Inspection on 26/11/07 for Paternoster House Care Centre

This inspection was carried out on 26th November 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Paternoster House Care Centre 18/11/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Paternoster House Care Centre Paternoster Hill Waltham Abbey Essex EN9 3JY Lead Inspector Mrs Bernadette Little Unannounced Inspection 26th November 2007 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 Care Centre DS0000069329.V350237.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.V350237.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 Barchester Healthcare Homes Ltd 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.V350237.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. N/A 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 for social services clients are £644 and start from £900 for private clients. Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was undertaken as part of a key inspection of Paternoster by two inspectors, who spent a combined total of fifteen hours at the home. Prior to this, the manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to the commission. Information from this document was taken in account and is included in the report. A tour of the premises was undertaken and records, policies and procedures were sampled. Case tracking was undertaken in relation to some residents living at the home at that time and additional records were sampled for specific issues. Feedback was given to the manager at the time of the site visit. Five residents, three visitors, five staff and the manager were spoken with at the site visit. Information was requested and received through surveys from residents, relatives and staff. Comments from the seventeen residents, three relatives and fourteen staff, including those from the surveys are reflected in the report. The assistance of all those who participated in this inspection process is appreciated. What the service does well: People who use the service felt that they were given enough information about the home before they moved in so that they could decide if it was the right place for them. A program of activities was available and whilst not all comments on this were positive many residents found these enjoyable. Most resident comments about the staff were positive and one said “they are caring and very supportive. Relatives spoken with said they were satisfied with the level of care provided Many parts of the home are pleasant and well decorated and a resident survey said about the home “very nice and clean and very comfortable”. There is strong management and leadership in the home and the organisation has good systems in place to support this, helping to promote the well-being of residents and staff. Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering moving into Paternoster are given sufficient information about the home to make an informed choice about where to live and can be assured that the staff will understand them and how best to support their abilities. EVIDENCE: Most of the people who completed surveys said that they had had enough information about the home before they moved in and some added comments that they or their family had visited to view it before making a decision. One person added the comment “it was a very friendly environment when I moved in”. The statement of purpose and service user guide were freely available in the home as was the most recent inspection report so that people had good access Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 9 to information whenever they wanted it. The service user guide is written in small print that did not make it particularly easy to read. The majority of residents who completed surveys stated that they had received a contract. One person who said they had not received a contract added the comment “it would be useful”. Pre=admission documents were reviewed. The service has a selection of documents that make up the pre-admission assessment this includes the companies simple check list of areas that should be considered as well as a more detailed pre admission sheet that covers range of daily living issues and includes information to prompt staff in completing the comments boxes alongside. The two documents are used to together to determine the prospective resident’s needs prior to their admission. They would provide the reader with a clear indication of the range of abilities and needs the person had and enable them to understand if additional equipment or staff skills were required in preparation for the persons admission to the home. Residents spoken with during the inspection said they had been visited by a member of staff from the home who discussed the assistance they needed and they had been able to ask questions about the service. They had also been provided with information about the home and how it worked prior to their moving in. In most cases their family had been able to visit the service before they moved there to find out about it on their behalf. The service does not provide intermediate care. Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 10 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 good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that they will be consulted on how their abilities, needs and aspirations will be supported, and documented. They can be assured that most staff understand how to provide their support in a way that recognises them as individuals and is carried out with respect. EVIDENCE: Care management documents were reviewed. They contained documents for care planning that covered a range of issues such as communication, mobility, tissue viability, elimination, personal hygiene nutrition social interests hobbies, spiritual and cultural needs and family and carers support. Some were written in ‘problems first’ style and focused primarily on the physical elements of the individual residents care. However, another used much more positive language and emphasised the persons abilities first with instructions to staff in how to support these clearly laid out. Whilst all provided staff with some indication of the