Care Home: Place Court

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What the care home does well Place Court is decorated to a high standard, warm and comfortable. Care plans clearly reflect the individual`s health and well being and provide a plan of care that is responsive to the varied and individual needs and preferences of the people who use the service. The daily records continue to provide good detail of a resident`s mood and activity not just the care delivered. Staff work well as a team and provide a high standard of care to people living in the home, in a friendly and sensitive manner. This was confirmed in comments seen in the surveys, completed by short-term care customers and residents and relatives surveys as part of the homes quality assurance process. Comments included, "the home has a calm atmosphere and friendly staff, who are always helpful and courteous" and "I am more than satisfied with my stay here, I would be very happy to stay again". What has improved since the last inspection? Four requirements were made at the previous inspection relating to pre admission needs assessments, water temperatures, staff recruitment and infection control procedures. Information provided in the AQAA and verified during the inspection confirmed that the management team had taken action to meet all of these requirements. Care plans seen contained detailed pre admission assessments completed by the homes manager, which they use to support their decision as to whether or not the home will be able to meet that person`s needs. Random checks of baths and showers confirmed that hot water is being delivered near to the recommended temperature of 43 degrees centigrade. Weekly checks are being made and a record of temperatures is being kept. The minutes of a recent staff meeting confirmed that infection control has been discussed in accordance with the homes and the department of health infection control procedures. Inspection of the laundry facilities confirmed the staff are following the correct procedures to prevent and control the spread of infection. The laundry was clean and tidy with appropriate equipment to launder soiled linen, clothing and bedding. Staff files examined confirmed the home operate a thorough recruitment process, which includes obtaining all the appropriate paper work, including a full employment history, Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks. A previous recommendation was made for all staff including, ancillary staff to attend updates in moving and handling and protection of vulnerable adults (POVA) training. Staff files and information in the training file confirmed this training had taken place. What the care home could do better: To ensure people living in the home receive their prescribed medication in order to maintain the health and well being, arrangements must be made for the safe recording, handling and administration of medication. Where each resident is provided with a contract setting out the terms and conditions of residence, the contract should include information about the individual`s current fees payable and by whom. Where the use of equipment, such as bed rails and recliner chairs have been agreed by the individual, the OT and physiotherapist as part of multi diciplanary assessment, moving and handling risk assessments need to be updated to reflect this decision.Staff must have access to appropriate training so that they have the skills necessary for their role. This includes regular updates of all mandatory training. Where staff are expected to work across all four houses, including the rehabilitation and dementia houses, specific training must be provided. This will ensure staff have the skills and knowledge to meet the individual and complex needs of the people using this service and that suitably, qualified, competent and experienced staff are available at all times. CARE HOMES FOR OLDER PEOPLE Place Court Place Court Camps Road Haverhill Suffolk CB9 8HF Lead Inspector Deborah Kerr Unannounced Inspection 9th January 2008 09:40 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 Place Court DS0000036919.V357597.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. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Place Court Address Place Court Camps Road Haverhill Suffolk CB9 8HF 01440 702571 01440 762191 tom.crichton@socserv.suffolkcc.gov.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Suffolk County Council Mr Tom Crichton Care Home 32 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (25), of places Physical disability (1) Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th March 2007 Brief Description of the Service: Place Court is a care home for older people, registered for 32 places, which is owned and managed by Suffolk County Council. The home dates back to 1963 although it reopened after refurbishment in 1995. The home is situated within walking distance of Haverhill town centre. The home is on two floors and has a shaft lift for full access throughout. There are private gardens for residents use. The accommodation is divided into four houses, Cedar, Hyacinth, Orchid and Ivy. Each house has between seven and nine bedrooms and is self-maintained save for the main kitchen facilities. Staff in Orchid and Ivy houses provide personal support for older people who are unable to manage all the daily activities alone. Staff in Hyacinth house provide support to older people with a diagnosis of dementia and Cedar house provides four beds for rehabilitation and three beds for short-term care. The home is owned by Suffolk County Council Adult and Community Services. The minimum fee payable by customers is £66.85 and the maximum £380. The actual amount paid is determined by the local authority following a financial assessment of an individuals means. The actual cost is in the region of £670 per week. Fees do not include the cost of hairdressing, chiropody, newspapers, transport and telephone calls. This was the information provided at the time of the key inspection, people considering moving to this home may wish to obtain more up to date information from the care home. