Care Home: Queen`s Court

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What the care home does well Queens Court offers a very pleasant and comfortable environment for residents to enjoy. It is purpose built and has spacious communal areas and wide corridors, enabling easy and safe access for wheelchair users and others with a mobility impairment. The home is kept clean and fresh throughout and both residents and visitors commented positively on this, one describing the home as `Spotless.` The manager, deputy manager and staff are friendly and helpful, and many positive comments were made about the staff from both residents and visitors, and also in written `thank you` letters from the relatives of past residents. Comments noted during this inspection included: `Staff are always friendly and welcoming, and individuals are very well looked after, and they seem very happy.` (Visitor) `I couldn`t have found a better place for him to be, staff are very, very kind. It has improved lots since he moved in.` (Relative visiting daily) `It is very good here. This is a lovely place. The girls are really great.` (Resident) What has improved since the last inspection? There have been a number of significant improvements since the last Key Inspection at Queens Court in March 2009. Requirements relating to staff recruitment records, and to quality monitoring arrangements, were noted to have been met at the follow up Random Inspection in June 2009. A Requirement relating to care planning had not been fully met at that time but work has continued on this, and during this current visit, care plans were noted to have improved and this Requirement has now also been met. Care plans are more organised, and they now describe clearly and in detail how people would like their care to be delivered, especially their personal care. Night care plans are also well done and inform night staff about each person`s preferences for both going to bed and getting up, as well as any personal care needs they may have throughout the night. Care plans have been regularly reviewed, and copies are now kept in each person`s bedroom to try as much as possible to involve them in their own care planning. The medication arrangements at the home are now being inspected by the local pharmacist as is customary in care homes; this took some time to arrange but is now working well with only one recommendation made at the last pharmacist`s visit. The management team has been boosted with the appointment of a new Registered Manager. This has enabled the previous manager to move into the deputy manager role, and take lead responsibility for clinical care. Another senior staff member has also been appointed with the intention of providing better cover at weekends. The vast majority of people spoken with before, during and after this inspection agree that Queens Court continues to make improvements both in relation to shortfalls identified by the home, and as a result of feedback it receives. What the care home could do better: There were a significant number of comments made on the staffing levels at this home. A Requirement has been made that staffing levels must be reviewed to ensure that at all times staff are available in appropriate numbers. Some of the goals on the current care plans are too general and residents would benefit by having more specific and measurable goals in relation to their care and support. The home should consider the benefits to residents of having a designated activities co-ordinator. It is recommended that the manager reviews the complaints arrangements and that some feedback is always given to those who raise concerns. Key inspection report Care homes for older people Name: Address: Queen`s Court 1 Dedworth Road Windsor Berkshire SL4 5AZ     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: Helen Dickens     Date: 0 1 0 2 2 0 1 0 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 37 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 37 Information about the care home Name of care home: Address: Queen`s Court 1 Dedworth Road Windsor Berkshire SL4 5AZ 01753838450 01753838451 Roseanne.Ince@ccht.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Central & Cecil Housing Trust Name of registered manager (if applicable) Ms Eileen Nartey Type of registration: Number of places registered: care home 62 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 62. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Queens Court opened in December 2007 (and was officially opened by the Queen in February 2008), and is managed by Central and Cecil Housing Trust. It is purpose built and registered to take up to 62 older residents. The home is on three floors which are all self contained with their own dining and lounge areas, and bathing facilities. All rooms are single with en-suite facilities. The top floor is for elderly frail residents who do not currently need nursing care. There is parking on site and the home is within Care Homes for Older People Page 4 of 37 Over 65 62 0 2 3 0 6 2 0 0 9 Brief description of the care home walking distance of local facilities in the Dedworth area of Windsor. Current fees range from £364 to £1000 per person per week. Care Homes for Older People Page 5 of 37 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: This Key Inspection was unannounced and was carried out over two days on 29th January and 1st February 2010, for a total of 10.5 hours. The inspection was carried out by Mrs. Helen Dickens, Regulation Inspector. Mrs. Eileen Nartey, Registered Manager, and the Deputy Manager, represented the establishment. A partial tour of the premises took place and a number of files and documents were sampled including five residents care plans, three staff files, and quality assurance information including the Annual Quality Assurance Assessment (AQAA), which was completed by the manager and returned to CQC prior to this inspection. Six surveys from residents and staff, also returned to CQC prior to this inspection were also used in writing this report. On arrival at the home the inspector displayed a notice informing visitors that they could speak with an inspector during the day. This was as a result of some comments Care Homes for Older People Page 6 of 37 received at CQC over the several months prior to this inspection. As a result, 10 visitors were spoken with over the two day site visit. The inspector also spoke with 9 residents, and three members of staff. Information was also sought before and after the inspection from the local council, (The Royal Borough of Windsor and Maidenhead), including from care managers, the contracts team, and the safeguarding adults team. The inspector would like to thank all those who assisted with this inspection, and especially the residents and staff at the home, for their time, assistance and hospitality. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? There have been a number of significant improvements since the last Key Inspection at Queens Court in March 2009. Requirements relating to staff recruitment records, and to quality monitoring arrangements, were noted to have been met at the follow up Random Inspection in June 2009. A Requirement relating to care planning had not been fully met at that time but work has continued on this, and during this current visit, care plans were noted to have improved and this Requirement has now also been met. Care plans are more organised, and they now describe clearly and in detail how people would like their care to be delivered, especially their personal care. Night care plans are also well done and inform night staff about each persons preferences for both going to bed and getting up, as well as any personal care needs they may have throughout the night. Care plans have been regularly reviewed, and copies are now kept in each persons bedroom to try as much as possible to involve them in their own care planning. The medication arrangements at the home are now being inspected by the local pharmacist as is customary in care homes; this took some time to arrange but is now working well with only one recommendation made at the last pharmacists visit. The management team has been boosted with the appointment of a new Registered Manager. This has enabled the previous manager to move into the deputy manager role, and take lead responsibility for clinical care. Another senior staff member has also been appointed with the intention of providing better cover at weekends. The vast majority of people spoken with before, during and after this inspection agree that Queens Court continues to make improvements both in relation to shortfalls identified by the home, and as a result of feedback it receives. Care Homes for Older People Page 8 of 37 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. 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 37 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 37 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. Prospective residents have an assessment of their needs, and are assured that these can be met, before they move into the home. Evidence: The AQAA states that visitors, including relatives of prospective residents, are given a tour of the home. The service user guide and the statement of purpose are on display in the home, and in each persons room. Pre-admission assessments are undertaken and the social services assessment is utilised. Prospective residents and relatives are invited to have a visit and a meal at the home. It also stated that they use a home brochure to take out and show people, where a visit is not possible for a prospective client. Three residents files (including assessments, care plans, and risk assessments), plus two other care plans were sampled during this inspection. On this Key Standard, preadmission assessments, the previous inspection report noted there was little detail on Care Homes for Older People Page 11 of 37 Evidence: each persons preferences. On the three files looked at in detail during the current inspection, all had a comprehensive assessment carried out by the home and an assessment from other community professionals where appropriate, including from the local authority and the hospital. The assessment by the home covered relevant areas and a copy of the assessment interview with the resident. The homes assessment recorded a personal and social history for each person, in better detail than previously noted, as well as their personal and health care support needs. The Commission sent a selection of surveys to the home for distribution prior to this inspection and six were returned to CQC; three from service users, and three from staff. In answer to the question about whether they had enough information before they moved in, two residents ticked No, and one ticked Yes. All three said they had not been given written information about the homes terms and conditions. This was followed up with the deputy manager who checked and found all that three residents had a copy of their terms and conditions in the office files. She was asked to mention to these residents that if their original version was missing, they could have a copy of the one held in the office. Staff surveys ask about whether they are given up to date information about the needs of people they support. Two staff ticked Usually and one ticked Sometimes. Whilst no specific comments were made either on surveys or during the inspection in regard to assessments, a number of visitors commented on how welcoming and friendly the staff were when they came to the home. This confirms the statement made on the homes AQAA about visitors being shown around and made welcome. One person who had been coming to the home for two years told the inspector that Staff are always friendly and welcoming, and individuals are very well looked after and they seem very happy. Overall however, the comments were rather mixed as will be seen later in this report, and where individuals had concerns, these were passed to the manager for further action. Care Homes for Older People Page 12 of 37 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. Care planning arrangements have improved considerably and now residents benefit from having a more person centred care plan which clearly sets out their support needs, and how they would like that support to be delivered. Residents confirm their health care needs are being met and they are treated respectfully by staff. Medication arrangements are well developed and should ensure the safe administration of medication. Evidence: The AQAA states that needs, abilities and choices are identified during the initial assessment of each client, and that all residents have individualised care plans. It also notes that relationships with GPs, the multi-disciplinary team, and relatives, has improved. A key worker system in place, and there is improved documentation, filing and safekeeping of care plans. It states that the new senior team have a clearer understanding of their roles and are better able to supervise staff and deliver a higher standard of care, and that quality audits relating to care plans are in place. During