Care Home: Zetland Court

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What the care home does well Pre admission assessments are thorough and form the basis for comprehensive risk assessments and plans of care, tailored to each person living at the home. Staff treat people with dignity and care, respecting their individual choices and preferences and activities are centred around the person`s abilities. There is a varied menu on offer and people are supported to maintain a balanced diet. People should be confident that complaints will be listened to and acted upon. Staff receive the training they need to know how to protect people from abuse. People live in comfortable surroundings where there is a regular programme of maintenance. The staff team are well trained and there are sufficient staff on duty to meet the health and social needs of people. Recruitment procedures ensure that only suitable people are employed to work within the home. There is a strong management structure in place. The home has a quality assurance system which listens to peoples views and takes action to improve and there is good management of peoples finances. What has improved since the last inspection? At the last key inspection in 2007 we made one requirement and nine recommendations. Zetland Court was previously registered to accommodate up to 5 people who had mental health disorder or dementia as their primary care need and several of the recommendations centred around improving the level of care provision for these people. However as the home is no longer registered to accommodate people in this category, several recommendations are no longer applicable. Improvements that have been made are: Staff now receive some training in dementia care. There is clear cross referencing of needs in care plans and accurate recording of nutritional intake. There is more training on tissue viability and wound management. What the care home could do better: At the end of this inspection there are three recommendations: Medication administration recording should be improved with no gaps left on the MAR charts and accurate dosage administration recorded by staff.The staff rota should accurately record what positions all staff hold within the home. All fire equipment which requires weekly testing should be recorded accurately each week. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Zetland Court 128 Alumhurst Road Westbourne Bournemouth Dorset BH4 8HU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joanne Pasker     Date: 1 4 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 25 Information about the care home Name of care home: Address: Zetland Court 128 Alumhurst Road Westbourne Bournemouth Dorset BH4 8HU 01202769169 01202764980 zetland@rmbi.org.uk www.rmbi.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Royal Masonic Benevolent Institution care home 63 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of people who may receive nursing care is 18. The maximum number of service users who may be accommodated is 63. The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old Age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Zetland Court is a large care home for older people registered to accommodate up to 63 people, of which 18 people may require nursing care. The home is one of 18 run by the Royal Masonic Benevolent Institution (RMBI) and provides accommodation and Care Homes for Older People Page 4 of 25 Over 65 63 0 Brief description of the care home care for older freemasons and their dependants. The home receives substantial support from their Association of Friends. Zetland Court is situated in the Westbourne area of Bournemouth, close to local shops and transport links to the centre of Bournemouth. The home was originally a summer home for a local landowner and has landscaped gardens leading down to the cliff tops. The communal areas of the home are on the ground floor and include a large and a small lounge, a library and a billiard room as well as a large dining room. The lounge and library overlook and provide access to the rear garden. The home has two pet cats, 2 cockatoos and 2 budgies. The building is on 4 floors with a passenger lift enabling easy access around the home. A call system is installed in all rooms. Meals are prepared on the premises. The weekly minimum to maximum charge, covering both residential and nursing care, was between £566-£868 in May 2009. Care Homes for Older People Page 5 of 25 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3*. This means that people who use this service experience excellent quality outcomes. This was a statutory unannounced inspection required in accordance with the Care Standards Act. We looked at information sent by the home before we visited. We spoke to people who live in the home as well as people who work in the home. We also spoke to people who visit the home. During the site visit we looked at a variety of care records to find out how people were being supported, we also observed care in the home. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: At the end of this inspection there are three recommendations: Medication administration recording should be improved with no gaps left on the MAR charts and accurate dosage administration recorded by staff. Care Homes for Older People Page 7 of 25 The staff rota should accurately record what positions all staff hold within the home. All fire equipment which requires weekly testing should be recorded accurately each week. 