CARE HOMES FOR OLDER PEOPLE
Paternoster House Watermoor Road Cirencester Glos GL7 1JR Lead Inspector
Mrs Ruth Wilcox Announced Inspection 16th January 2006 09:30 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 Paternoster House DS0000064617.V276099.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. Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Paternoster House Address Watermoor Road Cirencester Glos GL7 1JR 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) 01285 653699 01285 644630 The Orders of St John Care Trust Mrs Sheila Ling Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st August 2005 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 DS0000064617.V276099.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out this announced inspection over six hours on one day in January 2006. The registered manager was present throughout the inspection providing assistance where requested, remaining open to the inspection process and cooperative throughout. The home was warm and welcoming, and the majority of the staff were pleasant and helpful. The availability of information about the home to assist prospective residents and their families in making their choice about it was looked at. Care records and the systems for the management of medications were inspected. The care of four residents was closely looked at in particular, and there was direct contact with fifteen residents, two visitors and six other staff. Their views regarding the standards of services and care at the home were sought wherever practicable. The opportunities for residents to engage in social activities were looked at, which included the arrangements to receive their visitors. The management arrangements for the home were looked at, as were the systems for monitoring and ensuring quality of the service, and the policy for dealing with complaints. The provision of staff and the way in which they are recruited and trained was inspected, and a tour of the premises took place, with particular attention to the standard of maintenance, health and safety and cleanliness. What the service does well:
Paternoster House provides a pleasant, clean, satisfactorily maintained and safe home for the residents. Prospective residents and their families have access to information about the home ahead of their admission, in order that they can make an informed choice about moving there. Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 6 Staff record good detailed care plans based on each residents’ individual needs, and plans contain good examples of the home working in collaboration with external health care professionals, for the benefit of residents. Medications are well managed on residents’ behalf, though they can manage their own medications if they are able and wish to. Residents themselves were very happy with the care they receive from the staff, with those spoken to saying that staff were very kind and helpful. A good standard of food is provided, with a varied and balanced diet. Meals are well presented and allow for a good degree of choice for residents; residents themselves were very satisfied with the food on offer for them. A social activities programme is provided, with which residents can participate or not, according to their choice. There are good systems for monitoring the quality of the service provided at Paternoster House, with residents and their families having opportunities to give feedback on their views and ideas. Visitors are freely made welcome into the home, and two of those met during this visit confirmed their satisfaction with the home, the care and the staff. There are good training opportunities for the staff, with staff encouraged to achieve an NVQ qualification. There are good management systems here, and the home does all it can to promote the health and safety of all those living and working there. What has improved since the last inspection?
The home should be commended for its efforts and success in achieving the ISO Quality Assurance standard. The home has improved some of the facilities for the residents with some new equipment, items of furniture, carpets, décor and fabrics in some communal areas and bedrooms. The resident call bell system has been replaced with a new one. There has been some recruitment since the last inspection, which has reduced the amount of agency staff used in the home. New staff are being supported by the existing staff team, and are working hard to establish and consolidate a cohesive staff team. Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 7 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 DS0000064617.V276099.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 Paternoster House DS0000064617.V276099.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 The pre-admission information ensures that residents have access to adequate information when making their choice about the home. EVIDENCE: Prospective residents are provided with an information brochure, which informs them and their representatives about the home and The Orders of St John Care Trust. The guides still contain information relevant to the previous registered providers at this time. Required contents pertaining to the Complaints Procedure, the most recent Inspection Report, the CSCI details, the Terms and Conditions of the home, and a standard form of Contract are not currently being included. A notice in each folder informs the reader that the format is only to be temporary until later in 2005. It is reported that the information is currently under review, with a revised and more up to date Service User Guide being produced. Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 10 The home’s Statement of Purpose is contained in a folder, which is easily accessible for anyone choosing to read it. This is fully reflective of the requirements in the regulations, with added useful information for any reader, which should be in each Service User Guide, as detailed above. Paternoster House does not provide intermediate care. Paternoster House DS0000064617.V276099.