previous inspections the inspector had concerns about care plans and the staff Care Homes for Older People Page 13 of 37 Evidence: at the home have been working to improve them. The inspector asked the service to confirm in writing that the previous Requirement relating to care plans had been met, and this assurance was received prior to this inspection. Five care plans were sampled and were very much improved from the last two inspections. There was a good detailed description of how each service user wanted their care to be delivered, particularly their personal care, which should now be delivered in a much more person centred way as a result of the improvements in care plans. Goals are set and the care plans reviewed monthly. It was noted that the goals were very general, e.g. Maintain opportunities for social interaction, as a goal for activities care plans. Such goals would be difficult to measure. The manager and deputy manager said they would ensure more work was done on goals in residents care plans. Care plans are now also kept in each persons room unless they have stated they do not wish to keep a copy. This enables residents and their families to be involved in, and take more responsibility for their personal care needs. Several residents and relatives said they looked at the care plans. One relative said they hadnt realised what this document was, and it was recommended to the manager that she reminds everyone that care plans are now kept in each persons room. One resident did not have a copy of their night care plan in their room and this was highlighted to the manager who arranged for a copy to be printed and given to this resident. Night care plans were particularly well done, reiterating and giving guidance to staff about how to meet personal care needs during the night. They record each residents preferences, for example in relation to when they would like to get up and go to bed, whether they would like a wash, or any refreshments, and if a resident prefers not to be checked at night, they sign a form to confirm this in writing. These are preferred routines and can be flexible if the resident wishes, on a particular night, to change their routine. Care plans are reviewed on a monthly basis and on those plans sampled, some changes had been made and this was then reflected in the most recent care plan. This is also an improvement from the previous inspection where any changes were not always reflected on the latest care plan. Comments on care from residents, relatives and care managers are noted at the end of this section of the report. Residents have access to health care and all three who completed CQC surveys said they Always got the medical care they needed. Risk assessments were in place on residents files for example in relation to mobility and falls, and moving and handling. Some behavioural care plans were in place for those who needed them. Nutritional risk assessments are completed for each resident, and an eating and drinking care Care Homes for Older People Page 14 of 37 Evidence: plan sets out each persons preferences and needs in relation to their diet, and a record of their weights kept. The Saturn software system, the tool used for care planning at Queens Court, is now being used to produce line graphs of changes in weight so that staff can see, at a glance, if someones weight is changing. Assessments in relation to the risk of pressure sores, and continence were also seen, and each person had has a care plan relating to their wishes in relation to death and dying. The home has special pressure relieving equipment for those who need it, and the manager and deputy manager were overheard discussing the arrival of a new resident which they were arranging to coincide with the delivery of a special pressure relieving mattress for that person. Residents can have the GP of their choice though an issue relating to whether residents could in fact sign up with a GP of their choice was raised during the inspection. This is being looked into already, but was also passed to the manager for her attention. Medication arrangements at Queens Court are now checked by local pharmacist who visits the home 6 monthly to advise on any matters relating to the storage and administration of medication. The deputy manager is responsible for the clinical activities within the home and she said that during their last inspection, the pharmacist had only one recommendation to make. Medication is supplied to the home in blister packs and only those trained to do so can administer medication. On the nursing units, this is always a trained nurse. There is a policy and procedure in place. Part of the lunchtime medication administration session was observed during the inspection. Medication was noted to be kept securely during the session, and there were no unexplained gaps on the medication administration records that were sampled. The nurse said these records are checked at handover to ensure all medication has been given correctly. The nurse was noted to be flexible about when residents could have their medication over the lunch period to fit with their routines, and was also heard to address residents respectfully throughout. The home has a number of ways to ensure staff promote dignity and respect for service users, including during staff induction and training. All rooms are single so residents are not expected to share, though if two people wish to, arrangements can be made for adjacent rooms to be converted to a double bedroom and separate living room. An example of this was seen and the residents involved were pleased with the arrangements. On the day of the inspection staff were observed to be respectful to service users, and to interact well with them, and with their families. Several people Care Homes for Older People Page 15 of 37 Evidence: interviewed named individual members of staff who were especially good, and whilst individuals (other than the registered person) cannot be named in this report, these names were passed to the manager and deputy manager. Staff were seen to knock on doors before entering, and to ensure personal care was carried out in private. Whilst there were no specific instances of disrespect, concerns relating to lack of staff, including people having to wait for bells to be answered, could have a negative impact on the privacy and dignity of residents. Staffing numbers were discussed with the manager and this is discussed in more detail under the Staffing section of this report. As noted earlier, mixed comments were received on surveys, in telephone