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Inspection on 02/08/05 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 2nd August 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.

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

Partridge House provides a specialised service for older people who have mental health illness. The majority of the registered nurses have specialised in the care of mental health needs and the care assistants receive training related to these. The home provides a good, understanding atmosphere with residents having freedom of movement around the home and gardens, whilst being allowed to maintain their dignity and express themselves. The home aims to use as little medication as possible. Questionnaires sent to relatives of residents showed that the majority thought that the home offered a good standard of care to the residents, that the staff were very kind and thoughtful both to the residents and visitors and that they felt the residents were able to make choices in their daily lives. Most residents spoken with stated the staff were `wonderful`, `very kind`, `are my friends`, `are cheerful and smile a lot`. All residents appeared clean, well dressed and cared for and those in bed appeared to be comfortable. The kitchen can cater for a varied diet and provides both finger foods and special high protein and high calorie meals for those residents who need these. Appreciating that people with this type of illness often wish to eat at various times of day, simple foods that can be cooked by night staff are provided in fridges in the main kitchen or kitchenettes so that meals can be provided at any time of day or night.

What has improved since the last inspection?

The cleanliness, tidiness and general maintenance of the home has improved greatly over the past two inspections and the home now provides a very pleasant environment for residents. Some training in the provision of suitable activities for the older person has been undertaken by two members of staff and a limited programme of activities is now in place. This is intended to be expanded and improved upon. The standard of catering and meals has now improved over the past two inspections and most residents stated that they enjoyed the food, that it was `very good` and that `there`s always plenty to eat`. All staff personnel files now include the paperwork necessary to ensure that staff that are employed are fit to work with the older person. Some training, notably that in the protection of older people has taken place, along with some training in the physical health needs of older people. Most of the requirements made at the last inspection have been undertaken. Agency staff spoken with stated that they felt the standard of care provided at the home was `very good`, that they enjoyed coming to the home, and that if necessary, they would feel comfortable with one of their relatives being admitted to the home. It is evident that the deputy manager and staff have put in a tremendous amount of work to ensure that the home has improved so much over the last year.

What the care home could do better:

The employment of permanent staff must be made a priority, as although the agency staff working at the home are regular, there is a need to ensure that all staff are well trained in the care of the residents with these specialised needs. Recruitment is taking place but this is proving difficult due to the location of the home and lack of public transport. Some training for care staff in physical health and knowledge of the physical symptoms and results of illness should be implemented. Care plans need to be improved in clarity and detail and must be reviewed regularly. At present it is difficult to get a clear picture of the care needed, and there is evidence that reviewed needs are not put into the body of the care plan and not always followed up. Staff must ensure that all residents are given the choices of menu and that pureed foods do not have all their individual constituents mashed up together. Some health and safety issues need to be looked at. The electrical wiring review is overdue, and the fire risk assessment cannot be found and therefore may need to be repeated.Some items, such as paving slabs and piping had been left in the garden and should be moved, and the staff rest room door and the hairdressers room should be kept locked when there is nobody in there, to prevent residents wandering in and accidents with hot water or the kettle. Window restrictors need to be checked as some now allow the windows to be opened too wide.