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection was unannounced and took place over eight and a half hours on a weekday. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection, including the Annual Quality Assurance Assessment (AQAA). This document is issued by the Commission for Social Care Inspection (CSCI) and gives providers the opportunity to inform the Commission about their service and how well they are performing. We also assessed the outcomes for the people living at the home against the Key Lines of Regulatory Assessment (KLORA). A number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. During a tour of the home, time was spent talking with five residents and four staff. The Registered Manager was not available during this inspection, however the senior team leader was available and fully contributed to the inspection process. What the service does well: Place Court is decorated to a high standard, warm and comfortable. Care plans clearly reflect the individual’s health and well being and provide a plan of care that is responsive to the varied and individual needs and preferences of the people who use the service. The daily records continue to provide good detail of a resident’s mood and activity not just the care delivered. Staff work well as a team and provide a high standard of care to people living in the home, in a friendly and sensitive manner. This was confirmed in comments seen in the surveys, completed by short-term care customers and residents and relatives surveys as part of the homes quality assurance process. Comments included, “the home has a calm atmosphere and friendly staff, who are always helpful and courteous” and “I am more than satisfied with my stay here, I would be very happy to stay again”. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: To ensure people living in the home receive their prescribed medication in order to maintain the health and well being, arrangements must be made for the safe recording, handling and administration of medication. Where each resident is provided with a contract setting out the terms and conditions of residence, the contract should include information about the individual’s current fees payable and by whom. Where the use of equipment, such as bed rails and recliner chairs have been agreed by the individual, the OT and physiotherapist as part of multi diciplanary assessment, moving and handling risk assessments need to be updated to reflect this decision. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 7 Staff must have access to appropriate training so that they have the skills necessary for their role. This includes regular updates of all mandatory training. Where staff are expected to work across all four houses, including the rehabilitation and dementia houses, specific training must be provided. This will ensure staff have the skills and knowledge to meet the individual and complex needs of the people using this service and that suitably, qualified, competent and experienced staff are available at all times. 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. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6, People who use the service experience good quality outcomes in this area. Prospective people to use this service and their representatives are provided with the information they need to choose a home, which will meet their needs. They will have their needs assessed and will be provided with a contract, which clearly tells them about the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a detailed statement of purpose, which is up-dated when necessary and supports the easy to read customer guide. Prospective residents, whether considering long-term care or short-term care, are invited to spend a day at Place Court, so they can see for themselves what the accommodation and facilities are like. Examination of people’s care plans and files confirmed that residents are provided with contracts, setting out the terms and conditions of residence, however, these did not contain information to inform the individual of their current fee. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 10 Information provided in the AQAA and verified at the inspection confirmed that before people move in to the home a full needs assessment is undertaken, in conjunction with Social Services Community Care Assessment. This enables the manager to make a decision as to whether or not the home will be able to meet that person’s needs. The information gained by the pre-admission assessment is used to complete the care plan. This is done with the resident’s participation and their relatives and / or representative where appropriate. The AQAA identifies that as Place Court is a Local Authority home, first priority for admission are people whose discharge from hospital has been delayed. When a vacancy arises either the manager or senior team leader will visit the prospective resident to discuss and assess their needs. Where practicable members of care staff have also taken part in pre-admission visits. Care plans confirmed that a review is held within three months of the person’s admission to the home, involving themselves, their relative and /or representative, Place Court staff and social worker to discuss progress and any other issues before the resident formally commits themselves to permanent admission. A team consisting of an occupational therapist, physiotherapist and a social worker