Inspection on 07/09/05 for Paddock House

This inspection was carried out on 7th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 01/08/07

Paddock House 09/08/06

Paddock House 22/12/05

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 Jane Offord Unannounced 7 September 2005 th 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 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 I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Paddock House Address Wellington Road, Eye, Suffolk, IP23 7BE Telephone number Fax number Email 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 None Suffolk County Council Mrs E Hyde Care Home 30 Category(ies) of Older People - 20, Dementia over 65 years - 10 registration, with number of places Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 9/2/05 Brief Description of the Service: Paddock House is situated in the market town of Eye and owned by Suffolk County Council. It is close to all the local shops and other facilities in the town. The service offers accommodation and care for thirty older people with ten of those places being a special needs unit. All the bedrooms are single rooms with ensuite toilets and wash basins. The accommodation is on two floors, with a passenger lift for access, and divided into three units. 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. Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday between 10.00 and 16.30. The home was busy as there was a meeting room being used by external services and one office by Eye Social Services while building work takes place in their usual office. The staff on duty were co-operative and helpful. Three residents’ files and care plans were seen, three staff files and training records, the complaints log, the duty rotas, the menus and some policies were also seen. Part of a medication round was observed; the kitchens, laundry and all communal areas of the home were visited. The inspector spoke to a number of residents and visitors in the course of the day. Several care staff and the head cook also talked to the inspector. The home appeared tidy on the day of inspection but there was an odour of urine in some places. Residents looked relaxed and interaction with care staff was caring and appropriate. Several visitors, one accompanied by a dog, came and went during the day. What the service does well: The home offers an attractive environment, well maintained and decorated. The furnishings in the communal areas are homely and suited to the needs of the residents. The corridors are wide and there are large windows throughout the building giving a light and spacious feel to all the rooms. Residents’ bedrooms were pleasant with furniture arranged to suit the occupant. Personal belongings were evident including paintings, photographs and stuffed toys. The atmosphere during the day was relaxed and staff were observed interacting with residents with respect and care. The menus were seen and offered a wide choice for all meals. Residents spoken with commented on the high quality of the food, particularly the homemade cakes and pastry. Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 5 People who use this service can expect to have an assessment of their needs before moving into the home and have a trial period of residence before making a final decision about staying. EVIDENCE: Residents’ files contained evidence of comprehensive pre-admission assessments. Areas of need considered were physical health, mental health, medication, mobility, diet, activities, personal care, finance and social support. There was a ‘main goal’ box that recorded the prospective resident’s wishes for their future care. One resident had said, ‘to have twenty-four hour support as I am no longer able to manage in my own home’. There were records of a review four to six weeks after admission that included the resident, family members, the social worker and senior care staff. Comments made by the family and resident about the placement were noted. One record was ‘Mother is very happy. Happy to stay here’. Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 People who use this service can expect to be treated with respect and have their health care needs met, however they cannot be assured that their plan of care will cover all their assessed needs or that the present medication administration system will protect them. EVIDENCE: Residents’ records contained details of health professionals who were involved in caring for them. These included GPs, community nurse, optician, chiropodist and some out patient appointments. There was also a list of visits from or to these people. One resident said that they had been to a hospital appointment the previous day for a condition that the care staff had noticed but they had not. They had listened to the consultant explain the treatment options and decided that they would not have the problem treated. Staff were observed knocking on bedroom doors before entering and offering residents choices about where to sit or what they wanted to drink. Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 10 One resident who spoke to the inspector was resting on their bed after lunch. They said that they had been advised to do this daily by the district nurse to prevent any skin breakdown that could be caused by sitting in one position for a long period of time. All the records seen had a life story of the resident that was done by the resident or family. Two of the three records also had a recent photograph of the resident. The care plans that were seen were not very informative about the needs of the resident. Many of the pages only had the name of the resident on them. There was no indication on the sheet that the care need had been looked at and did not apply for that resident, or that the form was just not completed. The records for one resident in the special needs unit had a risk assessment completed because they are able to operate the door alarm and leave the unit. The care plan did not detail any intervention to help manage this and keep the resident safe. Staff said that they have developed a strategy to allow the resident to leave the home in safety but it was not recorded. On arrival at the home the inspector joined a member of staff completing the morning medicine round. Medication in the special needs unit was given sensitively without rushing the residents. Drinks of their choice were offered to help swallow the tablets. Residents were verbally encouraged to drink liquid medicines at their own pace. Medication is supplied to the home in a blister pack system and administration is recorded on Medication Administration Records (MAR sheets). One medicine cupboard contained a pot of dispensed medicine left by the previous shift and the corresponding signature box on the MAR sheet was blank. Some other blank boxes were noted and in one case a box for the lunchtime medication had already been filled in. The blister packs were not always returned to a locked cupboard when the staff left the room to give medication to a resident in another room. After lunch the inspector observed a blister pack frame, containing medication, left on the side in one kitchen that was open to residents and visitors. There were no staff around at the time. Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 People who use this service can expect to maintain contact with family and friends and be offered a well balanced diet but they cannot be assured that there will be a range of activities available to occupy them during the day. EVIDENCE: Residents’ records had details of their next of kin and who to contact in an emergency. Staff and residents said that friends and relatives were welcome to visit at any reasonable time. Some residents said that they went out with family when they visited but some visitors spent time in the lounges or bedrooms with residents. Several visitors were spoken with during the day. Opinions about the home and care varied but they all confirmed that they could visit as often as they pleased. One visitor was accompanied by their dog and the resident was clearly pleased to welcome them both. The menus were seen and looked varied and offered a wide range of choice. Lunch and supper offer cooked meals with a choice of lighter dishes if preferred. Home made cakes are available at teatime each day and birthday cakes are made for celebration. Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 12 The inspection took place on a particularly hot day and carers were observed offering regular fresh drinks to residents. Drinks were taken to residents in their rooms and the lounges. Residents said they could have meals in the dining room or in their rooms. Breakfast can be served at a time to suit the resident and one resident was finishing their meal at 10.15am. One visitor expressed concern that their relative does not receive the assistance to eat that they require because they do not choose to have their meal in the dining room. The resident does not always feel well enough to go to the dining room and has meals in their bedroom. Several residents who spoke with the inspector expressed the view that there were not enough activities offered during the day. They said staff are often too busy to spend time socialising with them but they would like the opportunity to be taken for a walk or to sit in the garden more. One visitor also said that the residents are rarely out in the fresh air. There was a programme of activities on the notice boards in the units but staff said that it was their responsibility to organise the activities and they were unable to do so due to the demands of meeting the care needs. Three residents said that they had regularly attended church services before coming to the home. They said they can see the church and enjoy hearing the church bells but have not been to a service. The staff said that the vicar visits the home monthly but these residents were unaware of that. Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 People who use this service can expect that any complaints will be listened to but cannot be assured that they will be informed of the outcome of any investigation or that all staff have received training in Protection of Vulnerable Adults (POVA) procedures. EVIDENCE: The complaints log was seen and consists of two sections, a formal complaint record and an informal complaint record. The documentation of the investigation for the most recent formal complaint appeared complete. There were two recent informal complaints recorded, one from a resident and one from a relative of a resident. Although there were actions recorded in response to the complaints neither complainant felt they had been given a proper explanation of the outcome or actions resulting from their concerns. Neither complainant was completely satisfied that the issues had been fully addressed. It is good practice to give a written reply of findings for all complaints. It enables the complainant to see clearly what has been addressed and is evidence should matters need to be taken to a further level. Staff files seen showed evidence that they had received POVA training and care staff spoken with confirmed that. Ancillary staff were aware of potentially abusive situations but had not received POVA training. In order for correct procedures to be instigated in the event of a suspicious situation all staff who come into contact with residents need up to date POVA training. Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 24, 25, 26 People who use this service can expect to live in a comfortable and wellmaintained environment with their own possessions around them and specialist equipment available to maximise their independence. They cannot be assured that the present arrangements for cleaning the home are sufficient to prevent unpleasant odours and maintain an acceptable level of cleanliness. EVIDENCE: The home is nicely decorated and feels spacious. The communal rooms in each of the units are furnished appropriately with the kitchens equipped to make tea and toast for a resident who may want a snack. Each bedroom has an en suite toilet and washbasin. The general bathrooms seen were fitted with assisted baths and some toilets had raised seats. There were hoists available to move people with limited mobility. Pressure relieving mattresses and cushions were in use. One resident had recently had a motorised wheelchair and was getting used to the controls. There was plenty of space for them to manoeuvre. Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 15 Individual bedrooms were furnished to suit the resident with furniture placed as they chose. Each room contained a lockable, fixed box for the resident to use for valuables. Personal items were evident in the rooms seen. The home benefits from large windows and some rooms have double aspect windows, which allow pleasant views of Eye and let in plenty of light. The laundry was seen and is equipped with machines with a sluicing programme. There were holders for liquid soap, alcohol rub and paper towels in all the bathrooms, toilets and kitchens that were seen. The infection control policy was seen. A previous recommendation to expand the policy to give more detailed guidelines on the use of chemicals to deal with accidental spills does not appear to have been actioned. In addition the policy uses inappropriate language, ‘nappy’, to describe bags used for disposing of continence pads. On the day of inspection there were some areas of the home that smelt of urine. One visitor said that their relative’s room smelt like it all the time. They had brought in toilet cleaner to try to eradicate it. They had also brought in a duster to dust the room as they felt it was not done regularly. One resident had been unwell the previous day. Their room smelled strongly of vomit still. The care staff were going to clean it on the day of inspection. Staff confirmed that there were no domestic staff in the home that day. Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 People who use this service can expect to be protected by the recruitment policy used but they cannot be assured that the present number of staff rostered will be adequate to meet their needs or that the training programme will equip staff to meet the needs of residents who have dementia. EVIDENCE: Three staff files were seen and all contained evidence of Criminal Record Bureau (CRB) checks and references. There were records of training undertaken and evidence that supervision takes place regularly. Staff rotas were seen and showed that there were three vacancies in the care staff team. Staff said that there was an active recruitment process ongoing to fill the posts. Some staff said that there were vacancies in the domestic team. There was no domestic cleaner in the home on the day of the inspection and, staff said, there were occasions that if the care team was understaffed a domestic would be taken off cleaning duties to undertake caring work. There was evidence from residents, staff and visitors that the level of cleanliness in the home had fallen recently. Staff felt that the care needs of residents had increased recently and that they were spending more time supporting residents with personal care needs and not able to undertake activities or outings with residents because of the pressure of work. Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 17 Training records showed that staff regularly had training in manual handling, fire awareness, food hygiene, Protection of Vulnerable Adults (POVA) and health and safety. Some staff had had training in supporting people with dementia. As staff can be required to work in any of the units, including the unit for people with special needs, when on duty, training in dementia care should be mandatory for all staff. Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 36, 38 People who use this service can expect that their personal money will be managed to safeguard their interests and that their health and safety will be promoted. They can expect that the staff are appropriately supervised. EVIDENCE: The administrator for the service showed the inspector the system for managing and recording the residents’ personal allowances. Residents can choose to have money paid directly into a bank account or retain cash in their room. The administrator will provide the resident with their money in the denominations they request. There is a fixed lockable box in all residents’ rooms for keeping valuables. The recording of all transactions is clear and offers an audit trail. Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 19 The staff records contained evidence of regular supervision sessions. Staff said that supervision was well handled and that they could discuss any issues including training and development needs. During a visit to the kitchens refrigerator and freezer temperature checks were seen and recorded that they were within safe limits for food storage. The certificate issued by the Environmental Health Inspector after a visit in January 2005 was verified. There was evidence that chemicals and cleaning agents covered by Control of Substances Hazardous to Health Regulations (COSHH) were stored correctly. All staff spoken with confirmed that they had had Induction training including instruction on safe working practices. There were records of the training in staff files. Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x 3 x 3 3 1 STAFFING Standard No Score 27 1 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x x x 3 3 x 3 Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 21 Yes 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 7 Regulation 15 (1) Requirement Each resident must have a care plan detailing the interventions needed to meet their assessed care needs. This is a twice repeated requirement. Medication administration and storage must meet the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society and the Misuse of Drugs Act 1971. A programme of activities must be developed and implemented to include the option to attend religious services if wished. Complainants must be informed of the outcome of their complaint. All staff must have training in up to date POVA procedures. Adequate domestic staff must be rostered on a daily basis to ensure the home is kept free of unpleasant odours and cleaned to an acceptable standard. A review of staffing levels in relation to residents assessed needs must be undertaken to ensure that the staffing levels Timescale for action 30/11/05 2. 9 13 (2) Immediate and ongoing. 3. 12 16 (2) (n) 16 (3) 22 (4) 13 (6) 16 (2) (k) 18 (1) (a) 18 (1) (a) 30/11/05 4. 5. 6. 16 18 26, 27.7 Immediate. 30/11/05 Immediate. 7. 27 30/11/05 Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 22 8. 9. 30 15 are adequate to meet the needs of the residents. 18 (1) (c ) All staff who work in the special needs unit must have training in dementia care. 12 (1) (2) Residents who require assistance (3) with their meals must be allowed to choose where they eat and still receive the assistance they need. 30/11/05 Immediate. 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 26 Good Practice Recommendations The infection control procedure should be expanded to include more detailled guidelines on cleaning spillages and/or bodily fluids and have inappropriate terminology removed. Paddock House I54-I04 S37493 Paddock House V248256 050907 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 5th Floor, St Vincent House 1 Cutler Street Ipswich Suffolk, IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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