has provided valuable information about the way the home functions. We received other information about how people view the home in the form of surveys that had been completed by 13 relatives/friends, 13 people who live in the home, 3 visiting professionals (Nurses and General Practitioner’s) and one member of the homes staff. What the service does well: The service uses a comprehensive format to record information about prospective admissions that has a dependency rating that gives them a baseline to measure everything they do beyond admission against. They also consider the impact on the people who already live in the home, and the staffing arrangements, etc, before making a final judgement about the suitability of the admission. Care planning is about the person and not just their condition. This is also the approach used during training that is focused on people and the home rather than simply limited to a procedure. Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 6 The “person centred approach” is not limited to care, it also is adopted in the planning of activities that are aimed at what people say they want as well as what might be “therapeutic” for them. The overall management of the home is very good and the staff should be commended for their team working. The home has produced and provided good documentation that verifies what they do to achieve the standards of care expected of them, and more. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 7 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 Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standard 3. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The approach to gathering information about proposed admissions, and how judgements are made regarding the suitability of the arrangement of admission for both parties, is excellent. EVIDENCE: We read the files of 3 people who now live in the home and have done so for various period of time from months to years. The record told us about them as individuals particularly where the personal history had been provided in full by the people themselves and their families and friends. The Registered Manager prefers the humanistic approach to care where his staff know the “person” they care for, rather than the needs that people have that need to be met. Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 9 The information the home had began with the completion of a comprehensive pre-assessment form that covers needs such as eating and drinking, eliminations, mobility and communication. It then goes on to look at the behaviours that people are presenting there present carer with, what challenges it presents and how difficult they might be in terms of management in the home environment. These and the other issues are given a rating so that upon competition the home have dependency score, and therefore a baseline by which all they do after a successful admission, can be measured. The assessment also records the levels of involvement from other health care professionals including Specialist Nursing Interventions that may include tissue viability, diabetic care or MacMillian Nurses. The assessment is always done by a qualified nurse who always takes a senior carer with them as they feel that a second viewpoint is advantageous and helps during feedback to the rest of the team. The Registered Manager wrote the following comment in the Annual Quality Assurance Assessment about the second opinion and value of the feedback to the team, “It helps to ensure that from day one the care team feel part of the admission process and feel more connected to the new resident”. The Registered Manager told me that all this information is considered and a judgement made that will take into account the effect the proposed admission will have on such things as the wellbeing of the other people in the home, the equipment requirements, and staff training implications as well as staffing levels. Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 7, 8, 9 & 10. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides excellent standards of nursing and personal care that is well planned and with the appropriate level of involvement from other health care professionals. People who live in the home are treated with the dignity and respect that they expect. EVIDENCE: We looked at the structure and content of the care plans for the 3 people that we case tracked. The plans were developed from the initial information gained at the pre-admission assessment. They were improved upon as a result of the ongoing risk assessments that had been carried out and held in the file. We saw risk assessments for a variety of issues such as falls, nutrition, and bed rail use. In addition to the normal physical subjects covered by care plans we Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 11 saw that the psychological issues are covered and in particular the subject of grieving for the persons loss of independence brought about by their physical condition and moving into care. They were each clear and comprehensive having an outcome. The care plans are easy to read, and follow, covering one issue at a time and identifying what should be done to bring about change and what staff should be involved. There was evidence that each plan had been reviewed regularly. The Registered Manager told me that he talks to the person the plan in about and their relative about the content and the plans have a space for their signature agreeing to the content. In addition to the care plan process we saw that the home also carries out a monthly health care check looking at blood pressure, weight, etc. Where this highlights a change the home will involve the skills of other health care professionals if necessary. One General Practitioner wrote, “The home will involve the General Practitioner early and appropriately”. A visiting Nurse wrote, “The Registered Manager is