assesses people admitted for residential rehabilitation. They complete their own assessments and also consider the motivation of the person to rehabilitate. Several members of the staff team have received training to support people during rehabilitation and to promote and encourage their independence. The rehabilitation part of the home is separate from the long stay areas thus the regular admissions and discharges do not affect the quality of life of other residents. Discussions with staff confirmed that they are expected to work across all four houses, including the rehabilitation and dementia houses, however they had not attended training for rehabilitation or dementia awareness. This was discussed with the senior team leader who acknowledged additional training is needed. Originally, training was provided at Newmarket hospital, but the senior team leader explained that as this is no longer available as a resource finding alternative training providers has proven difficult. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, People who use the service experience good quality outcomes in this area. The health and personal care people receive is based on their individual needs, however regular audit checks of medication records must be undertaken to ensure these are being fully completed and people are receiving the correct levels of medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of four people living in the home were inspected. Each contained a current photograph of the person together with their personal details including next of kin and other important contacts. The plans are well organised and provide detailed information covering all aspects of the individual’s health, personal and social care needs. The personal healthcare needs include where required, specialist health, nursing and dietary requirements. Each plan has a section containing the individuals life history, which, combined with the information obtained through the pre admission process, provides a plan of care that is responsive to the varied and individual needs and preferences of the people who use the service. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 12 The daily recording notes are well documented and clearly reflect the care and general state of well being of the individual and where medical intervention is required. The home has easy access to local surgeries, entries in care plans confirmed people who are fit and well enough are supported to access their General Practitioner (GP) and other local health services relevant to them. For people who are not well enough to leave the home arrangements are made for health professionals to visit them. Care plans confirmed that relevant health charts and assessments are in place, relating to moving and handling, pressure care, nutrition and continence management. A number of care staff have received training in footcare therefore reducing a reliance on chiropodists. Moving and handling assessments are detailed and include information about the person’s ability and the support required by staff. The assessments also identifiy the aids and equipment the individual needs to maintain their independence and enable staff to work in a safe environment. Information provided in the AQAA and verified at the inspection confirmed that Place Court has good links with an Occupational Therapist and Physiotherapist who provide advice regarding equipment for individual residents needs. Where the use of equipment, such as bed rails and recliner chairs have been agreed by the individual, the OT and physiotherapist as part of multi disciplinary assessment, moving and handling risk assessments need to be updated to reflect this decision. The home has a comprehensive medication policy covering ordering, prescribing, storing, administering and disposal of medicines. Medications are ordered on a monthly basis, which helps to maintain stock control. Medication is stored within locked metal cabinets in each of the four houses. Controlled medication is contained within a pupose made controlled drugs cabinet. Medication that requires refrigeration is stored in locked boxes and kept in the kitchen refrigerator. The temperatures of the refrigerators are monitored to ensure they are functioning at safe levels for storage of food and medicines. A team leader was observed administering the lunchtime medication. The practice of administering medication is generally well managed, safe and hygienic, however, examination of the Medication Administration Records (MAR) charts identified that six residents MAR charts showed that medication had not been signed to indicate medication had been given. We were not able to ascertain if the medication had been administered, for four people as their medication was in liquid or gel form. One person’s medication in a blister pack had been incorrectly dispensed by the pharmacy, which had lead to confusion on two occasions when the person’s medication was to be administered. Staff spoken with, who hold responsibility for administering medication confirmed they had received training to administer medication and are shadowed by a senior member of staff to ensure they are competent before undertaking this aspect of their work. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 13 People admitted for rehabilitation are supported to self medicate following risk assessment to ensure they can manage their own medication when they return home. Observation of staff during the day confirmed that privacy and dignity underpins every aspect of resident’s daily care. Where people are identified as having communication difficulties either due to health or where their first language is not English, these have been recorded in their care plan and their preferred method of communication established. Flash cards and phrase books have been introduced to ensure the individuals are able to communicate their needs and wishes. The interactions between residents and staff were observed to be friendly and appropriate, staff were observed chatting about day-to-day events with residents and were observed to knock before entering people’s rooms. Residents were observed being called by their preferred name. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, People who use the service experience good quality outcomes in this area. The routines of daily living and activities are flexible and varied to suit the expectations and preferences of people living in the home. People using this service receive a wholesome, appealing and well balanced diet in pleasant surroundings at times, which are convenient to them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each residents care plan includes details about their interests and preferred activities. The AQAA states that no resident is excluded from any activity and staff encourage participation whilst taking account of the residents personal abilities. The daily records confirmed this with information about the activities the resident had participated in and whether they had enjoyed it. The AQAA also provided information about the programme of activities available for residents. This was verified during the inspection. On the residents notice board there was a list of activities arranged for each month. Activities for December had included, a visit from a mobile clothes shop and entertainment included a Carol service held by the Salvation Army, a memory lane Christmas show, a performance and songs by a local dance school and a brass band. A couple of residents had attended an ‘Old Tyme Music Hall’ evening held at the Town Hall. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 15 Each house has a programme of activities, which include weekly cooking sessions and craft sessions, where residents have made cards, place settings and sweets. Additionally, group activities are provided in the large entertainment room on the ground floor. These include games, such as carpet bowls and fortnightly bingo and music sessions. (The inspector was shown a range of musical instruments purchased by the home and some that had been made by the residents). The home has a well stocked Reminiscence Room in Hyacinth House, containing many artefacts and memrobelia useful for rekindling memories. The local arts theatre often put on shows which a number of residents attend. The theatre reserves seating for Place Court residents. Football and beer evenings and coffee mornings are also held on a regular basis. Photographs in hallway of a summer garden party and coffee morning, confirmed these activities take place. The routine of daily life for people living in the home is flexible and varies according to their needs. Each of the houses provides people with a choice of how they spend their time. One person spoken with commented, “ I am very happy living here, I can do what I want to do”. Information provided in the AQAA and verified at the inspection confirmed that staff are encouraged to offer as much choice as possible to residents 24 hours a day. If a resident likes to lie in bed during the morning they can do so. There are no set getting up or going to bed times. Personal routines and preferences of residents are respected. Meal times are flexible, to cater for resident’s who do not feel like eating when meal’s are served. Some residents wish to remain in the rooms whilst others enjoy sitting in the lounges. All lounges are equipped with televisions and music systems, residents were observed watching televison and enjoying talking to each other, others had chosen to read their newspaper or magazines. Residents are encouraged to maintain links with relatives, friends and any social groups they have previously been members of. Many of the residents have their own telephones in their room. There is also a pay telephone available, fitted with the loop system to enable residents with hearing difficulties. The visitor’s book reflected there are regular visitors to the home and relatives were seen visiting during the inspection. The home has no set visiting times although visitors are respecfully asked to avoid meal-times wherever possible. Residents can receive visitors in private, also the entertainments room is available for use, should family or friends wish to hold a party for their relative to mark a special occasion. The lunchtime meal was observed in three of the houses. The dining areas provided a family style environment and residents were observed sitting and chatting with each other and staff during their meal. Meals are varied and nutritous offering residents a variety of choice. Fresh fruit and drinks are freely available in each house. The food served looked appetising and was nicely presented. Where an individual required assistance to eat their meal staff were Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 16 observed supporting them sensitively and at a pace that made the individual comfortable and unhurried. Although the kitchen in each house has facilities for making hot and cold drinks and preparing snack foods, main meals are prepared in a central kitchen and transported to the houses in hot trolleys. The main kitchen was visited, which was clean and tidy. Records maintained by the cook confirmed they are operating in accordance with good food hygiene and health and safety requirements of the Food Standards Agency (FSA). They are committed to providing a good service, and seek feedback from people living in the home, using questionnaires about the quality of the food. The results of the surveys are used to improve the menu to meet people’s likes and preferences, however the most recent survey relating to catering was undertaken in 2005. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 17 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): 16, 18, People who use the service experience good quality outcomes in this area. People who use this service have access to a robust and effective complaints procedure, and are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear complaints procedure in the form of the Suffolk County Council procedure, which offers an investigation and written response to any complaint. This information is available in other formats from Suffolk County Council, including Braille and audiotape for those registered blind or with visual impairment. Information provided in the AQAA and verified at the inspection confirmed that all residents are given a copy of the Comments, Suggestions and Complaints leaflet. Copies are also available in the entrance area. Staff spoken with were aware of residents rights and how to refer a complainant to a senior member of staff. The senior was aware that the home has a complaints log, but could not locate this at the time of the inspection, however, there has been no formal complaints received by the home, or the Commission for Social Care Inspection (CSCI) in relation to this service since 2004. The homes adult safeguarding policy has clear guidance of the procedures staff must take to report allegations of abuse, which links in with the guidelines issued by the interagency policy, Vulnerable Adult Protection Committee (VAPC). Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 18 The senior team leader was advised the Adult Safeguarding Board (ASB) has replaced VAPC and that they will need to amend the home’s policies and procedures to reflect this change. A whistle blowing policy is in place to protect any staff who raise concerns about staff practice. Staff spoken with, were clear about their duty of care and what they would do if they had concerns about the welfare of a resident. To ensure the safety and protection of people living in the home, robust recruitment procedures are in place. Staff files seen confirmed that all newly employed staff are subject to Criminal Records Bureau (CRB) and Protection Of Vulnerable Adults (POVA) check. A previous recommendation was made to extend the abuse awareness training to ancillary staff. A senior Adult Protection Manager facilitated two workshops at Place Court during the summer. Training records confirmed this training had taken place. This subject is also covered during staff induction training and covers the types and signs of abuse and the procedure for reporting allegations of abuse. At interview applicants awareness of abuse is also explored. Two of the four care plans examined had records of incidents where these residents had been verbally aggressive to other residents or staff. The senior team leader advised the inspector these incidents were very minor and were not frequent. However, there should be a care plan in place of the action staff should take to ensure that physical and/or verbal aggression and unpredictable behaviours are understood and dealt with appropriately. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 19 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): 19, 20, 21, 22, 24, 25, 26, People who use the service experience good quality outcomes in this area. The physical design and layout of the home enables the people who use this service to live in a safe, well maintained and comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Place Court was purpose built in 1963, however the home closed and reopened after refurbishment in 1995. The home spans two floors and has a shaft lift for full access throughout the home. Accommodation is divided into four houses, Cedar, Hyacinth, Orchid and Ivy. Each house has between seven and nine bedrooms and is self-maintained apart for the main kitchen facilities. Orchid and Ivy houses provide personal support for older people who are unable to manage all the daily activities alone. Hyacinth house provides support to older people with a diagnosis of dementia and Cedar house provides four beds for rehabilitation and three beds for short-term care. There is a large communal entertainments lounge on the ground floor near the entrance. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 20 The first impression, on entering the home is that it is nicely decorated, warm and comfortable. Furnishings and lighting throughout the home are domestic in character and are suitable for their purpose. There are private gardens for people living in the home to use. The grounds are well maintained. There is level access to a secure garden area from two of the downstairs living areas enabling residents to go out into the garden independent of staff assistance. Benches, chairs and a sunhouse provide residents with a range of seating areas in the garden when the weather permits. Each house has it’s own lounge, dining area and kitchen facilities and between seven and nine bedrooms. All bedrooms have the benefit of en-suite facilities, incorporating a toilet and hand washbasin. Additionally, each house has extra assisted bathrooms and toilets. A selection of bedrooms were seen, these were nicely decorated and evidence was seen that people had brought small items of furniture from their previous accommodation, photographs and ornaments to personalise their rooms. Peoples rooms are identifed by name and / or pictures of interest to them. All bedrooms are fitted with a call bell, a door lock and a lockable cabinet for personal items. People have the freedom to access all parts of the home, however, people living in Hyacinth house are protected from wandering by an alarmed door system. If a resident exits the