Care Home: Silk Court Nursing Home

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What the care home does well The service has made significant improvements and has established procedures for maintaining these. The service is focusing on the unique and individual needs of each person who uses and has carefully considered the impact of the major refurbishment programme that will soon be underway. This is not least in terms of people who suffer dementia and the effect that changes to the environment will have for them. What has improved since the last inspection? The service has made significant improvements with the way in which pre placement assessments, ongoing care planning and accuracy of information for ensuring diligent response to meeting care needs. A major refurbishment plan has been developed and the work to achieve these environmental improvements is to begin shortly. What the care home could do better: Only one requirement has been made as a result of this inspection. This is in respect of the manager needing to submit an application for registration to the Commission. Key inspection report Care homes for older people Name: Address: Silk Court Nursing Home 16 Ivimey Street Bethnal Green London E2 6LR     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: James Pitts     Date: 1 4 0 5 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 24 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 24 Information about the care home Name of care home: Address: Silk Court Nursing Home 16 Ivimey Street Bethnal Green London E2 6LR 02077296490 02077396023 bonita.witt@anchor.org.uk www.anchor.org.uk Anchor Trust Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Maricor Balinbin Type of registration: Number of places registered: care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 51 The registered person may provide the following category of service only : Care home with nursing - Code 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 - Code OP Dementia - Code DE (Maximum number of place: 12) Date of last inspection Brief description of the care home Silk Court is a care home providing accommodation personal, nursing and dementia care for up to 51 older people. However only 12 places are for dementia care. The home is registered to meet the needs of residents who require nursing or enhanced residential care. Silk Court is owned and operated by Anchor Care Homes, which is a Care Homes for Older People Page 4 of 24 Over 65 0 51 12 0 Brief description of the care home voluntary sector care provider. The home is located in Bethnal Green, close to shops, the post office, local amenities, bus routes and rail and underground stations. The home was opened in 1994 and is purpose built. The premises are three-storey and contain passenger lifts. All the bedrooms are single occupancy and have en-suite facilities. There is a limited amount of parking space at the front of the building and a patio area for sitting. The current fee range for the home is GBP450-GBP650 per week. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was carried out on behalf of the Care Quality Commission and the terms, we and us are used throughout. The inspection was carried out over two days, a Monday and a Thursday. We viewed the files of Eight people who use the service and we spoke with service users, relatives and staff and we were assisted by the manager and other staff. We inspected the environment, including the kitchen, and the arrangements for the administration of medication. We also viewed key documentation and records, including records of staff training. We would like to take this opportunity to thank the service users, relatives and staff of Silk Court for their co-operation and assistance with the inspection. Care Homes for Older People Page 6 of 24 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 7 of 24 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 8 of 24 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. The people who use this service have an assessment before admission which is then reviewed after a trial period of stay at the home. The home does not generally offer intermediate care, although a small number of short term stays have occurred in the last year. Evidence: We viewed the files of Eight randomly chosen service users. They all contained assessment information gathered prior to admission. Those that were viewed showed that the aims of the placement, and the care needs that have been identified are now being entered as was previously required. Once a person is admitted to the home there is further social care assessment, and Waterlow charts and health monitoring forms are completed. The home has taken up the recommendation made at the last inspection of using a nutritional assessment tool. Care Homes for Older People Page 9 of 24 Evidence: The home does not generally offer intermediate care, although a small number of short term placements have occurred in the last year. It should be noted that due to the planned refurbishment at the home the nursing unit is being wound down and will re open once the refurbishments are completed. Care Homes for Older People Page 10 of 24 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. There are individual care plans of a much improved standard, health care and medication practise are also much improved. Respect for the privacy of each person is also now to the required standard. Evidence: All service users have care plans that have been comprehensively reviewed since the previous inspection. These follow a standard format and are well organised with information easily accessible. There are also monthly evaluation and review sheets. The wording used in these plans is also more descriptive and provides a more accurate picture of progress and care needs. The previous inspection noted that one