Care Home: Scalford Court Care Home

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What the care home does well Scalford Court provides a comfortable and clean environment which is suitable and accessible for people living there. Some people told us that the home was always `spotlessly clean`. Medicines were managed in a safe and efficient way, all staff responsible for managing medicines had received appropriate training. What has improved since the last inspection? Since the last inspection a new wing has been built to provide further accommodation, lounges and dining areas. There is a library in the new wing with a computer providing internet access for people living at Scalford Court, all new rooms can also provide internet access should this be required. What the care home could do better: Management arrangements did not provide a clear sense of leadership and direction for staff to follow. Communication between staff and management was at times poor, this had resulted in some people not getting the care or treatment they needed or being protected from harm. At the time of this inspection the providers told us they were recruiting a suitable manager. Safeguarding procedures were not always robust and some people told us they did not feel confident that their complaints would be listened to or appropriate action taken. Care plans did not address all assessed needs where risk was identified such as risk of falling, appropriate action to minimize risk was not always taken. Staffing Numbers were not sufficient to meet the needs of people living at Scalford Court or to protect them from harm, some people told us that the lounge area was often left unattended and people who had mobility problems had no means to get staff attention. Other people told us that if they rang their call bell, staff would answer but say they were busy and would come back and then sometimes not return for up to half an hour. Key inspection report Care homes for older people Name: Address: Scalford Court Care Home Melton Road Scalford Melton Mowbray Leicestershire LE14 4UB     The quality rating for this care home is:   zero star poor 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: Debbie Williams     Date: 2 4 0 7 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 26 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Scalford Court Care Home Melton Road Scalford Melton Mowbray Leicestershire LE14 4UB 01664444696 01664444499 brenda@scalfordcourt.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): V & L Corporation Limited Name of registered manager (if applicable) Brenda Ann Grant Type of registration: Number of places registered: care home 59 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 59 The registered person may provide the following categories of service Care Home only, 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 Code OP, Physical Disability Code PD, Dementia Code DE. Date of last inspection Brief description of the care home Scalford Court is registered for 59 older people. It is registered to provide a service for older people with physical disabilities or dementia. The home is situated in its own grounds between the market town of Melton Mowbray and the village of Scalford and is Care Homes for Older People Page 4 of 26 2 6 0 5 2 0 0 9 59 0 59 Over 65 0 59 0 Brief description of the care home mostly surrounded by farmland although there is a Conference Centre nearby. Public transport is limited but the home has its own minibus for the use of residents. The home is a converted and extended stable block with all rooms used by the residents being on the ground floor. Staff facilities and the Proprietors accommodation is located on the first floor. The main lounge/dining area has views of an internal courtyard that is well maintained with plenty of flowers and shrubs. This courtyard has seating and is used by the residents during the warmer months. There is a further lounge and a conservatory that overlooks another attractive internal courtyard. A copy of the latest Care Quality Commission inspection report is available at the home. Care Homes for Older People Page 5 of 26 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: zero star poor 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: At the time of this inspection safeguarding concerns were being investigated and a voluntary suspension of placements was in place, this means that the providers had agreed not to accept any new people into the home until improvements had been made and a suitable manager appointed. The main method of inspection used was case tracking this meant selecting four residents and tracking the quality of their care through checking records, discussion with them and observation of care practice. We also looked at the providers Annual Quality Assurance assessment which they sent us, this provides information about what has happened at the service since the last key inspection. During this inspection we spoke with several people who live at the home and two Care Homes for Older People Page 6 of 26 relatives. We also spoke with care staff, catering staff, the registered manager and the registered provider. Care Homes for Older People Page 7 of 26 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. 