house staff are alerted via the call bell system. The AQAA confirms that the call bell system is brand new and was installed during the summer of 2007. There is a pay phone on each floor, which can be taken to resident’s bedrooms so they can receive or make calls in private. All toilets throughout the home are designed bearing in mind that assistance from staff may be required. Grab rails are situated to promote residents self care and offer independence. Different types of bath are provided for differing degrees of residents ability. Appropriate aids for safe moving and handling were sited around the building and evidence was seen that people are provided with aids and equipment for the prevention of pressure areas, where required. Information provided in the AQAA and verified at the inspection confirmed that the home is kept clean and tidy, due to the diligence of all staff, especially the housekeeping staff. Carpets are cleaned regularly and are replaced when severely soiled. A tour of the home confirmed that all areas of the home are maintained to a good standard of hygiene and cleanliness. There were no unpleasant odours. A previous requirement was made for staff to know and implement the homes policies and procedures for infection control in particular regarding the management of soiled linen. The minutes of a recent staff meeting confirmed that infection control procedures had been discussed. Inspection of the laundry facilities confirmed the staff are following the correct procedures to prevent and control the spread of infection. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 21 Staff are provided with protective clothing and soiled linen is placed in alginate bags that go directly into the washing machines on a sluice wash programme. The laundry facilities seen were clean and tidy with appropriate equipment to launder clothing and bedding. Appropriate hand-washing facilities of liquid soap and paper towels are situated in all bathrooms and toilets where staff may be required to provide assistance with personal care. An immediate requirement was made at the previous inspection to ensure that hot water is delivered to taps at or near the safe recommended temperature of 43 degrees centigrade. Random testing of water temperatures reflected that the water supply is within the recommended temperature, which minimises the risk of people living in the home scolding themselves when taking a bath or shower. Weekly checks are in place to monitor the temperatures. Information provided in the AQAA and examination of the fire logbook confirms that the building complies with the requirements of the fire service. Additional smoke detectors were installed in 2006 along all corridors ensuring that there is a smoke detector within 2 meters of each resdients bedroom. All residents bedrooms are fitted with smoke detectors. Fire alarms are tested weekly. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29, 30, People who use the service experience good quality outcomes in this area. This service provides good quality carers, who are available in sufficient numbers, however minor shortfalls in staff training does not ensure that all staff have the required skills and experince to meet the specific needs of the people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA states staff rotas are planned around the needs of residents. The duty roster confirmed each waking day is covered by a team leader and six care staff. Two carers are allocated to Hyacinth house and one carer is allocated to each of Cedar, Ivy and Orchid houses. One of the carers adopts a floating role across all four houses. A team leader and two carers cover the waking night shifts. There are three handover periods in every 24hours where information regarding residents is conveyed from one shift to another. Additionally, the home employs housekeepers, a maintenance person, catering staff and an administrator. The registered manager is usually working in the home during the daytime and is supernumerary to the team numbers. Two care staff act up in a team leader role, when needed. This opportunity offers willing staff an opportunity to gain additional experience. The AQAA and discussions with staff identified that maintaining staffing levels has been a problem due to staff sickness absences and the length of recruitment process. Agency staff have been used where appropriate. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 23 The senior team leader stated that the manager is in the process of requesting approval to recruit more relief staff. The home operates a robust recruitment process, which adheres to the Suffolk County Council policy. Information provided in the AQAA states the recruitment process includes a face-to-face interview. The interview panel has an appropriate gender mix and where ever possible resident involvement is encouraged. Pre- determined questions are asked of all applicants. Testimonial type references supplied by candidates are not accepted, neither are cirriculum viteas (CV). This ensures consistency and equal treatment of applicants. A previous requirement was made for appropriate checks to be obtained prior to any one commencing employment. This related in particular to proof of identification to include a recent photograph of the employee and exploration of gaps in the work history of one prospective employee. Staff files examined contained all the relevant documents and recruitment checks, including 2 references, photographic identification, and a completed application form, which reflected the individuals career history. Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks were received before staff commenced employment. Information provided in the AQAA and verified at the inspection confirms all staff undergo a period of in-house induction to ensure they fully understand what is required and to ensure the people living in the home receive a safe service. Initially, they work supernumerary alongside more experienced staff members. The induction process and ‘shadow’ shifts were confirmed in discussion with a carer who had recently commenced work at the home. As part of the induction training staff attend a mandatory two day manual handling course. Staff are not considered competent until they have demonstrated these technigues. Three members of staff are trained to give refresher training in manual handling. Samples of Skills for Care induction workbooks seen confirmed all newly appointed care staff complete Suffolk County Council’s induction training, which meets the requirements of the National Training Organisation (NTO). This involves practical training sessions, which cover all areas of mandatory training, including moving and handling, safeguarding adults, food hygiene, first aid, infection control and health and safety. Team leaders have completed Skills for Care assessor training to enable them to assess staff performance in the work place. Staff spoken with confirmed they receive training, which is relevant to their role and which helps them to understand and meet the needs of the people using the service. Records showed that staff are being kept up to date with annual refreshers for all mandatory training, with the exception of health and safety and infection control. The AQAA states that staff receive training specific to the individual needs of the people using the service. For example, staff working in Cedar house are Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 24 trained in rehabilitation techniques and staff who work in Hyacinth house have had training in caring for people with dememtia. However, discussions with staff confirmed that they are expected to work across all four houses, including the rehabilitation and dementia houses, and had not received this training. This was discussed with the senior team leader who acknowledged additional training is needed. Originally, training for rehabilitation techniques was provided at Newmarket hospital. They no longer provide this as a resource, the senior team leader explained finding alternative training providers has proven difficult. Information provided in the AQAA states that the home employs a total of 62 staff with a mix of managers, care staff and ancillary staff. These figures include 35 permanent and 6 relief care staff of which 27 staff have obtained National Vocational Qualification (NVQ) Level 2 and above, with 2 staff working towards completion of their level 2. Additionally, 2 care staff have achieved an NVQ 2 in Care and Health. These figures reflect that Place Court has reached the National Minimum Standard (NMS) target of 50 of care staff to hold a recognised qualification. The AQAA states that a further four care staff are to undertake NVQ, starting in January 2007 and 2 night team leaders have gained places to undertake NVQ level 3. Two cooks are working to complete NVQ level 3 in catering and 2 kitchen assistants are working to complete their level 2. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38, People who use the service experience good quality outcomes in this area. People using this service benefit from the leadership and management approach of the home, which is based on openness and respect and tested by an effective quality monitoring system. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA states that the Registered Manager is qualified and experienced in the running of a home. They hold a Certificated Qualifaction in Social Work (CQSW) and has completed National Vocational Qualifaction (NVQ) level 4 in Management of Care Services. They have manged two other care homes in the past. Although, the manager is in day to day control, there are clear lines of accountability and delegation of duties within the staff group. All staff have the opportunity to share in the way the service delivery is planned and actioned. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 26 A quality assurance survey involving reisdents and relatives conducted earlier this year showed high levels of satisfaction. The questionnaire covered staff attitudes, meals, social events, involvement in the care of the resident, the environment and whether people know how to make a complaint. These surveys were looked at during the inspection and overall, feedback confirmed people feel they receive a good service. Comments seen in the survey’s included “Place Court and the staff are heaven sent to the residents at a time of extreme vulnerability in their lives, the level of care and welfare shown and demonstrated is excellent” and “I am happy with my room, staff are wonderful, food is lovely and I really enjoy the entertainment”. The senior team leader confirmed that the quality assurance process is in the process of being repeated for this year, which will include writing to health professionals. The AQAA states that the service often receives letters of gratitude from residents and relatives as well as verbal compliments expressing satisfaction with the care provided. Several thank you cards were displayed on the notice board in the reception area. These were complimentary about the care and support provided to relatives either living in the home or having stayed for rehabilitation or short-term care. Comments included “ I would like to say a big thank you for your help and support you gave me during my stay”. The AQAA states the manager endeavours to be available to staff and residents as much as possible and that suggestions for improvements in how the home operates from staff are always welcomed. Minutes of meetings examined confirmed that