CARE HOMES FOR OLDER PEOPLE
Paternoster House Watermoor Road Cirencester Gloucestershire GL7 1JR Lead Inspector
Ruth Wilcox Unannounced 1 August 2005, 09.30. 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. Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Paternoster House Address Watermoor Road Cirencester Gloucestershire GL7 1JR 01285 653699 01285 644630 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) The Order of St John Care Trust Mrs Sheila Ling Care Home 40 Category(ies) of OP old age (40) registration, with number of places Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 13/12/04 Brief Description of the Service: Paternoster House is a purpose built care home providing nursing and personal care for 40 older people, aged over 65 years. It is situated near to Cirencester town centre, and is managed by The Orders of St John Care Trust. The home has one room in which respite care is provided on a contractual basis with Social Services. The home also offers day care for up to four people each day, and is able to offer an assisted bathing facility, a meal and social activity for these day care clients. The accommodation is purpose built, and is provided on two floors. A staircase and a shaft lift provide access to the first floor. Residents’ private accommodation is provided in single rooms on both floors, two of which have an en-suite facility. All rooms have a wash hand basin. Spacious and easily accessible toilets and bathrooms are conveniently situated around the home. Hoisting equipment and assisted bathing and showering facilities are provided, and throughout the home there is level access, grab rails and a resident call system. The home provides two spacious sitting rooms, a large lounge and dining area, and a small smoking lounge on the ground floor. There is a small sitting room on the first floor also. Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection over five hours, on one day in August. Care records, the opportunities for residents to exercise personal choices, and the standard of food were inspected, as were the policies and procedures for protecting the rights of vulnerable residents. A tour of the premises took place, and staff were observed going about their duties whilst interacting with the residents. The care of four residents in particular was closely looked at. Thirteen residents and two visitors were spoken to directly to obtain their view of the care and services they receive in the home. There was direct contact with the home manager and her deputy, the administrator and four care staff, all of whom were cooperative with the inspection process. The overall management of Paternoster House was looked at, as were the numbers of staff available in the home. What the service does well:
Paternoster House provides a purpose built, clean and comfortable environment. Residents are admitted to the home on the basis of a full and comprehensive assessment of their needs, and they and their representatives are welcome to visit the home before making their final decision about moving there. Residents are appreciative of the respect that is shown by the staff towards their personal choices and independence. The home provides a good standard of food, with a varied and balanced diet. Meals are well presented and allow for a good degree of choice for the residents. The home provides appropriate access to health care services in the community, ensuring joint working between them for the benefit of the residents. There are clearly written policies and procedures for the protection of vulnerable residents, and staff receive training and are able to demonstrate their awareness of these issues.
Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 6 The home has established a safe and transparent system to allow residents to place money or valuables in the main safe, keeping good clear records. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 5. The home’s admission procedure ensures that all residents, or their representative, can view the home before choosing to live there, and are admitted on the basis of a full assessment of their needs, ensuring that they can receive the care that they require. EVIDENCE: Residents are admitted to the home on the basis of a fully documented assessment of their health and personal needs, which can be performed in hospital or in the person’s own home, as appropriate; the assessment tool used for the three most recent admissions was seen to be comprehensive. Residents can visit the home, and stay in the home on a trial basis, the length of which can be one month or determined and made flexible according to the individual’s needs and wishes. Inspection of records confirmed that other helpful information is obtained prior to residents’ admission, such as the Social Services care plan and Registered Nurse Care Contribution assessments, where applicable. Paternoster House does not provide intermediate care.
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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 & 10. There is a care planning system in place, which in the main provides staff with the information they need to satisfactorily meet residents’ health and personal needs; additional recording in some cases would further enhance this. Care and support is offered in such a way as to promote the privacy and dignity of the individual. EVIDENCE: Residents have a personal plan of care, which is directly linked to their needs assessment; four plans were chosen as part of a case tracking exercise. Care plans in the main are well written, with clear instructions for staff to follow. In one case a continence care plan did not contain the detail of the initial assessment and the support equipment that was to be used as a consequence. In another case an assessed safety risk, associated with a shortterm memory loss did not have a documented plan of care associated with it. Reviews of plans are carried out regularly; in one case the interventions of the Consultant Psychiatrist did not feature in the review of the associated plan. Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 10 Records contained a large amount of evidence of how residents’ health needs are met, through sourcing the appropriate health care services in the community and through good multidisciplinary working. Community psychiatric services, hospital clinic reviews, and visiting health care professionals are well documented. Appropriate risk assessments are documented, with recorded risk reducing actions for staff to follow. Care plans contained records of residents’ general condition and health, vital signs and weights. Residents spoken to were very satisfied with the care they receive, confirming that staff are respectful of their needs and choices. One person said that she was ‘treated like a queen, and that staff couldn’t do enough for her’. One person said that they would like to ‘see more of the staff; they are so busy,’ and that generally they were ‘very respectful about their privacy’. Two visitors were very satisfied with the care their relative was receiving, with one saying that staff are ‘patient and kind’, and the other saying that ‘staff and manager are very good’. Staff were seen to be attentive, helpful and respectful during their contact with the residents. Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 & 15. The consideration and respect that is shown by staff towards residents ensures that residents are able to exercise control and choice in their daily lives. Dietary needs of residents are well catered for, with a balanced and varied selection of food available that meets their tastes and choices. EVIDENCE: Staff were observed very clearly demonstrating a respectful and mindful attitude towards residents’ choices. They were offering options for all aspects of life, from where and how residents’ were spending their time, to choices at lunch. Residents’ rooms reflect the individuality of the occupant due to them having the option to personalise their room with their personal belongings. One person said that staff are mindful of where she ‘prefers to sit and spend her time’, another said that the options available to her in terms of spending her time are ‘now more varied’, and that ‘staff respected the choices that she made’. There was a good degree of choice available for lunch, with two main dishes on the menu served, plus other alternatives in cases where the menu was not wanted.
Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 12 The meal was seen being served in the spacious dining room, and appeared very well cooked, nutritious and well presented. Residents, without exception among those spoken to, said that the food was very good and tasty, and that there was a lot of choice available to them. Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The home’s Adult Protection policies and staff’s knowledge and awareness of them helps to provide a safe environment, with the rights of those living in the home upheld. EVIDENCE: The home has written policies and procedures for the protection of vulnerable adults, and has copies of other relevant documents and information available. Staff receive mandatory training in abuse at induction and during the NVQ programme; in addition to this a video presentation about the recognition of abuse and how to deal with it has been given to all staff. All staff spoken to confirmed their training, and were aware of the Whistleblowing procedures to follow if they had any concerns. One person was slightly more vague regarding recognition of abuse, and this was relayed to the manager, who agreed to follow this up with the staff member concerned. Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26. The standard of the environment within this home is satisfactory, and provides residents with a clean, comfortable and homely place to live. EVIDENCE: The home has a full time maintenance person employed, and is generally well maintained and decorated. Redecoration and gardening is being done on a rolling programme. The grounds are tidy and well maintained. There are plans to purchase new armchairs for the front sitting room, and to replace some of the linen for the residents. A new call bell system is also being installed. Communal areas are clean, light and airy. There is one room, which is giving rise to some offensive odour; staff are endeavouring to control this with the use of deodorisers, and are considering the possibility of an alternative flooring. Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 15 The laundry was clean, tidy and orderly. There are facilities in here for the sluicing and disinfection of any foul or infected laundry. Staff are provided with gloves and aprons. Two visitors commented on how cleanly and pleasantly the environment is maintained. Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Provision of staff is adequate, in conjunction with the use of agency staff, to meet the needs of the residents. EVIDENCE: Rotas of all staff are maintained, and records of these were seen. Staffing recruitment and retention has proven to be problematic for some time at Paternoster House, and continues to be so at this time. Some agency staff are used, though a good degree of continuity has been achieved in this regard, which is reassuring for residents and visitors. Two agency carers on this day had worked in the home regularly, and clearly knew the residents very well. Nursing and care staff were meeting the needs of the residents on this day, and residents generally spoke very positively about the staff group. One visitor commented on how aware the staff were in terms of meeting his relative’s complex needs. The manager conducts a weekly staffing audit, using a resident dependency tool, in order to assess the ability of the team to meet the needs of the residents accommodated at the time. The latest audit has shown a correlation between the staffing numbers needed and those that are provided. Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 17 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) 34 & 35. Good management systems are in place to ensure that the welfare and rights of the residents are safeguarded. EVIDENCE: The overall management of Paternoster House is now provided by The Orders of St John Care Trust, and evidence of robust financial and business management systems was inspected as part of the recent registration process. Some residents have placed personal money and valuables with the home for safekeeping. Clear, transparent records for each person are kept. Residents or their representative have signed to acknowledge some transactions, but where this has not been possible in the majority of cases, two staff members sign the record to witness on behalf of the resident. A random check on some monies held was accurate. Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 18 Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x x 3 3 x x x Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 20 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15(1) Requirement Staff must prepare written care plans, which demonstrate how residents needs in respect of their health and welfare are to be met. (This is with particular reference to continence needs and safety risks associated with short term memory loss on this occasion). Timescale for action 31/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 7 Good Practice Recommendations Where relevant, any psychiatric interventions should be included in the associated care plan reviews. Paternoster House D51_D03_64617_Paternoster House_v233640_UI_stage4.doc Version 1.30 Page 21 Commission for Social Care Inspection Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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