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 8 of 26 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 9 of 26 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. People are able to make an informed choice before moving into Scalford Court. People have their needs assessed before moving in. Evidence: A service users guide is provided to all prospective residents, this provides people with the information they require to make an informed decision before moving in. We looked at assessment records for people we case tracked. The registered manager completes a needs assessment before people move into Scalford Court and this ensures the service can meet peoples needs. Terms and conditions of residency are provided to people when they move into the home. Care Homes for Older People Page 10 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people living at Scalford court did not have their health and personal care needs met. Peoples medication was managed in a safe and efficient manner. Evidence: We looked at care records for people we case tracked, care plans did not address all assessed needs, one person who displayed frequent aggressive behaviour did not have a plan of care to address this, therefore staff were not instructed on what action to take or how to keep people safe. The community nursing team had recently raised a concern regarding the incidents of pressure sores at the home. We looked at charts for the recording of positional changes which is part of the treatment of and prevention of pressure sores, charts were not always filled in and therefore it is unclear whether or not people had had their position changed at the required times. Charts which record fluid intake where also not always filled in by staff. People told us they had access to all required health-care services such as GPs and Care Homes for Older People Page 11 of 26 Evidence: community nurses. However, some people who where identified as at risk of falling and had frequent falls had not been referred to an appropriate professional in order to minimize the risk of harm. Nutritional risk assessments were in place for the people we case tracked, this enables staff to identify and take action against any risk of malnutrition. Some people had not been weighed for several months, the provider told us that they had ordered some new weighing scales which could be used with a hoist for people who were unable to use the sit on scales. We looked at medication policies and procedures and storage areas. Staff responsible for managing medication had received appropriate training in this area. Medication records seen were accurate and up to date. People spoken with told us that staff maintained their privacy and dignity and treated them with respect. Care Homes for Older People Page 12 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers restricted choice and autonomy for some people living at Scalford Court. Evidence: People spoken with said they could choose how to spend their day, when to get up and when to go to bed. However, people who required assistance from staff for their mobility were often made to wait for staff to attend to them and this restricted the choice and autonomy available to them. A full time activities organizer is employed and a daily programme of activities provided such as watching DVDs, games and quizzes. Some people living at Scalford court would prefer not to participate in group activities and others are unable to due to cognitive disabilities, The deputy manager told us that the activities organizer was planning to introduce activities on a one to one basis, this would provide more meaningful and appropriate activities for some people. The majority of people spoken with were very satisfied with the meals provided and the choices available, some people said they did not always like the choices available on the menu, the deputy manager told us that the cook would be very willing to Care Homes for Older People Page 13 of 26 Evidence: accommodate other alternatives where this was the case but it was evident that some people were not aware that this was the case. The lunchtime meal served during this inspection was well presented and appeared appetizing and nutritious. The cook told us that staff had access to the kitchen at all times and could make people snacks and drinks on request. People spoken with said they had attended staff meetings where they were given an opportunity to raise concerns or share their ideas about the day to day running of the service, however, some people felt that appropriate action was not taken in response to their requests. Care Homes for Older People Page 14 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people living and working at the home did not feel confident that their concerns would be listened to or responded to appropriately. Staff had received training in safeguarding vulnerable adults but policies and procedures were not always followed, this means that people living at Scalford Court were not always protected from harm. Evidence: At the time of this inspection a safeguarding concern was raised, there was some delay in the providers and Registered manager taking appropriate action in accordance with national safeguarding policies and procedures. We did not feel confident that staff were reporting incidents and events that may affect people living at the home in an appropriate and timely way. We spoke with people living at the home who said they had attended residents meeting. Some people said thay had raised concerns with the registered manager but did not feel that appropriate action was taken and their problems remained unresolved. Care plans did not instruct staff on how to respond to physical aggression where this was identified or what action to take to keep people safe. Care Homes for Older People Page 15 of 26 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. Scalford Court provides a comfortable, clean and well maintained environment which is suitable for the needs of people living there. Evidence: All areas of the home seen were extremely clean and tidy and appeared well maintained. People spoken with said their rooms were cleaned daily and they were very happy with the standard of cleanliness at the home. Peoples private rooms were personalized and people could bring in their own furniture if they wished to. Outside areas appeared well maintained and attractive and were accessible to people with disabilities. Since the last inspection a new wing has been built providing further accommodation, lounges and dining areas. Information sent to us in the providers annual quality assurance assessment told us that all routine maintenance and safety checks had been carried out. Staff had received