CARE HOMES FOR OLDER PEOPLE Partridge House Nursing and Residential Care Home Leybourne Road Bevendean Brighton East Sussex BN2 4LS Lead Inspector Elizabeth Dudley Announced 2 August 2005 10:00 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. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Partridge House Nursing and Residential Care Home Leybourne Road Bevendean Brighton East Sussex BN2 4LS 01273 674499 Address 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) Anchor Trust Vacant Care Home with Nursing 38 Category(ies) of Mental Disorder (MD) 38, Dementia (DE) 38 registration, with number of places Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated is thirty-eight (38). 2. Service users should be aged sixty (60) years or over on admission. Date of last inspection 11 April 2005 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 recently added bringing the number of service users able to be accomodated to 38. This will provide 30 nursing beds, 6 for residential care and 2 for respite care. A new conservatory has recently been added to the building. All of the accomodation 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. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on the 2nd August 2005 over a period of seven and a half hours, and was facilitated by Ms Sue Helliwell, deputy manager and Ms Angela Scott, regional manager. This inspection forms part of the annual inspection programme for the home. During the course of the day a tour of the home was undertaken and documentation, which included care plans, personnel files, health and safety documentation, menus and staff rotas, was examined. Twenty residents and eight members of staff were spoken with and discussed various aspects of living or working in the home. Although no visitors were seen on this day, a very good response to the CSCI questionnaires was received from residents relatives and representatives, allowing a well rounded view of the home to be gained and thanks are given to all those who responded. Comments received from these questionnaires will be included in the main body of the report where relevant. Thanks are extended to Ms Helliwell, Ms Scott, residents and staff for their courtesy and hospitality on this day. What the service does well: Partridge House provides a specialised service for older people who have mental health illness. The majority of the registered nurses have specialised in the care of mental health needs and the care assistants receive training related to these. The home provides a good, understanding atmosphere with residents having freedom of movement around the home and gardens, whilst being allowed to maintain their dignity and express themselves. The home aims to use as little medication as possible. Questionnaires sent to relatives of residents showed that the majority thought that the home offered a good standard of care to the residents, that the staff were very kind and thoughtful both to the residents and visitors and that they felt the residents were able to make choices in their daily lives. Most residents spoken with stated the staff were ‘wonderful’, ‘very kind’, ‘are my friends’, ‘are cheerful and smile a lot’. All residents appeared clean, well dressed and cared for and those in bed appeared to be comfortable. The kitchen can cater for a varied diet and provides both finger foods and special high protein and high calorie meals for those residents who need these. Appreciating that people with this type of illness often wish to eat at various times of day, simple foods that can be cooked by night staff are provided in fridges in the main kitchen or kitchenettes so that meals can be provided at any time of day or night. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: The employment of permanent staff must be made a priority, as although the agency staff working at the home are regular, there is a need to ensure that all staff are well trained in the care of the residents with these specialised needs. Recruitment is taking place but this is proving difficult due to the location of the home and lack of public transport. Some training for care staff in physical health and knowledge of the physical symptoms and results of illness should be implemented. Care plans need to be improved in clarity and detail and must be reviewed regularly. At present it is difficult to get a clear picture of the care needed, and there is evidence that reviewed needs are not put into the body of the care plan and not always followed up. Staff must ensure that all residents are given the choices of menu and that pureed foods do not have all their individual constituents mashed up together. Some health and safety issues need to be looked at. The electrical wiring review is overdue, and the fire risk assessment cannot be found and therefore may need to be repeated. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 7 Some items, such as paving slabs and piping had been left in the garden and should be moved, and the staff rest room door and the hairdressers room should be kept locked when there is nobody in there, to prevent residents wandering in and accidents with hot water or the kettle. Window restrictors need to be checked as some now allow the windows to be opened too wide. 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. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5. Sufficient information is provided to enable prospective and existing residents to be sure that the home will meet their needs. EVIDENCE: Anchor homes has supplied a generic statement of terms and conditions and a service users guide to the home, this has been personalised to the home and contains all details relevant. A complaints procedure which should be in an easily read format and which includes the address of the local CSCI office should be added to this service users guide. The deputy manager stated that all residents have a copy of the service users guide. It is recommended that the name and contact details of the regional manager is included in this guide, in order to enable residents and visitors to become familiar with her name, and be able to contact her, as required. All residents or their representatives have now been offered a copy of the terms and conditions, and evidence of this is supplied. The individual’s fee breakdown needs to be shown in more detail and this was discussed with the regional manager and administrator. The deputy manager assesses all residents prior to their being admitted into the home, emergency admissions are only accepted in rare circumstances. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 10 All staff working at the home have a knowledge of the needs of residents admitted with mental health needs of the elderly, but there are some areas of physical needs that they are unable to meet at present and further training is being arranged around this. The home should refrain from admitting residents with these needs (identified in standard 8) until all the registered nurses have updated their knowledge and skills in certain areas. This was discussed and agreed with the regional and deputy managers. Prospective residents and their representatives, families or friends are welcome to look around the home prior to making a decision about whether the home can meet their needs. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 Care plans need to have more clarity and frequency of review to ensure that residents assessed needs are met. EVIDENCE: Although care plans contain in-depth information relating to the psychological, social and physical needs of the resident, there is no evidence to show that the residents or their representatives have been involved in the formation of the plan of care. In some cases the care plans have been reviewed at two or three monthly intervals, in some plans this is six monthly, instead of a minimum of monthly as required by this standard. These have been made requirements on previous inspections. Likewise some of the reviewed needs are not entered on the appropriate care plan pages. In order to find relevant information it is necessary to search through the care plan, and the essence of good care planning is simplicity and clarity. However one care plan has been reformatted and this presents the proposed care to be given in an easy to read and succinct manner. Registered nurses are reminded that all parts of the care plan, including skin assessments, are required to be reviewed monthly. A good nutritional assessment is included in the care plans and those residents at risk from poor nutritional intake are weighed regularly and the cook provides supplements to the normal dietary intake. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 12 Comments received from the relatives of one resident stated that ‘the action points that emerge from care plan meetings need to be carried out, or the reasons for not doing so stated in the care plans.’ This indicates that the reviewed plan of care is not always followed, therefore showing a requirement for a new plan to be written clearly following a six monthly formal review, and the revised assessed needs to be cascaded to all staff involved in that resident’s care. This same relative also stated that specialised tests such as hearing and eyesight were not arranged to be done as soon as they were needed. Maintaining sensory abilities are an important part of the care of a resident. There have been criticisms in the past that the home has been slow to bring in specialist nurses, but there is evidence that this now takes place when needed. There are no registered nurses that are able to undertake male catheterisation at present. A requirement was made at the previous inspection that this training was undertaken, and although the home has made efforts to comply with this, further training is necessary and therefore this has been maintained as a requirement. Two more registered general nurses will be joining the staff and it is hoped that there will be an exchanging of knowledge between the different specialities of general and mental health nursing. The home holds some pressure relieving equipment and staff have received training in the prevention of pressure damage, there are no residents in the home with damage at present. The administration of medication has improved with only one medication not signed off when given, staff must be vigilant when administering medication. The deputy manager has been pro-active in dealing with the few times that minor medication errors have taken place, and at the present time some tablets ( not controlled drugs) are missing but the regional manager and deputy manager had commenced addressing this. All medications were seen to be in date and there was evidence of stock control. In view of the high temperatures reached in the clinic room (30C) it is recommended that all drugs that are temperature vulnerable be stored in the drug fridge until the room temperature can be controlled. Risk assessments were in place for one resident who was self administering medication, but this is no longer applicable. Residents spoken with stated that they felt they were treated with both dignity and respect, and questionnaires from relatives identified that they also felt that this was so. Very good interaction was seen to take place between staff and residents; two residents stated that the staff were ‘wonderful’. One questionnaire identified that although the staff were obviously keen to maintain residents dignity and independence, it was felt that intervention was necessary at times even if the resident was reluctant to allow this to happen. All residents were seen to be very clean, well dressed and appeared well cared for. Although there were no residents at this time that were very ill, past inspections have shown that the dying resident is well cared for and that relatives are allowed to stay with them. Macmillan nurses are brought in if required and advice is sought from them. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 13 A letter was seen praising the care given to a resident who died at the home and stating that the relatives felt that the resident had a very high standard of care which was ‘given with love and kindness’. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15. There is evidence that residents are able to make choices around their activities of daily living and that activities have now been commenced to improve their quality of life. Residents are not always able to make choices regarding food and this is also apparent in the presentation of some of the pureed food. EVIDENCE: Two care assistants have undertaken training on providing activities for elderly people with mental health needs and a limited activities programme has been commenced, this should be expanded to contain activities of interest for all the residents, a record is kept of those residents who are taking part. However it is evident that the importance of an active social life is beginning to be realised, and it is expected that this will move forward to include more activities and social events. A barbeque has been held recently, and musical entertainers brought in. Two relatives identified the need for more activities in the questionnaires received by the CSCI, and it is to be expected that the home will take note of this as it is an area that has caused concern, although it is starting to be addressed. A greenhouse has also been provided with the intention of enabling residents to start growing plants. Residents were seen to have freedom of movement around the home and the garden, and it was seen that staff were happy to keep meals for residents who did not wish to eat at the allotted times. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 15 Residents were seen to be able to take themselves to bed when they wished in the afternoon or request that staff took them, and residents stated that they could choose their times of getting up or going to bed. All residents spoken with stated that they were happy at the home and they felt they were able to choose what they wished to do, two stated that they felt that the staff were ‘their friends’. There were no visitors around the home but they identified in their questionnaires that they are always made welcome and that the staff were very kind and friendly. The home has an open visiting policy although visitors wishing to visit very late at night are asked to arrange this with the staff for security reasons. Ministers of religion visit the home. The menus are much improved and it was evident that there were choices available. Fresh fruit is put in the lounges three times a week and residents can help themselves to this. Most cakes and puddings are home made. The cook provides finger foods for those residents who will not sit for a meal and also late night snacks and easily cooked foods are left for those residents wishing to eat in the middle of the night. High calorie and high protein menus are available for those residents who have been identified as having special nutritional needs and the cook keeps records of these and the food given to them. However care staff need to sign the unit records that details the food taken by these residents. Likewise the cook stated that sometimes care staff do not approach each resident to ascertain their choice of food for that day, this is necessary insomuch as the cook is required to keep records of the food that is provided that is not on the daily menu and also all residents are entitled to be able to choose what they wish to eat. On one of the units care staff were seen to be mixing up all the constituents of the pureed meals therefore preventing the resident from being able to identify what they were eating. This is very bad practice and training must be held around this. The meal of the day was smoked haddock with a white sauce, broccoli and new potatoes or cottage pie, followed by ice cream and fruit. Most residents stated that the quality of the food was good. Fridge and freezer temperatures were seen to be recorded and all food was stored correctly. Attention to cleanliness in some areas of the kitchen is required, although it is appreciated that there is no regular kitchen assistant at present. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18 Residents are protected by a robust complaints procedure and staff awareness of their responsibilities in the protection of those in their care. EVIDENCE: There is a complaints procedure which is displayed in the foyer between the outer doors, some relatives stated that they were not aware of the complaints procedure but this has seen to be displayed on every visit made to the home. It has been moved from its previous place on the notice board due to constantly being removed by a resident. It is required that this is included in the service users guide. The home is in contact with solicitors who represent residents and will enable a resident to find a solicitor or financial advisor if required. The majority of staff have now received training in the protection of the vulnerable adult and the home is reminded of the necessity to continue to provide regular sessions in this. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 17 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) 19,20,21,22,23,24,25,26, Much improvement to the cleanliness and tidiness of the home is seen and Partridge House now provides a pleasant environment for residents. EVIDENCE: General maintenance at the home is much improved, with all curtains being on their tracks and evidence that some of the bathrooms have been redecorated, carpets look fresh and clean and there were no minor maintenance issues seen. The tidiness of the home has improved, items have been removed from corridors and bathrooms and it is obvious that staff have worked hard to achieve this. This must be maintained. The garden is on the whole, well maintained, although some of the shrubs now need to be trimmed or pulled away from windows where they are obstructing the light. Lounges are light and airy and there is the added facility of a pleasant conservatory. Meals are taken in the dining areas within the lounges. There are 38 single bedrooms all having an en suite facility consisting of a shower, washbasin and wc. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 18 All bedrooms have a lockable door and drawer, keys for these being given to residents within the auspices of a risk assessment. The rooms were all clean with furniture that is in good condition and suitable for the needs of the residents. All beds are variable height. Bed linen, carpets and curtains appear to be in a satisfactory condition. All water outlets used by residents have their temperatures monitored on a monthly basis and were seen to be within recommended parameters. Under floor heating is used in the building. Some window restrictors have been overridden and are now not functional, this was apparent in the upper floor dining area. Whilst looking at the building from the garden it appeared that two bathroom windows were wide open, but this was not apparent from inside and they may have only temporarily been overridden. This should be addressed and discussion with staff needs to take place to ensure that they do not override these restrictors. The home is purpose built and therefore has handrails and a shaft lift, other equipment for the moving and handling of residents is available and the home has been assessed by a disability specialist. All doors leading to the front of the property are alarmed for resident security, but residents have free access to the back garden which is secure. The majority of the home is clean and free from offensive odours, but some cleaning is needed in the kitchen, although there is no regular cleaning assistant at present. Staff have received some training in infection control and there are policies addressing this. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 19 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) 27,28,29,30 Staff training is taking place with permanent staff, but several shifts are worked by agency staff which does not guarantee a skill mix or the knowledge to ensure that residents needs are appropriately met at all times. There is now a robust recruitment system in place which ensures residents safety. EVIDENCE: Although Partridge House has a small core of permanent staff, there is an above average use of regular agency staff who cover several shifts a week. Interviews are being held to recruit permanent staff. This must continue. Although comments have been received stating that there were staff shortages at weekends, the off duty rota does not support this and staff spoken with stated that there are sufficient staff on duty at all times, and that they do not work short staffed. Permanent staff receive training in the needs of the residents in this category of need, but agency staff also will need to attend regular training sessions if they are working many hours in the home. Comments from a relative state that care assistants do not appear to have the knowledge of medical illnesses and conditions such as a resident ‘suffering from a stroke, and appear to take the residents efforts to communicate as dementia or nonsense’ and feels that the level of medical knowledge held by the care assistant should be broader. This must be addressed by the home, because although the permanent staff have a knowledge relevant to the care of the elderly with a mental health condition, a lack of knowledge around physical conditions has been identified at previous inspections. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 20 The home has a good induction course which is followed by all staff on commencing their employment and there was evidence that staff receive ongoing training and study days. The amount of staff that are undertaking NVQ 2 was not assessed at this inspection. Personnel files included all documentation as required by this standard and Regulations19 and Schedule 2. This information was easily accessed and the administrator has worked hard to achieve this. No staff now commence work prior to their CRB or ‘POVA First’ being obtained. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 21 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) 31,32,33,32,35,36,37,38. Although there is no permanent manager staff and residents state that there is a good atmosphere within the home thus ensuring that it is a pleasant place in which to live and work. Documentation is in place which identifies that the majority of utilities and equipment is regularly tested, a few issues were found that could cause problems for residents but generally the home provides a safe environment for residents. EVIDENCE: Ms S Helliwell, the deputy manager has been running the home in the absence of a permanent manager, with help from another manager from the Anchor Trust group. The regional manager Ms A Scott visits the home on a fortnightly basis. Recently a new manager has been appointed who will commence in post at the end of October 2005. There is a good ethos within the home and residents and staff were very positive about the support that they receive. The majority of residents spoken with stated that they were happy with the care they receive and that they liked all the staff. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 22 Staff stated that although they find the agency staff that they work with hard working and easy to work with, they would prefer to have regular staff that had the same training as they. There is a quality assurance programme in place and it is planned to send out questionnaires to all residents or their relatives to get their views on the services provided by the home. Staff meetings were taking place on a monthly basis and it is intended to recommence these. It is hoped to commence relatives meetings. Many of the CSCI questionnaires sent to relatives and residents identified that they were not aware of inspections or inspection reports in the home. Posters are put up in the home stating the date of announced inspections, and following discussions with Ms Helliwell and the Regional manager it was agreed that in future inspection reports will be available in the foyer and in the lounges on the units. Policies and procedures are in the process of being updated and these are available for all clinical staff in the nursing offices. No financial details relating to Anchor trust or the home business plan were available at this inspection, but these are to be sent to the CSCI. Anchor Trust holds one account for all residents monies and this does not allow individual residents to have the benefit of their interests. This is to be discussed with Anchor Trust in the future. Although resident’s personal allowances or money given in for safekeeping are kept individually within the home, no records of how this is being spent are kept. This must be commenced. Regulation 26 visits are made on a regular basis and these have now been improved to give a balanced view of the home, these are received by the CSCI. Staff supervision has been recommenced and records of these were seen. All records are kept in a secure environment. The majority of certificates relating to the servicing of utilities and equipment are in place but the IEE certificate was due to be undertaken in January 2005, and there was no evidence that this has taken place. Likewise there is no evidence that a fire risk assessment has taken place. Keypads have been put on most facilities such as the kitchenettes and staff changing room, however the staff room which holds a kettle and microwave, and the hairdressing room, which are secured by key or bolt only, were both found to be unlocked. This could place residents in danger. Staff must ensure that all residents toiletries and razors are removed from communal bathrooms when residents vacate the room. Paving slabs, metal pipes and a hosepipe across a pathway in the garden were seen, these are potential hazards for residents. All individual residents rooms are at present kept closed, if this situation should change, automatic fire closures will be needed. All staff have received mandatory training. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 23 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 2 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 2 3 x 2 3 2 2 Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 24 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 1 Regulation Reg 5 (e) Timescale for action That the service users guide Sept 1st includes a copy of the complaints 2005 procedure and contact details of the local CSCI. That all care plans include Sept 1st evidence that the service user or 2005 their representative has been involved in the formation of the care plan and all parts of the care plan are reviewed on a monthly basis. ( This was a previous requirement May 5th 2005) That service users are not Immediate admitted to the home unless their needs can be met and where required, additional training is given to enable staff to meet these needs. That the reviewed assessed Immediate needs of the service user are written in the main body of the care plan and staff identify that the reviewed care takes place or identify the reason that this cannot happen That staff ensure that identified Immediate needs such as sight or hearing tests are undertaken within a reasonable period of time. Version 1.40 Page 25 Requirement 2. 7 Reg 15(1)(2)( b)(c) 3. 8 Reg 14(1)(d) 4. 8 Reg 15(1)(2)( b)(c) 5. 8 Reg 13(1)(b) Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc 6. 15 Reg 16(2) (i) 7. 26 Reg 13(3) 8. 9. 10. 27 28 38 Reg 18(1)(2) To ensure that service users are able to make choices about the food they eat, that records are kept of these and that pureed meals are served in a manner that allows the food to be identified. That the standard of cleaning in the kitchen is improved with tiles being replaced and grouting cleaned. That efforts be continued to recruit permanent staff Immediate Sept 30th 2005 Immediate and ongoing Nov 30th 2005 Immediate 11. 12. 13. 38 38 38 Reg 18( c) That training, identified in the main bodyof the report in this standard is provided to staff Reg That the IEE examination and 23(2)(4) fire risk assessment are undertaken and evidence is sent to the CSCi Reg 13(4) That those garden items that could pose a hazard to service users are removed. Reg 13(4) That all personal toiletries and razors are removed from communal bathrooms. Reg 13(4) That a keypad or similar system is put on the staff rest room and hairdressing room or risk assessments take place. That window restrictors are regularly checked Immediate Immediate 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. 2. Refer to Standard 2 9 Good Practice Recommendations That the breakdown of fees in the terms and conditions identifies who pays which part of the fees. That the clinic room temperature is checked daily and action taken to ensure correct storage of temperature sensitive medication. H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 26 Partridge House Nursing and Residential Care Home 3. 4. 5. 6. 12 35 38 38 That measures are put in place to expand on the variety of activities offered. That a robust method of accounting for and auditing residents personal money given to the home for safekeeping, is put in place. That the shrubs overhanging bedroom windows are trimmed. That rooms are assessed for the need for automatic door closures when new service users are admitted. Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 27 Commission for Social Care Inspection Ivy House 3 Ivy Terrace Eastbourne East Susssex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Partridge House Nursing and Residential Care Home H59-H10 S14021 Partridge House V230390 020805 Stage 4.doc Version 1.40 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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