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Inspection on 01/05/07 for Partridge House Nursing And Residential Care Home

Also see our care home review for Partridge House Nursing And Residential Care Home for more information

This inspection was carried out on 1st May 2007.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has provides care for older people with mental health needs in a homely and understanding environment. Visitors are made welcome in the home and encouraged to spend as much time as they would like with the residents. All residents rooms are clean and homely and residents have freedom to make use of all areas of the home and garden, with those areas that could present a risk to the resident being protected by keypad entry. Staff were interacting with residents in a friendly and dignified manner, and it was evident that they understood the residents` likes and dislikes and were prepared to be flexible with residents choices. One resident is able to eat his dinner by the patio door, as is his preference, another is given beer when he wishes, whilst another resident preferred his lunch at a later time and staff ensured that this occurred.

What has improved since the last inspection?

The standard of cleanliness, tidiness and attention to minor maintenance matters has improved in the past twelve months and has improved the quality of the environment for residents. Care plans are improved, having now been reformatted in a manner which makes them easier for staff to both use and find information, they now have sufficient space to include social and nursing details and to detail actions required. The standard of medication administration and recording is now good; staff have worked hard with auditing each other`s recording of medication administration and are now practising a system which ensures resident`s safety. The standard of catering has improved, one resident said ` We are now having fresh vegetables in season, fresh fruit and the quality of the meals has improved, I can`t complain to you this time`. Personnel files contain all the information required by the regulations and the acting manager has commenced ensuring that all staff receive their mandatory training in fire, moving and handling and first aid.

What the care home could do better:

The home has had changes of management over the past few years and this has resulted in requirements not being addressed and general lack of communication between management. However a manager from one of the other Anchor homes is now in place as acting manager pending the finalisation of the recruitment process of a new manager. Requirements made on this inspection have been previous requirements that have not been fulfilled, with an additional requirement on continuing provision of activities and choices of meals being available to those residents who require their meals pureed. Lack of staff training in mental health issues is not acceptable in a home with this registration category, and whilst the home has just commenced training inthis area, it must be extended so that all staff have a formal working knowledge of the conditions that can affect residents in their care. Only a small percentage of staff have received training in safeguarding adults and this has to be addressed. Likewise there was little information on whether staff recruited in the previous year undertook induction training. Residents do not have a Service user guide, which is required in order that they know the staff, routines and fire and complaints policies, this must be produced in a format suitable for this category of resident to be able to understand. The provision of activities has been infrequent over the past two months, due to the activities coordinator having been seconded to other duties. The registration category of this home gives the expectation that it will concentrate on providing a therapeutic environment, with nursing as required. The activities programme is not produced in a format which would encourage residents to look at it, and inaccessible to those residents not using the ground floor. Although the home is generally malodorous, there are some odours present in the conservatory; this has been an ongoing problem. Likewise furnishings should be of an impermeable material, which will allow easy cleaning and prevent cross infection. Carpets in the lounges are stained in places and these require attention.

