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 Key Unannounced Inspection 5th June 2007 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.V335683.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.V335683.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.V335683.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 27th September 2006 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. The current fees are £490 - £508 weekly John Joseph Powell Memorial Care Centre DS0000065162.V335683.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 8 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 additional 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 deputy manager, senior nurses and staff. 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 2 of the resident’s care plans, staff files, staff training records and health and safety records. A pharmacy inspector from the Commissions visited the home on 8.6.07 and the findings and requirements / recommendations are included in this report. Although all core standards were reviewed the inspector was guided by the two previous inspections and more particularly the random inspection in March 2007, Which highlighted that care was not of a consistent standard and this was related to fluctuating staffing levels. Overall the inspection was positive in that the management were open and constructive and had a positive concept as to how the home should be progressing and have been actioning the requirements and recommendations previously made. There was still evidence of inconsistency in the care but this was less marked than previously and there is a feeling that the home is moving in the right direction. The home is currently in the end stages of a major refurbishment programme and so some of the environmental standards were difficult to assess. 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, who were aware,
John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 6 had found the information useful and it had assisted them in both choosing and settling into the home. All residents are assessed prior to admission to the home. Appropriate social care and health care assessments are 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. These are also completed on a routine basis during the stay in the home. 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. Care records contain very good reference to health and social care input from outside the home. These were clearly recorded. For example social worker reviews and doctors visits. 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 with ongoing decorating and general upgrading in progress 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 where easy to engage in conversation. Relatives interviewed reported that they were always welcomed and could visit at any time. There is good provision of disability aids and nursing equipment such as bath hiosts, raised toilets and handrails in corridors. The new developments in the home have taken into account the high level of disability of some of the residents. Bedrooms seen were very well personalised and homley. All were decorated appropiatly. There are various day areas so that residents have a choice. Staff training is organised well. There was a requirement previously for training around dementia care and this has been organised and staff will attend shortly. Staff reported that training is ‘excellent’ and that ‘there are always courses to go on. The home has over 80 of care staff trained to NVQ level. Staff files seen contained very good records for the purposes of recruitment with all checks in place so that residents are protected. There are good systems in place to gauge resident’s views and to further improve standards so that the home is run in the best interests of the
John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 7 residents. These include both internal and external auditing systems. The issues identified in recent inspections and from resident surveys are being addressed by the management. What has improved since the last inspection? What they could do better:
Contracts and terms and conditions of residency were discussed. One relative raised an issue around the need for a ‘probationary’ period once admitted to the home so that the normal rites of 28 days notice of termination of contract would be waived during this ‘testing period’ too see whether the home suited their needs. This should be considered, as current contracts do not include this. Although one care plan did record a resident’s signature none of the residents interviewed on the inspection had knowledge of their care plan or had had any input into it which increases the risk of care needs not being identified properly.
John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 8 Written records of medication entering and leaving the home were not always accurate and complete. This meant that it was impossible to see how much medication should be present and so it was not possible to fully audit all medication in order to find out whether it had been administered correctly. A sample audit of records and current stocks was undertaken and showed that medicines are not always given appropriately. The health and wellbeing of residents is at risk of harm if medication is not administered as prescribed and if adequate supplies are not available. Accurate recording of some ‘give when necessary’ medications and other medications such as anti blood clotting medicine where not recorded appropriately. One resident with severe communication difficulties currently had a pressure sore. There was no risk assessment or plan of care for pain relief and no pain relief prescribed. The health and wellbeing of this resident is at risk of harm if staff cannot identify pain and offer relief as appropriate. It was recommended that all eye-drops, insulin and other short dated products should have the date of opening recorded on them. This reduces the risk of residents being given medication that is out of date. One bottle of eye drops was out of date. Insulin in current use was stored in the fridge. This is also against current guidance. Medication must be stored at the correct temperature in order to ensure its’ safety and effectiveness. The standards around the giving of personal care was inconsistent. Some residents seen were clean and displayed high levels of attention in this area but others [more notably the more confused] were observed to have stained clothing, particularly following meals which care staff did not always get around to dealing with so that some residents were left with soiled clothing for considerable time which impinges on their dignity. One resident summed up the prevailing view: ‘Staff are very helpful and kind. This is most important when you are dependant. They are very respectful and understanding. They can sometimes take along time with the call bell. Can be 15 minutes [other people interviewed stated that this can be longer]. Change over time is the worst time. I get a shower every day but this can be dependant on staff time’. 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 still reported that they very rarely go out of the home unless relatives escort them. Meals were seen as well cooked and presented well. There is no real choice however. Some residents said that they could have a sandwich if they did not like the main meal. One resident commented:
John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 9 ‘The food is good and nutritionally sound and I enjoy it but there is no choice which would be nice.’ There was some discussion with the management regarding this and menus should be devised which offer daily choice and with consultation with residents. 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. The summary of this inspection report can be made available in other formats on request. John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 10 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.V335683.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): The quality outcome in this area is good. This judgment is made on available evidence. Residents admitted are assessed prior to admission so that care needs can be met and continue to be assessed during their stay in the home. They receive information about the home although so that they are able to make an informed choice and settle into the home. 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 [this was the same as the last inspection]. Residents and relatives spoken to, who were aware, had found the information useful and it had assisted them in both choosing and settling into the home.
