Inspection on 18/11/08 for Paternoster House Care Centre

This inspection was carried out on 18th November 2008.

CSCI found this care home to be providing an Adequate service.

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

Paternoster House Care Centre 26/11/07

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Paternoster House Care Centre Paternoster Hill Waltham Abbey Essex EN9 3JY Lead Inspector Mrs Bernadette Little Unannounced Inspection 18th November 2008 09:15 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 Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Paternoster House Care Centre Address Paternoster Hill Waltham Abbey Essex EN9 3JY 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) 01992 787202 01992 651401 paternoster@barchester.com www.barchester.com Barchester Healthcare Homes Ltd Post vacant Care Home 138 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (84), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (4), Old age, not falling within any other category (3), Physical disability (25), Physical disability over 65 years of age (80) Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. 9. Persons of either sex aged 65 years and over, who require nursing care by reason of dementia (not to exceed 84 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a mental illness (not to exceed 4 persons) Persons of either sex, aged 40 years and over, who require nursing care by reason of a physical disability (not to exceed 20 persons) Persons of either sex aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 80 persons) Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 3 persons) Persons of either sex, under the age of 40 years, who require nursing care by reason of a physical disability. Five persons, over the age of 50 years, who require nursing care by reason of dementia The total number of service users accommodated in the home must not exceed 138 persons No more than 8 people may attend the home on a daily basis in addition to those service users accommodated. 26th November 2007 Date of last inspection Brief Description of the Service: Paternoster House is a large two-storey purpose built establishment. It is situated in a semi - rural location on the outskirts of the small town of Waltham Abbey and near to the western fringes of Epping Forest. It is on a main bus route and road links such as the M25 and M11 are within a five-mile distance. The home is divided into four distinct units called Parklands, Uplands, Woodlands and Meadowlands. It is decorated and maintained to a high standard. The home can accommodate a total of 138 service users. There are 114 single rooms, 79 ensuite; and 12 double rooms, 10 ensuite. The home provides care to older persons who require nursing care due to physical illness or disability, nursing care for persons with dementia and nursing care for younger adults with a physical disability. A statement of purpose and service user guide are available. Current fees range between £594.93 to £1,137.79 per week. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The site visit was undertaken by two inspectors over an eight hour period on one day as part of the routine key inspection of Paternoster. Time was spent with residents, visitors and staff and information gathered from these conversations, as well as from observations of daily life and practices at the home have been taken into account in the writing of this report. A previous manager submitted an Annual Quality Assurance Assessment (AQAA) as required prior to the site visit. This provides them with an opportunity to detail an assessment of what they do well, what has improved and what could be done better. This information was considered as part of the inspection process. Prior to the site visit, we sent the manager a variety of surveys to distribute that asked questions that were relevant for each group, such as for residents, relatives, staff, care managers and healthcare professionals. Completed surveys were received from six relatives and three staff. The information provided and comments made are included in this report. A tour of the premises was undertaken and records, policies and procedures were sampled. The manager was present during the site visit and assisted with the inspection process. Another representative of the organisation was also present for part of the site visit. The outcomes of the site visit were fed back in detail and discussed with the manager and opportunity was given for clarification where necessary. The assistance provided by all of those involved in this inspection is appreciated. What the service does well: In responding to this question in a survey, one relative commented “not a lot”. However, many people positively complimented the nursing and care staff at the home. Comments included excellent ward/unit managers and the staff are very dedicated and have patience and understanding and never get ruffled. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 6 Excellent, and I have a great deal of respect for the carers (they do a difficult job well) and most of the nursing staff”. Some people commented on positive care outcomes for their relatives and told us I have nothing but good things to say about this home, my relative is well looked after, the carers are brilliant here or I cant speak highly enough of the care the staff provide, it is second to none. People said they feel welcome to visit at Paternoster. One person said I cant praise Paternoster enough, my relative is well cared for as are all the people here. We can visit when we want and we are always made welcome. Staff are reported as treating people with respect and one person said the staff treat and care for people as individuals and help them keep the dignity they have left. What has improved since the last inspection? What they could do better: Paternoster needs to have a permanent manager in post to provide stability and effective leadership. A relative commented on the number of managers in recent times certainly this did cause some unease with the staff. Whoever is appointed needs to be a ‘people person’. The success of this business depends almost entirely on keeping their staff appreciated and fairly rewarded. This is their major asset. Staff told us that the many changes in management had undermined staff morale. The prompt completion of the review of staff training records needs to be actioned to meet the requirement identified at the last inspection and ensure that staff are provided with appropriate training and support for the role they undertake. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 7 Management overview of issues such as complaints and safeguarding need to be improved to ensure that the health and well-being of residents and staff is promoted and vulnerable people are safeguarded. Appropriate numbers of staff must be in place to meet residents’ needs to ensure quality care outcomes. The range of leisure pursuits and meaningful social activities available to residents needs to be extended to meet the needs of all the groups of people living at Paternoster. Support for the manager, through the appointment of a suitably experienced and qualified deputy manager, is another area for development to ensure both administrative and clinical aspects of management are supported and effective. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Standard 6 does not apply to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People thinking about going to live at Paternoster could expect to have an assessment of their needs to ensure that the home could provide the necessary care and support. EVIDENCE: In the AQAA, the manager states that prospective residents are given enough information to make an informed choice about admission to the home. The statement of purpose and service user guide had been reviewed since the last inspection. They, the complaints procedure and the most recent inspection report for Paternoster were available on a low shelf under a table in the communal main entrance area. The manager was recommended to ensure that these are more clearly available. The recommendation from the last inspection that the service user guide to be made available in larger print to be easier for Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 10 people to read has not been acted upon. The information in the service user guide regarding the current home manager is inaccurate. The manager stated that qualified nurses now undertake the pre-admission assessments. The manager then reviews them and will have input in complex cases. Files for four residents were reviewed. These demonstrated that a senior representative of the home had undertaken an assessment of the persons needs prior to admission, to ensure that the home could meet these. Where appropriate, additional information was also available from the commissioning authority. The assessments covered a wide range of needs and contained a good depth of information. In discussions with staff regarding the use of life histories to support positive activities of daily living, staff told us that life histories are generally provided by families during the admission process but are not always detailed or reliable. Staff reported that sitting and chatting with people over a cup of tea breaks down barriers and provides more of an insight into what makes people tick. They acknowledged that much of this information was lost through lack of recording. In the AQAA, the manager states that one of the ways the home has improved in the last twelve months is in making sure that prospective residents have a copy of their terms and conditions prior to admission. A detailed residents terms and conditions booklet was available. The information in this was in large print and easier to read. Completed contracts were requested for review for the residents whose files were sampled. A resident admission agreement was available for one person but not for the others. It was noted positively that the agreement was signed by the person and the home manager at the time, however, it was undated. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there are generally positive care outcomes for residents, shortfalls in aspects of care planning mean that residents cannot be assured that all their needs would be met. EVIDENCE: The manager confirmed Barchester’s operating policy of staff having up to seven days after admission to produce a care plan for each person, relying on basic risk assessments and full assessment of each resident on admission that should detail the care required by each individual as an interim care plan. This does not best promote quality care outcomes for residents from admission and provide staff with clear instruction on how to meet each person’s needs in practice, in a consistent way and according to their preference. Care plans for four residents were reviewed. Some of these showed the involvement and signature of the person, where this was possible. The care plans cover fourteen specific and pre-determined areas that run in line with those identified in the pre-admission assessment. The care plans viewed Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 12 contained detailed information on each of the areas of need identified including communication, personal care/appearance, interests/hobbies/spiritual needs, pain management, sleeping, mobility, moving and handling, tissue viability and nutrition. Where appropriate they were supported by appropriate screening/ risk assessments, identified specific equipment needed, for example to support good preventative pressure area care management, and generally included sufficient information to support staff to meet the persons identified need in everyday practice. They also showed more focus on people’s strengths to support person centred care. However, it was disappointing to note that there was no specific care plan relating to medication for any of the residents and particularly for one person who regularly refused medication and where this was an identified risk for the person. Additionally it was discussed with the manager that a separate care plan needed to be in place in relation to management of diabetes and also where a persons assessment identified a specific religious preference that could clearly impact on the care to be provided. Care notes were written routinely and contained information to support effective monitoring of the plan of care. Care plans sampled had been reviewed regularly. They contained opportunity for short-term care