Inspection on 18/08/09 for Pax Hill Nursing Home

This is the latest available inspection report for this service, carried out on 18th August 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Pax Hill Nursing Home 20/06/06

Pax Hill Nursing Home 13/09/05

Pax Hill Nursing Home 13/04/05

Pax Hill Nursing Home 14/10/04

Pax Hill Nursing Home 05/04/04

Pax Hill Nursing Home 11/02/03

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Pax Hill Nursing Home Pax Hill Bentley Nr Farnham Surrey GU10 5NG Lead Inspector Christine Bowman Key Unannounced Inspection 18th August 2009 11:00 DS0000012225.V376503.R02.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pax Hill Nursing Home Address Pax Hill Bentley Nr Farnham Surrey GU10 5NG 01420 23786 01420 22690 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dr M Zaki Dr N Zaki Mr Sheik Yousoof Jaunoo Care Home 61 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0), Old age, not of places falling within any other category (0), Physical disability (0) Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Old age, not falling within any other category (OP) 2. 3. 4. 5. Physical disability (PD). A maximum of 27 service users may be accommodated in the nursing wing. A maximum of 6 service users in the PD category may be accommodated in the residential wing. A maximum of 3 service users may be accommodated with nursing care needs in rooms 16,17 and 19 of the residential wing. The maximum number of service users to be accommodated is 61. Date of last inspection 24th August 2007 Brief Description of the Service: Paxhill Nursing Home is a 61 bedded home offering both nursing and personal care. It is situated in the village of Bentley at the end of a private drive amidst farmland. The home comprises of a large country house, which had been adapted to provide residential accommodation, and which is of historical interest due to its links with the founder member of the scouting movement, and a nursing wing, which had been added at a later date. Extensive grounds are available to the residents and many rooms overlook the countryside. The home offers accommodation in 37 single rooms and 12 double rooms. A building project is currently underway on a site adjacent to the home to provide up to date accommodation for the residents. All existing care home Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 5 accommodation in the residential and nursing wings will be replaced by the new build structure. Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This inspection report includes information gathered about the service since the previous site visit on 24th August 2007 under the Inspecting for Better Lives (ILB) process. An Annual Quality Assurance Assessment (AQAA) was completed by the manager, and returned within the required timescale, giving up to date factual evidence about the running of the home and informing us of what they think they are doing well, how they have improved the service, and of their plans for further improvements. Eight people living at the home completed surveys, with support from relatives, friends or staff, giving their views on the service, and five staff and two healthcare professionals also completed surveys. The collated results of these surveys and comments have been included in the report. An unannounced site visit, conducted on 18th August 2009, was completed over six and a half hours commencing at 11:00am, to assess the outcomes of the key inspection standards for older people with respect to the people living at the home. The registered manager, Mr Sheik Yousoof Jaunoo, assisted with the inspection process by making records available to be sampled. We looked at service user files, the staff training matrix, quality assurance documentation, the service user guide, the statement of purpose, samples of policies and procedures. The provider, Dr Zaki, was available for consultation and provided the staff recruitment files to be inspected. We sampled two bedrooms and the communal living areas of the residential home and the nursing home and observed the staff as they carried out their duties. What the service does well: The home is located in its own grounds of well-tended gardens and woodland, which the residents can enjoy from their windows and relax in when the weather is fine. Some comments from residents, who engaged in the inspection process included, this is the most wonderful home I have ever been to and they look after me so well, the food is excellent, the staff are so kind and the manager is a gentleman, my room is lovely and clean and my clothes laundered well, I cant fault the place, and there are lovely views from my windows. A staff member commented in a survey, Pax Hill is a lovely place to work. We all try to do our best to give a good quality of care to the residents and the residents are very happy here. Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 7 The home has good relationships with community healthcare professionals, who visit the home regularly, and one healthcare professionals commented, we always receive up-to-date information about the health and well-being of the residents we visit and concerns are always brought to our attention, and Pax Hill staff follow any care plans that we have implemented and let us know when these may not be working. Another commented in the survey they completed, staff seem very helpful and considerate to the residents, respecting their privacy and dignity, when helping us with nursing needs. What has improved since the last inspection? What they could do better: The nursing wing, which was not purpose- built, and was not conducive to reconstruction, was due to be demolished when the new building project was completed. There had been delays in the building programme but completion of the first phase of the project was due within the next twelve months and all the residents will then be provided with up-to-date and purpose-built accommodation. There were the same number of staff on the duty rota as at the previous site visit, but eight more residents, and evidence that residents, although generally Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 8 satisfied with the care they receive to meet their needs, sometimes need to wait for a short time for staff support and attention. There were some gaps in the training programme and staff did not have individual training and development profiles to aid their professional development and to ensure that there were always sufficient numbers on duty with specialist knowledge of the residents individual needs. 