CARE HOMES FOR OLDER PEOPLE Partridge House Nursing And Residential Care Home Leybourne Road Off Heath Hill Avenue Bevendean Brighton East Sussex BN2 4LS Lead Inspector Elizabeth Dudley Key Unannounced Inspection 1st May 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 Partridge House Nursing And Residential Care Home DS0000014021.V336243.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. Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Partridge House Nursing And Residential Care Home Leybourne Road Off Heath Hill Avenue Bevendean Brighton East Sussex BN2 4LS 01273-674499 01273 693332 cliff.parker@anchor.org.uk sharon.blackwell@anchor.org Anchor Trust Address 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) Vacant Care Home 38 Category(ies) of Dementia (38), Mental disorder, excluding registration, with number learning disability or dementia (38) of places Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is thirtyeight (38) Service users must be aged sixty (60) years or over on admission Date of last inspection 26th May 2006 Brief Description of the Service: Partridge House is a purpose built home that was developed in partnership between Anchor Trust, ARDIS and Brighton and Hove Social Services to provide care for 24 older service users with mental health problems. Fourteen new rooms were added bringing the number of service users able to be accommodated to 38. This now provides 30 nursing beds, 6 for residential care and 2 for respite care. A conservatory has been added to the building. All of the accommodation provided is in single rooms, which have en-suite facilities, and the home is divided into four units. The gardens are well maintained and accessible to all service users, a shaft lift gives access to all parts of the building. Anchor Trust is a not for profit organisation and ARDIS is a local charity providing services for people with dementia. Partridge House is situated in a residential area, local transport links are poor, but there are good car parking facilities. The current fees as of the 1st May 2007, are £716 per week. Additional charges are payable for chiropody, hairdressing and other items and details of these are available from the home. Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on the 1st May 2007 over a period of seven hours. It was facilitated by Mrs S Greene, acting manager. During the inspection care plans, medication charts, menus, personnel files and staff training records were assessed, and a tour of the home was undertaken. All residents were seen and conversations took place with seven residents, two visitors and eight members of staff. Residents and visitors to the home made positive comments regarding the home and the staff. One resident saying ‘ I like it here and the food is good’, whilst another said ‘The food is much improved, much more fruit and vegetables are now being served, I can make no complaints this time’. Visitors to the home said ‘ I am very satisfied with the care here’, and ‘ I am glad we found this home, they are very understanding’. What the service does well: The home has provides care for older people with mental health needs in a homely and understanding environment. Visitors are made welcome in the home and encouraged to spend as much time as they would like with the residents. All residents rooms are clean and homely and residents have freedom to make use of all areas of the home and garden, with those areas that could present a risk to the resident being protected by keypad entry. Staff were interacting with residents in a friendly and dignified manner, and it was evident that they understood the residents’ likes and dislikes and were prepared to be flexible with residents choices. One resident is able to eat his dinner by the patio door, as is his preference, another is given beer when he wishes, whilst another resident preferred his lunch at a later time and staff ensured that this occurred. Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home has had changes of management over the past few years and this has resulted in requirements not being addressed and general lack of communication between management. However a manager from one of the other Anchor homes is now in place as acting manager pending the finalisation of the recruitment process of a new manager. Requirements made on this inspection have been previous requirements that have not been fulfilled, with an additional requirement on continuing provision of activities and choices of meals being available to those residents who require their meals pureed. Lack of staff training in mental health issues is not acceptable in a home with this registration category, and whilst the home has just commenced training in Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 7 this area, it must be extended so that all staff have a formal working knowledge of the conditions that can affect residents in their care. Only a small percentage of staff have received training in safeguarding adults and this has to be addressed. Likewise there was little information on whether staff recruited in the previous year undertook induction training. Residents do not have a Service user guide, which is required in order that they know the staff, routines and fire and complaints policies, this must be produced in a format suitable for this category of resident to be able to understand. The provision of activities has been infrequent over the past two months, due to the activities coordinator having been seconded to other duties. The registration category of this home gives the expectation that it will concentrate on providing a therapeutic environment, with nursing as required. The activities programme is not produced in a format which would encourage residents to look at it, and inaccessible to those residents not using the ground floor. Although the home is generally malodorous, there are some odours present in the conservatory; this has been an ongoing problem. Likewise furnishings should be of an impermeable material, which will allow easy cleaning and prevent cross infection. Carpets in the lounges are stained in places and these require attention. 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. Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 8 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 Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 9 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 this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information provided to prospective and existing residents is not produced in a manner that facilitates resident’s choice of home. No residents are supplied with a Service User Guide. Few staff have formal qualifications or training relating to the specific needs of older people with mental health needs. Pre- admission assessments addressed the health care and social care needs of the prospective resident EVIDENCE: Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 10 The Statement of Purpose has been reviewed to reflect the current status in the home and meets the regulations. Whilst all residents have a copy of the Statement of Purpose in their rooms they have not been provided with a Service User Guide and the acting manager stated that this had not yet been reviewed to reflect current status or to be presented in a manner that is in a suitable format for residents. The Statement of Purpose is not produced in a manner conducive to facilitating residents’ understanding about the home; this is expected of the Service User Guide. A requirement was made at the last inspection regarding providing residents with a service user guide has not been complied with. Evidence that all residents or their representatives have received a copy of the Terms and Conditions of Residence, which is compliant with regulation, was seen. The home employs two Registered Mental Health Nurses on a part time basis with Registered General Nurses on duty the remainder of the time. One care assistant has the National Vocational Qualification level 2 in care but no specific training has been undertaken by the majority of staff in relation to the mental health issues of those in the home. However a study day in this has been planned to take place in the near future. Many of the care assistants have worked at the home for a number of years and therefore have experience in caring for residents in this category. A requirement was made at the last inspection to ensure that suitably qualified persons were working at the home. The acting manager assesses all residents prior to their admission to the home, and recent assessments were seen to have been comprehensive, with information gained forming the basis of the care plan. During the assessment prospective residents are shown the generic Anchor Trust brochure and the Statement of Purpose. Prospective Residents or their representatives can visit the home prior to deciding whether they wish to make it their permanent home and all residents are admitted for an initial six week trial period. The home does not admit residents for intermediate care, but admits for transitional and respite care. Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 11 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 this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst most care plans addressed the needs of the residents in full, some lacked information, consultation with residents and regular review. Lack of information and may compromise the well being of residents. The standard of medication administration and recording has improved and safeguards the residents EVIDENCE: During the inspection 10 care plans (27 ) across all five units were examined, there has been previous variation in the standard of care planning across units therefore it was deemed necessary to look at this amount in order to reach a judgement. Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 12 The new care plan format has facilitated the care planning system, with some staff able to use this to its full capacity. However as this new format has only just been put in place, not all documentation had been transferred across from the old system or full completed therefore not fully enabling staff to have information relating to the residents care. Six care plans contained sufficient relevant information to assist staff with giving care to meet the assessed needs of the residents. However in four care plans relevant information including visits from health care professionals was not immediately available. The standard of care planning varied from very good to adequate but generally overall improvement was seen. Different units showed variations in the amount of information in the care plans and reflected whether the staff had received the appropriate training. Six out of the ten care plans had been reviewed on a monthly basis, but only two care plans showed that consultation had taken place with the resident or their representative during formation or review. A relative of a resident stated she was not aware of the care plan or decisions reached relating to the use of bed rails. In the majority of care plans, signature of the staff member forming the care plan had not been included. Good risk assessments were in place and in general the standard of care planning is much improved. This improvement in care planning and delivery is expected to be sustained. Staff said that the new care planning system improved clarity and they found them easier to follow. A mattress audit has recently been undertaken by the Wound Care Specialist Nurse, and this has resulted in some mattresses being replaced with a type more suitable for residents at risk of pressure damage. Wound care plans showed updating and consultation with the wound care nurse. It is recommended that information regarding the grading of pressure damage be put in the main nursing office to be available to all staff. Nutritional care plans in place although some were not completed and records showed that residents at risk of weight loss or excessive weight gain had been weighed at regular intervals, and nutritional intake monitored. Although some residents had received attention from a physiotherapist, there was no information to show that this service was available to all residents with mobility problems. Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 13 The clinic room was clean with evidence of servicing of equipment and recording of the drug fridge temperatures. There are policies relating to the administration, receipt and disposal of medication and these have been followed. All records relating to administration of medication had been signed and reasons for non-administration were in place, with photographs of individual residents in place. The controlled drugs were appropriately stored and recorded. Two members of staff have phlebotomy skills and the acting manager stated there is difficulty in accessing this. Certain medications prescribed to residents in the home require frequent blood level monitoring, and although the community phlebotomist is available, staff said that acquiring these skills would ensure that this monitoring took place immediately it was required. Staff were interacting with residents in an appropriate and dignified manner and relating to residents in a manner relevant to their abilities . All residents were appropriately dressed and were clean and tidy, one resident appeared unkempt but care plans identified that he refused most personal care and that staff had respected that choice. Medical and nursing interventions take place in the resident’s own room. On occasions the home has residents requiring end of life care. Staff have not received on going training relating to this and it is recommended that this be considered. Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 14 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 this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities programme is not sufficiently clear to inform residents of what activities are planned. The recent provision of activities has been spasmodic; therefore not providing the therapeutic environment expected for residents with mental health needs. The standard of catering is good but there is no choice available to those residents with special needs. EVIDENCE: A range of activities provided by an activities co-ordinator is offered to residents in the home. However when the activities co-ordinator is not working or is seconded to other duties within the home there is no provision made to ensure that residents are able to participate in suitable activities. Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 15 As the homes registration is that of provision of a therapeutic environment with nursing provided when required, it is expected that suitable activities are provided the majority of the time. The programme of activities and the diary showed that these included outings, cooking, art therapy, musical entertainment and gardening, with staff saying that they will often take a resident to the local shop. The activities diary showed that these had not been provided recently due to the absence of the coordinator or his allocation to other duties. The activities programme was not produced in format that could be easily read by residents and was not easily accessible to the majority of residents in the home. One resident said ‘ I enjoy the music and the films, they are good’, whilst another said ‘I did some cooking once and think I made some biscuits’. ‘They arrange things for us to do sometimes but mostly it’s boring’. The management is in the process of arranging training by the Alzheimers Society for staff in activities for residents in this registration category, this was in progress at the last inspection. Residents are allowed to walk anywhere in the home including the gardens, they are safeguarded from areas which may prove a risk by keypads. The acting manager said that residents could choose their times of rising and retiring, and residents spoken with generally agreed with this, although two residents said that staff tell them when to get up. A member of staff said that they have to get up at least four residents in the morning, and this commences at 0600. This is very early for residents to be up and dressed unless it is their wish. The choice of residents who require their diet to be liquidised or pureed is restricted with there only being one choice on the daily menu being available in pureed form. Visitors are welcomed at any time and two visitors spoken with said that the staff made them very welcome and kept them informed of what the resident was doing and any doctor’s visits or general health matters. Ministers of religion visit the home, at present this is confined to Church of England or Roman Catholic ministers due to the religion of the people currently living in the home, but staff are aware of how to access other ministers if required. The menu is varied and shows choices of two meals both at supper and lunchtime. It includes fresh fruit and vegetables and the standard of supper menu was reasonable. Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 16 Staff stated that they inform residents of menu choices one hour prior to the meal and then again at the meal times, cooked breakfast are available twice a week and several residents have this. The day’s menu is also displayed on boards in all the lounges. Staff were seen to be helping residents with their meals in a discreet and dignified manner, the registered nurses are now present in the dining rooms whilst residents were eating and were made aware of any residents reluctance to eat when this occurred. Fresh fruit is available in baskets in the small kitchens in the lounges but it was unclear how often residents were offered this. Residents spoken with said ‘ The food is not bad usually’, ‘ At last we are getting fresh fruit and vegetables, and the food has improved, for the first time I have no complaints to make’. ‘ The food is good and you get to choose, very good indeed’. There has not been an Environmental health inspection recently, but there was a considerable improvement in the standard of cleanliness in the kitchen, all permanent catering staff have the ‘Food Hygiene Course’. Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 17 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): 15,16.17,18 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was insufficient evidence in the home to identify whether residents have been adequately protected by the homes complaints policy. Staff require training in the safeguarding of vulnerable adults to ensure that they are aware of their responsibilities towards the residents in their care. EVIDENCE: There was evidence of a complaints procedure that meets the regulations displayed in the ground floor corridor, however due to the lack of a service user guide, many residents or relatives would be unaware of this. It was unclear whether complaints have been received by the home between October 2006 and January 2007, as no records of these were available. The acting manager stated that two complaints have been received since she took over the home two months previously. These related to staff not having knowledge of a resident’s previous medical history including a diagnosis of diabetes, and the appropriate care had not Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 18 been given, this was partially substantiated due to