residents and staff meetings take place. Residents meetings are held approximately twice a year and residents are invited to express their views about the home and make suggestions for improvements. Monthly meetings of the senior team are held and full staff meetings are held twice a year, or more frequently, if needed. The AQAA states that all financial records are kept and comply with Suffolk County Councils Policys and Procedures. All invoices are paid regularly and paperwork relating to staff payroll is completed within defined timescales. The service has a clear policy and procedure concerning the handling of cash and valuables belonging to residents. The manager does not hold appointeship for any person living in the home. Residents’ personal money is managed through a computerised central banking system. Individuals have their own account and statements of transactions and a balance are available to residents and families or appointees. Where they are able, people living in the home receive their weekly allowance, where they are not petty cash held in the home is used for purchases, which is re-cooperated from the individuals account. Clear records are kept of money spent on behalf of a person and all transactions require the individuals and /or two staff’s signatures. One resident’s money being held was checked against their personal allowance sheet and found to be correct. Care plans also listed people’s personal property. All resident’s have lockable cabinets in the rooms so that they can keep personal monies and items of value secure at all times. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 27 The AQAA identifies that all staff are supervised and trained appropriatly. However, staff records seen did not contain evidence that regular supervision takes place. Staff spoken with confirmed that they did have supervision, where they were able to discuss work issues, training and their development needs. The AQAA states that a live supervision book has been introduced in which observations of staff are recorded to be discussed in one to one supervision. Additionally, the management team have introduced the Policy of the Month which staff are asked to make themselves familiar with to ensure they are aware of the services policies and procedures and to ensure they comply with safe working practices. Records examined at the inspection and information provided in the AQAA confirmed the home takes steps to safeguard the health, safety and welfare of people living and working in the home. The home employs a maintenance person who undertakes day-to-day repairs and some weekly and monthly safety checks. These include monitoring hot water temperatures and flushing of shower heads to reduce the risk of the Legionalla virus. Faults with the building are reported promptly by all staff and steps taken to ensure either repair by our handyman or reported to the appropriate people to authorise repair or replacement. The most recent Gas and Electrical Safety Certificates, including Portable Appliances Testing (PAT) were seen and records showed that equipment hoists, rise and fall beds and Parker baths is regularly checked and serviced. The building complies with enviromental health standards and the local Fire service requirements. The Fire alarm system is serviced on a regular basis. The fire logbook confirmed that regular drills take place and a record of the evacuation and drill is recorded. There are notices next to electricity switch panels, informing staff of the location of gas, electrical and water cut off points, should this be necessary, in an emergency. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement Arrangements must be made for the safe recording, handling and administration of medication. This will ensure that people living in the home will receive their prescribed medication in order to maintain the health and well being. Timescale for action 09/01/08 2. OP30 18 (1) (a) 31/03/08 Staff must have appropriate training so that they have the skills necessary for their role. This includes regular updates of all mandatory training and where staff are expected to work across all four houses, including the rehabilitation and dementia houses, specific training must be provided. This will ensure staff have the skills and knowledge to meet the individual and complex needs of the people using this service and that suitably, qualified, competent and experienced staff are available at all times. Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 30 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 OP2 Good Practice Recommendations Where each resident is provided with a contract setting out the terms and conditions of residence, the contract should include information about the individual’s current fees payable and by whom. Where the use of equipment, such as bed rails and recliner chairs have been agreed by the individual, the OT and physiotherapist as part of multi diciplanary assessment, moving and handling risk assessments need to be updated to reflect this decision. Where residents have been identified as being verbally or physically aggressive to other residents or staff. A plan of care must be developed which provides staff with guidance on the action’s they must take to protect the individual, other residents and themselves. This will ensure that physical and/or verbal aggression and unpredictable behaviours are understood and dealt with appropriately. Care staff should receive formal supervision at least 6 times a year and a record of these meetings should be kept. 2. OP7 3. OP18 4. OP36 Place Court DS0000036919.V357597.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge CB21 5XE 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. 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