John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 12 Contracts and terms and conditions of residency were discussed. One relative raised an issue around the need for a ‘probationary’ period once admitted to the home so that the normal rites of 28 days notice of termination of contract would be waived during this ‘testing period’ too see whether the home suited their needs. This should be considered, as current contracts do not include this. On this inspection it was clear that terms and conditions of residency are given to residents or their supporters, which is an improvement from the previous inspection. All residents are assessed prior to admission to the home. 2 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. These are also completed on a routine basis during the stay in the home. 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. One theme amongst those interviewed was that staff were occasionally not around in enough numbers at times so that personal care had to be delayed. John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards The quality in this outcome area is adequate; this judgement has been made on available evidence. The home manages the health and social care of resident’s with appropiate care interventions and refferals made for specialist input if needed although the consitency of care interventions can fluctuate and can be further improved so that care needs can be fully met. EVIDENCE: The managers and staff are currently involved in trying to improve the care planning process so that care plans are written in more detail and are more individualised. This follows previous requirements. Two care plans were seen and discussed on the inspection. One was a care plan that has not been updated to the new style documentation and relies on standardised written care interventions, which are then personalised by some additional notes. Whilst this gives a rough outline of the care to be delivered it runs the risk of not being in enough detail to ensure care interventions are met effectively or consistently. For example the resident had communication needs. One staff explained how to communicate through various signs and also what the
John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 14 residents likes and dislikes were. None of these was recorded on the care plan however. The evaluations of this care plan tended to be written as ‘continue plan’ with no clear reference as to what progress had been made [or not] against the main aims and objectives of the care. The other care plan seen was signed by the resident. It was written in the new format. It was clearer and more personalised. Evaluations were recorded, which are more pertinent to the care, plan and are descriptive of progress to date. [Not just ‘continue plan’]. The daily notes referred more directly to care needs and although written mainly by care staff, a trained nurse countersigned them. Both records contain very good reference to health and social care input from outside the home. These were clearly recorded. For example social worker reviews and doctors visits. Although one care plan did record a residents signature none of the residents interviewed on the inspection had knowledge of their care plan or had had any input into it which increases the risk of care needs not being identified properly. Medication Written records of medication entering and leaving the home were not always accurate and complete. This meant that it was impossible to see how much medication should be present and so it was not possible to fully audit all medication in order to find out whether it had been administered correctly. The manager must make regular checks on how well medication is managed within the service. A system of audit was in place, however this had failed to highlight the shortfalls noted on this visit. An effective audit should include checking Medication Administration Record charts (MARs), and stocks to make sure that all stock can be accounted for. It was suggested that the number of tablets and other medications ‘brought forward’ from the previous month be recorded in order to make auditing easier. The results of the audits should be recorded, together with action taken where necessary. A sample audit of records and current stocks was undertaken. This showed that some residents were not given their medication as prescribed, some medication had been signed for, but not given and some medication could not be accounted for. Not all residents had supplies of their current medication available, although MARs indicated that medication had been given. This indicates that either medication is being shared or that MARs are being signed incorrectly. Both of these situations are unacceptable. The health and wellbeing John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 15 of residents is at risk of harm if medication is not administered as prescribed and if adequate supplies are not available. Staff did not always have enough information to administer medication safely. All medicines that are only to be used ‘when required’ should have clear instructions that are personalised to needs, signs and symptoms of the individual resident. This is particularly important for residents who have communication problems and who find it difficult to express their needs. Where variable doses are prescribed, the actual dose administered should be clearly recorded. Warfarin tablets were being cut in order to get the dose prescribed. This is not an accurate way of administering this potent medication, especially when the correct dose can be made up of readily available tablets. The health and wellbeing of residents is at risk of harm if medication is not administered correctly and recorded accurately. One resident with severe communication difficulties currently had a pressure sore. There was no risk assessment or plan of care for pain relief and no pain relief prescribed. The health and wellbeing of this resident is at risk of harm if staff cannot identify pain and offer relief as appropriate. A number of handwritten entries had been made on MARs following verbal dose changes, new admissions or the prescribing of new medicines. Not all the MARs entries were accurate. It was not possible to verify the current dose of two medicines prescribed for one resident. Verbal dose changes and new medications should be clearly recorded on the MARs and signed by two members of staff, so that residents receive the correct dose of medication. Written confirmation of dose changes should be obtained from the prescriber where possible. Medication was stored securely. It was recommended that all eye-drops, insulin and other short dated products should have the date of opening recorded on them. This reduces the risk of residents being given medication that is out of date. One bottle of eye drops was out of date. Insulin in current use was stored in the fridge. This is also against current guidance. Medication must be stored at the correct temperature in order to ensure its’ safety and effectiveness. Personal care. The standards around the giving of personal care was again inconsistent. Some residents seen were clean and displayed high levels of attention in this area but others [more notably the more confused] were observed to have stained clothing, particularly following meals which care staff did not always get around to dealing with so that some residents were left with soiled clothing for considerable time which imposes on their dignity. Residents reported that when staff did attend to personal care they were respectful and mindful of preserving privacy.