plans to be in place where this became necessary, which is good practice. Additional risk assessments were in place to support individual specific needs such as falls management or the persons inability to use the call bell. The care files contained a detailed health needs assessment and showed appropriate monitoring, for example maintenance of weight charts. The record of healthcare professional involvement demonstrated multidisciplinary input and noted issues such as medication review. A resident told us the medical side of things is very good, the nurses are very nice. Varied responses were received in surveys from relatives as to whether the care home met the needs of the residents and provided the support expected with some people feeling it always or usually did and others feeling it only sometimes did. Medication was not reviewed at this site visit. A specialist pharmacist Inspector undertook a separate inspection of medication at Paternoster in September 2008. Medication management, recording, storage and administration were found to be satisfactory. Residents spoken with confirmed that they felt that the staff at Paternoster respected their privacy and dignity. One person said in relation to receiving personal care they make sure the doors are closed. Another comment was they always knock on doors and wait before coming in. In a survey, a relative said x is treated with respect. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 13 Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While some people living at Paternoster may not have their recreational and religious needs satisfied, they can expect their visitors to be welcomed and to have a pleasant dining experience. EVIDENCE: The AQAA states that the routines of daily living are flexible, based on a person centred care approach and residents have opportunity to enjoy varied activity and social contact both inside and outside the home with opportunities to exercise their own choices throughout. Paternoster employ four dedicated activity staff, one of whom was on longterm leave. Each of the units within the home had a separate activity plan. Much of the emphasis on activity was directed to the units for people living with dementia. A relative commented “recently x was taken out for a day visit which proved highly successful and certainly was beneficial and stimulating”. Activity staff working in the unit for people living with dementia had enthusiasm for the role and for person centeredness, however they demonstrated little real understanding or knowledge of the life history of the Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 15 people living in the unit and how best to provide them with a sense of wellbeing. Shopping, chatting and domestic chores were considered to be activities as opposed to integral parts of daily living. There was evidence of outside entertainers or opportunity for dancing each week and some residents going on outings in the two available minibuses. Staff said they read the Bible for a resident who is no longer able to do this for themselves. As noted previously, there was no care plan in place to meet another resident’s specific religious needs. While the library van visits, it is not accessible to many of the people living at Paternoster. Some people spoken with said they enjoyed regular manicures and found having this one-to-one time comforting. They could also choose to participate in available group activities such as card games and dominoes. Residents told us they felt there was not enough stimulation or outings for those people who were more mentally able. Activities recorded for one resident included ‘dining room’ and ‘menu options’. Staff demonstrated awareness that activities such as throwing a plastic ball are not always appropriate or respectful of people’s dignity but reported that resources were not always available to provide more appropriate stimulation and recreation on an individual basis. A survey received from a relative thought one way the home could improve would be by “more outings and activities”. Residents told us that planned trips have sometimes been cancelled at the last minute due to staff shortages. Staff told us that a recent organised trip to Southend had not taken place because residents decided not to go on the day. A number of partners and relatives were visiting residents in the communal hub area of the home and the scene presented as a pleasant social event that all parties seemed to be enjoying. Visitors spoken with and information from surveys confirmed that people felt welcome to visit Paternoster, at any time of the day or night and were encouraged to participate in the care of their relative if they wish to. One person said “In such a demanding dementia unit they make you feel very welcome” and another person said “I can see X as much as I want”. Surveys from relatives who commented on whether people living at the home were supported to live the life they choose provided the varied responses of sometimes, usually and always. The care plans sampled included people’s preferences, for example times for getting up and going to bed. A resident spoken with said that they can exercise choices in the time they go to bed, whether to spend time in their own room or in the communal areas, whether or not to join in the available activities or whether to have a shower or bath. They stated that sometimes when the home is short staffed they are not given the support they need to get up at their usual preferred time of 8.30am and they may not actually come downstairs until 10.30am. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 16 Many of the people we spoke to were satisfied with the food served at Paternoster. People said the food is fresh and varied and always looks delicious”, “food is pretty good, there is a good variety and always a choice of two meals and “food is not always up to scratch”. Residents expressed recent dissatisfaction about the meat on Sunday and this was being investigated with the supplier. Residents spoken with confirmed there are choices at each meal including a cooked breakfast option. Comments from surveys suggested a need for “swifter service at mealtimes”, “could offer proper vegetarian meal alternatives rather than just vegetables without the meat” and “the quality of the food could be improved”. Another person noted there had been some catering problems “but on the whole the food is pretty good now”. Ample stocks of good quality foods were available. The kitchen areas were clean and well organised. A new chef has been employed. A hostess organises the dining room and oversees the dining experience. We took lunch with the residents in one of the many dining rooms at the home. The room was clean, bright and sunny and tables were nicely set with cloths and flowers. Carers were observed to provide assistance, seated next to residents, in a sensitive and caring manner and were heard to chat brightly with people while waiting for the next course to be served. Observations in another dining room concurred and residents were offered choice as identified in their care plan and were addressed respectfully by name. Staff quietly monitored residents and encouraged them to stay at the table and to eat and drink. Although it was a very busy and demanding time, staff worked well as a team to support a positive dining and social experience for the residents. Where a resident held out their hand as a staff member walked past, the staff member returned, took the person’s hand, gave them eye contact, conversation and a smile. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to be listened to and to be safeguarded by the skills and knowledge of staff but shortfalls in effective security of the building and management of complaints and safeguarding may not best promote resident best interests. EVIDENCE: All but one survey received from relatives indicated that they would know how to make a complaint and that the service had usually or always responded appropriately if they had raised any concerns about care. Surveys from staff confirmed that they would know what to do should a person raised a concern about the home. A complaints procedure was available in the home, however as stated earlier it could be made more readily available. It does advise people that it can be read to them if their vision is impaired and arrangements can be made in special circumstances for an audio version to be made available. The manager advised in the AQAA that thirteen complaints had been received in the previous twelve months, none of them had been upheld and one was still being investigated. A log of complaints received, with dates, had been maintained by previous managers until the end of April this year. There was no log of the more recent Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 18 complaints that would have assisted monitoring, particularly with the continuing change of managers. While they were filed individually, there was some lack of clarity as to when they were received, responded to and what the outcome was. The manager advised that she was unaware of some of them as they had been dealt with by other people. Complaint responses sampled included apologies for a resident wearing somebody elses clothes, for having to wait for care support at night or for having to wait 35 minutes to be hoisted onto a commode. A more recent complaint, notified to the Commission as required by regulation, was not included. When raised with the manager that the commission had not received a notification on another concern, the manager advised that a notification had been sent to the Commission, but no copy of it had been kept to evidence this. The AQAA identifies that three safeguarding referrals had been made in the past twelve months and one safeguarding adult investigation has been undertaken. The current manager had no full knowledge of the issues that had occurred before her time at the home, some of which were still ongoing/ outstanding. The Commission was aware of five safeguarding referrals having been made regarding residents at Paternoster that were investigated, however the manager was unable to advise on the pathway of the investigations, outcomes and any monitoring of these to identify trends and patterns that could better safeguard people living at the home. It was noted positively that the manager had a copy of the current Local Safeguarding Adults guidance, procedures and formats. The commission had received a number of notifications where staff had referred incidents of aggression between residents to the safeguarding team and where the notification stated that the home were to investigate. The manager confirmed that she expects staff to be responsible for forwarding individual notifications. The commission had recently been made aware by Social Care of a further safeguarding referral relating to a resident at Paternoster. The manager confirmed that they had not notified the Commission of the event leading to this as required. The AQAA states that all staff receive training in the protection of vulnerable adults and are aware of the whistleblowing policy. Computerised records identified that further training sessions were planned this week to capture any staff who had not yet had training on safeguarding. A member of staff spoken with, whose training file identified that they had not had this training, confirmed that they had attended the training and were able to demonstrate a clear and sound knowledge of what constituted abuse and of appropriate action to take in response. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 19 On arrival at Paternoster, we signed in and spent some time standing in the central communal area. As no staff appeared in this area we then went into a lounge with residents, and moved on to spend some time sitting in a dining room with a number of clearly vulnerable people, who were unsupervised, before spending more time walking around the home. None of the staff we met challenged us or queried why we were there and after 30 minutes we deliberately found staff to make our presence known. It is of concern that we were able to enter the home and spend time alone with residents firstly without being seen and secondly without being challenged. The manager expressed disappointment that staff had allowed this to happen. A regular visitor told us “it is rare that the reception is not manned”. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a mainly clean and pleasant environment that may not be warm enough for some people or best meet their needs in terms of supporting the experience of living with dementia. EVIDENCE: Paternoster is divided into individual units leading off a central area. Residents had use of a number of lounge and dining rooms on the various units. People were also actively using the central communal hub area where seating was arranged in social groups creating a homely feel. Some first-time visitors to the home told us they felt it was very homely. Residents in an upstairs lounge told us that they were cold at 9.30 in the morning and that they were often cold in this room. A staff member had just shut the windows and having been told that residents said they were cold and that the radiators were not on, was asked to turn them on. A comment in an Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 21 otherwise very positive relative survey on how the home could improve noted “for some reason there are always problems with the heating system”. While the design of their unit lends itself to it, residents living with dementia did not move freely or wander/purposefully walk around their dedicated unit, but remained in the lounge area. Staff sat with them here and gave personal attention in rotation and attending to those people needing attention when they called out. The last inspection report identified that the lounge and dining space in some of the units for people living with dementia were as one and there was no quiet area for residents who may prefer a change of scenery or just to be in a quieter space. In response to this a small area of the room, that had been the nurses’ station, has been partly sectioned off. Discussion with staff and time spent observing on the a unit demonstrated that in practice this did not create a calm, quiet space intended to allow people opportunity to be away from the sometimes noisy or stressful atmosphere in the room. Parklands had been decorated since the last inspection and this was a noted improvement. Bathroom doors had been painted a bright colour to help people to recognise them more easily. All the bedroom doors were painted uniformly brown, this does not support people to identify their own personal space. It was noted positively that one person had an individual sign on their door to help them recognise their own room. Memory boxes had been attached to the doors but remained empty, as did the wooden chests of drawers with colourful handles in the hallways. Tidy baskets of soft puppies and teddies for cuddling were seen in the corridors, clearly not well used or available to the residents who remained in the lounge area. Some soft toys were available to, and seemed to be used by, residents in the communal area. The manager told us that they were waiting for budget approval for muchneeded redecoration for some of the communal areas at Paternoster. Bedrooms throughout the home were corporately decorated but were personalised to individual needs and wishes. Residents spoken with were satisfied with their own room. One person said that their room “is lovely” and they can “choose to go and spend their time there and watch television”. On arriving at the home in the morning, a red laundry bag containing dirty aprons and tablecloths was on the floor underneath the table where residents were sitting, which shows a lack of respect. A slice of toast was on the floor and staff pushed wheelchairs through it without picking it up. Some bathrooms had a very strong smell of urine. Corridors were cluttered with equipment such as wheelchairs, hoists, sit on weigh scales and trolleys. This presented tripping hazards for residents. The overall appearance and cleanliness of the home was generally improved later in the day when the housekeeping staff had done their rounds. However, later in the afternoon, one bathroom in Parklands still Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 22 had a very strong odour, possibly from a very full bag of disposed incontinence pads. One bedroom also had a sticky carpet and a very strong odour. Regular visitors to the home told us that “the place is always clean tidy and comfortable”. Other comments in surveys included “usually well maintained and clean, attractive gardens/grounds and comfortable and bright seating areas” and “ always very clean and other relatives all say how much they like visiting X there”. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents cannot be reassured that their needs will be met by adequate numbers of competently trained staff at all times, but will be safeguarded by recruitment procedures. EVIDENCE: In the AQAA, the manager states that residents’ needs are met by the numbers and a skill mix of staff that are dictated by the total care assessments carried out for all residents. Of the three staff surveys received, one person felt there are always enough staff to meet the needs of the people who use the service, one person said there usually are and another person said there are only sometimes or never are. The staff member indicated that where the qualified nurse was included in the ratios, the nurse is generally involved in medication and paperwork and not available to provide hands-on care and this “is not fair to the quality of care” for residents. Most residents spoke positively about the carers with comments such as “staff are very good here” but indicated that the team were often short staffed and it made them feel “anxious” or “distressed” if they were not attended to in a timely manner. This concurs with some issues identified and recorded as complaints at the home. A resident said “sometimes they are short staffed, they work blinking hard”. Staff reported that colleague absences were a problem and that they “were often short staffed on day shifts”. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 24 The manager confirmed that they were absentee issues within the staff team and she was actively working with the team to address this. The manager added that they never work short staffed because agency staff would be requested, but went on to say if there are times when the agency are not able to provide staff to cover last minute shifts they actually do have to work short staffed. The Commission has not been notified of these events as required by Regulation. The manager also added that staffing levels naturally alter with numbers of residents in the home and staff perceptions of being short staffed very often do not take this into account. The AQAA, completed in August 2008, states that no shift, either nursing or care staff, had been covered by temporary staff or staff from an agency in the preceding three months. The manager informed us that 26 of the care staff at Paternoster have achieved National Vocational Qualification (NVQ) to at least Level 2, that another 12 staff are planned to start in December, and there are also 2 senior care staff on work permits for equivalent of NVQ Level 3 or above. The AQAA states that in the preceding 12 months, 46 full-time and 20 parttime staff had left employment at Paternoster. Recruitment and training records were reviewed for four staff members. Staff recruitment files were well organised and contained evidence of appropriate references and checks having been in place prior to the person starting work at the home. This is an improvement from the last inspection and safeguards residents. It was noted that in a limited number of instances, more specific dates of past employment could have been clarified. The last inspection report also contained a requirement that records of staff induction and training to evidence the skills necessary to safeguard and meet the needs of residents must be available. The manager who completed the AQAA said that one of the ways they had improved in the last twelve months was by updating all training and setting up a training matrix and individual staff files for certificates. The training matrix was not available on request and the current manager advised that training records were currently being reviewed by the administrator and were a ‘work in progress’. The requirement from the last inspection was therefore not fully met but was in the process of being actioned. Sight of computerised records provided for us at this site visit indicated a number of shortfalls in core staff training necessary to keep people living at the home safe from harm. This included for example eight nursing staff and thirty care staff who had not attended moving and handling training and ten nursing staff, thirty four care staff, eight catering staff, two laundry staff, three housekeeping staff and one maintenance staff who had not attended training on health and safety. Records also showed that a number of people had not attended training on control of substances hazardous to health (COSHH) or fire training. It is unclear how accurate these records are. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 25 The four staff files reviewed generally indicated that more long-term staff had attended basic training such as moving and handling, infection control, basic food hygiene, health and safety. Where certificates were not available such as relating to safeguarding vulnerable people, the staff member was able to confirm that they had attended this training. Records of induction were not available on reviewed files of recently recruited staff. The current manager informed us that each person employed since she had been at the home had definitely commenced induction in line with Common Induction Standards and training records were in the process of being organised. Care staff told us they enjoyed the dementia awareness training as it had opened their eyes to dementia from the perspective of the person living it and they felt that it would be beneficial if the registered nursing staff also undertook this training. The file for one registered nurse reviewed contained evidence of recent attendance at this training. Of the six surveys received from relatives one person stated that “some staff do and some staff don’t” have the right skills and experience to look after people living at the home properly, while the other five felt they did. One had the comment “never any problems and very attentive, often in busy times” and “my observations are of a very professional group of carers who have infinite patience and respect all the individuals in the unit”. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect a management approach that in many aspects promotes their best interests, but where the affects of a period of management instability and some management systems may not best safeguard them. EVIDENCE: Paternoster has had a period of unsettled management. A permanent manager has been appointed to start next month, and with this appointment there will have been eight managers of the home in twenty five months. The current manager is an experienced operation manager from Barchester and has been supporting the home for the past four months. The deputy manager post has also been vacant for some months. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 27 Some aspects of the service continue to progress effectively. Other aspects of management need attention including the effective ongoing supervision of safeguarding issues and complaints and effective supervision, support and training for staff to improve morale and staff retention, safeguard residents and promote quality care outcomes. People who told us they were regular visitors to the home also said they were not aware of who the manager was and would not recognise her. One person said they would be happier if the manager would introduce herself to relatives, especially as there has been so many changes in the management of the home. The manager advised that she talks to people around the home as often as her diluted time permits and that she operates an open door policy. The manager reported that the organisation had a robust quality assurance system in place and that they were currently waiting for completed surveys from residents, family members, staff members and health care professionals. We requested a copy of the summary of the annual quality assurance exercise undertaken since the last inspection of the home, but this was unavailable. The manager was reminded that a summary of this must be sent to the Commission. Records were available to confirm that regular visits were undertaken to the home by a representative of the organisation to ensure that the home is running properly and in the best interests of people living there. The management of the home do not look