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. There is a clear care planning system in place that provides staff with the information they need to meet residents’ health and personal needs. The systems for the management and administration of medications are good, with arrangements in place to ensure that residents’ medication needs are appropriately met. EVIDENCE: Each resident has an individual plan of care, which is based on an assessment of their needs, including a range of risk assessments; four were selected as part of the case tracking exercise. Care plans are well written in the main, and each is regularly reviewed. Most aspects of plans contained clear instructions as to how each individual’s health needs are to be met, with visual evidence confirming that this is carried out. Plans demonstrated very good collaborative multidisciplinary working with a wide range of health care professionals where applicable. Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 12 The content in the ‘falls’ risk assessments was not sufficiently detailed to indicate specifically what was necessary in terms of monitoring the resident, and reducing the risks they were actually at. Residents themselves confirmed their satisfaction with the care they received, with many saying that the staff were very good and caring. One resident said that staff could be a ‘bit rough’ on occasions when carrying out manual handling tasks, though were mainly very kind. This person wanted this observation made to the manager, which was duly done. Medications are stored in safe, clean and secured locations. Many medications are supplied in a monitored dosage system, and any boxed and bottled medications are dated when opened to ensure timely usage. There are clearly printed Medication Administration Records from the supplying pharmacist, which are meticulously recorded and kept by the staff. Residents are supported to self-medicate if they wish and are able to, and this is done on the basis of a documented risk assessment. In addition to the qualified nurses, care leaders who have received accredited medication training from a local college, have responsibility for administering medication to those residents not in receipt of nursing care. Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 13 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 & 15. A planned activities and entertainments programme enables residents to have regular and varied opportunities for social activity. The visiting arrangements at the home ensure that residents can keep close contact with their families and friends in accordance with their wishes. Dietary needs of residents are adequately catered for, with a good selection of food available that meets their tastes and choices. EVIDENCE: There is a designated activities coordinator to consult with the residents, and plan social events. In order to be more accommodating to the needs of the residents, staff have endeavoured to provide social opportunities at various times of the day, including doing evening quizzes. The recent Christmas period has been celebrated, and photographic displays of different social events involving the staff, residents and some families are situated in the hallway. A programme of planned activities is displayed, and residents confirmed that they are given choice and opportunity for participation; some choose not to, instead electing to pursue their own interests such as reading and watching television. A choice of library books was being taken around to the residents in the afternoon, for those who wanted it.
Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 14 The home provides a relaxed environment for visitors, and does not place any restrictions on them. Residents confirmed their close contact with their relatives and friends, and visitors were seen coming in and out of the home. Two visitors confirmed that they were always made to feel very welcome when visiting their relative, saying that the staff were ‘very nice and helpful’. One of these visitors was having a cup of tea with his relative in the privacy of her own room. Menus are varied, and offer a good degree of choice for the residents. The meal at lunchtime looked wholesome and appetising. The meal was served in the spacious, airy dining room, in a calm and pleasant atmosphere. Staff were providing assistance where needed, with some less able residents being fed, and some meals served to residents in their room on a tray. All residents spoken to, without exception, were very positive and happy about the quality and quantity of food provided for them, with some saying it was ‘excellent’. Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 15 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. The home has a satisfactory complaints system, with evidence that residents feel that any concerns they may have are listened to and acted upon. EVIDENCE: A copy of the complaints procedure is displayed for anyone wishing to read or use it. Residents confirmed that the staff are attentive to them, saying that staff will do what they can to help them if they raise anything. However, one resident said that there had been at least one occasion when one or two staff could have been more helpful and reassuring when dealing with a particular situation she had raised. The home maintains a record of any complaints and concerns received. The record contained evidence of a number of concerns that had been received since the last inspection; records showed that each had been appropriately addressed, with corrective actions taken. Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 16 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 & 26. The standard of the environment at Paternoster House is generally satisfactory, and provides residents with a comfortable and safe place to live. The home is clean, with appropriate and full observations regarding the control of infection. EVIDENCE: The home has a designated maintenance person, who works hard to ensure the home is well maintained; he keeps meticulous records, which show a range of cyclical and periodic tasks that are carried out regarding the safe upkeep of the environment. Redecoration is carried out as an ongoing feature as needed, and various items of new equipment, furniture, carpets and fabrics have either been provided, or are about to be. However, there remain one or two bedroom carpets that are older and look well worn, and there are some items of bedroom furniture that also show signs of wear and tear. A new call bell system has been installed.
Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 17 All areas of the home were cleaned to a good standard, and were largely odour free; there were very transient faint odours at one point of the visit. Clinical waste is managed safely, with sluices appearing clean and tidy. The laundry room was orderly and clean, and contains two large washing machines, capable of managing the laundry loads, and with sluicing disinfection cycles. Gloves, aprons, liquid soap and paper towels are provided throughout the home. Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 18 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 & 30. Staffing provision is adequate to meet the needs of the residents currently living in the home. Staff have good training opportunities, with care staff encouraged to undertake a care qualification, in order that they can fully understand their roles. Robust recruitment procedures would ensure that suitable staff are employed for the protection of residents, however any failure to observe these consistently could pose some risks. EVIDENCE: Recorded staff rotas demonstrate the staffing provision, with recent ones showing that there has been significant agency usage. However, due to some successful recruitment, this usage is now reducing. In consideration of a number of new team members, the manager and staff are now endeavouring to establish and consolidate a cohesive team, which seems to have placed a degree of strain on the home, as people settle in and become more familiar. There is a good ancillary team of catering, cleaning, laundry, maintenance and administration staff, though there are currently vacancies with cleaning on alternate weekends, and with meal preparation on certain evenings of the week. On evenings when there is no teatime catering assistant, a member of the care team is allocated to the kitchen, which removes them from care duties. Although this is not an ideal arrangement, and must be kept under
Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 19 review, it does not appear to be adversely impacting on meeting the needs of the residents at this time. Residents themselves generally spoke very positively about the staff, saying that they were very helpful and kind. Two visitors also spoke positively regarding the staff and the way their relative was cared for. There are currently eight care staff who are qualified to NVQ level 2 standard. There are two others making progress on the level 2 programme at present, with a further two care staff waiting to commence their NVQ training. The number of qualified carers does not meet the 50 target that should have been achieved by the end of 2005, though the home is making all efforts to work towards achieving it as soon as possible. A selection of staff files was chosen for inspection, on the basis of their recruitment to the home since the last inspection of staff records. Each record contained application forms, including a full employment history. Records of interviews were seen. Evidence of the required pre-employment checks was seen in practically all cases. However, in one case the worker had previously worked with vulnerable adults in their last place of employment, which had been some time before commencing at Paternoster House. A professional reference had not been sought in this case, and there was no written verification of the reason why the worker had ceased to work in that position. Although the manager had seen documentary evidence of new workers’ declared qualifications and photographs of the worker themselves, neither of these things had been retained. Training records demonstrate structured induction training for new staff. This is carried out in-house within the first six weeks of appointment, with new staff attending a two day induction course at the training department, which is linked to NVQ standards, and completing an in-house induction programme, specific to Paternoster House, also. Staff have the opportunity to maintain their professional development, and have undertaken a range of training specific to their role in the home. The manager is awaiting a new training programme for the coming year at the time of this inspection from the training manager at the county office. Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 20 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, 33 & 38. There are good management systems in place to ensure that the health and safety of the residents is safeguarded. The home reviews aspects of its performance through a good programme of self-review and consultations, which includes seeking the views of residents and their relatives. EVIDENCE: The home’s manager is a first level nurse, who has long experience of caring for people in this setting, and has been at Paternoster House for nine years. She is registered with the CSCI, has achieved the NVQ level 4 Registered Manager’s Award, and has undertaken additional management training specific to her role. Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 21 The home has worked hard regarding the introduction of new policies, procedures and systems, and should be commended for recently achieving the ISO 9001 Quality Standard, for its services and facilities. A six monthly ‘Resident’s Review’ survey has been introduced, in order to establish that the service is meeting the residents’ needs and expectations, and meal monitoring forms have been introduced on a random but frequent basis, in order that residents’ views about the quality of the food can be obtained. Residents have attended a meeting, at which they had the opportunity to voice their opinions and ideas about the home. ‘Feedback and Suggestions’ forms are available in the hallway for anyone wishing to use one. A report has not yet been produced on the basis of all the quality monitoring work that is being carried out, but this is apparently being addressed by The Orders of St John Care Trust at this time. There was evidence that health and safety issues are addressed well in this home, with written policies, procedures and risk assessments, provision of necessary equipment and staff training. A full fire safety risk assessment throughout the whole building is due to take place in the immediate future by an external assessor, with due regard to revised fire safety regulations; in the meantime, the manager has reviewed the existing risk assessment. There are four members of staff currently qualified to provide First Aid, with updated training planned for the shift leaders. All necessary safety checks and maintenance of equipment is undertaken in a timely fashion. Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 22 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 2 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? No 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 4(2) 5(2) Requirement The home must send the revised copies of the Statement of Purpose and Service User Guide to the CSCI upon completion. The home must ensure that falls risk assessments contain clearly recorded information and guidance on how staff are to reduce the risks that the person is at. When recruiting new workers, the manager must ensure that: • Written verification of the reason why the person ceased to work in their last position (if it involved contact with vulnerable adults or children) is obtained Documentary evidence of any relevant training and qualifications is obtained A photograph of the worker is retained. Timescale for action 31/05/06 2 OP7 13(4.c) 28/02/06 3 OP29 19(b.i) 28/02/06 • • Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 24 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 3 Refer to Standard OP27 OP28 OP29 Good Practice Recommendations Evening catering support should be provided on each day of the week, in order that care staff are not removed from care duties. A minimum ratio of 50 of care staff qualified to NVQ level 2 should be achieved in the home. The manager should obtain a professional reference for new workers from their previous employer. Paternoster House DS0000064617.V276099.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Gloucester Office 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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