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 set out 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 25 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 25 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. A good admissions procedure, including information provided and trial stays, enables people to make an informed decision about whether Zetland Court is the right place for them to live. Evidence: The statement of purpose and service users guide (welcome pack) was up to date and reflected the service and facilities available at Zetland Court. Copies of the welcome pack are given out to people who enquire about the home, and who live in the home and these contain all the necessary information to enable people to make a choice about living at Zetland Court. 16 residents returned Commission surveys prior to the inspection. All stated that enough information had been received by themselves or their family, prior to moving in, so they could decide if Zetland Court was the right place for them. People also commented that they had stayed previously and this had helped them make up their Care Homes for Older People Page 10 of 25 Evidence: mind, visited home for a week. Very happy here and previous respite short stay. Four peoples care files were seen. Pre admission assessment visits are made by either the registered manager herself or one of the other RMBI home managers, as people come from all over the country. Where appropriate, additional information was seen from health and social care services, so that as much information as possible is gained about the persons needs. All documentation seen was comprehensive and covered the full range of care needs. Two good practice recommendations were made in the last report regarding this outcome area, however the home no longer admits people whose primary need is dementia, therefore these recommendations no longer apply. Care Homes for Older People Page 11 of 25 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. Comprehensive systems are in place to ensure that peoples health and personal care needs are met safely and with dignity and respect. Improvements could be made to address some minor shortfalls in medicine administration recording. Evidence: The care files of six people were looked at and showed that a care plan is prepared for each person upon admission to the home which sets out the specific care needs of the individual. The plans are clearly based upon the initial information gained during the pre admission process and give clear instructions to staff as to how to meet these needs. Two good practice recommendations made at the last inspection regarding care plans and nutritional recording, were found to be met at this visit. 13 out of the 16 surveys returned by people living at the home, stated that they always received the care and support they needed, whilst 3 said usually. A daily record is kept for each person and it was possible to see that individuals care needs were being met each day as identified in their care plans. A comprehensive Care Homes for Older People Page 12 of 25 Evidence: record is kept of when healthcare professionals visit a person or are involved in their ongoing care. These included diabetic nurses, chiropodists, paramedics, physiotherapists, opticians and dentists. There is a dedicated doctors room in East wing for the local GP, who visits every week and holds a surgery so that any person can see him. When asked if they received the medical support they needed, 15 out of 16 survey respondents said always and 1 said usually, with a comment that the house doctor is very good. The 5 healthcare professionals who responded to the surveys, felt that peoples healthcare needs were almost always well met by the home and commented that the care team are pro active in trying to maintain optimal health of residents. There are well managed systems in place for the ordering, receipt, storage and disposal of medications, with all staff appropriately trained and regular medicine audits carried out. People wishing to self-administer their medicines can do so following a risk assessment process, although all medicines were administered by the home at the time of the visit. Where medications are prescribed as required or PRN, there are instructions for staff to follow regarding how often they can be administered and for what reason. All good practice recommendations made in the last report were met at this visit, however some other shortfalls were found. Some gaps were seen in the administration recording of medicines and incorrectly recorded amounts of medication actually given, were seen. This was also discussed at the visit and followed up by the registered manager who reported back her findings in writing to the Commission. Staff were observed to be compassionate and caring in their interactions with people living at the home and clearly well aware of individuals needs. Comments received included I am very happy at this home and would not like to be anywhere else-its very, very friendly and someone also said that they felt the staff were very helpful. Care Homes for Older People Page 13 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported and encouraged to make informed choices about their daily activities and lifestyles, whilst recognising individuals needs and preferences. Evidence: Zetland Court employs two dedicated activity organisers, both of whom previously were employed as night nurses at the home. Between them they arrange a wide array of activities throughout the week. A plan of the months activities is displayed on noticeboards in throughout the home and the weekly activities are displayed on the back of menus at the dining tables, as