Inspection on 27/09/06 for John Joseph Powell Memorial Care Centre

This inspection was carried out on 27th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

John Joseph Powell Memorial Care... 08/05/08

John Joseph Powell Memorial Care... 05/06/07

John Joseph Powell Memorial Care... 08/11/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE John Joseph Powell Memorial Care Centre McKenna`s Court 11A High Street Prescot Merseyside L34 3LD Lead Inspector Mr Mike Perry Unannounced Inspection 27th September 2006 10:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service John Joseph Powell Memorial Care Centre Address McKenna`s Court 11A High Street Prescot Merseyside L34 3LD 0151 431 0247 0151 431 0247 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) Meridian Healthcare Ltd Mrs Dorothy Pye Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (38), Terminally ill (6) of places John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up 44 OP old age and up to 6 TI (Terminally Ill). Service users to include up to a maximum of 7 under pensionable age. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 8th November 2005 Date of last inspection Brief Description of the Service: John Joseph Powell Memorial Nursing Home is registered to provide nursing care for forty-four older people. The homes registration is for thirty-eight older persons over the age of sixty-five and seven persons under pensionable age. The home also provides seven beds for palliative (terminal) care. Intermediate care is no longer provided. John Joseph Powell is located in the Prescott area of Liverpool, close to local shops and road links. The home is purpose built over two floors. There is a passenger lift to access all areas and handrails are in place in the main corridors. Recreational space comprises of a dining room, lounges and conservatory. These rooms are bright and attractively decorated. Bathrooms have suitably adapted equipment and a call system with an alarm facility is operational for the residents. The home has garden areas, a large pond and a secure entrance to the car park. The home was acquired by Meridian Healthcare Limited in July 2005. Meridian Healthcare owns other care homes in the area, Leeds, Tameside and Scunthorpe. Mrs Dorothy Pye is the registered manager. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was a ‘key’ inspection for the service and covered the core Standards the home is expected to achieve. The inspection took place over a period of 12 hours over 2 days. The inspector met and spoke with a number of residents and a number of relatives and visitors who were visiting over the two days. There were addition conversations with relatives and health care professionals by phone following the visit. The inspector also spoke with members of care staff on a one to one basis and the registered manager and deputy manager. A tour of the premises was carried out and this covered all areas of the home including some of the resident’s rooms [not all bedrooms were seen]. Records were examined and these included 5 of the resident’s care plans, staff files, staff training records and health and safety records. Although all core standards were reviewed the inspector was guided by concerns around health and personal care highlighted in a current adult protection investigation and therefore concentrated on these areas in more detail. The issues around the adult protection case are discussed under the heading ‘complaints and protection’. Overall the inspection was positive in that the management were open and constructive and had a clear concept as to how the home should be progressing in the future. Most of the requirements from the previous inspection have been addressed. There is a willingness to look at the issues raised from this inspection and to address them positively. What the service does well: The home has written information [Service User Guide] and this is available for residents and relatives. Residents and relatives spoken to had found this useful and had assisted them in both choosing and settling into the home. All residents are assessed prior to admission to the home. Care files were reviewed and appropriate social care and health care assessments had been John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 6 completed. Following admission there are further, more detailed, assessments carried out so that a plan of care can be drawn up. Residents spoken to felt generally that staff attended to their needs and they felt safe in the home. Relatives were very positive in support of the staff’s general approach to care and felt that staff had a clear understanding of residents needs. Staff have specialist skills in palliative care and all nurses and most care staff have attended specialist courses for this. Relatives and residents interviewed felt that they were generally kept up to date and that staff communicated well regarding how care was being carried out. Residents have a range of risk assessments within their care plans covering, falls, nutrition, moving and handling, dependency and pressure sores. These look into the resident’s risk of harming themselves or others. These were completed to a good standard and then are included in the care plan. One resident reviewed has very complex needs including a pressure sore. currently and this is monitored through the care plan with regular, daily records maintained. The resident when interviewed was fully aware of the condition of the wounds and said that the staff gave continual updates. The resident described how staff had given support and how he ‘couldn’t have chosen a better place. Staff cheer me up – moral support is very important’. Liaison with the health professionals outside the home was very good. Residents and relatives spoken to at the inspection said that they were treated with respect and that privacy was maintained when needed. Residents were asked about toilet and bathing arrangements and stated that staff were careful to ensure privacy. During the inspection residents were observed to be appropriately dressed and clean and well presented so that dignity is preserved. Staff have good rapport with residents and the general atmosphere in the home is positive with care staff seen talking to and supporting residents. Over the two days in the home there was much activity in terms of visitors and staff interacting with residents and receiving ongoing support. The home was very lively and the general atmosphere was positive and friendly. The residents interviewed felt that staff were approachable and helpful. Residents were observed to be interacting with each other and reported that they often got together for a chat. Relatives interviewed reported that they were always welcomed and could visit at any time. Meal times were observed to be relaxed and social affairs with staff on hand to assist some residents as needed. There is choice available and the portions of meals were very good and were commented on by the residents. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 7 Those residents and relatives interviewed felt that they were able to approach staff and that their concerns would be listened to. There is a complaints procedue and this is in all of the service user guides which are in bedrooms. Most of the care staff in the home have attended training sessions with social services around abuse awareness and the local adult protection protocols and those interviewed were aware of how to report any allegations of concerns. During the visit the home was obseved to be clean, bright and well maintained. Residents reported that facilities such as bathrooms and toilets are always maintained in a clean and hygienic state. Bedrooms seen were very well personalised and homley. All were decorated appropiatly. There are various day areas so that residents have a chioce. Staffing numbers in the home were good and have been consistent so that residents needs can be addressed. Residents and relatives comments were generally very supportative of the staff who were seen as helpful and kind. The home has over 80 of care staff trained to NVQ level [40 at level 3]. Staff reported that there is always some training event. All trained staff have palliative care training and care staff have attended the Macmillan palliative training course. Staff generally felt supported by the managers and felt that they were approachable. Dorothy Pye is the manager of the home. She has been in post or 12 years. She has very good experience in the clinical field working as a Registered Nurse [RN] for many years. All staff and residents / relatives were supportive of the managers approach and she was known to all of the residents, relatives and staff spoken to. The home is subject to some external Quality Assuranc processess. The company also carry out their own quality audit on a yearly basis and this was seen. It contains the results of a resident / relative survey and the overall satisfaction was noted to be high What has improved since the last inspection? The medication administration records [MAR] were seen and were clear and accurate for those residents reviewed. Staff are now recording the administration of creams and ointments following the last report. The home is currently being assessed in terms of the provision of disability aids and also the suitabilty of bathing areas in terms of the increasing dependecy of John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 8 residents addmitted to the home. During the inspection the process of upgrading furnishings and décor was well underway and some of the residents commented on, and were pleased, with new wardrobes and other furnishings. Staff training is organised. The requirement from the previous inspection for training to be kept on record was evidenced in the staff files as well as the requirement for staff to receive manual handling training. Following a previous requirement the recruitment of staff complies with standards around checks on fitness to work with vulnerable adults. Staff files were seen and all contained full references and Criminal Record checks [CRB]. What they could do better: Residents interviewed where generally not aware of any contract or terms and conditions of residence. This is required on admission to the home and should include a breakdown of the fee structure for each resident s that there is full awareness of the terms of living in the home. There was a requirement from the previous inspection and also from the recent adult protection meeting [see complaints and protection] to improve the care planning with respect to detail of care interventions. Overall there is still a need to develop this further. Plans were being reviewed by staff on a monthly basis, or sooner if needed. This evaluation process was discussed. It was agreed that care plan evaluations should contain more than a general statement of ‘continue care’ and should be a discussion and statement of progress made set against the aims / goals of the care plan. This should show evidence of discussion with key workers and periodically relatives and residents. The care plans are ‘standardised’ in that certain care interventions appear on a set list depending on the residents need. The issue with this sort of approach is that the personalisation needed to reflect individual care could be lost. There was some discussion how this process could be improved. Care needs were not addressed in enough detail; for example one resident who attends for hospital therapy 3 times weekly did not have any detail of this arrangement and how they were being supported through the process. The care plans seen could however be followed and generally gave a good out line of the care needs of the residents concerned. The discussion with the manager centred on the need to develop the quality of the care planning by having regular auditing meetings with staff. Some feedback was given the manager from a social care professional who had previously visited the home and had reported some incidence of bedroom doors being open and residents being exposed. Also one relative reported that some times staff were rushed in their work and residents had been witnessed John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 9 not to be covered properly when coming from the shower/ bath. Overall it would appear that personal care is carried out well but there are occasional lapses, which the manager needs to be aware of. The inspector did not observe any activities planned for residents during the inspection. The feed back from residents was that although the routine of the home was relaxed there could be more planned in the way of activities, particularly local outings There have been two complaints about care in the home since the last inspection The first complaint was from a relative of a resident who had bruising on her body. There were also issues around the privacy and dignity of residents as staff were allegedly observed to be not carefull in ensuring that residents are covered appropiatly when in public areas. The outcome of the investigation [ by social services] was that the