always willing to accept advice from professionals, and seeks advice if required with any problem. The nursing care at Palm Court is very good. As a visiting professional I have never been aware of any problems”. Another General Practitioner answered to the question what do you feel the care service does well, “Good continuity of care”. We are aware that the home also has involved the multidisciplinary team, including social and psychiatric professionals, and the Commission, when dealing with more complex problems. The trained nurses staff manage the homes medication system. The medicine administration system is a pre packed blister pack system that the local pharmacy delivers with some additional boxed or liquid medicines. The storage area of the medicines was, clean, tidy and secure and the systems for the collection and disposal of medicines were well managed. Although medication is securely stored within the room it would be good practice to make sure the door is locked when the room is not in use. The recording of medication was on the whole well completed. Specialist wound care plans and notes were kept in the treatment room, which prompts staff to renew dressings when they are needed. The home uses the “Stirling Scale” to describe wounds and allows them to describe changes that result from treatment in a professional way. Only a small number of people had wound dressings and none had pressure sores. During the course we noted that people where treated with dignity and respect. Personal and intimate care was provided without fuss in the privacy of their own rooms or in another appropriate place such as the bathroom or toilet. Staff referred to individuals in a way that they seemed to be comfortable with, and their visitors were treated in the same way. Visiting professionals were given the support they needed and time to feed back information before leaving the home both in writing and verbally. This information was recorded in two ways, once in the persons care records and also in a file that provided at glance information for handovers and other reasons. Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 12 People were appropriately dressed in their own cloths and were sitting where they were comfortable, mostly being in the lounge in large groups. Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 12, 13, 14 & 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides a wide and varied range of activities for people that provide entertainment and therapeutic outcomes. People are enabled to exercise choice in many ways, which has good psychological benefits for them. The meals that are provided are nutritious, well balanced, and in the main meet with the approval of those who live in the home. EVIDENCE: During the course of the inspection we saw relatives come and go. We saw that they took advantage of the level access to the town to go out for a walk into town, using a wheel chair where this was necessary. We also saw that the ambulant people who live in the home also went out for short walks perhaps to use the local shop just a hundred yards from the entrance of them home. Visiting is open to people at any reasonable time and each bedroom is fitted Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 14 with a telephone line so that the residents can maintain contact with families and friends by this method if they wish to do so. When talking to individuals we were told that the routine revolves around them and not that they revolve around the homes routine. People told us that the staff are aware what their time to get up is, where they prefer to have breakfast, when they wish to go to the lounge and where they wish to sit. Some people preferred to eat their mid day meal in the lounge and others went to the dining room on the ground floor. They said that they go to their room at a time generally convenient to them and will have their lights out at night when they are ready. The less vocal people have details about their own likes and dislikes recorded and communicated to staff from an early stage in their admission so that settling into the home is less traumatic. The purpose of the homes history taking procedure is so that people are known as an individual’s, and their individual needs are important when delivering holistic care. Activities are formally provided to individuals and groups five days of the week by the homes Activities Coordinator. This has increased by 2 days since the last inspection. The activities that are available range from the general bingo, crafts and board games to the more adventurous shopping trips, walks in the park, entertainers who sing and perform pantomime to the latest hi tech Wii electronic game that was demonstrated to us during the inspection. This was generating lots of interest among the people in the lounge who were playing ten pin bowling and had gone fly fishing from the comfort of their chair. The physical and psychological benefits from the use this new technology was looked into by the homes management. They felt that it would be advantageous to the people who live in the home and therefore purchased it. Less technical, but also physically and psychologically adventurous are the Tai Chi sessions that are undertaken with the residents by a lady who visits the home for this purpose. When activities of any sort are undertaken the staff record this in the daily note. Some people who live in the home did comment that although there are various activities available they chose not to attend them. For these people there is a collection of books from the library that are changed several times a year, this includes a variety of speaking books, and there are films on DVD’s. For more tranquil times there is the view from the second floor lounge window, and some bedrooms at the front of the building, across the sea that is immediately in front of the home. The meals that are produced