inadequate information being provided to the home following discharge from hospital. The second complaint regarded staff perceived inability to set up a syringe driver for a terminally ill resident, and was passed to the CSCI. It was acknowledged that this skill would not necessarily be expected in a mental health nursing home and that it was appropriate for the staff to access other health care professionals, which was the case. However it was partially substantiated on the basis that the staff did not follow up the prescription for the required drugs. Records of these complaints were available at the home. There have been four adult safeguarding alerts since the last inspection, two of these were judged to be accidents and not a safeguarding issue and two were substantiated with appropriate action taken, this did not involve any member of staff being referred to the Protection of Vulnerable Adults list and one was referred back to the agency which placed a member of staff in the home. Nineteen (33.9 ) members of staff have undertaken Safeguarding adults training in the past two years, this is not sufficient given the number of staff on duty and therefore efforts must be made to ensure that all staff undertake this. Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 19 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 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Cleanliness and maintenance in the home show improvement but replacement of stained carpets and controlling odour in the conservatory would ensure that the home continues to provide a pleasant environment for residents. Lack of assisted bathing facilities, if allowed to continue, will impact on the wellbeing of residents. EVIDENCE: There has been substantial improvement in the cleanliness and maintenance in the home over the past year, with minor maintenance issues being addressed promptly and all areas of the home being kept in a tidy condition. Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 20 The ground floor lounge and conservatory give access to a well-maintained garden which residents can use as they wish. Some areas of carpets in the lounges and the conservatory are stained, with the conservatory needing odour control. However carpets in resident’s rooms were clean and all other parts of the home were free from odours. Only two of the four assisted baths are in working order at present due to problems with the hot water temperature valves, replacements have been ordered and the maintenance person stated that these are expected soon. However there are assisted showers in all residents’ rooms and two other baths functioning, so this has not affected residents as yet. Three new adjustable beds have been purchased for residents’ rooms; all rooms were clean and adequately furnished with curtains and bed linen that is fit for purpose. All residents’ rooms have lockable doors and drawers, with keys being given within the auspices of a risk assessment. Records showed regular monitoring of water temperatures and these were within recommended parameters. Window restrictors are in place on all upper windows. The home has moving and handling equipment, assisted bathing facilities and grab rails in corridors and in bathrooms. There were sufficient supplies of disposable gloves and aprons and infection control policies and procedures were in place. It was noticed that a fabric covered dining room chair was put out for cleaning with soap and water and it is recommended that the home considers furnishings that have an impermeable covering for general use, to facilitate the cleaning and control of infection. Partridge House Nursing And Residential Care Home DS0000014021.V336243.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): 27,28,28,29,30 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are employed over a twenty-four hour period to meet the assessed needs of the residents, but deployment of staff in peak times does not allow residents choice and safety to be upheld at these times. Staff have not received suitable formal training to relevant to the needs of residents in the home, however many existing staff demonstrated knowledge gained by experience of working with the residents ensuring the standard of care given was appropriate. EVIDENCE: The duty rota showed that sufficient staff are employed during the daytime shifts to meet the needs of the residents. Staff stated that there were sufficient staff on duty and that fewer shifts were now being covered by agency staff, although 50 of night duty remains covered by agency staff. It was previously recommended that deployment of staff was considered to cover the early morning and late evening hours when night staff had previously stated they had insufficient staff to monitor residents moving around the home when they were giving personal care in a resident’s room, Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 22 this has not been taken up by management. A member of staff said that they were still experiencing difficulties at these times although there were sufficient staff on duty for the main part of the night. There are only two Registered mental health nurses employed by the home at present- both of whom work few hours at the home, other shifts are covered by registered general nurses. As the category of the homes registration is for older people with mental health needs, it is not considered that sufficient staff with this qualification are employed. Until recently no staff have received training in the mental health needs of older people, but a one-day introductory course in dementia has recently been held. Whilst many of the staff demonstrated good informal knowledge of resident’s needs, which has been gained by experience, training is needed for all grades of staff to enable them to have the expertise required in this very specialised area. Likewise training is needed in addressing challenging behaviour and restrictive practices. All new staff are undertaking the ‘Skills for Care’ induction training, which includes some Protection of Vulnerable Adults training, however the acting manager could not find evidence of whether staff employed in the recent months prior to her had undertaken induction training. A training programme to ensure that all staff have the mandatory training has been commenced. The maintenance person is awaiting courses in first aid and COSHH New staff are receiving the General Social Care Code of Conduct handbook but there was no information to support whether these had been given to existing staff. One member of staff (1.7 ) has National Vocational Qualification level 2 in care. Ten personnel files were examined, these contained all documentation as required by the regulations with staff not having been employed until the Criminal Records Bureau check had been received. Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 23 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 this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems currently in place are working towards maintaining the safety and well being of resident’s staff and visitors to the home. The views of residents and their representatives have not been used to inform the quality monitoring process and therefore there is no information to ensure that their expectations are being met. EVIDENCE: Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 24 The manager’s post at the home is presently vacant with management support being supplied by a manager from another Anchor sister home as acting manager. The acting manager has been in the home for two months and during this time has concentrated on establishing new care plans and supporting staff in both their use of these and of maintaining care given to residents, ensuring that staff are booked in for mandatory training and staff recruitment. The ethos in the home was good with staff and residents making positive comments regarding the home. Due to the home being without a manager and area manager there has been no consistency of information between the home and Anchor Trust resulting in requirements made at the last inspection not followed through and assurances given by the previous manager not maintained. Anchor Trust employs a commercial company to oversee the quality monitoring and audit on a yearly basis, with the acting manager taking on the responsibility for ensuring that regular audits of cleanliness and health and safety take place. There were no records available of the yearly audit but the acting manager was able to show records relating to the audits that she has completed. There were no records available of relatives or stakeholder comments. Staff meetings have been held with different grades of staff on a regular basis and minutes were seen of these, these showed that staff were able to express their views and that they were listened to. No relatives or representatives meetings have been held for several months. The financial records and business plan for the home was not assessed at this inspection. An audit of residents’ finances was being undertaken at the home on this day and the auditor gave assurances that all was in order. Residents now receive any monies they may require from a communal pool and expenses debited to their account, with all residents money being put into a bank account under separate names. Anchor Trust has a policy relating to this. All registered nurses have received supervision recently, however this has not been extended to the care staff at this time. There was a lapse over supervision of trained staff during the period that the home was without constant manager supervision. The receipt of Regulation 26 reports by CSCI (provider monitoring reports) was not constant during the periods of December 2006 – April 2007, but a new area manager has now been recruited. Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 25 The acting manager is in the process of reviewing generic policies and procedures and implementing new Anchor policies, all policies discrete to practices at Partridge House have been reviewed in the past two months. All records relating to residents and staff are kept in a secure environment. The manager is in the process of ensuring that staff are participating in mandatory training with all staff now having undertaken recent fire training, with moving and handling training aiming to be completed by the middle of May 2007.No staff have updated on Health and Safety training which is a mandatory course in Anchor Trust and some care staff require food hygiene training and updating of first aid certificate. All certificates relating to the servicing of utilities and equipment were in place and in date and fire safety precautions and window restrictors were in place. Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 26 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 1 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 2 3 2 3 X 3 3 2 STAFFING Standard No Score 27 2 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 x 3 1 3 3 Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation Reg 4 & 5 Requirement That a service users guide, that reflects the current status of the home are made available to current and prospective residents. That all residents have a copy of the service user guide. (This has been a requirement on the inspection of 26 May 2006 and past inspections) That all parts of the care plan are reviewed on a regular basis. (This was a previous requirement Sept 1st 2005 and 3rd November 2005, February 9th 2006, May 2006) Anchor trust to ensure that at all times suitably qualified, competent and experienced persons are working at the home and ensure that temporary workers will be able to meet resident’s needs. (This was a previous requirement, 3rd November 2005, February 2006, May 2006) Timescale for action 30/06/07 2 OP7 Reg 15 (2)(b) 30/06/07 3 OP27 Reg 18(1)(a) 30/07/07 Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 28 4 OP12 Reg 16(m)(n) Reg 16(i) Reg 16(2)(k) Reg 18(1)(a) 5 6 7 OP15 OP26 OP27 That activities for residents are recognised as an important part of their holistic care and that the provision of these is a priority. That residents who require pureed meals receive the same choice as other residents. That the home is kept free from offensive odours. Staff Recruitment of permanent staff to continue (This was a previous requirement, 3rd November 2005, 9th February 2006 and 25 May 2006) 30/06/07 01/06/07 30/07/07 30/07/07 8 OP30 Reg 18 That all staff receive an induction 30/07/07 (1)(c) Reg course on commencement of 18(4) training and further training relative to the work they are to do. That all staff receive a copy of the GSCC handbook.( This was a previous requirement February 2006, May 2006) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Partridge House Nursing And Residential Care Home DS0000014021.V336243.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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