central allegations were unfounded. There were however some concerns expressed about observations made by social workers during the visit to the home around the privacy and dignity of some residents being undermined by, for example, doors being left open whilst residents were getting undressed. These observations were discussed with the manager during the inspection. The second complaint was recieved just prior to the inspection of the home and again concerned some observations of poor nursing and personal care [ see main body of report for details]. The outcomes are that the care planning process needs to be developed in more detail [requirement of this report and discussed in more detail under ‘Health and Social care’]. The provision of personal care was also raised as a discussion on the need for consistency in this area although standards on the inspection were noted to be satisfactory. Some of the bedooms seen who had wheelchair users in them where rather small however and do not meet the standard of 12 square mettres of floor space. This was discussed and it is important that senior staff are aware of the rooms that do meet standards for wheelchair users and this is taken into account when assessng residents prior to addmission so that such residents can be appropiatly placed. There are some environmental issues that were raised on the inspection. There is a smell of urine at the top of the main day area [this is not apparent anywhere else in the home]. The smoking lounge is inadequate for its purpose. Residents were observed to be very crouded [ overspilling ontot he corridoor] and there is poor ventilation. There is also no barrier between this area and the corridoor and main day area. Alternatives were discussed. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 10 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 11 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 John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 The quality outcome in this area is adequate. This judgment is made on available evidence. Residents admitted are assessed prior to admission so that care needs can be met. They also receive some information about the home although this could be further reinforced. There is a need to ensure all residents have a contract/terms and conditions of residency following admission. EVIDENCE: The home has written information [Service User Guide] and this is available for residents and relatives. Although kept in each resident’s room not all residents interviewed where aware of the contents and perhaps this should be reinforced more both prior to and during the admission process. Residents and relatives spoken to, who were aware, had found this useful and had assisted them in both choosing and settling into the home. The package does not include the latest CSCI inspection report and this should be made available. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 13 Residents interviewed where generally not aware any contract or terms and conditions of residence had not been explained or signed. This is required on admission to the home and should include a breakdown of the fee structure for each resident s that there is full awareness of the terms of living in the home. All residents are assessed prior to admission to the home. 3 care files were reviewed and appropriate social care and health care assessments had been completed. There were copies of referral assessments from health and social care professionals to compliment the homes own assessments. Following admission there are further, more detailed, assessments carried out covering areas such as manual handling, falls, and nutrition so that a plan of care can be drawn up. Residents spoken to felt generally that staff attended to their needs and they felt safe in the home. Relatives were very positive in support of the staff’s general approach to care and felt that staff had a clear understanding of residents needs. Staff have specialist skills in palliative care and all nurses and most care staff have attended specialist courses for this. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards The quality in this outcome area is adequate; this judgement has been made on available evidence. The home manages the health care needs of resident’s well with appropiate care interventions and refferals made for specialist input if needed. There is work needed in ensuring that care planning is more detailed and effective however so that the daily care is reflected. Personal care needs are met overall so that residents are treated with respect and their dignity maintained although consistency is not always maintained. EVIDENCE: There was a requirement from the previous inspection and also from the recent adult protection meeting [see complaints and protection] to improve the care planning with respect to detail of care interventions. For example the district nurse involved with a previous resident had reported that there had been no care interventions for the residents pain. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 15 Care plans were looked at for this resident and 4 other residents. The home are trying to involve both residents and relatives in the planning of the care and some residents had signed plans to say they have discussed how their care is going to be given. Plans were being reviewed by staff on a monthly basis, or sooner if needed. This evaluation process was discussed. It was agreed that care plan evaluations should contain more than a general statement of ‘continue care’ and should be a discussion and statement of progress made set against the aims / goals of the care plan. This should show evidence of discussion with key workers and periodically relatives and residents. The care plans are based on a recognised model of nursing, which centres on the daily activity residents are able to achieve and the aim of the care is to support this. The care plans are ‘standardised’ in that certain care interventions appear on a set list depending on the residents need. The issue with this sort of approach is that the personalisation needed to reflect individual care could be lost. Staff have attempted to change these however to include care needs / interventions already not covered and to personalise the plans as much as possible; for example ‘likes TV, music and betting on the horses’ for one resident under the heading ‘working and playing’. There was some discussion how this process could be improved and it was agreed that the care plan documentation should have blank spaces so that