a reminder of what is happening. Every person who goes to live at Zetland Court, has an individual personal profile completed, which records their interests, hobbies and preferences regarding social activities. One to one sessions are held with people if needed or unable to join in group activities and other things available include reflexology, aromatherapy, Tai Chi, Extend exercise classes and entertainers. During the visit we saw a well attended poetry group take place. Film nights, theatre trips and an art group are also offered and library books are changed every week by Friends of the home. There is an annual fete which is extremely well supported and the home is also helped out by the local Association of Masons, in obtaining any other resources needed. Care Homes for Older People Page 14 of 25 Evidence: When asked if there were activities that they could take part in, 7 out of 16 people responded always, 8 responded usually and 1 said sometimes but also commented that I am never bored. Healthcare professionals felt that the home generally supported people to live the life they chose. Comments included, home always give appropriate support but will intervene if life choices are inappropriate and I have spoken to many residents about their time in the home and they cant praise it enough. Mealtime arrangements were discussed with the chef and menus were seen displayed on all dining room tables. Cooked breakfasts are available and people have 3 choices for the main meal of the day, with a salad bar always available. We joined the registered manager for lunch on the day of the visit and observed that there was a pleasant atmosphere in the dining room, with people clearly enjoying their lunch and personal preferences met. Comments received about meals included, If I do not want a hot meal, I have a salad which I find very tasty and filling, sometimes meat too tough, standard is high and good menus. Two good practice recommendations were made in the last report, both relating to meeting the needs of people with dementia. These are no longer relevant, as the home now does not accept people whose primary need is dementia. Care Homes for Older People Page 15 of 25 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. There are robust complaints and safeguarding procedures in place, which encourage people to express their concerns and protect them from abuse. Evidence: The Commission or the home has received no complaints since the last inspection and an appropriate complaints policy and procedure is in place to deal with any. The homes complaints procedure is also included in the statement of purpose (residents handbook) and is prominently displayed in the home. All 16 people who responded to the surveys knew who to speak to if they were not happy and how to make a complaint. There have been no safeguarding referrals made either, since the last inspection and all staff receive regular training in the safeguarding of vulnerable adults. Staff spoken with demonstrated a clear awareness of different types of abuse and the procedure they should follow to ensure it was properly reported. Care Homes for Older People Page 16 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Zetland Court provides a high standard of accommodation whilst remaining homely, safe and comfortable for people living and working there. Evidence: Zetland Court is sited in a large, splendid house which has beautiful, landscaped gardens and was one of the original houses built in the area. A tour of the premises found the home clean, tidy and well maintained with building work underway to ensure that the home met fire regulations, following a recent risk assessment. En suites were also being fitted to several bedrooms and the bathrooms were in the process of being upgraded. At the time of the visit there was only one lift to all floors, however another lift was being fitted to access both upper and lower floors. One good practice recommendation was made in the last report regarding improving the environment for people with dementia, however this is no longer applicable. The AQAA submitted detailed what improvements had been made since the last inspection and all maintenance and upgrading planned for the coming year. All bedrooms have safes fitted in them for the storage of valuables if needed and Care Homes for Older People Page 17 of 25 Evidence: people have their own furniture and keys to their room. Daily newspapers can also be delivered and there are utility rooms on every floor, providing lockers so people can store their own cups and groceries etc The East wing appeared well equipped with plenty of hoists available and a level access to the garden for people in wheelchairs or unsteady on their feet. Sluices seen were clean and odourless with handwashing facilities available. The laundry is sited in the basement area and appeared well ordered and clean, with adequate handwashing facilities for staff. Staff had also recently completed infection control training and this was seen to be well managed around the home, with ample supplies of gloves on every floor. All 16 people responding to the surveys said that the home is always fresh and clean. Care Homes for Older People Page 18 of 25 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. There are sufficient staff members on duty and robust staff recruitment and training systems ensure that people living at Zetland Court, will be competently cared for and protected. Evidence: Sufficient staffing levels are provided to ensure that all peoples assessed needs can be met whilst living at Zetland Court. In addition to