and e-mail interactions with care managers, and during the visit to the home. The majority of those who had known the home over at least the last 12 months since the previous inspection said that the home had, and continued, to improve. Remaining concerns were on staffing levels, and the perception that a few staff were not as good as others when it came to caring for residents. There were some comments made about care records needing more work, but all those familiar with this homes care plans, agreed they had improved. Staff surveys asked if they felt they has enough support, experience and knowledge to meet the different needs of people who live at the home? Two ticked Usually and one ticked Sometimes. Other comments made on these surveys were discussed with the manager. Some positive comments included Cares for local people well; staff and management seem to be working well together; training is up to date. Negative comments included Some new staff have no idea about caring; employ more suitable carers. On surveys from residents, two ticked that they Usually received the care and support they needed, one ticked Never. Two ticked that staff were Usually available when they needed them, and one ticked Sometimes. In response to the question Do staff listen and act on what you say?, one ticked Always, one Sometimes, and one Usually. All three said they Always got the medical care that they needed. Six residents were visited and spoken with individually, and some had their families present who also made comments. Three other visitors were spoken with independently of the people they had come to visit. Asked if they got the care they needed, one person said We are waited on hand and foot. Others made comments such as I couldnt have found a better place for him to be, staff are very, very kind. It has improved lots since he moved in. One resident said It is very good here. This is a lovely place. The girls are really great. The family of a resident who has been at the home for over two years and had Care Homes for Older People Page 16 of 37 Evidence: recently died wrote a letter of thanks to Roseanne and Eileen which said: My family and I cannot thank you and all the staff at Queens Court enough, especially the staff on the ground floor, for your and their dedication and care. Care Homes for Older People Page 17 of 37 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. Residents have opportunities to take part in enjoyable activities, and contact with the local community and families is encouraged. They also have opportunities to exercise some choice and control over their daily lives, and are offered a varied menu in pleasant surroundings. Evidence: The AQAA states that the home has a monthly newsletter which details the activities and events for that month. Residents are encouraged to attend local day centres and social events that they attended prior to admission. Fortnightly church services are held. A hairdressing service is available up to three times per week and on one day local residents can come in to use the service. The current hairdresser looked after the hair of some of the residents before they moved in to Queens Court. Other regular activities include yoga and gentle exercise, and aromatherapy. A member of staff has done a chair based exercise programme and runs a group at the home. Residents have some opportunities to participate in the running of the home including one couple who manage the shop and run the film club. The AQAA also notes there is a gardening group to bring colour and light to each floor of the home, and each resident has an activity record which is maintained by staff. Care Homes for Older People Page 18 of 37 Evidence: During the inspection it was noted residents had had a personal and social profile completed on admission, and they did have an activities care plan on their file. There was a good record kept of any activities they had participated in e.g. when they had their hair done, attended bingo or a sherry morning, or had taken part in the exercise class or craft class. The home has purchased some 50 inch flat screen TVs which were positively commented upon by some residents and visitors during the day. During this unannounced inspection there was a sherry morning in progress and those residents who participated seemed to enjoy the quiz game that was being run by a member of staff. Several people said this was a new event and there had only been a few so far, but it was well attended. One resident said there had also been some coffee mornings; a young man who came in to play the organ; and someone else who came in and played the guitar. There is a shop at the home, and a film club, run by one of the residents. People are able to buy toiletries and other small items from the shop during selected opening times. The home has paid for a session with a reminiscence worker from Age Concern Camden who visited Queens Court and recommended some specific reminiscence activities. The visit included some reminiscence resources and guidance for staff who can now continue this work, and the manager is now promoting this activity and a weekly session is taking place. Special food events are held and the chef outlined the recent Burns Night meal, and the forthcoming Valentines tea and pancake day supper. There was a notice on each floor letting people know about these food events. The chef has started a cookery class on one morning a week and several residents and relatives commented on how much they had enjoyed this. It is held on the first floor in the kitchen/dining area, and some residents from all three floors have the opportunity to attend. The day before the inspection they made shortbread. It was nice to see that even those with a cognitive impairment were supported to attend and make their own cakes and biscuits. Visits are made to the home by local faith groups including from the Church of England and from the Catholic Church. One such representative who was in the home on the day of the inspection said they had been visiting the home over a couple of years and commented very favourably on the home and the staff. She also said she had heard the food is Very good and the home Seems spotless. The majority of people spoken with said relatives were made welcome. Several Care Homes for Older People Page 19 of 37 Evidence: relatives commented very favourably on the staff. Relatives are encouraged to remain involved in the care of the family member they visit, including making drinks and taking them out. One person has breakfast with their relative