begin from the nutritional assessment that is carried out and regularly reviewed. This information is enhanced through obtaining the likes and dislikes of individuals so that what they receive, whether in a normal meal or pureed diet, is what they would wish to eat. The menus were on display at the entrance to the dining room and showed that there is a variety of things on offer each day. People are asked what they would like to eat for their main meal the next day, and are given initially a choice of 3 main meals. They may choose another alternative if nothing they Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 15 might like is on the menu. The evening meal is buffet style so that people can choose again what they would like to eat, designing their meal to suit them and their nutritional needs as staff are there to guide them. Despite the knowledge of individuals likes and dislikes the staff always ask people what they would like even when bringing drinks around during the day. We saw this happening during the course of this inspection. The dining room was not cluttered and tables were laid with small vases of flowers etc to make them attractive. The kitchen is of hotel design and quality with many stainless steel surfaces and equipment. Food is stored correctly either in the fridge, freezer, or the two food stores that were well stocked. During the tour of the home we spoke to people and asked for comments about the food. Generally people were satisfied or more than satisfied with the food they have. One person said that although they have their diet pureed due to swallowing problems the food is always very good and appetising being nicely presented. From the 13 survey responses from people who live in the home we received the following information to the question, “Do you like the meals at the home”. There were 6 people who recorded that they always like the food they receive, a further 4 recorded that they usually like the food served to them. There were 3 people who recorded that they sometimes like the food and they wrote comment such as, “Don’t like the buffet at tea time”, and, “Would like more variety of food, more flavour and vegetables cooked a little longer”. The relatives survey provided interesting responses to a difficult question, “Does the care service support people to live the life they choose?” One response made the point that their relative has not chosen to live the rest of their life in the condition they have to endure”. But they do say that the home does the best it can for there relative. There were 10 other responses to this question with 5 recording “always” and 5 recording “usually” in answer to the question. One person wrote, “As far as possible” whilst another said, “From what I’ve seen, the staff seem to go to great lengths to be socially acceptable to different life styles. Socially people dine together, and meet each other in the day room, while people who prefer to eat in their rooms, are allowed to do so”. Palm Court Nursing Home DS0000050094.V358809.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. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home method of making the complaints procedure is good, and was verified during the inspection process. Staff vulnerable adults training is effective in that it deals with more than observation and procedure, it makes staff think more widely about issues. EVIDENCE: The complaint procedure was displayed in the entrance hall and in resident bedrooms. It provides sufficient information to the reader about how they can lodge a complaint and who they can lodge it with, including the Commission for Social Care Inspection. The Registered Manager provided us with the complaints folder that showed they had handled a small number of complaints in the home. It had a description of the complaint, how it had been investigated and what the outcome had been. The Commission for Social Care Inspection received one concern raised by a person who visited the home in the last 12 months. It was investigated and not substantiated. Whilst talking to the people in the lounge we asked if they knew how to raise a concern or complaint. Most indicated that they did and that they would speak Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 17 to the Registered Manager in the first instance. The survey forms from people who live in the home showed that 12 of the 13 people filling in the form knew how to make a complaint. The relatives survey forms had responses in 11 of them about complaints. There were 8 people who said they did know how to make a complaint and one pointed out that, “There are “flash cards” in rooms explaining “How to make a complaint””. One said that they knew they should talk to the Registered Manager but did not know where to complain outside of the home, and 2 did not know how to make a complaint. The that find that Registered Manager wrote on the Annual Quality Assurance Assessment their aim is to engage residents and relatives in communication and to out about any troubling issues before they become complaints. He said more often than not they do well at this. We saw that the staff have received protection of vulnerable adults training. This is provided in house by the Registered Manager who has the experience of being a Nurse Tutor for several years when working within the National Health Service. He has also provided focused training to the independent health care sector for the Health Authority when they were responsible for Nursing Home Registration. His approach is not just one of “what is abuse and what is the procedure to follow should you witness it” but to make staff think about the subject, cause and effect, and at a level that is proving to be understood by all the staff. The staff team are good at picking up issues about each other’s practice that might need addressing so that people do not feel abused. Recruitment is dealt with in the “Staffing” section of this report. Palm Court Nursing Home DS0000050094.V358809.