Care Home: Pretoria Court Complex Care Home

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What the care home does well A good standard of care is provided for the people who live at the home. People said they enjoyed living there, and that the staff were kind and helpful. Comments received were very positive about the home. One relative who completed a survey responded to the question about what the service does well, `very homely atmosphere, outstanding medical supervision, loving care from all staff, attention to all needs and any concerns we have raised, strong leadership, a very efficiently run establishment`. A healthcare professional wrote, `Give high standard of care, are flexible, respond well to residents changing needs`. Staff were motivated and enthusiastic about their work. What has improved since the last inspection? Medication which has a limited shelf life now has the date of opening identified on the label. Four activity coordinators have commenced to provide improved social activities for the people who live in the home. A programme of refurbishment has commenced. The ventilation to the bathrooms has been improved and the programme of replacing the windows in the occupied part of the home have been replaced. Furniture has been replaced in some of the rooms. What the care home could do better: The pre admission assessment with regard to the areas of sleep and social activity should contain more detail to make sure that all of the persons needs can be met by the home. A system must be in place to identify the expiry dates of medication. This is to make sure that people receive their prescribed medication. The balances in the controlled drug book should be accurate at all times. Life stories should be developed for all of the people who live in the home, so that staff can tailor activities to individual need. All staff should receive regular training in safeguarding adults to make sure that people are protected from abuse. The programme of refurbishment should continue to provide a high standard of accommodation in Edmundbyers House and Stanhope suite. The current training programme should continue to achieve the minimum ratio of 50% of care staff having an NVQ level 2 in care as identified in the National Minimum Standards. Key inspection report Care homes for older people Name: Address: Pretoria Court Complex Care Home Corbridge Road Medomsley Consett Durham DH8 6QY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Lowther     Date: 2 8 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Pretoria Court Complex Care Home Corbridge Road Medomsley Consett Durham DH8 6QY 01207561880 01207563094 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Alliance Care (Trendlewood) Ltd (wholly owned subsidiary of Four Seasons) care home 91 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Physical disability - up to 24 persons with a physical disability (younger adults) may be accommodated in the Stanhope Suite only, commensurate with the home`s statement of purpose. The home may accommodate up to two persons with a Physical Disability in Edmundbyers House only. Date of last inspection Brief description of the care home Pretoria Court Complex is a large, partly purpose built establishment, located in a rural setting with spectacular views from many rooms overlooking the Derwent Valley. It is provided by the Four Seasons Health Care group. The care home complex provides accommodation for people with nursing or personal care needs. It is staffed with registered nurses and care staff, who are supported by a team of ancillary staff, Care Homes for Older People Page 4 of 27 Over 65 67 0 0 26 Brief description of the care home including cooks, domestics and handyman. The home is divided into separate units to enable people with different care requirements to be catered for. Edmundbyers House (37 beds) is registered for older persons. Stanhope Suite (24 beds) is for younger adults with physical disabilities (18-65 years). The current registration for Blanchland House (30 beds) is for older persons, but it has been unoccupied for some time. All bedrooms are single rooms and there is a good range of sitting and dining areas for communal use. Most bedrooms are supplied with en suite toilet and wash hand basin. There are pleasant garden and patio areas around the home and ample parking space for visitors. The Registered Manager for the whole complex is Mrs Christine Munro Marr. A deputy site manager supports her in her duties. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The last inspection of this service was carried out on 3rd October 2007. An Annual Service Review (ASR) was carried out on 2nd October 2008 when it was considered that the service continued to provide good outcomes for the people who use the service. This unannounced inspection of Edmundbyers House and Stanhope Suite took place on the 28th September 2009. Blanchland House is currently unoccupied. Records were examined and a tour of the occupied areas of the building took place. Time was spent talking to staff, the people who live in the home and their relatives. The manager supplied some written information to the CQC before the inspection on a document called an AQAA (Annual Quality Assurance Assessment). Providers are required to supply this information on yearly basis. Surveys were also returned by Care Homes for Older People Page 6 of 27 staff, people who use the service and professionals. The inspection focused on key standard outcomes for people who live in the home and to check whether requirements from the previous report had been met. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The fees charged at the time of this inspection were between 436 pounds and 60 pence and 499 pounds and 21 pence plus any assessed free nursing care element. This does not include the cost of hairdressing, chiropody, toiletries, newspapers, aromatherapy and holidays. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 27 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient information is available for people to decide whether they would like to live in the home. Assessment procedures are in place to ensure that the home can meet all of the needs of the people who go to live there. Evidence: People are only admitted after a full assessment of need is carried out by an appropriately trained person. This is usually the manager. This is to make sure that the home can meet the care needs of the people who go to live there. The records of four people were examined. The home have recently introduced new documentation with regard to the assessment. These are very comprehensive and give staff good guidance about the areas that need to be covered. However in some seen areas covering sleep and social activity should contain more detailed information. Two people spoken with confirmed that they were given an opportunity to look around the home and had been supplied with all of the information they needed to make a decision about whether or not they would like to live there. One person said, I knew Care Homes for Older People Page 11 of 27 Evidence: about the home beforehand. My son and daughter came to see it to make sure it was what I expected. All of the people who responded to the survey said that they had received enough information about the home before they went to live there. The home does not admit people for intermediate care therefore assessment of standard 6 is not required. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good systems are in place to ensure that health care needs of the people who live in the home are met. Evidence: The manager said that all of the people who live in the home have care plans so that staff know how to look after people on an individual basis. Four were examined during the inspection. These were comprehensive and contained individual plans of care. This is to make sure that staff meet all of the needs of the people who live in the home. People spoken to during the inspection said that they are happy with the care received and the level of information given. One person said, The care here is excellent. The staff look after me well. One relative said, This is an excellent home. The staff keep me informed about everything that goes on and they are lovely. It is the next best thing to home for my relative. One health care professional said, This is an excellent home, nothing to worry about here. Records examined showed that people receive visits from other healthcare professionals. These include district nurses, doctors, and care managers. Care Homes for Older People Page 13 of 27 Evidence: Medication is administered by qualified nurses. The home has a comprehensive medication policy. Accurate records of all medicines received and those leaving the home are maintained. However during the audit it was identified that the stock balance for one controlled drug did not correspond with what was recorded. It is accepted that this is a liquid medication and that the shortfall was due to acceptable wastage, but this should have been recorded in the book. One pack of as required medication was out of date as it has a limited shelf life once dispensed. Staff were not aware of this. Again it is accepted that it had not been given as it had not been needed. A system must be put in place to identify expiry dates of medications. People spoken to said that staff always treat them with dignity and respect. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities are varied and provide recreation for some of the people living in the home. Family and friends can visit the home at any time and are made to feel welcome. The meals are of a good standard. Menus are varied and people are given a choice. Evidence: Most of the people said that activities are suitable. There are four activity coordinators employed within the home. Life stories are available for some of the people who live in the home. These should be developed for all of the people who live in the home, so that staff can tailor activities to individual need. Regular activities include arts and crafts, bingo, board games, carpet bowls, jigsaws, painting, drawing and jewelery making. Outside entertainers visit on a regular basis and a church service is held once per month. People are also taken out. Some of the people are also involved in fund raising activities for other organisations for example Macmillan Nurses. One relative who completed a survey wrote, We appreciate efforts to involve residents in activities, outings and entertainment. Relatives said that they could visit at any time and that they are always made welcome. People said that they have a choice about how they like to spend their day. Care Homes for Older People Page 15 of 27 Evidence: They can also choose what time to get up and go to bed and when they would like to have a shower or bath. The lunch looked nice. Staff who were helping people were doing this in a discreet and dignified manner. Evidence was seen in care plans to confirm that nutritional needs are assessed and other professionals consulted if required. Special dietary needs are catered for. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns and complaints are dealt with appropriately and that safeguards are in place to protect them from abuse. Evidence: Information about complaints, how and who to make them to, is made available to the people who live in the home and their families through information displayed in the entrance to the home and in the Service Users Guide. There have been no complaints recorded since the last inspection. The home had a comprehensive adult protection procedure. This gives staff the support they need to make a referral should this be required. The staff spoken to during the inspection were asked about abuse and what they would do if they saw or heard anything inappropriate. All said that they would tell someone, for example the manager, or make a referral themselves if this was more appropriate. Some of the staff spoken with had had Safeguarding training. However one trained nurse had commenced in February and had not had training, although did confirm that she knew the process to follow. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and well maintained. It is decorated and furnished to a good standard and provides a homely environment for the people who live there. Evidence: A tour of Edmundbyers House and the Stanhope suite took place. The inspector saw that many of the rooms are decorated to the persons own taste and there was evidence to confirm that people can take in some personal items when they go to live there. This includes pieces of furniture as well as photographs and ornaments. One person said, When the manager came to see me at home we had a chat about what I could bring in. She was very good and explained what would fit in the room because of the other specialist equipment I needed. A programme of refurbishment was commenced in July. Four bedrooms in Edmudbyers House have been redecorated and new furniture has been purchased. The inspector saw that some of the carpets are worn and shabby. The manager told the inspector that the plans include the replacement of these carpets and staged refurbishment of several more bedrooms. Since the last inspection the ventilation to the bathrooms has been improved and the programme of replacing windows in the occupied parts of the home has been completed. Care Homes for Older People Page 18 of 27 Evidence: There are sufficient baths and showers available throughout the home. A range of equipment seen around the home to support people with bathing and mobility. This promotes independence for some people and allows staff to safely help those people who need assistance. The inspector found the building to be clean, tidy and free from offensive odours. People who returned surveys indicated that is always the case. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are appropriately recruited and in sufficient numbers to meet the needs of the people who live in the home. The training programme is good. Evidence: From the rota supplied at the inspection there was sufficient care staff on duty to meet the assessed care needs of the people who were using the service. People said that staff were usually around and answered the call bells quickly. One person said, The staff come quickly when I need them. The home had staff files in place, which provided evidence that the appointment of a new staff member is in the main made through proper recruitment processes. This includes the vetting of staff through the use of references, protection of vulnerable adults (POVA) first checks and Criminal Record Bureau (CRB) checks. There is a commitment at the home to having a trained workforce, with some of the staff having an NVQ at level 2 or above. Although the home do not currently meet the standard of 50 of care staff having an NVQ qualification, several people are enrolled on the programme. Records seen confirmed that there has been recent training in fire safety, palliative care, equality and diversity, moving and handling, infection control, dementia awareness and the administration of medications. Staff said that they are also supported with regard to personal training needs. Staff comments in this area were positive. One member of staff who returned a survey wrote, The in house Care Homes for Older People Page 20 of 27 Evidence: training is excellent. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that the home is well managed and they are given the opportunity to comment on how the home is run. Policies and procedures are in place to safeguard their health, safety and wellbeing. Evidence: The manager is qualified and competent to run the home. She is a qualified nurse and holds an appropriate management qualification. There was an open and friendly culture between the management team and staff working at the home. People living at the home and visitors who were spoken to during the inspection confirmed that the manager is approachable and that they would go to her if they had any concerns. Staff also confirmed this to be the case. There are a number of quality assurance systems in place which includes regular meetings with staff, the people who use the service and relatives. These are held monthly and information from these are included in the quality monitoring. The manager frequently audits all areas of care and the environment. The area manager Care Homes for Older People Page 22 of 27 Evidence: completes a Regulation 26 visit on a monthly basis. This includes a tour of the building, examination of care records and discussions with people who use the service, relatives and staff. The results of the audits undertaken by the manager are also considered during this visit, resulting in improvements being made where possible. However the medication audit had failed to identify issues which can be found in the Health and Personal Care section of this report. Personal finances are kept in the home for people who request this. The administrator is responsible for the record keeping with regard to peoples finances. Signatures are obtained and receipts are kept to ensure peoples financial interests are safeguarded. The company carry out an audit on a regular basis. There was evidence in staff files to show that supervision was taking place and that the staff were being appraised. Staff confirmed that supervision takes place on a regular basis and that they are well supported. The manager confirmed that all equipment in the home is regularly checked. The maintenance certificates that were seen at this inspection were found to be in order. Health and Safety checks are carried out regularly to safeguard people living and working at the home. Safe working practices are maintained in line with current regulations and appropriate risk assessments are available. All accidents are recorded and reported appropriately. Accident statistics are audited monthly and care plans amended where required. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 A system must be in place to identify the expiry dates of medication. This is to make sure that people receive their prescribed medication. 30/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The pre admission assessment with regard to the areas of sleep and social activity should contain more detail to make sure that all of the persons needs can be met by the home. The balances in the controlled drug book should be accurate at all times. Life stories should be developed for all of the people who live in the home, so that staff can tailor activities to individual need. All staff should receive regular training in safeguarding adults to make sure that people are protected from abuse. The programme of refurbishment should continue to provide a high standard of accommodation in Edmundbyers House and Stanhope suite. Page 25 of 27 2 3 9 12 4 5 18 19 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 6 28 The current training programme should continue to achieve the minimum ratio of 50 of care staff having an NVQ level 2 in care as identified in the National Minimum Standards. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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