each day, and several relatives reported visiting the home daily. One said that though they arrive very early, staff are welcoming, and I know that he is 100 safe while he is here. Some concerns noted during discussions with relatives were then highlighted to the manager for further action. During the second day of the inspection the home the manager had already taken steps to rectify some of the issues raised, and had made an appointment with another family to meet them privately. The home has no activities co-ordinator and this was discussed with the manager. There had been several comments made about this for example on staff surveys returned to the Commission. One staff member wrote, in response to the question about what the home could do better: Employ an activities manager. Another noted Have more activities and outings for residents bringing in external help instead of expecting understaffed carers to somehow fit it in with their many other duties. These comments were made anonymously on surveys and were highlighted to the manager. She said staff were given extra hours, in addition to their care hours, to assist with activities in the home. Three service users who returned surveys ticked Always, Usually and Sometimes in relation to whether there were enough activities at the home. Other comments received included from a care manager who noted that lack of activities came up during some reviews. Arrangements for activities have improved and records of residents participation are kept. However, the manager and deputy manager took on board comments about lack of activities and between the first and second part of the inspection, devised a folder which it is intended each resident will have, containing information about their preferred activities, and their activities care plan, together with a record of what they had joined. They had started this as a pilot and they said the resident who had agreed to participate took their folder with them when they joined activities over the weekend. The daily record was then up-dated by staff and the resident together. It is recommended that the manager review arrangements for activities and consider whether residents would benefit by having a designated activities co-ordinator at the home. Residents have some opportunities for exercising choice and control over their lives and they were overheard to be offered choices in relation to meals and drinks for example, with three choices of main course each day on the menu. The chef will make other alternatives if needed and examples of this were discussed. Residents are asked Care Homes for Older People Page 20 of 37 Evidence: about their preferred daily routines and these are recorded on their care plans, similarly on their night care plans for night routines. Some relatives are very involved and assist staff on preferences where their relative at Queens Court has a cognitive impairment. One family member whose relative has dementia commented that staff are Endlessly patient. Staff are wonderful, they chat with him. Another person, whose relative with a cognitive impairment has been at the home for a year and was spoken with last year when the move to the home was very recent, said they were still happy with the care at the home, and added We are very lucky. This person said they had overheard two visiting professionals saying this was one of the better homes in the area. Some residents have joined staff for training sessions, for example on safeguarding adults, infection control and dementia. The manager said this was a good thing as it ensured residents had a wider knowledge of these subjects. Residents had also been given a certificate of attendance. Queens Court offers a varied menu to residents and in an interview with the chef he said all the food is usually home cooked, though recently residents had requested a change to the fish on Friday and now preferred frozen breaded fish instead. Dining areas are bright and spacious and offer a pleasant dining experience for residents. Residents relatives can join them for meals, and one comes for breakfast each day. The home caters for special diets and all residents have nutritional risk assessments using a recognised nutritional risk assessment tool. Residents are weighed and records are kept. Some comments received about food were passed to the manager and the chef, including sometimes the vegetables were not cooked enough, and portion sizes can be small. The chef said avoiding overcooking vegetables preserved their nutritional value, and whilst he was not aware of people commenting on portion sizes being small he would monitor this himself. One relative, when asked if portion sizes were sufficient, said that when for example the pieces of cake were small at tea time, their relative usually had three, and they were always offered some fruit as well. She said her relative had a good appetite and he ate well at Queens Court. Several residents commented positively on their cooked breakfast. This did not appear on the menu but the manager and chef said people knew they could have a cooked breakfast if they wished. The manager and chef were asked to think about how this could be added to the menu or advertised in some other way to ensure all residents were aware of it. The arrangements for lunch were observed on one floor and found to be well Care Homes for Older People Page 21 of 37 Evidence: organised with a designated care staff member taking charge. Food was kept hot and served only when each resident was ready for it, and people who needed assistance to eat were given help in a timely way. Care Homes for Older People Page 22 of 37 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. Complaints are taken seriously at this home but more work needs to be done. Policies and procedures are in place which should protect people from abuse. Evidence: The AQAA states that there is a complaints policy on view throughout the home in the form of a leaflet. It also notes they are introducing a managers surgery once a week. During the inspection the complaints procedure was indeed on display and each person has a perspex holder in their room with guidance about the home, and which also contains information on how to complain. The Home has tried to foster an open culture in relation to concerns for example they had introduced a comments box in reception, though the manager said very few comments are received this way. Since the last inspection they have also introduced a board with post-it notes for people to add short comments about the home. This was well