John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 16 One resident summed up the prevailing view: ‘Staff are very helpful and kind. This is most important when you are dependant. They are very respectful and understanding. They can sometimes take along time with the call bell. Can be 15 minutes [other people interviewed stated that this can be longer]. Change over time is the worst time. I get a shower every day but this can be dependant on staff time’. Staff spoken to had good concepts of the basic principals of care and the importance of privacy and dignity. Staff reported that numbers of carers on duty is more stable lately but that if they were short due to sickness then it was more difficult to maintain adequate care overall. John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 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 the social life of the home but more needs to be developed in terms of activity to ensure a better quality of life for 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 with ongoing decorating and general upgrading in progress 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 where easy to engage in conversation. Relatives interviewed reported that they were always welcomed and could visit at any time. The inspector did not observe any activities planned for residents during the inspection. A requirement on the last inspection was that more attention
John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 18 should be given to this area and management reported that a designated person now worked two shifts a week to provide/organise input for activities. Unfortunately this person was not available 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 still reported that they very rarely go out of the home unless relatives escort them. There were some positive projects in terms of the upgrading of the home to make the gardens and outdoor areas more accessible for residents and this should improve the lives of residents once completed. Staff on the Mary Ann Powel unit had developed such an area of their own initiative but there needs to be further input in terms of risk assessment so that this area is both safe and accessible for all residents. It was agreed that more could be done and that more focus should be put into organising the social life of the home. Meal times were observed to be relaxed and a social affair with staff on hand to assist some residents as needed. Tables are set and flowers are placed on them. The portions of meals were very good and were commented on by the residents who said that they enjoyed the food. These were seen as well cooked and presented well. There is no real choice however. Some residents said that they could have a sandwich if they did not like the main meal. One resident commented: ‘The food is good and nutritionally sound and I enjoy it but there is no choice which would be nice.’ There was some discussion with the management regarding this and menus should be devised which offer daily choice and with consultation with residents. John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards 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 but there needs to be a focus on areas of quality outcomes for residents to ensure that consistent care standards are maintained. 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 has been one complaint about care in the home since the last key inspection and this 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 issues of concern were around care of people with communication difficulties, particularly dementia. A ‘random’ inspection was conducted in March 2007 by two inspectors from the Commission for Social Care Inspection [CSCI] and a report was produced at
John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 20 the time which highlighted that there was a lack of adequate care planning and that staffing was inconsistent so that care standards also fluctuated. Social services also reviewed many of the residents in the home and found similar concerns as well as issues around medication. For this reason a pharmacy inspection has been conducted on this inspection and the findings are listed under ‘Health and personal care’. During this inspection it was noted that the quality team for the home were present and were working on a new care planning system. Evidence over all is that staffing is more settled although there still remain inconsistencies at times. There are some concerns around medication that need addressing. Most of the care staff in the home has 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. Senior staff, mainly through recent experience, are now knowledgeable with working with adult protection protocol. John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards 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: Overall it was difficult to assess the range of facilities and general ambiance of the home as there is currently a total overall of the home in progress covering all areas. The home is being decorated throughout, new furnishings being provided, new bathing facilities being installed, a new conservatory day space and there is a current registration in progress for another bedroom. The inspector was also able to discuss with a senior manager the planned development for the exterior of the home and it was pleasing that attention is being paid to developing safe garden areas for residents. The space outside the
John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 22 Mary Ann Powel unit should be considered and planned in with the developments. There is therefore a lot of disruption and residents, who are, never the less, positive about how the home will look in the future, commented on this. There were reported, and also observed, to be good provision of disability aids and nursing equipment such as bath hoists, raised toilets and handrails in corridors. The new developments in the home have taken into account the high level of disability of some of the residents. Bedrooms seen were very well personalised and homely. All were decorated appropiately. There are various day areas so that residents have a choice. The home have a domestic team who work until 2pm daily. The cleanliness was again difficult ot assess as the building work was creating debris in nearly all areas. The chairs in the lounge area were noted to have an offensive odour and this area generally was worse in terms of the smell than previous visits when it has also been commented on. The new décor and furishings will sort the problem out but longer term the managers may need to review both cleaning and management of continence or the problem may return. The comments from residents was that the home is generally maintained in a clean condition. John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are recruited and trained appropriately and staffing numbers are more consistent although this should continue to be monitored carefully to ensure that residents needs can be met at all times. EVIDENCE: For 40 residents in the home at the time of the inspection the staffing was 3 trained nurses and 6/7 care staff. Appropriate 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 supportive 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. One relative reported that at times it could be difficult to find a staff if immediate assistance was needed. The staffing rota confirmed regular numbers of staff and staff reported that basic staf numbers had stabalised somwhat since the random inspection in March. New trained nurses have started work in the home and two more are in