the registered nurses and care staff on duty, several other staff are also employed to meet peoples collective daily needs and assist in the running of the home. These include a business co-ordinator, administrative assistant, head of maintenance, assistant handyman, gardener, domestic supervisor and six staff and a chef and five kitchen assistants/waiters. Agency staff are rarely used with most shifts being covered by permanent staff members. the staff rota reflected who was on duty each day but did not clearly identify what each persons job role was. When asked if staff were available when they needed them, 9 out of 16 people said always, whilst 7 said usually. The recruitment files of four staff were looked at and found to contain all the required documentation, including 2 references and evidence of identity. Criminal Record Bureau (CRB) disclosures were also present and had been obtained prior to starting Care Homes for Older People Page 19 of 25 Evidence: work. Comprehensive interview notes were kept and any issues arising from this or references or CRB checks, were thoroughly discussed and appropriate actions taken if needed. New staff complete a thorough three day induction training programme, ensuring that they are familiar with the homes policies and procedures and are competent in meeting peoples needs. They then shadow an experienced member of staff for two weeks and will work on both wings to enable them to get to know all people living at the home. There is a dedicated member of staff-a senior carer-who oversees all the inductions, which meet Skills for Care standards. 92 of staff have achieved an NVQ in care at level 2 or above and all staff have training passports, which record all courses attended. Recent training included infection control, dementia training, moving and handling, first aid, safeguarding and the management of Parkinsons disease. One staff nurse was attending the Mental Capacity Act training on the day of the visit and there were plans for attending a course on the Deprivation of Liberties. Comments received from people living at Zetland Court and healthcare professionals, included, Based on my experience care staff seem highly trained and have good insight into residential care needs and most of the staff do act on what you say-some much better than others. One requirement and two good practice recommendations were made in the last report. Recommendations made regarding tissue viability training were found to be met and staff have received training in caring for people with dementia, meeting the requirement made. Care Homes for Older People Page 20 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed by someone who is skilled, experienced and very competent and puts the needs of the people using the service, at the centre of good practice. Evidence: The home continues to be managed by Tina Beament, who has worked at the home for 14years and is a registered nurse and holds an NVQ level 4 in management. There are regular visits to the home from other representatives of the RMBI, including the regional manager and regional human resources manager. Comments received from healthcare professionals regarding the management and running of Zetland Court included, Zetland has the highest standards of management and care, I feel they provide a very good standard of care to all their clients but especially to the dying patients. All residents appear well cared for and treated with respect. I would be more than happy if one of my relatives had to live there. Whilst one person living at the home commented that they believed they were living in the Care Homes for Older People Page 21 of 25 Evidence: best residential home available in the UK. The RMBI employ an external company, Laing and Buisson, to conduct their annual quality assurance work and they issue surveys to residents and relatives which cover a variety of areas. Regular audits are also carried out within the home for such things as medication and resident care files. Regular resident meetings are also held with the most recent minutes seen posted on the notice board and relatives are invited to meetings twice a year. The finances of people are extremely well managed by the use of an online system and all paper receipts and statements seen to be kept. Maintenance records were sampled and evidenced that regular checks were carried out as required, including the gas boilers, hoist equipment (LOLER) and Legionella treatments. As already discussed, the home was updating its fire system to meet requirements following a recent fire risk assessment held in March 2009. The fire log book was seen and although the required weekly and monthly checks were confirmed to have been carried out, by the registered manager and the head of maintenance, some weekly checks had not been recorded. Accident records were seen and all forms appeared well completed, with good details and were audited every three months to identify any trends. Care Homes for Older People Page 22 of 25 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 23 of 25 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 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 9 Medication administration recording should be improved with no gaps left on the MAR charts and accurate dosage administration recorded by staff. The staff rota should accurately record what positions all staff hold within the home. All fire equipment which requires weekly testing should be recorded accurately each week. 2 3 27 38 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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