used with over 25 comments for December 09/January 10. None of the comments raised any concerns or complaints and in the main were very positive The manager said these were all of the comments received on the post- its, none had been removed so far but it was about to be cleared to make room for the February comments. On surveys returned to the Commission, all three staff ticked Yes in answer to the question about whether they knew what to do if someone had a concern about the home. On the day of the inspection a complaint was raised by a resident to a member Care Homes for Older People Page 23 of 37 Evidence: of staff who was then seen to follow the proper procedure. Two of the three residents who returned surveys said there was someone they could speak to informally if they had a complaint. All three said they knew how to make a formal complaint. The AQAA states that the home received 10 complaints in the previous 12 months and two of those were still being investigated. Details of some issues raised with the inspector were passed to the manager for further action during feedback at the end of the first day of the inspection. Several people spoken with had made complaints and had satisfactory outcomes; others commented that they had received little or no feedback about the outcome of their complaints, and this was discussed with the manager. More work is needed to ensure people know who to complain to, and some feedback should always be given to those who raise concerns. On the second day, the manager had already made an appointment to speak with one family, and had decided to have two manager surgeries per week, rather than one, to allow both daytime and evening visitors some designated time to speak with the manager. Residents and relatives meetings are another way that people can raise concerns, though the manager said that the recent relatives meeting, though well advertised, was not well attended. The monthly Regulation 26 visits on behalf of the provider to monitor the quality of the service, also looks at complaints, and reports on these are sent to head office. The home also keeps copies of compliments they receive, and these are noted throughout this report and under the quality assurance Standard in the last section of this report. The AQAA states that they ensure that all staff are POVA checked and CRB checked when they are recruited, to ensure prospective staff have not previously been deemed unsuitable to work with vulnerable people. Personal money audits are carried out by outside auditors as well as in some Regulation 26 visits. The AQAA also notes there have been seven safeguarding referrals made regarding residents at this home. Since the AQAA was completed, a further two referrals have been made. The home has a safeguarding adults policy in place and uses the local multi agency procedures. The deputy manager said that all but the new staff had attended safeguarding adults training, and that new staff had covered this in their induction to the home. This was found to be the case when new staff records were checked during the inspection. The more detailed three day Skills for Care induction also covers this topic. Some residents have joined staff on the Safeguarding Adults DVD training and have a certificate of attendance. This will ensure that not just staff, but also some residents Care Homes for Older People Page 24 of 37 Evidence: are aware of what may constitute a safeguarding adults matter, and how this should be reported. Safeguarding adults issues identified by the management have been properly reported to the appropriate authority, and the home has co-operated with any safeguarding adults investigations. As noted earlier in this report, one person who is a daily visitor and therefore knows the home well, said they knew their relative was 100 safe at Queens Court. Care Homes for Older People Page 25 of 37 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. Residents benefit by living in a pleasant and comfortable environment, which is clean and hygienic throughout. Evidence: The AQAA states that the home is maintained to a high standard. A member of staff can assist with minor repairs, and Windsor Housing respond very quickly when reports of faults are made. The home is purpose built with large bedrooms and en suite facilities. A partial tour of premises took place including some bedrooms and communal areas, and dining rooms, bathrooms and quiet areas. The home is spacious with each floor having a large dining area with a kitchenette where residents and relatives can make their own drinks. As mentioned earlier, the chef does a weekly cookery class in the kitchenette on the first floor. Residents all have en suite facilities with walk in showers. Residents spoken with liked their rooms, with several commenting that they appreciated having their own bathroom. Aids and equipment are available to residents including hoists, special mattresses and special baths. During the inspection the home was noted to be well maintained and clean and fresh throughout; there were no unpleasant odours anywhere in the home. Residents rooms visited had been personalised with pictures, photographs and other Care Homes for Older People Page 26 of 37 Evidence: memorabilia. One resident had brought their bird with them which was kept in their room and their relatives kept it clean and fed. A recent Regulation 26 visit report noted that not all rooms were as personalised, and the manager should look into this as some residents may not have the support they need from relatives to personalise their rooms in the way they would wish. Whilst staff surveys do not ask specifically about the environment, one staff member wrote that Repairs take a long time, and this was passed to the manager for her attention. The AQAA stated that infection control is maintained and monitored following practices and measures outlined in our policies and procedures, and recommended from our audit. The manager had also ticked that they had an action plan to deliver best practice in the prevention and control of infection. There were good hand washing facilities and alcohol gel throughout the home, including on the table with the signing in book. During the inspection, several people commented that the home was kept clean and fresh, including one visitor who described Queens Court as Spotless. On surveys returned to the Commission, all three residents ticked Always in answer to the question about whether the home was fresh and clean. Care Homes for Older People Page 27 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels must be kept under review to ensure service users needs are met by the numbers and skill mix of staff. More work is needed to ensure the recommended number of care workers hold a qualification in care work. The recruitment arrangements at this home promote the safety of service users. Staff training arrangements continue to improve and ensure staff are competent to do their jobs. Evidence: The AQAA states that there is a strict company recruitment policy and procedure in place, and staff undergo the Skills for Care induction, and attend various mandatory training courses. New staff have a one day induction to the home on their first day. The head office now has a new structure with a Director of Care who is an RGN and an Operations Manager. It also states We now have a full recruited staff care team in place. A new post has been developed for a third senior to work alongside the deputy manager to cover weekends. As a result of concerns raised with the inspector on staffing levels, the manager was asked to send written information to the Commission about staffing levels, and residents needs, for a set period, prior to this inspection. In addition, the manager noted if staff had been off sick or unable to work, and what alternative arrangements had been made. Further discussion was then held with the manager during the inspection. Care Homes for Older People Page 28 of 37 Evidence: The manager said staffing numbers reflected the number and needs of current residents. She had tried to address concerns about staffing levels in a number of imaginative ways. For example, she has returned to the home when off duty, with the deputy, to do unannounced visits, including at night. She said she regularly checks the call bell print out to look at how long people are waiting to have their call bells answered, and was doing this when the inspector arrived to start the inspection. All calls had been answered within five minutes. She said these checks are not currently documented but said she will do this from now on so that she can compare differing periods, and so that there is a record that the checks have been done. The manager has also enhanced the senior team so that there will be a third senior person to cover weekends. She said care staff have been given extra hours to carry out activities with residents, rather than trying to fit this in with their care work. Comments on staff surveys included the need to employ more carers, and more suitable carers. One staff member ticked Never in response to the question about whether there are enough staff to meet the individual needs of all the people who use the service; the others ticked Sometimes and Usually. All three mentioned the need to value existing staff more, and two commented on the pay. Service user surveys all noted they thought the home could be improved by more staff. Whilst six surveys are only a small sample, these comments were repeated by some relatives and other service users during the inspection. Whilst the manager demonstrated she is constantly trying to address concerns about staffing levels, more work is needed and a Requirement will be made in this regard. The National Minimum Standards recommends that at least 50 of care staff should have a qualification in care work, this is in addition to any qualified nurses in a care home with nursing. Currently 11 out of the 40 care staff have this qualification, though the manager said that 9 others are doing an NVQ qualification at present and 2 others are ready to register on a course. Recruitment records continue to improve at Queens Court. During this inspection three staff files were sampled, one each for a care worker, an RGN, and an agency worker. A proforma is completed relating to staff records and these showed that both permanent staff had satisfactory recruitment checks in place. For both workers, there was a record of their start dates, confirmation of a full employment history, suitable references, CRB and POVA check reference numbers, and photographic identification. There was also a record of induction and their past training, as well as training attended since coming to Queens Court. Details of supervisions and competency Care Homes for Older People Page 29 of 37 Evidence: assessments were also on file. The records for the agency worker confirmed suitable checks had been carried out, and a print out recorded their CRB reference number, and noted the dates of mandatory and additional training, as well as a summary of their key skills. Details of supervisions and competency assessments were also noted. The Recommendation from the Random inspection relating to having more robust arrangements for checking agency staff has now been met. Training arrangements also continue to improve at Queens Court. There is a training matrix in place which enables management to check which staff have done which training courses, and when refreshers are due. This was a Requirement from the last Key Inspection and was found to have been met at the Random Inspection carried out in June 2009. A print out from the training matrix is now also placed on individual staff files and this was seen during the inspection. In answer to the question about whether they thought they had enough support, experience and knowledge to meet the differing needs of people who live at the home, two staff ticked Usually and one ticked Sometimes. Though there were comments from residents and relatives that at times more staff were needed, and that a few staff ....dont do their job properly, the majority of comments on staff were very positive. Individuals staff members were named as providing a particularly good service and these names were passed on to the manager. General comments included: Staff are very, very kind and endlessly patient. (Relative) Individuals are very well looked after. (Faith visitor) The girls are really great. (Resident) Staff all seem very friendly and helpful. (Relative) Some of the girls are really kind and helpful. (Resident) I cant fault it. Sometimes have to wait for the bell but Im not the only person here. (Resident) The home keeps copies of thank you letters and cards, and the following excerpt is Care Homes for Older People Page 30 of 37 Evidence: taken from a thank you letter from relatives of a person who had died during the previous month: To Eileen and all her staff - it was such a relief to know that such caring staff looked after our Mum. They were all professional and very caring and it showed. Forever grateful. Care Homes for Older People Page 31 of 37 