Inspection on 01/08/07 for Paddock House

This inspection was carried out on 1st August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Paddock House 09/08/06

Paddock House 22/12/05

Paddock House 07/09/05

Paddock House 09/02/05

Paddock House 11/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Paddock House Wellington Road Eye Suffolk IP23 7BE Lead Inspector Deborah Kerr Key Unannounced Inspection 1st August 2007 9:30 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 Paddock House DS0000037493.V347827.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. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Paddock House Address Wellington Road Eye Suffolk IP23 7BE 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) 01379 870440 01379 873332 elainehyde@socserv.suffolkcc.gov.uk Suffolk County Council Mrs Elaine Margaret Hyde Care Home 30 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (20) of places Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th August 2006 Brief Description of the Service: Paddock House is situated in the market town of Eye. The home is owned and administered by Suffolk County Council. It is situated close to all the local shops and other facilities in the town. The service offers accommodation and care for up to thirty older people with ten of those places being offered for people with special needs. All the bedrooms are for single occupancy and have the benefit of en-suite facilities. The accommodation is on two floors, which is divided into three units. Access between floors is via a passenger lift. Each unit has its own kitchen/dining area and separate lounge. There are also assisted bathrooms and toilets in the communal areas of the building. A detailed statement of purpose, colour photographic brochure and a service user guide provides detailed information about the home, the services provided and access to local services. Each of the people living at the home has a contract of terms and conditions; which reflect their fees and how much they are expected to pay per month. The cost to the individual person living in the home is £361 per week. This was the information provided at the time of the inspection, people considering moving to this home may wish to obtain more up to date information from the care home. Their individual contributions are based on their level of income and / or capital; these are usually lower than the weekly fee. These charges cover all care, accommodation, meals, laundry and continence products. They do not cover additional services such as the hairdresser, personal items such as toiletries, clothing, dry cleaning, confectionary and tobacco or daily newspapers. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over nine hours on a weekday. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from the Annual Quality Assurance Assessment (AQAA), issued by the Commission for Social Care Inspection (CSCI) and a selection of residents, relatives and staff ‘Have Your Say’ surveys. A number of records were inspected, relating to people using the service, staff, training, the duty roster, medication, health and safety and a range of policies and procedures. A tour of the home was made and time was spent talking and observing people on each of the three units. The manager was available and fully contributed to the inspection process. Time was also spent talking individually with three staff, one visitor and eight people living in the home. What the service does well: What has improved since the last inspection? Six requirements were made at the previous inspection relating to insufficient arrangements for activities, staffing, self-administration and storage of medication and records to monitor health and safety. The home was found to have complied or partly met all of these requirements, during this inspection. Medication was seen to be stored appropriately and in it’s correct packaging. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 6 Care plans contained updated risk assessments which, clearly reflected if and how the individual could manage their own medication and where applicable, stated the reasons why this was not an option. Examination of health and safety records, confirmed the home had obtained a copy of the most recent Gas Safety Certificate and provided details of weekly fire alarm tests. Paddock House is registered to provide care to 30 older people. There are currently twenty-four people living in the home, with six empty beds in one unit. The manager and staff spoken with felt that the staffing levels at present are enough to meet the needs of the people using the service. However, if the number of people living in the home increases and /or the proposed intermediate care unit is developed, staffing levels would need to be reviewed. What they could do better: 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. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 7 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 Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 8 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): 1, 2, 3, 4, 5, 6, People who use the service experience good quality outcomes in this area. People who may use this service have the information they need to make an informed choice about where they live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a detailed statement of purpose; service user guide and brochure, which include colour photographs and information setting out the aims and objectives of the home and the services provided. People are provided with a copy of the Service User Guide in their room, which also contains a copy of the Suffolk County Council complaints procedure entitled “Having your Say”. A resident’s ‘Have Your Say’ survey confirmed that they had been visited by a member of senior staff prior to visiting the home and had been provided with all the information they needed about the home and had been given a lot of reassurance. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 9 All placements at Paddock House are accessed via the Local Authority. Examination of two peoples files confirmed that prior to moving into the home a Social Worker had completed a Community Care Assessment, identifying their need for residential care. A pre admission assessment also completed by the home providing detailed information about the individual’s health, social and personal care and determine if the home are able to meet that persons needs. All people moving into the home are accepted on a six-week trial basis, with a review held at the end of that period. Documents seen confirmed that all relevant people involved in that person’s care are invited to a review meeting to determine if the placement is appropriate to meet the individuals needs. Individually and collectively staff have the skills and experience to meet the needs of the people living in the home. Staff files and training records confirmed that staff have received training in falls prevention, working with dementia, life story work, symptoms of depression and confusion in the elderly, sensory awareness, medication training and a skills for care course relating to drugs and bugs. Most recent training involved training in intermediate care. This training was held in view of the proposal to create an intermediate care unit with in Paddock House. There has not been a final decision as to whether the owning organisation is to pursue this service. Although, the home currently does not offer this service, they do offer periods of respite care. All prospective users of the service are offered a “look see day” which gives them the opportunity to spend some time to try out the home. Information obtained during discussions with people confirmed that they are given the opportunity to visit the home before deciding to move in. One person commented “ they tried the home out for a week, liked it and decided to stay”. People’s files contained a written contract setting out the terms and conditions of residence, including a trial period, the method of payment and how much they are expected to pay per month. The assessed needs of the individual and their level of income and / or capital determine how much each person is expected to contribute towards their fees to reside in the home. These charges cover all care, accommodation, meals, laundry and continence products, but do not cover additional services such as the hairdresser or personal items. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 10 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): 7, 8, 9, 10, 11, People who use the service experience good quality outcomes in this area. The health and personal care people receive is based on their individual needs, although they cannot be assured that at the time of serious illness, death or dying their wishes will be respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of three people living in the home were inspected. Each contained a current photograph of the person together with their personal details including next of kin and other important contacts. The plans are well organised and provide detailed information covering all aspects of the individual’s health, personal and social care needs. The personal healthcare needs include where required, specialist health, nursing and dietary requirements. Each plan has a section containing the individuals life history, which, combined with the information obtained through the pre admission process, provides a plan of care that is responsive to the varied and individual needs and preferences of the people who use the service. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 11 The daily recording notes are well documented and clearly reflect the care and general state of well being of the individual and where medical intervention is required. Regular visits were documented showing that people who are fit and well enough are supported to access their general practitioner (GP) and other local health services relevant to them. For people who are not well enough to leave the home arrangements are made for health professionals to visit them. Care plans confirmed that relevant health charts and assessments are in place, relating to moving and handling, pressure care, nutrition and continence management. Generally these are being reviewed to monitor and reflect the individual’s current and changing needs. However, it was noted and discussed with the manager that the turning chart for one person had not been completed and the nutritional assessment for one individual with diabetes, needed to be amended to reflect the risks and actions staff need to be aware of due to the individual’s choice to eat unsuitable foods. A senior member of staff was observed administering the lunchtime medication. The Monitored Dosage System (MDS) is used and each blister pack had a front sheet with the individual’s details and a photograph for identification purposes. The quantity and date of medication received was seen entered on the Medication Administration Record (MAR) charts. The senior confirmed that the night staff completes a monthly audit of medication. Generally the process of receipt, administration and safekeeping of medication is well managed. The senior was observed checking medication against the MAR chart and the individual’s details before administering the medication. Where a person had been prescribed a new medication, they checked the manufactures instructions to ensure that they administered the medication appropriately, which needed to be placed under the individuals gum, and allowed to dissolve. A previous requirement was made to ensure people living in the home are offered the opportunity to control and self-administer their own medication. Where this is not appropriate, a risk assessment must provide evidence as to why the person cannot maintain control over the prescribed medication. Examination of care plan’s confirmed that risk assessments had been completed and amended to clearly reflect if and how the individual could manage their own medication and where applicable, stated the reasons why this was not an option. Of the three people’s plans seen, one had chosen to administer their own medication and one person is supported to administer their own insulin injections with support from the district nurses. The manager advised that only one person living in the home is currently prescribed controlled medication. This is managed in line with the Suffolk County Council policy and procedure for medication. These procedures are well documented providing staff with guidance for the safe receipt, storage, administration and self-administration of medication. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 12 During the inspection, staff were observed treating people living in the home with respect and dignity. They demonstrated a genuine affection, care and concern for each person. People’s choice is respected, regarding their age and frailty as to whether they wish to join other residents or remain in their room. The interactions between the individuals and staff were observed to be friendly and appropriate. Comments received in relatives surveys confirmed that the home generally provides a good service, one stated “The home sets a good standard, staff are good at attending to the personal details, which add a personal touch to the individuals care, but inevitably it is sometimes missing”. Another comment stated, “carers are friendly and look after my relative well, however we are not always kept fully informed about their health until we visit”. Care plans did not have information relating to the individuals end of life needs including the arrangements for terminal illness, death and dying. Where people require palliative care, to manage degenerative and terminal illness, systems need to be in place which constantly monitor their pain, distress and other symptoms to ensure the individual receives the care they need in accordance with their wishes and religious beliefs. Although this is a sensitive subject this information needs to be ascertained and agreed with the individual to ensure that at the time of their death, staff will treat them and their family with care sensitivity and respect. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14, 15, People who use the service experience adequate quality outcomes in this area. People living in the home can expect to have a good choice of wholesome and appealing food, however not all people can expect to have access to activities that will satisfy their social, recreational interests and needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A previous requirement was made to ensure people living in the home are offered a programme of meaningful activities. Although, there has been some improvement, there are still not sufficient activities to meet the varied expectations, preferences and capacities of the people living in the home. People using the service shared their experiences about what it is like for them living in Paddock House. They talked of limited activities and felt that staffing levels still do not allow for regular planned activities. Discussions with staff confirmed that limited activities take place, but also commented it was hard to get people involved. Feedback from a relative’s questionnaire stated, “with more resources, people living in the home could be engaged in regular activities” and “staff are very busy, it is very dependent on the individual care staff as to the level of activity that takes place”. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 14 People were complimentary about the care they received, comments included “the carers are very good and helpful, the food is very good and I am able to choose when I get up and go to bed”. Another person commented “when I ring for assistance in the night the carers are always there for me, they are very helpful”. However, they spoke of being bored, their comments included “there is nothing much to do, I am not a television person, but I do join in the Bingo” and “ I am bored, there is nothing much to do, I don’t know what I would do if I did not have XXXX to talk to”. Each unit has a programme of planned activities, these included flower arranging, video shows, chair aerobics, reminiscence sessions, knitting club and a variety of games and quiz nights. However, staffing levels influences if these actually take place. It was suggest at the previous inspection that the home should employ an activities co-ordinator, to make sufficient time for activities. Information obtained in the AQAA and discussed with the manager at the inspection confirmed that this has not happened, as the County Council do not have the resources to fund the additional staff hours. However, the manager has recruited two volunteers, which will mean there will be more time available for one to one work with people using the service, whilst the volunteer arranges group activities. The routine of daily life for people living in the home is flexible and varies according to need. Each of the units provides people with a choice of how they spend their time, which is based on their unique and individual personalities. This was demonstrated during the inspection, the life history of one person living in the dementia unit stated that they loved ‘music and singing’. They were heard engaged with staff singing old time songs at different intervals throughout the day. Another individual requiring bed rest was observed in their room looking relaxed and comfortable listening to classical music. Other people were seen occupying themselves listening to music, reading, knitting, doing word puzzles and watching television. People described the use of a reminiscence box. The manager confirmed this is a service set up through the local library. The box is delivered to the home for a month at a time, with a number of items inside which, are used to instigate discussion. The home has it’s own library providing a range of talking books for people with visual impairments. One individual spoken with, registered blind confirmed they received books and talking newspapers from The Royal National Institute for the Blind (RNIB). People are provided with opportunities to attend religious services of their choice. The local church has been working with the home and age concern to train five of the congregation in the use of wheelchairs. These people are willing to escort people living in the home to the church service and return to the home afterwards. This venture has widened the links between the home, the church and the local community. The home was able to demonstrate in the AQAA that they respect the religious beliefs of other people living in the home. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 15 Visitors are welcome at any time, entries in the visitors book confirmed that friends, relatives and family visit on a regular basis. Visitors were seen coming and going during the inspection. A relative spoken with commented, “I cannot fault the home, I wouldn’t have my relative live anywhere else, the home is spacious and they have everything they need and the staff are wonderful”. All three units were visited whilst people were having lunch. The chef was seen earlier in the day talking with people to confirm their choice of meal. People can chose from a main menu or a list of standard alternatives, which are set out on table menus. A pictorial menu is available on Bluebell unit to assist people with dementia to make a choice of meal if they are having difficulty understanding the verbal choices. Observation of meals being served confirmed that people had been provided with alternative meals on request. One person had chosen sausages and gravy, another person had sweet and sour chicken and several people had chosen cold ham. The main meal was displayed on a chalkboard in each of the dining rooms, which was Chicken Pie, accompanied by seasonal vegetables. The mid-day meal is served from a hot trolley, which comes directly from the kitchen. Meals were served quickly, these looked appetising and nicely presented. People were seen sitting in small groups and helped themselves to the vegetables, which are provided on each table in dishes. Where required people had been provided with adapted plates and cutlery to aid independence. Individuals spoken with described the food as “very good” and “the food is lovely”. Time spent observing the mealtime on Bluebell unit confirmed that staff were engaged with people throughout mealtime. They responded to each person’s level of need using and responding to fun and humour generated by the individuals, whilst encouraging and prompting individuals to maintain as much independence as possible to eat their own meal. The chef has worked at the home for seventeen years. They demonstrated a good understanding of the importance of good food hygiene and health and safety. They are committed to providing a good service, and actively seeks feedback using questionnaires about the quality of the food. They use the results of the surveys to improve the menu to meet the likes and preferences of the people using the service. All meals are ‘home-cooked’ using mainly fresh ingredients. The food store seen confirmed that the home has a good range of quality food. These were being stored in accordance with food safety standards. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 16 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): 16, 18, People who use the service experience good quality outcomes in this area. The home has an open culture that allows people using the service to express their views and concerns and are protected from abuse by the home’s policies and procedures for managing unpredictable behaviours and safeguarding adults. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear complaints procedure in the form of the Suffolk County Council procedure entitled “Having Your Say”. This was seen displayed around the home and people are provided with a copy in their room. This information is available in other formats from Suffolk County Council including Braille and audiotape for those registered blind or with visual impairment. The complaints log seen had entries relating to formal and informal complaints, which provides an audit trail of the investigation carried out and outcomes reached. There have been no formal complaints received by the home, or the Commission for Social Care Inspection (CSCI) in relation to this service since the last inspection. The log also contained a number of compliments from people who have used the home for respite and from relatives. These included comments such as “thanks to all the staff and the cook for a very pleasant week of respite” and “please except our gratitude and thanks for making our relatives last days comfortable and happy”. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 17 All complaints made within the home are collated and sent to customer complaints team for inclusion in the Suffolk County Council annual report on comments, compliments and complaints, which is a public document. The home has a copy of the Suffolk County Council Protection Of Vulnerable Adults’ procedure. Staff receive appropriate training in the recognition and reporting of suspected abuse, however, staff spoken with were not clear that they should refer allegations to Social Services, Customer First team. Staff personnel files seen at the time of the inspection, confirmed that all newly employed staff are subject to Criminal Records Bureau (CRB) and Protection Of Vulnerable Adults (POVA) check. Care plans seen contained detailed risk assessments to ensure that physical and/or verbal aggression and unpredictable behaviours are understood and dealt with appropriately. The plans identify, monitor and manage the individual persons patterns of behaviour and identify triggers to predict when behaviour may occur. They also set out guidance for staff to manage the situation to lessen the frequency of these incidents. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 18 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): 19, 20, 21, 22, 24, 25, 26, People who use the service experience excellent quality outcomes in this area. The physical design and layout of the home enables the people who use his service to live in a safe well maintained and comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Paddock House is purpose built home, which spans two floors. The first impression, on entering the home is that it is nicely decorated and coordinated with matching furniture and soft furnishings. The floors are divided into three units; these are named, Bluebell, Church View and Poppy. Each unit has it’s own lounge, dining area and kitchen facilities in addition to ten single bedrooms. All bedrooms have the benefit of en-suite facilities, incorporating a toilet and wash hand basin. Additional communal areas include a large reception area with a day centre and a library. There is an attractive paved garden area to the side of the home and a more secure enclosed garden to the rear. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 19 An individual with a keen interest in gardening told the inspector they have been supervising staff to improve the appearance of the courtyard garden. The garden has raised flowerbeds, which as a wheelchair user enables them to take part in weeding and planting. People are able to access all parts of the home, whatever their age or ability. All internal doors are kept open automatically, with the exception of people’s private rooms. There is also good signage around the home directing people around the building, with a passenger lift between the two floors. All three units were seen, these were all decorated differently, each providing homely and comfortable accommodation. People had been involved in making decisions about the décor, choosing the colour and the style of the communal areas. Furnishings and lighting throughout the home are domestic in character and are suitable for their purpose. Bluebell, which accommodates people with dementia, comprises of a large open plan lounge and dining room with dividing doors. There is also a spacious and well-equipped kitchen. The lounge and dining area have large floor to ceiling windows, which provides a lot of natural light. There is an additional smaller lounge situated at the end of the corridor, providing a quieter area for people to use. This room opens out onto a small enclosed garden; the door has a pressure mat, which alerts staff if people go outside. In addition to the ensuite facilities provided, Bluebell unit has two assisted bathrooms, one of which has a shower cubicle, fitted with a seat. All bathrooms in the home are carpeted which provided a warm, comfortable and safe environment. Appropriate aids for safe moving and handling were sited around the building and evidence was seen that people are provided with aids and equipment for the prevention of pressure areas, where required. All bathrooms and toilets are provided with grab rails for people’s safety and to promote independence. A selection of people’s personal rooms were seen, these were nicely decorated and evidence was seen that people had brought small items of furniture from their previous accommodation, photographs, ornaments and paintings to personalise their rooms. Rooms were all furnished comfortably and maintained to a good standard of decorative order and repair. Many of the rooms were equipped with people’s own televisions and music centres. A coloured drawing of a different flower, personal pictures, room number and their name identifies each person’s room. All bedrooms are fitted with a call bell, door lock and lockable cabinet for personal items All areas of the home were found to be maintained to a good standard of hygiene and cleanliness. Some unpleasant odours were detected, during the tour of the home, however these were temporary whilst staff were assisting people with their personal care needs. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 20 The laundry facilities seen were clean and tidy with appropriate equipment to launder clothing and bedding. The washing machine has a sluice facility for dealing with soiled linen. Appropriate hand-washing facilities of liquid soap and paper towels are situated in all bathrooms and toilets where staff may be required to provide assistance with personal care. Random testing of water temperatures reflected that the water supply is within the recommended 43 degrees centigrade, which minimises the risk of people living in the home scolding themselves when taking a bath or shower. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 21 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): 27,28,29,30, People who use the service experience adequate quality outcomes in this area. There is a stable staff team who between them are trained and skilled to do their jobs providing a safe and homely environment, however there remains some concerns about the staffing levels in the home, which impact on the quality of daily activities available for the people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels and training were examined during the inspection. The duty roster confirmed each waking day is covered by a total of five care staff, supported by a senior carer and the manager. Two carers are allocated to the dementia unit, Bluebell and one carer is allocated to each of Church View and Poppy units. An additional carer adopts a floating role between the latter two units. Additionally, the home employs domestics, laundry staff, a maintenance person, catering staff and an administrator. Requirements made at the last two inspections of December 2005 and August 2006 were to ensure that an adequate level of staffing is provided to meet the needs of the people living in the home. The home still operates with the same number of staff, however, the manager and staff spoken with felt that the staffing levels at present are enough to meet peoples needs. This is in part due to the fact that the home has six empty beds in one unit. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 22 The current level of staffing and dependency levels of people using the service still does not allow for activities to meet the varied expectations and preferences of the people living in the home. Information recorded in the AQAA and discussed with the manager during the inspection confirms that the home runs on a set number of established hours, which means there are times when the level of staff prevents planned activities taking place. The situation would be improved by the recruitment of an activities co-ordinator, however the County Council do not have the resources available. One has already visited the home and facilitated a game of bingo, which a number of people said they had attended and enjoyed. Another volunteer is awaiting clearance from the Criminal Records Bureau (CRB) department. Dependency levels of some people using the service require the assistance of two members of staff for safe moving and handling when attending to their personal care needs, this leaves other people using the service with little or no assistance at that time. This was confirmed in conversation with people using the service, who commented “ Although, I ring for assistance, staff do respond quickly, although there are people here that require a lot more help and support with their personal hygiene than me, which puts a strain on the carers”. People spoken with were complimentary about the staff and were confident that they met their needs. Comments included” I moved in to Paddock House as I could not look after myself at home anymore, I found it very difficult as I am used to doing things for myself, I accept carers can’t all be the same, some are better than others, but none of the staff are unpleasant” and “staff seem generally experienced in the care of the elderly and adopt a respectful, friendly and caring approach”. The home operates a robust recruitment process, which adheres to the Suffolk County Council policy. Staff files seen were well organised and contained all the relevant documents and recruitment checks, including a Criminal Records Bureau (CRB) and a Protection of Vulnerable Adults (POVA) check. The files confirmed that the new employees had completed induction training, which included all mandatory training and the Skills for Care Induction. Records confirmed that staff are provided with the training they need to gain the knowledge and skills to perform their work role and meet peoples needs. This includes all areas of mandatory training, for example moving and handling and fire safety. A previous requirement was made for staff involved in food preparation on the living units, required “refresher training” in basic food hygiene. The chef provided information confirming all staff had attended an in house training session they had facilitated, comprising of a video and a question and answer paper in August 2006. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 23 Training more specific to the individual needs of the people using the service has included working with dementia, life story work, sensory awareness and symptoms of depression and confusion in the elderly. All senior staff have been trained to (National College of Further Education) NCFE level 2 in the safe handling of medicines, which ensures that people administering medication have the skills and knowledge to undertake the task safely. One of the senior staff has also completed a Skills for Care course relating to drugs and bugs. Most recent training has involved training staff to meet the needs of people requiring intermediate care. The home employs a total of forty-seven staff, with a mix of managers, care staff and ancillary staff. These figures include thirty-seven care staff of which twenty-nine have obtained National Vocational Qualification (NVQ) Level 2 and above, with two staff working towards completion of level 2. These figures reflect that Paddock House has reached the National Minimum Standard (NMS) target of 50 of care staff to hold a recognised qualification. The AQAA states that an application has been made for further staff to undertake NVQ. This will ensure that all staff are NVQ trained at the same level and have the same understanding of resident’s diversity. There are plans for senior staff members to undertake assessor training to enable them to assess staff performance as part of their induction training. Staff spoken with and comments received in the staff surveys confirmed they receive good training, which is relevant to their role and which helps them to understand and meet the needs of the people using the service. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 24 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): 31, 32, 33, 35, 36, 37, 38, People who use the service experience good quality outcomes in this area. The home is run in the best interests of the people living in the home, which is tested by an effective quality monitoring system. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is owned and administered by Suffolk County Council. The Registered Manager has a wealth of experience in the provision of care for older people. They have a Diploma in the Management of Care services. A senior team of staff who have either National Vocational Qualifications at level 3 or 4 supports them. Feedback obtained through discussion with people using the service, relatives and staff questionnaires was very positive. People find the manager approachable, friendly and supportive. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 25 The home has good quality monitoring systems in place. The most recent survey was conducted in 2006. The manager advised that the analysis for the quality assurance survey for 2007 was underway and will be completed by September. The analysis of the 2006 survey reflects that resident’s questionnaires confirmed that overall people are happy with the care and support they receive, with the exception of the provision of activities. Staff questionnaires reflected that poor communication within the home was a particular issue. A minority of staff felt the level of day-to-day support and teamwork was poor. People spoken with and comments received in the Commission for Social Care Inspection (CSCI) staff surveys confirmed communication within the home could be improved. This was also identified in the AQAA where the manager states that not all staff are aware of the changes happening as a result of the residential review and the plans for intermediate care within the home. Although, regular staff meetings are held, to improve the communication, within the home, these meetings are now held bi-monthly rather that quarterly to ensure that people are kept informed of the future plans and aspirations for the home. The meetings are scheduled at different times and varying days to ensure optimum attendance. Additionally bulletin sheets are available in the staff room to keep staff up to date with matters concerning the home and re structuring of Suffolk County Council. The home has regular residents meetings, which provide a forum for people living in the home to raise any concerns or suggestions they may have. The AQAA reflects that a recent meeting identified issues with the repetitiveness of the summer menu. This issue is currently being addressed by the chef who is consulting with people using the service to reflect their preferences whilst taking into account the nutritional needs of individual’s. The AQQA confirms people using the service are encouraged to maintain control over their finances where they are able to do so. To protect people from the risk of financial abuse, the home has a mechanism in place to ensure that there is an audit trail in place where staff or others may need to access their money on their behalf. The home has a detailed financial risk assessment, developed to ensure that people using the service will have their finances managed effectively and ensuring they will have their finances protected. The AQAA reflects that the fees charged for individuals to live in the home are not a true reflection of the cost for the provision of care per person and that the fees are subsidised by the owning organisation. It states that staff are paid well above the minimum wage, which is reflected in the calibre of staff employed in the home. Staff training and development ensure that staff are trained and have the skills to provide a high and consistent quality of care. Together with the robust procedures in recruitment to ensure peoples protection, the home is able to demonstrate that they provide people a service that is good value for money. Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 26 Staff personnel records seen confirmed that a formal supervision process was in place. Records confirmed that work issues and performance, training and further development needs had been discussed. Generally, people using the service are protected by the home’s record keeping. The accident book confirmed incidents and /or accidents are being reported and monitored. The AQAA confirms that policies and procedures are reviewed and updated, however, some of these do not appear to have been reviewed since 2001/02. These need to be reviewed to ensure they are up to date and reflect current practice. Records examined at the inspection and information provided in the AQAA confirmed the home takes steps to safeguard the health, safety and welfare of people living and working in the home. The most recent Gas and Electrical Safety Certificates, including Portable Appliances Testing (PAT) were seen and records showed that equipment, is regularly checked and serviced including regular hot water checks and fire alarm drills and testing. Paddock House DS0000037493.V347827.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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 4 3 X 4 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 3 Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 OP12 Regulation 16 (2) (n) Requirement People living in the home must be consulted to establish their interests and develop a programme of activities. This will ensure that people are provided with recreational activities, which meet their expectations, preferences and ability. This is a repeat requirement from the previous inspection of 09/08/06 2. OP11 12 (3) The end of life needs of people living in the home need to be discussed. This will ensure that in these circumstances the individual and their relatives will be treated with dignity and respect and in accordance with their wishes. 22/10/07 Timescale for action 17/09/07 Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 29 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 OP1 Good Practice Recommendations The service users guide and other information about the home should be available in a format suitable for the people with a visual and other sensory impairments. All records relating to people’s health needs must be regularly assessed, reviewed and updated to ensure any changes in their health are identified and action is taken to promote their well being. If the number of people living in the home increases and /or the proposed intermediate care unit is developed, staffing levels will need to be reviewed to ensure they are in sufficient numbers of staff on duty to meet the needs of people living in the home. Policies and procedures need to be updated to reflect they are up to date and reflect current practice. 2. OP8 3. OP27 4. OP37 Paddock House DS0000037493.V347827.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colchester Area Office Fairfax House Causton Road Colchester Essex CO1 1RJ 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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