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. Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are supplied with all the information they need to make an informed decision about moving to the home, and the home ensures that prospective residents individual needs are fully assessed so that a plan of care can be drawn up to show how their needs will be met. EVIDENCE: A leaflet providing initial information about the home had been produced. It included colour photographs of the exterior and interior of the building, views of the beautiful surrounding countryside, and showed residents relaxing in the extensive gardens and having their hair styled in the hairdressing salon. A Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 11 colourful folder, also illustrated with images of the home and happy residents, containing a statement of purpose and a statement of facilities and services and range of needs accommodated, was provided for prospective residents and their representatives to help them to decide if the home would be able to fulfil their needs. The folder included a complaints procedure and details of the homes fees. The philosophy of care promised prospective residents that their privacy and dignity would be respected, their views listened to and their active lifestyle and freedom of choice promoted. A more detailed statement of purpose was available at reception, containing a full map of the layout of the home, facilities and room sizes. The manager confirmed that prospective residents were encouraged to visit the home to sample the facilities and the food and to meet the residents already living there. Seven of the eight residents, who completed surveys, recorded that they had been supplied with sufficient information to help them to decide if this was the right home for them. Two residents assessments sampled contained enough information to enable a holistic care plan to be compiled covering the physical, emotional and spiritual needs of the prospective resident. The manager wrote in the AQAA, we obtain as much information as possible regarding the prospective residents past occupation, spiritual needs, likes and dislikes, diagnosis, prognosis, current treatment, infections etc. to ensure they receive person-centred care. Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans address the residents health, personal and social care needs and safe arrangements are in place for the handling of medication to protect the residents and the staff. The residents right to privacy is upheld and their dignity maintained. EVIDENCE: The residents care plans sampled had been drawn up from the assessment documentation and covered all areas of their care and nursing needs. Each resident had a summary sheet in the front of their care plan recording their abilities with respect to carrying out self-care activities, identifying their preferred choices and informing carers how independence should be promoted Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 13 when supporting individuals with their care needs. Records confirmed that care plans had been reviewed on a monthly basis. One resident with Mental Health needs, whose file was sampled, contained a Community Psychiatric Nurse Assessment and a care plan based on the Care Programme Approach. Moving and handling risk assessments were included for those with mobility needs, and nursing interventions were documented in the care plans sampled, including the level of support required to meet the residents needs. Risk assessments, identified the level of risk involved in identified areas and the methods of risk reduction. Six of the eight residents, who completed surveys with support, recorded that they always received the medical and personal care and support they needed, and two that they usually did. Care plans sampled had been signed by residents to confirm acceptance. The manager stated that the home had a good relationship with community health care professionals and that their specialist advice was often sought. The local GP (General Practitioner) was completing his weekly visit to the nursing home, on the day of the site visit. Residents files sampled contained a section to record multi-disciplinary contacts and these included the GP, a chiropodist, a community nurse and a psychiatrist. All records were signed and dated and important information with respect to the care of individuals was recorded to inform the nursing and care staff. Healthcare professionals commented, we always receive up-to-date information about the health and well-being of the residents we visit and concerns are always brought to our attention, and Pax Hill staff follow any care plans that we have implemented and let us know when these may not be working. The homes statement of facilities and services informed residents that they could make alternative arrangements if they did not wish to be registered with the local GP, that physiotherapy could be accessed through the GP, and that the home also provided the services of a registered physiotherapist usually free of charge, except where extensive treatment is required. Opticians visited the home and one residents records confirmed that they had received dental treatment in the community. Medication administration records sampled had been completed in a satisfactory manner, showing that residents had received the required dosage of their prescribed medication, as set out by their medical