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. Residents benefit from the improved management resources at this home, and quality assurance processes have also improved. Arrangements for assisting service users with their day to day expenses should safeguard their interests. Health and safety policies and procedures promote the safety and welfare of service users and staff at this home. Evidence: The AQAA states that the home manager participates in some of the activities with residents and spends one to one time with them. She holds the Registered Managers Award (RMA) and has several years management experience. The deputy is a trained nurse who also hold an RMA; she was previously the Registered Manager. The new management arrangements have brought about further improvements at Queens Court, and the manager and deputy manager outlined the improvements made since the last inspection, including extensive work done on care planning and training all the relevant staff to use the software system that generates the care Care Homes for Older People Page 32 of 37 Evidence: plans. They also set out plans for improving things further. They were noted to work well together and were both enthusiastic about making more improvements to Queens Court. The new manager and the deputy manager had a very positive attitude to the inspection process. In the weekend interval between the first and second day of the inspection, they had already taken action to deal with some of the issues highlighted including improving activities records, making an arrangement to have a meeting with one family who had some outstanding concerns, and revising the frequency of the managers weekly surgery. They had also re advertised for more Friends of Queens Court a new venture where people had helped with fund raising and organising outings. In the week before the inspection concerns had been raised with the manager about people being able to enter the home and not be challenged by staff regarding their identity. The manager and deputy manager had spoken with staff and put up posters on each floor reminding staff to check on visitors they did not know, and this was working well on the day of the inspection. On the surveys returned to the Commission staff were asked if they had enough support from their manager. The three respondents ticked different answers which were Often, Sometimes and Never. The comments received on surveys were passed to the manager for her attention. These included one staff member who noted Lack of organisation and leadership. Another however wrote: The home is running in a more well run way. Staff and management seem to be working well together. The ongoing complaints about staffing is a management issue which is not yet resolved, and a Requirement has been made in this regard. Quality Assurance arrangements needed to be reviewed and at the Random inspection it was noted that this area had improved and that the previous Requirement was considered to have been met. The AQAA states that they maintain a resident - focused attitude to the running of the home. It noted that they listen and act on on feedback from residents, social services and the Commission. Records of service reports, risk assessments, residents monies, COSHH sheets and fire checks and servicing are kept in the office. During the inspection it was noted that the various auditing procedures in place, for example on care plans, were much improved, and the ways the home were trying to receive constructive feedback were commendable. In addition to residents and relatives meetings, the comments box, and the managers surgery, they had also Care Homes for Older People Page 33 of 37 Evidence: started encouraging people to post comments on the downstairs notice board. A number of very favourable comments were seen on compliments letters and cards received by the home and some of those received in the last 6 months are quoted elsewhere in this report. The AQAA states that records are kept of service users monies and personal money audits are randomly checked by outside auditors and are covered on occasions by the Regulation 26 visits. Receipts are kept for expenditure on behalf of residents, and there are policies and procedures in place to safeguard residents finances. Residents are encouraged to be as independent as possible in this regard and there are locks on room doors, and a lockable drawer to keep their own money or valuables. This was confirmed by one resident who told the inspector that they preferred to keep their room locked when they were elsewhere in the building, and that staff had given them a key. The AQAA states that there are a number of safety policies in place including fire safety, food safety, health and safety, moving and handling and smoking. Audits are carried out on health and safety and they have monthly water testing by an external company, with a domestic worker doing water flushing and water temperatures. The home is purpose built and has spacious communal areas and corridors, good access for wheelchairs, and a range of aids and adaptations to improve safety for residents and staff including hoists, adjustable height beds and bed rails, and bathing aids. Audits are carried out on health and safety matters, and risk assessments were seen on residents files including for falls, moving and handling, and nutrition. A maintenance worker deals with any maintenance and repairs, and was seen working in the home on the day of the inspection. During the two day visit to the home, no obvious health and safety shortfalls were noted. Care Homes for Older People Page 34 of 37 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 35 of 37 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 29 18 Staffing levels must be reviewed to ensure that at all times staff are available in appropriate numbers. For the health and welfare of service users. 28/02/2010 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 7 Some of the goals on the current care plans are too general and residents would benefit by having more specific and measurable goals in relation to their care and support. The home should consider the benefits to residents of having a designated activities co-ordinator. It is recommended that the manager reviews the complaints arrangements and that some feedback is always given to those who raise concerns. 2 3 12 16 Care Homes for Older People Page 36 of 37 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. 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. 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