John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 24 the pipe line. Four new care staff have also been recruited and start work soon. Staff training is organised well. There was a requirement previously for training around dementia care and this has been organised and staff will attend shortly. Staff reported that training is ‘excellent’ and that ‘there are always courses to go on. Staff files evidenced certificated training. The home has over 80 of care staff trained to NVQ level. Trained staff have palliative care training and some care staff have attended the Macmillan palliative training course. Staff generally felt supported by the managers and felt that they were approachable. Staff files seen contained very good records for the purposes of recruitment with all checks in place so that residents are protected [would recommend that there is a photograph of each staff member on file]. John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems in place to gauge resident’s views and to further improve standards so that the home is run in the best interests of the residents. EVIDENCE: Dorothy Pye is the manager of the home. She has been in post for 12/13 years and has been involved in the process of the new owners of the home introducing new auditing and management systems. 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
John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 26 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. Most commented on her personal approach and were appreciative of the time she spent with them. The home is subject to some external Quality Assurance 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. The areas identified on the surveys that require attention were activities and décor of the home; both of which are currently being addressed. The quality assurance systems in the home should identify further improvements. The higher management team were seen in the home during the inspection and provide support for the manager. The issues identified in recent inspections such as care planning and staffing of the home are also being addressed at present. Health and Saftey records were seen [fire records and risk assessments] and all were up to date and provide evidence of good ongoing management in this area. The policies and proceedres around the management of residents monies was also reviewed and followed good practice guidelines. John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 27 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 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.V335683.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement Care planning in the home must continue to be developed with reference to the following: Continued 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 to be addressed by the auditing process and by updating the documentation as discussed. [Last requirement dates 9.2.06 and 01/01/07 not met]
John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 29 Timescale for action 01/09/07 2 OP9 12(1) Risk assessments and care plans should be in place for residents with communication difficulties and/or confusion to ensure that staff can recognise signs and symptoms of pain and offer treatment where necessary. 06/07/07 3 OP9 13(2) Full and accurate records of all 06/07/07 medicines received, administered and leaving the care of the home must be maintained to ensure people are given the correct medication. There must be a full record of all medication and doses currently prescribed for each resident. Staff must administer medication 06/07/07 in accordance with the prescribers’ instructions so that people who use the service receive the correct amount of medication at all times. There must be adequate supplies of all medication available for each resident so that residents are not left without medication. There must be an effective system in place to audit medicines management within the service in order to ensure that people who use this service are receiving the correct medication. Personal care for residents must be given in good time and with consistency The manager must consult with and further develop a programme of activities in the home which as much as possible accommodates residents wishes and needs.
DS0000065162.V335683.R01.S.doc 4 OP9 17(1) Sch3 5 OP9 24 06/07/07 6 7. OP10 OP12 12(4) a 16 06/07/07 01/09/07 John Joseph Powell Memorial Care Centre Version 5.2 Page 30 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 OP2 Good Practice Recommendations There should be a consideration of ‘probationary’ period written into contracts and the terms and conditions so that residents are able to test drive the home for a period before becoming permanent residents. Dose changes should be clearly recorded and signed by two members of staff, so that residents receive the correct dose of medication. Where possible, changes should be confirmed in writing by the prescriber. There should be clear, personalised directions for the use and administration of when required and variable dose medication for all service users prescribed such items. When required and variable dose medicines should also be included in the residents care plan. The opening date should be recorded on eye drops and other items with a short expiry date. Insulin in current use should not be stored in the fridge. 3 4. 5. OP15 OP19 OP26 There needs to be more than one main meal on the menu so that residents can exercise some choice and improve their quality of life. The area outside the MAP unit should be developed along with current upgrading work so that it is safe and accessible for all residents. The offensive smell apparent at the top end of the main day area should be addressed with reference to comments in the report. All staff should have an up-to-date photograph on file. 2 OP9 6 OP29 John Joseph Powell Memorial Care Centre DS0000065162.V335683.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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