training in infection control and this minimized the risk of cross Care Homes for Older People Page 16 of 26 Evidence: infection. Care Homes for Older People Page 17 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Scalford Court did not always have their needs met by the numbers and skill mix of staff. Recruitment procedures could be more robust in order to protect people from harm. Evidence: People spoken with felt there were not enough staff on duty and said they were kept waiting for staff to attend to their needs. The lounge area was often left unattended and people had no means of getting staff attention for long periods of time. One person was confused and anxious and was left unsupervised for the majority of the time. We looked at staff recruitment procedures and staff files, all staff undergo checks with the Criminal Records Bureau before the commence employment, this is to ensure staff are suitable to work at the home. Two references are also obtained for each staff member. References were not always taken from the staff members manager at their last employment, where possible this should be done in order to ensure that any issues or concerns are identified. We looked at staff training records, staff had received most of the training they required to do their jobs and to keep people safe but some gaps were seen in training records where people had not had their training updated, records stated that none of Care Homes for Older People Page 18 of 26 Evidence: the staff employed had received training regarding the control of substances hazardous to health. a part time trainer was employed at the home. All staff had received induction training when they first commenced employment. Some staff had achieved a National Vocational Qualification in care and some staff were working towards this qualification. Most people spoken with were generally satisfied with the competency of staff employed but some people felt that some staff did not have the skills or experience required to meet their needs. Care Homes for Older People Page 19 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was not always run in the best interests of people living there and health, safety and welfare was not always promoted or protected. Evidence: The registered manager resigned shortly after this inspection. There was a lack of leadership or sense of direction, some people said they lacked confidence in the management team at Scalford Court. The providers told us they were in the process of recruiting a new manager. A quality assurance and quality monitoring system was in place, however, the effectiveness of this was in question due to the number of shortfalls identified and requirements made. A record of accidents and incidents occurring at Scalford Court was maintained but appropriate action to minimize further risk was not always taken and care plans did not take into account some of the risks people were exposed to or how to minimize Care Homes for Older People Page 20 of 26 Evidence: them. Staff had received all mandatory health and safety training. The management team were not aware of some accidents and incidents that had occurred and therefore staff must revisit this training and ensure that lines of communication are open to ensure that appropriate action can be taken. Care Homes for Older People Page 21 of 26 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 22 of 26 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 7 14 Care plans must be in place for all assessed needs. This is to ensure people have their needs met. 31/08/2010 2 8 13 All risks to health and 06/08/2010 welfare must be identified and appropriate action taken to minimize risk. This is to ensure that people are protected from harm. 3 12 12 Routines of daily living must be flexible in order to meet peoples needs and preferences. This is to ensure that people experience a lifestyle that meets their expectations and preferences. 27/08/2010 4 16 22 All complaints must be dealt with promptly and effectively. This is to ensure that people 02/08/2010 Care Homes for Older People Page 23 of 26 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 living at Scalford Court feel confident that their complaints will be listened to, taken seriously and acted upon. 5 18 13 Robust procedures for 02/08/2010 responding to suspicion or evidence of abuse or neglect (including whistle blowing) must be in place and adhered to. This is to protect people from harm. 6 27 18 Suitably skilled and qualified 27/08/2010 staff must be working at the home in sufficient numbers to meet the needs of people accommodated at all times. This is to ensure that people have their needs met. 7 31 8 The providers must appoint a manager with the qualifications, skills and experience necessary to manage the service. This is to ensure the service is run in the best interests of people living there and that health, safety and welfare are promoted and protected. 30/09/2010 Care Homes for Older People Page 24 of 26 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 8 33 24 The registered provider 20/09/2010 must establish and maintain a system for reviewing and improving the quality of care provided. This is to ensure that people receive the care that meets their needs and expectations and promotes safety. 9 38 13 Risk assessments must be carried out for all safe working practice topics and appropriate action must be taken to minimize risk identified. This is to promote health and safety and protect people from harm. 01/09/2010 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 15 People living at scalford Court must be made aware that alternative choices are available to those on the daily menu. Where possible, references should be obtained from the staff members manager at their last employment. This is so that any issues or concerns that may affect people living at the home are identified. 2 29 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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