service user had lost a significant amount of weight with loss of appetite and had been referred to her gp and the dietitian. Review documentation stated that the service user needed prompting to encourage and stimulate her mentally, athough there had been no evidence that the care plan had been updated to reflect this. Monitoring and response to weight loss and poor appetite was examined again at this inspection and the sample of care records that we Care Homes for Older People Page 11 of 24 Evidence: examined showed that these areas are now properly addressed. A previous concern had also been raised about what should appropriately be written in care plans, for example standard post care cleaning arrangements. The sample of care plans that we viewed showed that inappropriate recording about standard procedures is not now being used. Another concern had been raised about whether information about health care needs, for example blood pressure checks, was being responded to. We noted at this inspection that no further concerns about these matters was identified. The care planning documentation also includes risk assessment for pressure sores and preventative measures. It is noted that instances of pressure sores are low and even when a concern has arisen the home has responded appropriately. A previous concern was raised that call alarm bells were not always responded to and in certain cases the call alarm lead was not connected. During the two visits that took place for this inspection it was seen that call alarm bells were be responded to when service users required assistance. We noted on each floor that the current british national formulary was in place for reference as previously required. An examination of a wide sample of medication administration records also took place. The records that we viewed were accurate and up to date. The home has also undertaken a programme of seeking signed consent from each service user or their representative if appropriate for the service to hold and administer medication. The medication that is used is delivered by a local branch of a well known pharmacy. The home was able to demonstrate that further updated training from this company has been requested and dates for training are being arranged. The home benefits from having a GP surgery right next door to it and all service users are registered with this practise when the cannot continue to use their former GP. The manager stated that they home receives an excellent response when health issues arise and a GP from the surgery also visits regularly. The previous inspection noted that files of service users were left out on a trolley in a communal space. It was noted that service users or visitors could pick out a file and read it if staff were not around. The previous inspection made a restated requirement that service user information must be kept confidential to respect their privacy. This has now been met. Care Homes for Older People Page 12 of 24 Evidence: We noted from the files that we inspected that end of life wishes are addressed, and it is also noted if a person does not wish to express a view. Care Homes for Older People Page 13 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities in the home are well developed, visitors are welcomed and meals are well cooked and presented. Evidence: Our visits to the home as a part of this inspection again noted that visitors are made welcome and have unrestricted access to the people they are visiting. The home has a full time activities co-ordinator. She has no assistant but the staff do assist her. There is normally an activity am and pm every day. Exercise class is a popular activity. Once a year there is a reminiscence day when service users who have died are remembered. The co-ordinator attends the national organisation NAPPA meetings. The home varies the location where activities occur in the building in order to maximise the opportunity for people to attend. This does not prevent anyone from other floors attending. For those who may not be able to go out independently out into the community the activities co-ordinator takes people out with her on shopping trips. Staff also take people out occasionally if they are shopping for toiletries etc. At the time of this inspection the home were preparing for Barbecue which is well publicised Care Homes for Older People Page 14 of 24 Evidence: for service users, visitors and within the local community. The chef and the service users continue to meet every three months to prepare a rolling menu programme. This is posted up in the reception and in the dining room. The food that was noted on the menu on each day of the inspection visits was actually what had been served. A tray service is available for people who choose to eat in their rooms. The manager stated that there is an after hours service, which service users do know about. The nurse in charge has the key to the kitchen and service users can have sandwiches, biscuits and fruit or toast and butter, if they want a snack. Care Homes for Older People Page 15 of 24 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 listened to and taken seriously. Concerns are dealt with appropriately through the established polices and procedures. Evidence: The home has received 9 complaints since the previous inspection. Two of these were upheld and the appropriate follow up action was taken. The others were matters that appeared to be more about differences of perception and were resolved through communication and explanation. Each of these complaints were well recorded and the complaints procedure had been followed. The number of safeguarding alerts in the home has still been higher than would be expected. Many of these seem to have been as a result of the previously poorer performance of the service. The home has taken a cautious approach to making referrals, even when there may have been concerns that might be considered complaints rather than safeguarding issues. The Commission is satisfied that the processing of safeguarding alerts has been robust. The home has followed its own organisational policy, and that of the local authority, London Borough of Tower Hamlets. There is a marked increase in the level of overall satisfaction with the service. This is noted from comments that were made during the inspection visits and the homes satisfaction surveys. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment of the home is safe, clean, and reasonably well maintained. A programme of refurbishment is due to commence shortly. Evidence: We inspected the premises. The environment which the service users live in is generally safe and well maintained. A programme of refurbishment has been developed and this is starting shortly. In planning for this the home is closing the nursing floor and reducing occupancy. As there is a refurbishment programme it would not be appropriate to make any further comment until after this work is completed. A number of issues were raised at the previous inspection regarding storage of personal care items, for example incontinence pads, and the storage of other items. The home has worked hard to ensure that these matters were attended to and items are now being properly stored in designated areas. Communal parts of the home are now clean and there were no offencive odours detected. The manager stated that at present in the home there were no pressure sores, no MRSA and no C diff infections. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can feel confident that there is a more diligent approach to ensuring that staff are safe and trustworthy people to care for them. Evidence: We were concerned at the previous inspection that the nursing cover for the home has been reduced. As the service is reducing the number of people admitted with specific nursing care needs the current level of cover is appropriate. However, this would need to be reviewed at such time as the home is preparing to re institute full nursing care occupancy. At the previous inspection it was noted that bank staff do not read care plans before assisting with care tasks. We recommended it might be helpful for there to be a sheet where the basics of care plan needs are stated in bullet point form. A more accessible basic information sheet is in place that makes it easier for temporary staff to read the core care need details of those who they are assisting. The manager has continued the programme of a check of all staff files to ensure that all necessary recruitment checks have been made. The sample of four care staff files that we examined at this inspection, including a sample of recent and more long term employees, show that the necessary back ground checks and relevant information is in Care Homes for Older People Page 18 of 24 Evidence: place. We looked at the record for staff training. The home is using interactive computer software for some of its training and has a programme of courses for staff on a training plan. The home is once again able to evidence a pro active approach to keeping carers training in core basics up to date. Care Homes for Older People Page 19 of 24 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. The manager is being supported to discharge her duties. The service has made a number of improvements and the best interests of service users are considered in the running of the home. Their financial interests are safeguarded. Health and safety matters are now well managed. Evidence: The current manager came into post a little before the previous inspection. She has yet to apply for registration with the Commission and must do so without unnecessary delay. Service user satisfaction questionnaires from September 2009 to February 2010 were viewed and these show a much improved level of satisfaction with the service. A relative had also written to the home in high praise of the standard of care that is provided. The home has a health and safety calendar and certain tasks are performed each month to keep health and safety matters up to date. We checked the records for Gas, Electrical and fire safety. All of these checks have occurred within the necessary timescale. The manager stated that the fire alarm is tested every Wednesday, including the smoke alarms. The fire exits are also checked by staff to make sure they Care Homes for Older People Page 20 of 24 Evidence: are clear and working. Fire drills are programmed to occur quarterly. COSHH items are stored in a locked cupboard and the manager had data sheets and risk assessments for the items. No COSHH items were seen to be stored inappropriately during the inspection visits. First aid boxes are now appropriately stocked and opened food items are labelled with the date of opening and expected use by date. The manager stated that the home receives regular monthly Regulation 26 visits from an area manager. They look at files, complaints, the environment and speak to service users, relatives and staff. We note that all visits that were due in the last year have taken place and that action plans for response to each visit are drawn up and are being acted upon. Care Homes for Older People Page 21 of 24 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 24 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 31 9 The manager must complete 04/08/2010 and submit an application for registration to the Commission. To ensure the safety and wellbeing of the people who use the service. 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 Care Homes for Older People Page 23 of 24 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. © 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. 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