after any personal money on behalf of the people living there. Relatives are invoiced monthly for such items as hairdressing or chiropody. The registered nurses undertake formal supervision for care staff. Records confirmed that supervision sessions had taken place however there was no detail recorded to ascertain if the sessions were effective or where in fact just ‘lip service’. The manager advised that the deputy manager was responsible for undertaking supervision of the qualified nursing staff but as this post has been vacant since August 2008 the staff members remain without supervision. Additionally, the manager reported that management changes had meant that administration and support staff had not received supervision for some considerable time. Findings on the review of records are included throughout this report. The organisation has a computer system reporting accidents and incidents that automatically prompted the person to contact the necessary authorities depending on the nature of the incident. Records indicated there had been 225 accidents/incidents this year and recorded issues such as resident falls, accidents in the kitchen and events were people living at the home had been involved in incidents of verbal or physical aggression towards other residents or staff. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 28 The maintenance team of two full-time and one part-time staff are responsible for the monitoring of health and safety within the home. Clear and well maintained records were available to show us that regular checks were made of water temperatures, electrical systems, portable electrical appliances, lifts, pest control etc. Where appropriate, outside contractors are brought in to deal with any maintenance issues. Records available included a ‘daily walk around checklist’ to ensure maintenance staff keep on top of issues as they arise. Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 29 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 X 2 X X 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X N/A 2 3 3 Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15(1) Requirement Care planning must identify, and be effective in meeting, all of the person’s assessed needs and give staff clear instructions on how to apply these in daily practice to ensure that residents get the care they need and in the way they prefer. The current social/ recreational/occupational programme must be developed and extended to include and meet the needs and preferences of all the people living at Paternoster. The manager must keep a record of safeguarding referrals and events to support and evidence their effective management, communication and monitoring to safeguard residents and notify the Commission of such events as required. Timescale for action 01/01/09 2. OP12 16(2) n 01/01/09 3. OP18 13(6) 01/01/09 Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 31 4. OP27 18 The manager must ensure that the needs of people using the service are met at all times by the number of staff on duty, and must notify the Commission of any occasion where minimum staffing levels are not met as an event that affect the well-being of the residents. 01/12/08 5. OP30 18(1)Sch4 The manager must ensure that 13(6) staff have all training and skills necessary to both safeguard and meet the needs of the residents, and that evidence of this training, including induction training, is kept in the care home. This requirement remains outstanding as it was not fully completed at the time of this site visit. 01/03/09 6. OP31 10 Ensure that the home is managed consistently and effectively to safeguard residents and ensure that the home is run in their best interests. Supply the Commission with a report of the review of the quality of nursing/care at the home and that includes the views of the people using the service. 01/01/09 7. OP33 24(2) 01/03/09 Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 32 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 OP1 Good Practice Recommendations The service user guide should be available in a large print to make it more user friendly for residents and it should be kept up-to-date with accurate information. So that they are fully informed, people moving into the home should have a copy of their terms and conditions. To ensure that residents/relatives are listened to and their concerns actioned, the manager should keep a log of complaints to support and evidence their effective management, communication and monitoring. To ensure resident safety, corridors should be kept free of equipment where this could present a tripping hazard. Consideration should be given to ensuring that all units include a quieter lounge area to give residents choice and meet needs. Consideration should be given to improving the environment for people living with dementia in line with current good practice guidelines, for example clear symbols, photographs and use of colour for recognition and orientation etc. To ensure the well-being of residents, the manager should, taking residents views into account, review the heating arrangements to ensure they are appropriate. To ensure people live in clean, pleasant and hygienic surroundings, more effective cleaning schedules should be implemented to manage odour and carpet cleaning, and red bags with dirty laundry should not be sited under tables where residents are sitting to eat. A minimum of 50 of care staff should achieve NVQ Level 2. 2. 3. OP2 OP16 4. 5. OP19 OP20 6. OP22 7. OP25 8. OP26 9. OP28 Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 33 10. 11. OP29 OP32 To ensure accuracy of information in recruitment, more specific dates should be obtain in relation to employment history. The manager should ensure they are known and available to people using the service and their representatives to support open and effective relationships and communication. To support to staff morale, retention/consistency and the quality of care outcomes received by residents, staff should receive effective supervision at least six times a year. 12. OP36 Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Paternoster House Care Centre DS0000069329.V373263.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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