practitioner, and there were no unexplained gaps in the recordings. Medication records included photographs of the residents to ensure correct identification and to reduce the risk of medication errors. The staff training matrix confirmed that the registered nurses in the nursing wing, and the five care staff and one registered nurse in the residential wing, responsible for the administration of medication, had undertaken this training for the safety and protection of the residents. A list of their signatures and initials were kept on record for identification purposes. Controlled drugs were stored appropriately and a random sample of residents controlled drug stock, confirmed that the controlled drug register was correct. Records were kept of medication received Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 14 and returned to the pharmacy to ensure it was all accounted for in the residential wing, and the AQAA confirmed that there was a contract with a specialist disposal service for the disposal of drugs and sharps in the nursing wing. The manager stated that when residents wish to take responsibility for their own medication, risk assessments are undertaken and suitable storage facilities in bedrooms are made available. Observations of the staff throughout the day confirmed that they were respectful and polite in their interactions with the residents, who smiled in response to them and appeared relaxed and happy in their home. New staff had completed the Skills for Care common induction standards, which provide an introduction to the caring role and promote the residents rights to be treated as an individual, with respect for their privacy and dignity. Three of the five staff members, who completed surveys recorded that they always felt they had the right support, experience and knowledge to meet the different needs of the residents with respect to equality and diversity issues, and two thought that they usually did. A healthcare professional commented in the survey they completed, staff seem very helpful and considerate to the residents, respecting their privacy and dignity, when helping us with nursing needs. Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 People using the 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 variety of social activities and entertainment, the promotion of relatives involvement in the lives of the residents, and the provision of varied and nutritious meals meet the residents needs. EVIDENCE: Since the last site visit, an activities organiser had been employed, but she was not working on the day of the site visit. A notice board, situated centrally in the residential home, informed residents of visits from the mobile library, religious services they could attend, and birthday celebrations. The most recent newsletter was also posted here. It was illustrated with colour photographs of the annual Summer Fete and showed groups of happy residents enjoying lunch on the extensive lawns. There were stalls of home made cakes and sweets, a raffle, a tombola, games and competitions, flower Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 16 arrangements and handmade crafts produced by the residents. Forthcoming events included an outing to the seaside, with lunch at a fish and chip restaurant and a visit to a museum, musical entertainment (Music for Health), described as, an energetic act which encourages everyone to dance, sing and make music along to popular tunes from the past and the prospect of two other artists specialising in songs from times gone by, to help residents to reminisce. An album of photographs of events and outings was kept at the front desk for residents to enjoy. Records of residents participation in planned activities and scheduled one to one time were held on file in the nursing unit. Colourful booklets had been produced, and a sample viewed, recorded the monthly participation of the residents in one to one activities, such as hand massage, manicures, and outings with relatives, and group activities such as art, discussion group, musical entertainment and balloon games. On the day of the site visit, there was no evidence of organised activities, but several residents sitting in the garden, stated they were enjoying the summer borders. Others were relaxing in the conservatory in the nursing wing, one resident was walking in the grounds with a relative, and an independent resident was out in her car. A visiting dog provided some entertainment in the afternoon. Four of the eight residents, who completed surveys, confirmed that the home always arranges activities they can take part in if they want, three recorded that activities were usually arranged, and one that they sometimes were. The home did not provide transport for the residents, but money raised at open days and fetes, enabled minibuses to be hired for trips out to places of interest such as Bird World, Music in the Park and the seaside. Comments on surveys, which relatives had supported residents to complete, recorded that they are made welcome in the home and there are no restrictions on visiting. The AQAA recorded that relatives were encouraged to join in meals, accompany residents on trips out, take part in celebrations and attend meetings. The dining rooms in both wings provided pleasant spaces for the residents to enjoy their mealtimes and to socialise. Both of the rooms were well colour coordinated and the furnishings were of good quality, solid and comfortable. The dining tables were nicely set out for lunch with table cloths and wine glasses. A drinks cabinet contained sherry and wine for the residents to enjoy prior to, or to complement their meal. The five week menu included a choice of two main dishes at lunch time and there were other choices such as salads and omelettes always available. The menu included fresh fruit, fruit salads and yoghourts in addition to traditional puddings for dessert. The manager was in the process of producing a pictorial menu of colour photographs to help residents to make their choices. Six of the eight residents, who completed surveys, confirmed that they always liked the meals at the home and two that Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 17 they sometimes did. Residents commented, the food is very good, the food is excellent, and they are very good at providing alternatives. Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are confident they will be listened to, should they express concerns, and a satisfactory procedure is in place to deal with complaints, should they arise. Residents are safeguarded from abuse by staff, who know how to protect them EVIDENCE: The complaints procedure was displayed on notice boards in the residential home and the nursing wing to inform the residents, their representatives, staff and visitors, of the procedure to follow should they wish to make a complaint. It was also included in the information pack produced for prospective new residents. A suggestions box was available so that comments could be made anonymously, should anyone wish to do so. All the residents, who completed surveys, confirmed that there was someone they could speak to informally if they were not happy, and seven of them recorded that they knew how to make a formal complaint. The five staff, who completed surveys, confirmed that they knew what to do if someone had concerns about the home. Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 19 The manager recorded in the AQAA that one complaint had been received over the previous twelve months and that it had been resolved within twenty eight days. The complaints log was viewed and the letter to the complainant included action taken to resolve the issue. Compliments were also recorded and one relative wrote, I would like to express my sincere thanks to you and your staff for the care and kindness shown to my mother whilst she was at Pax Hill. The nursing and care staff have been so kind and always shown dedication in their care, and my mother said many times, they look after me well here and nothing is too much trouble for them, and another commented, our sincere gratitude to you for the relentless care and attention you devoted to our dad/granddad. We know in our hearts that he was loved not only by us but by you too, through your kindness above and beyond the call of duty. We are confident you helped to make his last years as happy and comfortable as you possibly could. The registered manager stated that he had completed the local authority safeguarding adults training and that all new staff receive this training in induction. The staff training matrix showed that the majority of the staff had received updated safeguarding adults training within the previous two years to keep them up to date with current practise. The AQAA recorded that the homes policy and procedure for safeguarding adults and the prevention of abuse had been reviewed within the previous year, and the manager confirmed that the staff had been made aware of the whistle-blowing policy. There had been no safeguarding referrals over the previous twelve months. However, a safeguarding referral had been made after the previous site visit, but no records were available on request, to confirm that appropriate action had been taken by the home to address the issues. Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean and safe environment, which is well-maintained, and the residential wing is homely and comfortable. The nursing wing is not conducive to the purpose of nursing people with physical and mental disabilities, but a building project is underway to provide purpose-built accommodation for all the residents. EVIDENCE: Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 21 The home comprised of a large country house, which had been adapted to provide residential accommodation, and which was of historical interest, due to its links with the founder member of the scouting movement. The nursing wing had been added at a later date. The home was located at the end of a long private drive close to the small village of Bentley, and a car parking area was provided close to the property. Surrounding the home were nine acres of grounds, including well-tended gardens and woodland, which the residents could enjoy. Main routes close to the home provided easy access to London, Winchester, the South Coast and the West Country, and a railway station in the village provided direct access to London via Waterloo. The situation with respect to the environment continued to pose the same problems as described in the previous inspection report, and the AQAA highlighted the limitations of the current building, as being a barrier to improvement. The new building on the site adjacent to the home, which is the first phase of the renewal project, was progressing at the time of the site visit, but there had been a delay of several months, and the completion of this phase of the project was expected within the next twelve months, according to the AQQA. The residential wing was homely and comfortable and, some of the current residents spoken with, confirmed that they liked living there, enjoyed relaxing in the gardens, and appreciated the peaceful views of the surrounding countryside and woodlands. There were several communal rooms, including a large hall providing a space large enough for all the residents to gather for communal events. A piano was located in this room, and, one of the residents, who was an accomplished pianist often provides accompaniment for communal singing, the manager stated. A widescreen television, DVD player, video, games, puzzles and books provided entertainment for the residents, and the manager stated that, activities such as dancing, armchair exercises, and music for health were organised there. Smaller lounges provided spaces, where residents could entertain visitors in private and one resident was enjoying the view of the garden from one of these rooms. Two more residents were sitting in the entrance hall and several were sitting in the garden. A hairdressing salon provided a dedicated space for the visiting hairdresser and the chiropodist. It was well-equipped with basins for hair washing and professional hairdryers. Residents bedrooms viewed in the residential wing were of a good size and provided with en-suite facilities, some had separate sitting rooms and one resident had an apartment with a separate entrance. Residents private rooms were personalised with photographs, cabinets containing ornaments, standard lamps and some residents had their own telephone lines connected and televisions for their entertainment. The double bedrooms are used by couples preferring to share a room, the manager stated, otherwise they are currently used for single occupancy. A chair stair lift enabled access to the first floor. Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 22 The nursing wing was not designed to be a nursing home and the providers had acknowledged that it was not conducive to nursing people with physical and mental disabilities. This area was due to be demolished in the next phase of the building project. As highlighted in the previous inspection report, there was no passenger lift to the first floor in the nursing wing only a chair lift fitted to the stairs. For those who are physically disabled, it has been assessed as too high a risk to transfer people from a hoist into a chair lift in the confined area of the first floor landing. This has been a reason why some residents have changed rooms to move downstairs, as their condition deteriorates, and three bedrooms on the ground floor of the residential wing had been registered for nursing care. The AQAA recorded improvements to the environment completed over the previous twelve months for the benefit of the residents, including the construction of a safer, permanent ramp between the two units to facilitate access for those with mobility needs, improved access to the conservatory in the nursing wing, and a programme of re-decoration. The home employed two permanent maintenance workers to deal with day to day environmental issues and maintain safety. The laundry area was suitably equipped with industrial washing machines and dryers for laundering the residents personal clothing. As there was no designated laundry person, this work was completed by the carers. Other laundry, including bed linen, was collected by an outside contractor. The home had an infection control policy and procedures in place and the AQAA recorded that 98 of the staff had received this training. The staff training matrix also confirmed this information. A requirement from the previous inspection report, that all toilets and bathrooms used by the residents should be fitted with soap dispensers and paper hand towels to aid infection control, had been completed, in that all the bathrooms, en suite facilities and toilets, sampled had been supplied with them. Gloves and aprons were available to protect both the staff and the residents, in the carrying out of personal care and nursing procedures and hand gel was freely available. Seven of the eight residents, who completed surveys, recorded that they thought the home was always fresh and clean and one that it usually was. Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are not always available and not always updated with respect to mandatory and specialist training to ensure the needs of the residents are met. Satisfactory recruitment practices protect the residents from being cared for by unsuitable staff. EVIDENCE: The AQAA recorded that, for the forty one residents in the residential and nursing home, twenty nine nursing and care staff were employed, five of which were part-time. Fifteen other staff were employed to complete domestic tasks, including cleaning, cooking, maintenance and laundry, and an activities coordinator had been employed since the previous site visit to provide a programme of activities for the enjoyment of the residents. The rota demonstrated that five care staff and two trained nurse were on duty during the day. Although the number of residents had increased by eight, from thirty three at the previous site visit two years ago, to forty one at the present time, the manager stated that the residents now living at the home were more Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 24 independent and an increase in staffing levels had not been necessary. He confirmed that the residential forum, which is a tool to assess the number of staff required with respect to the assessed needs of the residents, had been completed. One resident on the nursing wing complained that they had been waiting a long time to be taken to the toilet and assistance was immediately provided. Of the five staff, who completed surveys, only two thought there were always enough staff to meet the individual needs of the residents. Five of the eight residents, who completed surveys recorded that the staff were not always available when they needed them. A nursing and care staff turnover of fourteen staff members over the previous twelve months was recorded in the AQAA, and two thirds of the care workers and registered nurses were of one racial background, which does not reflect the ethnic and cultural diversity of the geographical area or of the residents. The manager stated that for the staff from abroad, whose first language was not English, he had arranged colloquial English lessons to promote their understanding of the language and culture of the residents. The AQAA recorded that nineteen of the twenty-nine nursing and care staff staff had completed a National Vocational Qualification (NVQ) in Care or Health and Social Care at level 2 or above to support them in their role. New staff had completed the Skills for Care common induction standards, which provide an introduction to the caring role and promote the residents rights to be treated as an individual with respect to their equality and diversity issues. The induction records of two staff sampled, confirmed this, and four of the five