Inspection on 26/05/06 for Partridge House Nursing And Residential Care Home

This inspection was carried out on 26th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Partridge House Nursing And... 01/05/07

Partridge House Nursing And... 09/02/06

Partridge House Nursing And... 03/11/05

Partridge House Nursing And... 02/08/05

Partridge House Nursing And... 11/04/05

Partridge House Nursing And... 11/01/05

Partridge House Nursing And... 24/08/04

Partridge House Nursing And... 04/06/04

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

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 26th May 2006 07:00 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.V292014.R01.S.doc Version 5.1 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.V292014.R01.S.doc Version 5.1 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 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) sharon.blackwell@anchor.org Anchor Trust 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.V292014.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is thirtyeight(38) Service users should be aged sixty (60) years or over on admission Date of last inspection 9th February 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 26th May 2006, are £702 per week. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 26th May 2006 over a period of ten and a half hours. During the inspection a tour of the home was undertaken, ten residents and four visitors were spoken with and discussions held with twelve members of staff. Documentation which included care plans, health and safety documentation, personnel files, medicine and catering records were examined. Comments from interested parties such as visitors, relatives of residents and health care professionals were also received by email, telephone and questionnaires, these have been included in the report where appropriate. Thanks are extended to the residents, manager, night and day staff for their courtesy and hospitality, and to all persons that furnished the information necessary to complete the report. What the service does well: The home provides a specialised service for older people who have mental health illness. Residents have freedom of movement around the home and garden, with staff providing support in an understanding and tolerant manner. The aims of the home are to use as little medication as possible whilst allowing residents to enjoy a maximum quality of life as they are able to have, within the scope of their abilities. The home is clean and has recently benefited from redecoration (which is ongoing). It has a well-maintained garden, which is accessible to all residents and residents are encouraged to help in the garden where able. Some of the registered nurses have a mental health qualification, whilst care assistants are encouraged to gain further understanding of the care of the older person with these needs. Comments received from relatives of residents included: ‘I’ve always been the carer because I didn’t realise that a care home could be like this, and I shan’t worry about her coming in next time’, ‘my mother usually looks well dressed and she is happy here’ and ‘She has found a sense of peace at Partridge and staff have managed to improve her mental cognition’. All relatives contacted said that they were kept informed of their relative’s condition and any incidents that occurred. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 6 Most residents spoken with were satisfied with their care and liked the staff, some comments received were, ‘I’m happy here’ and ‘They look after me and the staff are quite nice’. The menu offered is varied, including fruit and vegetables and some home made cakes. Whilst some residents said it was quite nice, some comments were made to the contrary. However it appeared well cooked and well presented on the day of the inspection. What has improved since the last inspection? What they could do better: Comments were received both prior to and during the inspection about the number of agency staff used to cover shifts especially at weekends. One resident stated that they found it ‘wearing’ to have to keep repeating how they wished to be looked after to different members of staff. A relative of a resident said that there were ‘too many agency staff, who do not appear to be fully briefed’. The standard of care planning is variable with lack of detailed explanation about what care is needed and how it is to be given. This is especially important given the amount of agency staff used. Some care plans had not been reviewed on a regular basis and there was no evidence of resident involvement in the formation of the plans. Although most residents found the food ‘alright’, others commented that ‘it depends – sometimes good, sometimes not’, whilst another complained about the lack of vegetables in season and that too much ice cream was served. Some staff and a few residents commented on the reliance on baked beans and tinned spaghetti ‘even when its not on the menu’. One relative and some residents said that they did not always have a choice of food. Although staff training has improved the manager must ensure that staff receive training appropriate to the needs of the residents in the home. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 7 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 DS0000014021.V292014.R01.S.doc Version 5.1 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.V292014.R01.S.doc Version 5.1 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 the following standard(s): 1,2,3,4 and 5 Quality in this outcome area is poor; this is based on the available evidence including a visit to this service. The home does not provide sufficient information to enable prospective service users to make an informed choice of whether they wish to move to the home. EVIDENCE: The statement of purpose was not available to be seen at this inspection, the manager is not sure of its whereabouts but does not believe it has been updated to reflect the current management status within the home. The service users guide does reflect changes taken place but few residents have a copy of this. The manager undertakes pre -admission assessments, all residents being assessed prior to their admission to the home. The assessment forms are well formatted and address the psychological, physical and social needs of the resident. Although the preadmission assessments should form the basis of the care plan, Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 10 it was noted that the original diagnosis, and therefore the relevant care, had been changed by the nurse that transcribed the information onto the care plan. The manager must ensure that this does not reoccur. The manager says that he takes neither the service user guide or the statement of purpose when he assesses a resident, but takes the home’s brochure and the Anchor Statement of Purpose with him. However this is very generic to Anchor and does not necessarily reflect this particular home. Prospective residents or their relatives need to have the home’s documents in order to be able to make an informed choice of home. Relatives spoken with stated that they can and did come into visit the home prior to the admission of the resident, but three said that they had no knowledge of the home before this visit. One relative stated that she had never seen the statement of purpose or the service user guide but that ‘this would have been useful as I had no idea about the home until I came to look around’. All residents have received a copy of the terms and conditions excepting one, and reasons for this have been discussed. The home is registered for the older person with mental health needs. At present the registered nurses are mainly comprised of registered general nurses rather than registered mental nurses. In order to meet the specialised needs, as well as the general health needs of these residents, a balance of both categories of nurses need to be employed. Some staff have received training in dementia care and challenging behaviour, and this should be extended to include the majority of the staff, in order to ensure that residents needs are met. Relatives and prospective residents can visit the home prior to a resident being admitted to the home. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor, this is based on the available evidence including a visit to this service. Care plans do not show evidence of resident involvement and do not clearly identify the care to be given to residents. Improvements in medication administration ensure resident’s safety. EVIDENCE: A selection of ten care plans was examined during the day. The quality of care planning was variable. Some of the care plans did not detail how the care was to be given, there was no evidence of residents or their relatives involvement in the care plan and not all care plans (or parts of the care plan) had been reviewed on a monthly basis. There were no signatures indicating which nurses had written the care plans. One care plan gave a different diagnosis of the resident to that written in the original assessment, and the care plan written accordingly, without any reference to the complications of the original diagnosis, or any reference of how the personal care was to be performed. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 12 Care assistants are responsible for the personal care but the lack of detail of action to be taken in the personal care planning would not assist the care assistant in performing this care. This was particularly evident in one care plan which related to a resident who was immobile and unable to perform any of the activities of daily living for herself, no information on how personal care was to be performed or on how to ensure that the existing pressure damage would be protected was in place. One resident admitted in 2005 for respite care and readmitted this year, initially for respite care, was still being cared for under the instruction of the previous care plan. This had not been reviewed or a new care plan made up on his readmission. This resident also had sight impairment but no instruction as to how to manage this was in the care plan. Although there was evidence of the wound care nurse having been involved with the treatment of pressure damage, wound care plans did not identify the grade of pressure sore, and the complete pressure damage care required was not detailed. Some wound care training has taken place, this was attended by both the registered mental nurse and carers, and a concern was raised with the manager that this may not have been sufficiently in depth for the registered nurse who would be doing the dressings and making judgement relating to wounds. Risk assessments in the care plans were in general, adequate, and had been reviewed regularly. One registered nurse raised concerns that the risk assessments were ‘too repetitive and difficult to see clearly what risks were involved’ these are company generated risk assessments and she has carried her concerns forward to Anchor Trust. There was evidence that other health care professionals including the Older Persons Specialist Nurse have been involved in the home. G.Ps and a dentist visit the home. Concerns were raised by a relative about the lack of physiotherapy available for his mother and the discussions were held with the manager regarding the Nursing Home Support team who can access physiotherapy. A relative of a resident receiving respite care said ‘Its wonderful here, the care given is very good, this home has made me realise that care-homes can be good, with good food and good staff’. It was noted that several forms were in the clinic room for blood samples that had not been taken. The nurse on duty said that they were waiting for a member of staff who had venepuncture skills to attend to these. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 13 Residents were seen to look clean and tidy and appeared well cared for, and staff were seen caring for them in a relaxed way whilst enabling residents to make choices. There have been concerns raised around administration of medication in previous inspections, but much improvement has been seen relating to this. However some aspects require attention. Medication training was taking place on the inspection day and trained staff were seen coming in for this, although some were coming in from the sister home in Bevendean. All drugs and dressings were in date and there was evidence of stock control. The clinic room was reasonably clean and room temp and drug fridge temps taken. All medications for this month had been signed for on administration. There were no controlled drugs in the home and no residents receiving medication by percutaneous gastric tubes. The MAR charts need to include signatures following application of creams, not just ticked as previously. Hand written drug prescriptions require signing by two people and photographs need to be put on those MAR charts relating to new resident. Policies and procedure relevant to medication were not examined on this inspection, but staff assured the inspector that the requirement made by the pharmacy inspector relating to this had been met. Residents, and their relatives that were consulted, felt that they were treated with dignity and that they were able to make choices about their activities of daily living. One resident said that ‘I don’t like speaking to the others and they don’t make me, I can go to my room when I want’. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 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 the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. The home has commenced a programme of activities which is varied allows for one to one contact for those who do not wish to participate. The food served is not always as identified in the menu, and some residents are not aware of the food choices available. EVIDENCE: An activities person has commenced and is providing a programme of activities suitable for the people within the home, these include food tasting, cake and ‘smoothie’ making, movement to music and painting. Outside entertainers come in and there are picture quizzes and teas in the garden. He has helped residents make new name labels for their doors. The activities co-ordinator will be attending two courses addressing the provision of activities for older persons within the next month. He appeared enthusiastic about his role and spoke very positively about his plans for the activities in the future and about what he is currently doing. A programme of activities is in place on the resident’s notice board and they are also verbally informed about what is on offer that day. Records of those Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 15 that take part in the activities are kept and the co-ordinator is writing the preferred activities and how these are addressed in the care-plans. Residents can make a choice over what time they get up and go to bed and this was verified by the Registered nurse on night duty and by some residents. Some residents stated that they do not know what will be offered for various meals until they receive them, although care assistants stated that they go around with the menus on a daily basis. Some form of ‘aide memoire’ such as a chalkboard in the dining rooms with the meals written on them should be considered. There is open visiting within the home and visitors said they were made welcome. Some relatives spoken with both during and prior to the inspection stated that they were kept informed of the resident’s progress and of any concerns that the staff may have. Ministers of religion visit the home. Visitors said they found the staff friendly and helpful and that they were always offered tea and included in whatever was occurring within the home. The menu is prepared to cover a month’s meals, but staff said that the menu was not always followed with other food being substituted, however the menu appeared varied. The meal of the day was fish and chips or chicken breast and chips, followed by sponge pudding and ice cream. The cook stated that some puddings are home made, and as residents do not like ice-cream roll this has been stopped by manager — however several cartons were in the freezer. Fresh fruit and vegetables were seen in the storeroom, however the cook said that vegetables in season were not always provided. One resident had complained about the lack of fresh vegetables or vegetables in season — on this day ‘mushy peas’ were being served. Staff and one resident commented about the frequency of baked beans at meals even though this was not on the menu on a regular basis, all felt that the provision of these should be limited. The menu identified that supper is varied, however on this day soup, sandwiches and jelly were being offered. Homemade cakes were provided at teatime on this day. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 16 The home provides two days when cooked breakfasts are offered. Residents were seen to be offered toast and cereal on this day with breakfast being informal and given to residents when they were ready or in their rooms. The manager stated that he has been undertaking quality monitoring on a monthly basis within the kitchen, but accepted that he may need to go in there more often. Temperatures of fridge, freezer, and hot and cold food were being monitored and recorded. All staff undertaking preparation or handling of food have the appropriate training. Presentation of meals was good but one member of staff seen was mashing a pureed diet together instead of serving it with the individual components being able to be identified. It was noted that at some meals some of the tables were provided with tablecloths, and it would be appropriate if all tables were set properly for all meals to maintain the dignity of residents. Staff were seen to be assisting residents with meals in a dignified and patient manner, and also to be preparing cups of tea or other drinks during the day when residents asked for them. Cleanliness in the kitchen needs attention and this is addressed in National Minimum Standard 26. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 and 18 Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. Measures to address complaints and to ensure the protection of residents within the home are in place. EVIDENCE: The complaints policy meets the standard and is displayed on the main notice board and in the service user guide. Evidence showed that complaints received have been dealt with in an appropriate manner and actions taken to resolve any reoccurrence. Few complaints have been received by the home. Two adult protection issues from March 06 showed there was insufficient evidence to prove that they occurred, but the Brighton and Hove Multidisciplinary adult protection team made recommendations to the home. Staff have had training and appeared to be aware of their role in the protection of the vulnerable adult. Adequate information relating to adult protection issues have been received by the CSCI. Relatives of the residents involved in the allegations stated that they had been kept informed of any developments as they occurred. The manager can access advocates and solicitors for residents if required; one resident has an advocate visit on a regular basis. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 and 26 Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. Continued improvement in décor and maintenance contribute to the wellbeing of residents by providing a pleasant environment. Attention to cleanliness in the kitchen and clinic room areas would further the protection of residents. EVIDENCE: The home now has a full time maintenance person and the previous improvement in maintenance and decoration noted at the last inspection is on going. Some carpets are in need of replacement, corridor and some lounge carpets are stained and there was evidence of some odours within some rooms, the ground floor lounge and conservatory area. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 19 Some parts of the home have been redecorated and there is a redecoration programme in force. Room 29 was seen to be in need of redecoration. A drawer in one kitchenette was broken and staff said that this had been broken for some time. This was repaired during the inspection. The home provides lounges on each floor and a conservatory area, which is available to residents all year round. This opens on to a very pleasant welllandscaped garden, which can be accessed by all residents including those in wheelchairs. Sufficient bathrooms, with hoists and other equipment including specialist baths are provided for the residents. All rooms have an ensuite bathroom with a washbasin and toilet with sufficient space to be accessed by wheelchairs. The home has been assessed by an occupational therapist and has sufficient handrails and other aids to meet the needs of the service users. All residents personal accommodation is provided in single rooms, some of which have the ‘magic eye’ facility which informs staff of when a resident gets out of bed in the night. However night staff stated that only one key was available to turn off this system when they went into the room and this was often difficult to obtain. All rooms have lockable doors and a lockable drawer, with keys being given to residents within the auspices of a risk assessment. All beds are variable height and all bed linen seen on this day was fit for purpose. Residents may bring in their own possessions to personalise their rooms, which are pleasantly decorated and well maintained. Window restrictors are fitted throughout the home and these were in a good state of repair. Water temperatures have been monitored on a regular basis and are within recommended parameters. There is a good standard of cleanliness in most of the home apart from the kitchen where improvement is needed. Some tiles and the washbasin were in need of cleaning, the hot food trolleys had dried food on them and there was some cardboard stored in the kitchen, which had dust on it, as did the tops of containers and fire extinguishers. The kitchenettes on individual units were clean. The clinic room requires some attention to cleanliness and this must be addressed as part of the general cleaning of the home. There were odours in one room and in the lounge and conservatory. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 20 Sluices, bathrooms and toilets were clean. One resident stated that laundry is sometimes lost or misplaced and she had put a complaint to the manager relating to this. Ironing of resident’s clothes and bed linen was of a good standard at this inspection. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. The deployment of staff during the evenings and early mornings may compromise residents’ safety. The recruitment policy operated within the home ensures resident safety but continued use of agency staff may affect the continuity and quality of care. EVIDENCE: The duty rota showed that sufficient staff are working during the day to meet the needs of the residents. However night staff spoken with stated that the home’s policy of having two members of staff attend to residents resulted in the individual units not having anyone in the corridors or listening for other residents if one resident was being attended to. Similarly each floor has two units on it and there are two care assistants on each floor, therefore when a resident is receiving care the other unit is not being monitored. Discussions were held with the manager that thought be given to providing extra staff during peak periods in the evening and early morning to ensure resident’s safety. Staff stated that there was sufficient staff on duty for the main body of the night. Day staff also stated that one unit had more high dependency residents on it than the others, and that staff on this unit felt rushed and only had time to shower one resident in the mornings, other residents having a strip wash. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 22 As the rota evidences that 9 staff are employed during the day, deployment of staff must be examined and also the care routines. eg showering residents in the early evening or afternoons. It was seen that the main body of registered nurses being employed are Registered General Nurses as opposed to Registered Mental Nurses. Although previous inspections have required the home to have some general nurses given the frailty and general nursing care needs of some residents, a balance, in view of the home’s specialisation, must be in place. The specialised knowledge of the mental health nurse is required in this environment, and registered general nurses must undertake some training in the care of the older person with mental health needs. Although more permanent staff are being recruited, a substantial number of hours are being filled by agency staff. This does not ensure continuity of care or allow residents to be familiar with staff. Staff stated that the majority of the shifts over the weekend are filled by agency staff with very few permanent staff being on duty, and that they were unwilling to work at the weekends. The Multidisciplinary Adult Protection team made a recommendation that there is an integration of day and night staff and the manager must consider this. Recruitment of a deputy manager is ongoing. The turnover of staff has improved, with few staff having left in recent months and new staff recruited. This is a definite improvement and must continue. One member of staff has gained the NVQ 2 and ten further members of staff are to commence this. A staff training programme has commenced and some registered nurses have attended venepuncture and male catherisation training. Some of the newly recruited general nurses already have these skills. Care assistants are being offered training on the Dementia care and Managing Challenging Behaviour. Most staff have attended mandatory training. Staff receive an induction pack on commencing employment, with most being supervised for the first few weeks. However one member of the catering staff stated that she had received neither an induction nor training in COSHH. A member of care staff employed last Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 23 year said that she had not had an induction course on commencement of her employment. Six personnel files were examined which included those of new staff. All documentation was in place and no member of staff had commenced employment without a POVA First check being in place. The manager is unsure of whether all staff are in possession of the GSCC (General social care code of conduct) and is obtaining these. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37 and 38 Quality in this outcome area is adequate. This is based on the available evidence including a visit to this service. Current management has commenced the implementation of systems including staff supervision, staff training and health and safety measures within the home, to ensure the well being of the residents. EVIDENCE: The manager has been in post since October 2005, and has previous experience in managing care homes. He is a Registered General Nurse, but on commencement of his employment assurances were given to the CSCI by Anchor Trust that he would take an accredited course relating to mental health needs of the elderly and also the Registered Managers’ Award. These must be commenced. He has not yet applied for registration with the CSCI. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 25 Many improvements have been seen throughout the home since he came into post, this is particularly apparent in the notification of incidents to the CSCI, adherence to adult protection protocols, cleanliness and décor within the home and the retention and recruitment of staff. Several on-going issues have been addressed and there is an open and transparent relationship with the Local authority and the CSCI. There remain some issues to be addressed as detailed in the body of the report including care plans and some catering matters. There is a good ethos in the home, the staff which include longstanding members of staff, new staff and regular agency staff, all stated that they enjoyed working at the home and with this category of residents, that they felt that they were enabled to get the training they required and that they felt able to take any concerns to the manager. Positive feedback from residents and visitors relating to the staff were received, ‘Everyone looks after me well, the food good and usually very nice, I’ve got a nice room and people help me to get things done’, ‘Staff are good’, ‘Nurses come when I need them’ and ‘Yes its ok here’. A visitor talking about her mother said ‘they reviewed her medication and she moved rooms and she is happier than she has ever been’. Another visitor said ‘everyone is very friendly and helpful’. Quality monitoring around the catering is now taking place monthly, residents have been given questionnaires relating to the food and also to their opinion of the home and results are being collated. The manager intends to take the quality monitoring into other areas in home. Views of stakeholder such as other health care professionals and visitors to the home should be obtained. The manager states that he gets much feedback about the home from discussion with visitors to home, this must be formalised to form the basis of the quality monitoring system. Anchor Trust has commenced a new system of recording resident’s personal allowances and is now putting residents money into bank accounts under individual names. Personal allowances kept at the home are kept separately and recorded. Staff state that regular supervision has commenced and records were seen to this effect. This must be continued with all staff having the supervision at the times dictated by standard. Reg 26 visits taking place and received by CSCI. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 26 Staff meetings are taking place. All records and documentation relating to residents and staff are in locked areas. A requirement made at the last inspection has resulted in care plans being locked in cupboards in the lounge, however care staff say that they can never get the key when they need it. Consideration should be given to keeping these in the nurse’s office or some other place where they would be secure. Policies and procedures were not examined on this occasion, but the manager gave assurances that these are reviewed. Not all staff spoken with were aware of where the policies were kept, although new staff stated they were reading them as part of their induction. The manager stated that some staff have not been updated in their mandatory training such as fire training although most have moving and handling. The manager and the maintenance person have just attended training to enable them to give fire training and therefore although staff have a basic fire training in the induction, the manager was waiting to complete his course prior to giving the full training. Sixteen members of staff have undertaken training in first aid. All certificates relating to utilities and equipment were seen and up to date, regular fire testing is being undertaken and hot water temperature monitoring is taking place on a regular basis. A fire officer visited the home in February 2006 and a fire risk assessment is in place along with magnetic closures on individual room doors. In the early morning it was noticed that the security door to the stairs was left unlocked. A member of staff locked it when mentioned to him, and stated that the decorators, working during the night, may have left it open. However care staff must be vigilant to ensure that this does not reoccur. It was also noted that two kitchens on the units had been left unlocked when there were no staff in there, this must be monitored to safeguard residents. A member of kitchen staff was unaware of the COSHH documentation or hazard analysis. Training must be put in place. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 3 2 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 1 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 3 2 2 Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation Reg 4 & 5 Requirement Timescale for action 20/06/06 2. OP7 Reg 15 (2)(b) 3. OP8 Reg 15(2) Reg 13(b) That a statement of purpose and service users guide, that reflect the current status of the home are made available to current and prospective service users. That all service users have a copy of the service user guide. (This has been a requirement on past inspections) 30/06/06 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) That the reviewed assessed 30/06/06 needs of the service user are written in the main body of the care plans and that these reflect the current and changing needs of the service user, that reviews of care plans assess whether the care plan identifies needs that are current and still viable, and reflect appreciation of changes of needs which may occur due to the sudden change in a service users’ condition. (This was previous requirement, November 2005, February 2006) DS0000014021.V292014.R01.S.doc Version 5.1 Page 29 Partridge House Nursing And Residential Care Home 4 OP9 Reg 13 (2) 5. OP26 6 7 OP26 OP27 8 OP27 9 OP30 The MAR charts need to include signatures following application of creams. Hand written drug prescriptions require signing by two people and photographs need to be put on those MAR charts relating to new residents. Reg 13(3) That the clinic room and kitchen receive the surface cleaning identified. (This was a previous requirement Feb 9th 2006) Reg That the home is kept free from 16(2)(k) offensive odours. Reg Anchor trust to ensure that at all 18(1)(a) times suitably qualified, competent and experienced persons are working at the home and ensure that temporary workers will be able to meet service users needs. (This was a previous requirement, 3rd November 2005, February 2006 and is ongoing) Reg Staff Recruitment of permanent 18(1)(a) staff to continue (This was a previous requirement, 3rd November 2005 and is ongoing) Deployment of staff around the home to be addressed. Reg 18 That all staff receive an induction (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. 26/05/06 30/06/06 30/07/06 30/07/06 30/07/06 30/07/06 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 DS0000014021.V292014.R01.S.doc Version 5.1 Page 30 Partridge House Nursing And Residential Care Home 1 2 3 OP8 OP15 OP15 That night staff have access to extra keys to turn off the ‘magic eye’ in rooms when service users have received attention. That attention is paid to the setting of tables prior to each meal. That a method to remind service users of what is on the menu (e.g. a menu board) is set up in each lounge. Partridge House Nursing And Residential Care Home DS0000014021.V292014.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex 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 DS0000014021.V292014.R01.S.doc Version 5.1 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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