further care needs / interventions could be added as necessary [currently no room for this and the documents are very crowded and sometimes brief]. Also all care needs were not addressed in enough detail; for example on resident who attends for hospital therapy 3 times weekly did not have any detail of this arrangement and how they were being supported through the process. [It was noted that the resident who had previously not had his pain addressed on the care plan had now got a plan of care addressing this]. The care plans seen could however be followed and generally gave a good out line of the care needs of the residents concerned. The discussion with the manager centred on the need to develop the quality of the care planning by having regular auditing meetings with staff. Relatives and residents interviewed felt that they were generally kept up to date and that staff communicated well regarding how care was being carried out. Some were not aware of the care plan however and others had not seen the care plan since the initial viewing. Residents have a range of risk assessments within their care plans covering, falls, nutrition, moving and handling, dependency and pressure sores. These look into the resident’s risk of harming themselves or others. These were completed to a good standard and then are included in the care plan. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 16 One resident reviewed has very complex needs [a feature of many residents in the home] including a pressure sore currently and this is monitored through the care plan with regular, daily records maintained. The records included wound charts and photographs showing the progress and improvement in the wound [Some of the photographs were undated and lacked information identifying the wound]. The resident when interviewed was fully aware of the condition of the wounds and said that the staff gave continual updates. The resident described how staff had given support and how he ‘couldn’t have chosen a better place. Staff cheer me up – moral support is very important’. The same resident has been supported through numerous medical appointments and the liaison with the health professionals outside the home was very good. Residents can choose their own GP (General Practitioner) and are visited by a range of health and social care professionals such as social workers, opticians and dentists. One resident with diabetes is monitored by the diabetic services. The relevant nursing observations were in place for this resident and the nursing staff in the home were regularly monitoring blood glucose levels. Residents and relatives spoken to at the inspection said that they were treated with respect and that privacy was maintained when needed. One resident told the inspector that he spent most of his time in his room as this was his preference and he could see visitors in private. Residents were asked about toilet and bathing arrangements and stated that staff were care full to ensure privacy. Some feedback was given the manager from a social care professional who had previously visited the home and had reported some incidence of bedroom doors being open and residents being exposed. Again one relative reported that some times staff were rushed in their work and residents had been witnessed not to be covered properly when coming from the shower/ bath. Overall it would appear that personal care is carried out well but there are occasional lapses which the manager needs to be aware of. During the inspection residents were observed to be appropriately dressed and clean and well presented so that dignity is preserved. Staff have good rapport with residents and the general atmosphere in the home is positive with care staff seen talking to and supporting residents. Residents reported that medication is always given on time. The medication administration records [MAR] were seen and were clear and accurate for those residents reviewed. Staff are now recording the administration of creams and ointments following the last report. There are no residents self-medicating presently although this has been instigated previously and the manager was John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 17 able to display an understanding of the risk assessment needed. All residents have a lockable draw in their rooms for security if necessary. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards The quality in this outcome area is adequate; this judgement was made on the available evidence. Residents are supported to be involved in activities although there is a realisation that more can be developed in this area to ensure a better quality of life for residents. Residents are encouraged to maintain their independence and exercise choice. A choice of good quality home cooked food is provided to the residents EVIDENCE: Over the two days in the home there was much activity in terms of visitors and staff interacting with residents and receiving ongoing support. The home was very lively and the general atmosphere was positive and friendly. The residents interviewed felt that staff were approachable and helpful. Residents were observed to be interacting with each other and reported that they often got together for a chat. Relatives interviewed reported that they were always welcomed and could visit at any time. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 19 The inspector did not observe any activities planned for residents during the inspection. The feed back from residents was that although the routine of the home was relaxed there could be more planned in the way of activities, particularly local outings. All residents interviewed reported that they very rarely go out of the home unless relatives escort them. One resident would like to go out more frequently [and this is recorded in the care file as a need] but is confined to a wheelchair and staff very rarely have the opportunity to accommodate this. The manager reported that one of the staff is designated to organise activities and advised the inspector about some of the regular activities such as chair based keep fit, card games and bingo sessions. These are not advertised however and are reported as being inconsistent. Staff reported that often when activities are organised residents would often renege on joining in at the last minute. It was agreed that more could be done in this area and that more focus should be put into organising the social life of the home. Meal times were observed to be relaxed and social affairs with staff on hand to assist some residents as needed. Tables are set and flowers are placed on them [one of the residents get involves in the cleaning and setting of the tables]. There is choice available and the portions of meals were very good and were commented on by the residents. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 20 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The quality in this outcome area is adequate; this judgement was made on available evidence. There is a complaints procedure including action for more serious allegations so that residents rights are upheld and people feel that concerns are addressed EVIDENCE: Those residents and relatives interviewed felt that they were able to approach staff and that their concerns would be listened to. There is a complaints procedue and this is in all of the service user guides which are in bedrroms. There have been two complaints about care in the home since the last inspection and both have involved the instigation of the adult protection proccedures so that the issues could be dealt with openly and with external input from social and health care professionals. The first complaint was from a relative of a resident who had bruising on her body. There were also issues around the privacy and dignity of residents as staff were allegedly observed to be not carefull in ensuring that residents are covered appropiatly when in public areas [ for example whilst being tranferred back to bedrooms following bathing]. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 21 The outcome of the investigation [ by social services] was that the central allegations were unfounded and that there had been difficulties with managing the residnet in the hiost. There were however some concerns expressed about observations made by social workers during the visit to the home around the privacy and dignity of some residents being undermined by, for example, doors being left open whilst residents were getting undressed. These observations were discussed with the manager during the inspection [ see health and personal care]. The second complaint was recieved just prior to the inspection of the home and again is being considered under the adult protection procedures. This concerns a resident in the home who was undergoing a review by the district nurse as part of ongoing assessment and review. There are a number of concerns raised: • • • • • Negative attitude of the staff to the resident Lack of management of the resident’s pain and lack of detail on the care plan. The nurse call bell had been observed to be disconnected and the door closed so that the resident was isolated and could not call for assistance. Concerns around the moving and handling of the resident in that equipment [slide sheet] was not available]. The reporting of an incident by the resident involving an accident, which had not been recorded. These concerns were discussed openly at a ‘strategy meeting’ involving a number of care professionals, The Commission and the manager of the home and it was decided that they would form the basis of some of the forthcoming inspection of the home and would be reported on in a general sense throughout the fabric of this report. The outcomes are that the care planning process needs to be developed in more detail [requirement of this report and discussed in more detail under ‘Health and Social care’]. The provision of personal care was also raised as a discussion on the need for consistency in this area [although standards on the inspection were noted to be satisfactory]. Most of the care staff in the home have attended training sessions with social services around abuse awareness and the local adult protection protocols and those interviewed were aware of how to report any allegations of concerns. Despite this the management appeared to rather naive and unaware of the processes involved in the current meeting and need to ensure that they are aware and comfortable with how to report and support the process. The policy document should be immediately available. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The quality in this outcome area is good, this judgement was made on available evidence. Residents are provided with a safe, comfortable and homely environment in which to live. EVIDENCE: During the visit the home was obseved to be clean, bright and well maintained. Residents reported that facilities such as bathrooms and toilets are always maintained in a clean and hygienic state. There is easy access for wheelchairs and residents with mobility difficulties so that getting around the home was reported as good. Some of the bedooms seen who had wheelchair users in them where rather small however and do not meet the standard of 12 square metres of floor space. The residents did John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 23 not complain however and seemed satisfied with their rooms. This was discussed and it is important that senior staff are aware of the rooms that do meet standards for wheelchair users and this is taken into account when assessng residents prior to addmission so that such residents can be appropiatly placed. There were reported, and also observed, to be good provision of disability aids and nursing equipment such as bath hiosts, raised toilets and handrails in corridors. The home is currently being assessed in terms of the provision of such aids and also the suitabilty of bathing areas in terms of the increasing dependecy of residents addmitted to the home. The manager has been involved in this process and the upgrading of bathrooms/ shower rooms and some ensuite facilities is planned. During the inspection the process of upgrading furnishings and décor was well underway and some of the residents commented on, and were pleased, with new wardrobes and other furnishings. Bedrooms seen were very well personalised and homley. All were decorated appropiatly. There are various day areas so that residents have a chioce. The extenal grounds are maintained well and can be accessd by residents [the pond is undergoing repair presently. Some issues that should be addressed: • • There is a smell of urine at the top of the main day area . [this is not apparent anywhere else in the home]. The smoking lounge is inadequate for its purpose. Residents were observed to be very crouded [ overspilling ontot he corridoor] and there is poor ventilation. There is also no barrier between this area and the corridoor and main day area. Alternatives were discussed. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. The quality in this outcome area is good; this judgement was made on available evidence. Staff numbers are appropriate so that service user’s needs can be met effectively. Staff training is co ordinated enabling them to understand and meet the needs of the residents more effectively. Staff are recruited appropriately so that residents are protected. EVIDENCE: For 44 residents in the home at the time of the inspection the staffing was 3 trained nurses and 7/8 care staff. There were also 3 student nurses who were on placment in the home. Appropiate ancilliary staff are also employed on cleaning and in the kitchen and laundry. The manager is usually supernumery to these figures and is supported by an administrator. Residents and relatives comments were generally very supportative of the staff who were seen as helpful and kind. Some residents felt that not enough staff were around at times and stated that this was because call bells were not always answered quickly enough. The staffing rota confirmed regular numbers John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 25 of staff and there has been good continuity of staff ove rhe past 6 months [ although initially there was some staff movment following the take over of the home by Meridian Health Care. Staff training is organised. The requirement from the previous inspection for training to be kept on record was evidenced in the staff files as well as the requirement for staff to receive manual handling training. The home has over 80 of care staff trained to NVQ level [40 at level 3]. Staff reported that there is always some training event. All trained staff have palliative care training and care staff have attended the Macmillan palliative training course. Staff reported that supervision sessions have now commenced and that this is a valuable way of keeping up to date with and reviewing training needs. Staff generally felt supported by the managers and felt that they were approachable. Following a previous requirement the recruitment of staff complies with standards around checks on fitness to work with vulnerable adults. 3 staff files were seen and all contained full references and Criminal Record checks [CRB]. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. The quality in this outcome area is adequate; this judgement was made on available evidence. The manager of the home displays the skills and knowledge to manage the home so residents and staff needs are supported There are systems in place so that the quality of the service can continue to be improved with reference to service users needs and comments. EVIDENCE: Dorothy Pye is the manager of the home. She has been in post or 12 years and has been involved in the process of the new owners of the home introducing new auditing and management systems. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 27 She has very good experience in the clinical field working as a Registered Nurse [RN] for many years. She has a qualification in health and social care at degree level and is able to provide evidence of continual self-development for example in palliative care. All staff and residents / relatives were supportive of the managers approach and she was known to all of the residents, relatives and staff spoken to. The home is subject to some external Quality Assuranc processess such as Investors in People award and the yearly audit of quality under the RDB . The company also carry out their own quality audit on a yearly basis and this was seen. It contains the results of a resident / relative survey and the overall satisfaction was noted to be high It is recommended that there are now quality audits on care planning so that a more consistent standard can be evidenced in the future [see health and social care]. Health and Saftey records were seen [fire records and risk assessments] and this area is managed satifactorily. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? 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. 1 Standard OP2 Regulation 5 Requirement All residents must be provided with a contract/ terms and conditions of residency at the point of moving into the home. This must give a breakdown of the fees paid. Care planning in the home must continue to be developed with reference to the follwing: • An auditing of the care files must be undertaken on a regular basis as discussed to improve and ensure uniformity of care documentation. The involvement of residents and / or relatives in the care planning process must be reinforced particularly around ongoing evaluation. Evaluations must be recorded as discussed and outlined in this report. The process of ensuring that all care needs are recorded in more detail and care plans are more personalised must continue Version 5.2 Page 30 Timescale for action 01/01/07 2 OP7 15 01/01/07 • • • John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc to be addressed by the auditing process and by updating the documentation as discussed. [Last requirement date 9.2.06 not met] 3 OP12 16 The manager must consult with and organise a programme of activities in the home which as much as possible accommodates residents wishes and needs. The manager must ensure that all staff are aware of the rooms available for wheelchair users in terms of adequate floor space [12 metres square minimum] and that this should be addressed in admission assessments. The comments in the report around the current smoking area must be considered and addressed. 01/01/07 4 OP19 23 01/01/07 5 OP19 23 01/01/07 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 2 Refer to Standard OP1 OP7 Good Practice Recommendations A copy the most recent CSCI inspection report should be made available in the service user guide. All care documentation should be signed and dated by the staff to ensure care records are maintained to a good standard Manual handling forms should include the number of staff required to assist the residents and details of manual handling equipment 3 OP8 John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 31 4 5 6 OP18 OP19 OP26 The managers and senior staff in the home should be conversant with the local adult protection procedures and their role with in any investigation. The planned assessment of the home for the development of disability aids and facilities should continue. The offensive smell apparent at the top end of he main day area should be addressed. John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI John Joseph Powell Memorial Care Centre DS0000065162.V311423.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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