staff, who completed surveys recorded that their induction mostly covered everything they needed to know to do the job when they started. The registered provider took responsibility for the recruitment of the staff, and the personnel files of two recently recruited staff, confirmed that this process was carried out safely, in that staff were not confirmed in post, until the appropriate checks and references had been received. The five staff, who completed surveys, also confirmed that their employer had carried out checks, such as Criminal Record Bureau checks and references, before they started work. The staff training matrix confirmed that mandatory training including Moving and Handling, Health and Safety and the Control of Substances Hazardous to Health, Fire training, Infection Control, Food Hygiene, the Protection of Vulnerable Adults, had been completed by the majority of the staff, but there were some gaps and a small number of staff had not been updated as required. Most of the staff had also undertaken The Mental Capacity Act and Deprivation of Liberty Safeguards training and sufficient staff had accessed training in First Aid and Medication Administration to ensure a representative was always on duty. Approximately half the staff team had received training in Dementia Care and most of the registered nurses and one care worker had been trained in Care Planning. Small numbers of staff had received training in Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 25 Palliative Care, Bed Safety and Pressure Relieving, Optical Awareness, Seizure Management, Handling Diabetes and Managing Behaviours. All the staff, who completed surveys, confirmed that they were being given training which is relevant to their role, and three, that it helps them to understand the individual needs of the residents with respect to equality and diversity, and keeps them up-to-date with new ways of working. The manager stated that community nurses could be accessed through the residents General Practitioner, should any specialist nursing input be required. The staff did not have individual training and development logs, but copies of certificates were kept in a collective file. Two staff commented on the good team work, one stated that, Pax Hill is a lovely place to work, and another thought that, one thing the home could do better was to provide more clinical training for the registered nurses. Residents commented in their surveys under what the home does well that, the staff are nice and helpful, the staff are pleasant and always try to help if we have a problem, and the home provides good, friendly staff. Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a well managed home, in which their opinions are sought and acted upon for the improvement and development of the service. Effective systems are in place to promote the residents health, safety and welfare creating a safe environment for them to live in. EVIDENCE: Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 27 Since the last site visit, the registered manager had resigned, and a new manager, Mr Sheik Yousoof Jaunoo, had been recruited and registered to manage the home. The current registered manager was a psychiatric nurse with many years of experience in the nursing field. He had also previously worked in a management position in a business environment. The registered manager kept himself up to date with current practise by completing train the trainer certificates in dementia, the Mental Capacity Act and the Deprivation of Liberty safeguards, fire wander and safeguarding adults. Recently, he had completed National Vocational Qualification (NVQ) at Level 4 NVQ in Leadership and Management to support him in his role. A staff member wrote in a survey, Pax Hill care home has a good management and administration team. The manager is very supportive and works as a good team leader. The manager stated that quality assurance questionnaires had been completed by residents and their relatives and the results had shown a high level of satisfaction with respect to the accommodation, the food, the staff and access to communication with friends and relatives. Meetings with residents and their relatives were held on a regular basis to gain feedback on the service provided, and the minutes were recorded. The home also produced newsletters to keep everyone informed of forthcoming events, entertainment and the progress of the new building project. The AQAA recorded that some of the changes made as a result of listening to the people who use the service, included, introducing a menu board to inform residents of the menu for lunch and dinner, consulting with the residents daily about their meal preferences, keeping information about the staff on duty and the weather on a central notice board to inform the residents and encouraging more relatives to join in meals. Small amounts of money were held in safekeeping for some residents and the manager confirmed safe storage, and the keeping of accurate records and receipts, to protect the residents interests. The Annual Quality Assurance Assessment, completed by the manager confirmed that policies and procedures with respect to health and safety were in place to keep the staff informed, and that the essential maintenance of equipment had been carried out according to manufacturers recommendations to ensure it was safe to use. A sample of certificates, seen on the day of the site visit, confirmed that maintenance checks had been carried out in a timely fashion. Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP30 Good Practice Recommendations All staff should be provided with an individual training and development profile to record their professional development and to confirm that there are sufficient staff, with the right training, and specialist knowledge of the residents needs on duty at all times. Pax Hill Nursing Home DS0000012225.V376503.R02.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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