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. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 19, 21, 24 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, suitably equipped, clean and safe environment for people to live in. EVIDENCE: Palm Court was a purpose built nursing home more than a decade ago. It is still suitable for its purpose and had been upgraded over time to provide modern facilities such as new baths with built in hoists and better sluicing facilities on each floor of the home. The new macerators have reduced the need for “yellow bags” thus have a positive environmental impact. There is a shaft lift to each floor and two staircases, one at each end of the building. The home is well maintained and we saw evidence of this in invoices that verified Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 19 what the Registered Manager had told us in the Annual Quality Assurance Assessment form. Only one bedroom has an en-suite toilet, however the home is well provided for with bathrooms and toilets on each floor, in suitable numbers, and good locations for people whether they are using the lounge, dining room, or their won bedroom. We made a full tour of the home and saw that people have decorated their rooms to their own requirements. Many had a lot of personal items whilst others were minimalists in their approach to decorating their room. The home is satisfactorily decorated, which is an ongoing task. We saw that several rooms had new flooring and carpets and some had new flat screen digital televisions with built in DVD players. The Provider told us that all room s are to be fitted with these televisions that they have already purchased. We were also told that all the windows in the home are to be replaced in the near future. New hi/low beds were seen in people’s rooms that had a variety of mattresses to meet the individuals needs for pressure relief. We saw a variety of hoists in the home that provide a range of support, and independence, to the people who have to use them. The equipment level, and its maintenance show’s a large investment to achieve good, safe standards of care. As we walked the home we saw that it was clean and free from odours. This was the same in the homes laundry that is well provided for in terms of equipment and staff time. There are 2 commercial dryers, one commercial washer with a sluicing cycle, and one without a sluicing cycle. The laundry is staffed 6 hours a day seven days a week by dedicated staff who launder, iron and deliver the cleaned cloths to peoples rooms in separate named baskets. The laundry has suitable flooring and wall surfaces. The home displays a certificate from the Department of Health, Essential Steps to Safe Clean Care, which shows a commitment to avoiding infection through good practices that the home has adopted with regard to hygiene practices. We did note that the staff have disposable aprons and gloves to wear and that there are soap and hand towels in every room for staff to use to reduce the risk of spreading infection. Palm Court Nursing Home DS0000050094.V358809.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. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home prepare their staff appropriately for the tasks that they will encounter in the home through a well thought out, and delivered training program. Staff recruitment arrangements, and training, provide appropriate safe guards for good care to be provided by the people that are employed to do so. EVIDENCE: The home employs a team of registered nurses and care staff who are well prepared for the task of meeting the needs of the people who live in the home. They bring with them the skills that are needs for the job, some learnt in this home and some brought with them from their professional training. We saw the training that everyone goes through as a member of staff that includes the mandatory training such as moving and handling and fire plus first aid, food handling and advanced first aid. The Registered Manager is a well-qualified Registered Nurse and Nurse Tutor with a wealth of experience in the management of care in the independent health care sector. The ancillary staff are also experienced in their role and have received training in such things as Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 21 food hygiene and protection of vulnerable adults. There is always suitably skilled staff, in sufficient numbers, and on duty and the rotas verified this. When looking at the staff files we saw that everyone goes through an induction period that is managed by the trained staff and the senior care who has a National Vocational Qualification assessor certificate. She also has a National Vocational Qualification at level 3 in Care and in Management. They work along side of the senior carer and receive instruction in a task, and when they are found to be competent at it, they sign the induction form and this is countersigned by the instructor. We have evidence that more than 50 of the care staff have an National Vocational Qualification at level 2 or above. The home has also employed people from overseas who have a professional nursing qualification but are not registered nurses in this country. They have however had their qualifications assessed by a recognised accreditation centre that are verifying the individuals qualifications are equal to National Vocational Qualification in Care at levels 3 and 4. The visiting professionals agree that there is an excellent standard of care provided at the home by the staff. They recognised that the staff team is constant, many having worked at the home for several years, and some a good deal longer. This has meant good continuity of care with just 2 single agency shifts staff being required over the past 12 months. We looked at the recruitment process and interviewed 2 members of staff who were on duty. We found that each person had records in their files that showed the home had followed its own recruitment procedure fully. There were application forms, references, equal opportunities questionnaires, proof of ID and also Criminal Records Bureau checks. A third file was read to see how staff from overseas are recruited. Again the file was complete along with work permit information and translated copies of qualifications obtained in the parent country. The relatives survey asked the question, “Do the care staff have the right skills and experience to look after people properly?” There were 4 responses that said “always” and 9 that said “usually”. One person said that certain staff members are excellent whilst another commented that they were not in a position to assess there skills, but everyone seems competent and often respond to things beyond their remit. From the 13 survey responses from people who live in the home 12 said that the staff listen and act upon what they say, whilst 1 said “sometimes” to the same question. Palm Court Nursing Home DS0000050094.V358809.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. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 31, 33, 35 & 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. This home is very well managed both from a care and business point of view, to the benefit of the people who live there, who are its main focus. EVIDENCE: The Registered Manager is a very experienced Registered Nurse, Nurse Tutor, and manager of people and services. He has great leadership skills and has drawn his team of dedicated people to provide high standards of individual care to the people who live in the home. The term “person centred care” is clearly demonstrated at this home when we observed the interaction between Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 23 staff and the people who live there, and listen to the discussions about their individual care. The same dedication to provide high standards of care can be said of the Registered Providers. There commitment to the home and the business is also demonstrated in the ongoing investment in training and equipment. The relationship between them and the Registered Manager, and the other staff, is healthy and productive. The home has a continual approach to quality assurance that includes gathering the views of the people who live at the home. We saw evidence that it beings shortly after their admission when they can record in a questionnaire their experiences about the admission process, such as did they feel that they were given suitable information about the home before they arrived. This continues with regular surveys that are sent randomly to people who live in the home and their relatives, professionals who visit the home, etc. We saw the questionnaires, and the responses along side how the information is then used. There were also surveys of the staff that work at the home and their comments were read during this inspection. There are also monthly residents meetings and 1 or 2 relatives meetings a year. The Registered Manager provided this information also in the Annual Quality Assurance Assessment. The Registered Manager wrote, “We send out newsletters to relatives and encourage them to talk to us about any matter connected to the Home and the care we give”. The volume of response to the Commission for Social Care Inspection survey of people who live in the home, their relatives, and health care professionals provided valuable information that has been used to from the judgement about this home and how it performs against the standrads and legislation. We took the oppurtunity to look at the way the home manages any money that it may handle on behalf of people who live in the home. We were told that the home does not manage the financial affairs of anyone, but it does manage small amounts of pocket money. This is used to pay for everyday items like papers, chiropody and hairdressing. In looking at a number of records we saw that the home keeps individual records of the money held, it has receipts for any money spent and regular checks are made on balances. The money is held in a secrure place. In the course of this inspection we have seen how the home is managed from a care and business point of view. We saw that the equipment is well maintained at least at the required intervals. The fabric of the home is continually being managed with decoration and new flooring being part of an ongoing program. The comforts and entertainment of the people who live in the home are addressed with efforts made to add things that will attarct those who normally do not take part in activities. We saw that training is also a continuing program with a humanist approach being an important element in Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 24 its delivery. The main observation we made was that the people who live in the home seemed comfortable, happy and well cared for in a clean and safe environment. Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 25 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X 3 X 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 4 Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 26 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. 1. Refer to Standard OP24 Good Practice Recommendations Standard not inspected: Doors to Service Users accommodation should be fitted with locks suited to Service Users capabilities and accessible to staff in emergencies to fulfil this standard. Medications are stored securely within a room but the room is not always locked. It would be good practice to lock this room when not in use. 2 OP9 Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Palm Court Nursing Home DS0000050094.V358809.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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