support residents may need to meet their daily living needs, the latter style provided the reader with Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 11 a greater sense of the resident as an individual who has strengths as well as weaknesses. This better supports staff in creating a person centred philosophy in their care provision. Resident comments showed overall satisfaction with the care and support they received at Paternoster, for example “ they are very supportive here and very friendly and always keen to listen”. The manager reported that a recent audit carried out by the company on the quality of care planning documents had fed back some weakness in the content of the care planning documents and the two heads of units have been asked to develop an action plan in response. As a result a project was due to start in the new year commencing in the units supporting people with dementia, to look at how information in care plans can enhance the way staff support the residents. This demonstrates a service that is insightful into its own practice and is seeking to improve and develop this to provide the best quality of support to residents. The records relating to residents health care contained a good level of information of the individuals’ health issues and how these had been addressed. They referred to health professionals’ visits and the action taken as a result of their instructions. Other information held on the file recorded individuals weight and diet, as well as monitoring significant health concerns such as diabetes. Overall the information enabled staff to monitor and promote the residents physical wellbeing. The AQQA confirms that all care plans contain assessments relating to tissue viability, continence management, nutrition and falls risks. Staff expressed views that they generally received up-to-date information about the needs of the residents so that they were able to give them appropriate care. Resident comments confirmed that they were generally satisfied that they received the medical support they needed. Medication management was examined on one unit and found to be satisfactory. There are separate medication rooms and trolleys for each area of the home. All senior staff have received training in medication dispensing administer medication. The drugs are kept in a locked temperature controlled room within locked metal cabinets. There is also a fridge with a thermometer to monitor the safe storage of medication. The lockable storage is divided into current medication, stock medication and controlled drugs tp support good practice. The administration of controlled drugs is recorded separately in a controlled drugs log and examination of this determined appropriate records were being maintained. The staff member responsible on the unit was very aware of the requirements of good practice in medicines management and the steps taken to ensure a high quality in this area of the care provision Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 12 Staff were observed assisting residents to eat at the midday meal. Generally they spoke with residents as they supported them and there was a light chatty atmosphere in the room. However some staff were seen feeding two residents at once, this practice does not promote a quality of care that respects the individual and this was pointed out to the memory lane manager who immediately intervened and corrected the practice. Staff and residents spoke pleasantly to each other through out the meal and both enjoyed some light-hearted ribbing demonstrating an easy relationship with mutual respect. Residents were asked for their preferences and alternatives were offered readily when they did not appear to enjoy their choice. At the end of the meal staff assisted residents to leave the dining room. Although on the whole staff conversed with residents about leaving and where they were going next, some staff took residents without speaking to them and in the case of a resident in a recliner chair on castors the sudden movement without prior warning caused them to call out in surprise as they were moved. The observation indicated a mixed understanding by staff of the way in which residents should be supported and denotes a need to work with some staff in developing their sense of residents’ rights to dignity, respect and diversity. Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The majority of residents can be assured that they will be provided with a range of activities to suit their preferences, however lack of care staff involvement means that not all residents needs are met. EVIDENCE: The service has employed a team of staff to promote activities for residents in the home. The team are responsible for ensuring that both the large-scale group activities and opportunities for smaller activities take place throughout the week. There are lists of group activities ranging from a cheese and wine party on the day of the inspection to outings to local shops. These are promoted on notice boards in the home and people are encouraged to participate. Barchester provide two minibuses so residents have opportunities to go out. An activities assessment is also carried out for each resident to help the staff identify the interests and residents’ preferences. There is also a second sheet called the activity information assessment that lists the residents’ physical abilities such as dexterity, hearing, sight etc. then spiritual needs identified, social groups, family involvement and friends with space to add details. Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 14 These two pieces of information are designed to aid staff in offering the most appropriate range of activities to each individual. The file also contained a daily activity record set out in calendar months with an alphabetical key to the activities offered or undertaken. This would assist the staff to understand the frequency and success of the programme of activities on offer to the resident. In the samples seen during the inspection for those residents’ files that were case tracked, the success of the activities programme varied. For some, although there were activities identified, these did not appear to take place very frequently. The daily records completed by staff did not identify how they stimulated residents. Eight of the 17 resident of surveys received said that there are only sometimes activities arranged by the home that they could take part in. One person said this is because they were not informed what was happening on a daily basis. The other nine surveys that there are activities available that people can join in with, including one-to-one interaction. One resident advised that they preferred to be on their own watching their television and clearly could choose to do this. During the day of the site visit a number of small scale activities were on offer in the units with activity staff sitting with residents and in the afternoon a large group cheese and wine party took place supported by the activities team. Residents who were present for these events were happily engaged in the activities on offer and there was a bright social atmosphere. Relatives also attended the cheese and wine party and were observed visiting throughout the day. Residents were able to receive them in the communal rooms or in their own personal space. The visiting policy is set out in the service users guide and posted in the home. The policy encourages relatives to visit without prior notice and to take refreshments with residents. Residents spoken with said their visitors were always made to feel welcome by staff. Relatives spoken with confirmed they can and do visit freely and feel welcomed. During the visit to the home the inspector had opportunity to speak with the activities co-ordinator who explained that the team were a fairly recent addition to the way in which activities were provided in the home. They had commenced by ensuring that each resident had an activities assessment as their priority, and were now working both as a team and with the larger staff group to provide stimulation to residents in every aspect of the support they are provided with. The manager states in the AQAA that residents receive a weekly activities programme and that there is now a plan to introduce a monthly Paternoster newsletter. He also confirms that peoples’ diverse needs would be respected in relation to their religion as they would wish, and that church services are available in the home for those who wish to attend. Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 15 From records and discussions it was evident that for some staff there was a separation of duties between providing care support and activities and further developments could be made in helping staff understand how in carrying out their daily duties in supporting residents they could engage and stimulate them. As an example the mealtime preparation of the dining room was ably carried out by a member of staff, however, this task could be developed into an activity for residents to engage in if they were supported by the staff. The Activities Co-ordinator had a good understanding of both person centred philosophy and the way in which residents could be engaged in daily living tasks as part of the activity provision. They reported that the manager and the organisation had been supportive to the initiative and had listened when feedback had been given to improve the service. The lunchtime meal was observed during the inspection. There was a very comprehensive menu that not only had a choice for the set meals planned for that day, but also provided a standard range of alternatives that could also be ordered on any day. The manager advises in the AQAA that residents are actively encouraged to have input to the planned menus. Diversity is respected and specific dietary needs are supported. Residents spoken with during the meal said there was a good range of meals and they liked what was on offer although one said here were too many sausages. They said the cook comes and asks what they thought of the meals occasionally and staff come and tell them what is on the menu and ask for their choices each morning. They felt the food was a good standard and would not be able to find anything to complain about. However, resident views in the seventeen written surveys received varied widely with some people being dissatisfied and others who said they always like the food served. The organisation operates a quality measuring tool called the “Five Star Dining Award” for the catering arrangements in each of its services. This requires the catering staff to work in a customer focused way and includes the quality of ingredients used, the menu choices and range of specialist diets catered for and the presentation of food. Paternoster has been awarded this standard in the past but as a new cook had taken up post the rating has to be re-assessed to confirm the award remains. The manager was confident that the quality of service would meet this. Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents had access to good systems to raise complaints and people feel confident to use it. Residents were generally safeguarded by the systems in place although some gaps in staff knowledge do not best protect residents. EVIDENCE: Information on the complaints procedure is available in the home and in the service user guide and encourages residents and family members to express their views. Information that people can complain directly to their local funding authority or contact details for this is not included. The complaints procedure explains that the policy can be read to people who have a vision impairment and in special circumstances an audio version can also be made available. The complaints folder was reviewed. It included a clear overall log and individual files recording the investigation and management of complaints received. Recent complaints related to inconsistent personal care, communication systems, lack of staff supervision in a particular unit, dissatisfaction with arrangements for smokers or medication being left with a resident who was unable to take it on their own. Records showed that all complaints made were actioned promptly. Responses to complainants have clear information on the outcome and actions to be taken in some, but not all, cases sampled. Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 17 All but one of the service users surveyed, and the relatives spoken with said that they would feel able to make a complaint. All the staff surveyed stated that they would know what to do if a resident or their relative/friend had any concerns about the home for example “refer to the manager”. One staff spoken with confirmed that protecting vulnerable adults was part of their induction training and that they had received the blue information booklet on this issued by the local authority. Staff training files sampled showed that staff had attended the organisation’s training on this, which includes watching a video and completing a worksheet. Staff knowledge and competence about acting on concerns varied. Some staff spoken with said they would report any concerns to the manager to safeguard residents, for example if residents were not treated well. They were unclear what action to take if they could not take the concern to the manager and were unaware of the whistleblowing procedure. The staff had ready access to the policies and procedures folder on the unit and on request, found the whistleblowing procedure, which had recently been updated. Soon after the site visit, the manager competently referred an incident to the safeguarding team that had been reported to him, in a timely manner by a staff member. Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents of Paternoster have a safe, clean and homely living environment that generally is suitable for their needs. EVIDENCE: The home is a large building that is divided into self contained units with a central communal hub where people congregate and take part in activities. Overall the home is bright and generally well decorated with an ongoing refurbishment and maintenance plan being implemented to update décor. At the time of the inspection the two units Uplands and Parklands were awaiting redecoration and the contrast with areas of the home already completed was apparent. The AQQA confirms that an ongoing programme of routine maintenance and redecoration is in place that have included improvements to the garden to make it more accessible to wheelchair users. Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 19 Efforts have been made to make the building homely and personal with lots of pictures and ornaments on display throughout the building. This is particularly the case in the units accommodating people with dementia where household paraphernalia that residents would recognise from their youth are on display in the corridors. The lounge and dining space in some of the units are as one large communal lounge and dining area, where people watch television or are involved in other activities. While staff have tried to make best use of the space and create different areas, there is no quiet area facility for residents who may prefer a change of scenery or just to be in a quieter space. Although residents’ rooms were not decorated individually they were provided with opportunity to personalise their space with ornaments, photos and pictures. Many bedroom doors were not fitted with locks to allow residents active choice to lock them and operate a higher level of privacy and dignity. There is a range of bathing facilities with assisted baths to meet the range of needs of residents living at the home. By far the majority of the surveys received from residents said that the home is always clean and fresh and comments included “the housekeeper always makes this a priority” and “some of my visitors remark how clean the place is”. The AQAA states that the premises complies with the requirements of the local fire service and environmental health department. Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 20 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 can expect to be cared for by a reasonably stable and well informed staff group, which offers them consistency of care. Recruitment and training procedures do not fully safeguard residents. EVIDENCE: Rosters sampled showed that there were identified qualified and care staff on duty in each unit, which offers more consistency of care to residents. There has been some recent use of agency staff but the manager expects that this will be reduced significantly with the recent recruitment of several staff. In discussion and surveys received, most staff expressed views that there were always or usually enough staff to meet the individual needs of the people who live at Paternoster. Residents had varied views and experiences on whether staff were available when they needed them. Some residents felt that they usually were, however other residents comments included too busy and short staffed, because there are often too busy, it can take a long time but they will come in and find out what I want and give some reassurance, sometimes busy and short staffed and leave alone for a long while, not enough staff in place and staff missing at weekends. In the main, residents felt that staff are listened to them and acted on what they said although a few people said that this depended who was on duty. Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 21 The AQAA shows that sixteen of one hundred care staff have achieved NVQ level 2 or above and four staff are working towards this. The manager states that one of his plans for improvement in the next year is to increase the number of staff holding NVQ qualifications. Staff recruitment files reviewed were well organised but did not show all the documents required to evidence a robust recruitment procedure to safeguard residents. The majority of files sampled did not contain a photograph to support identity. All showed that a Povafirst check had been completed prior to employment. There was no evidence of a criminal record bureau check on one file and others only had part of the record so did not provide full information to show that these were undertaken in a timely way in line with stated induction practices. The majority of staff surveys received and all staff spoken with felt that they were provided with ample induction/training and support to enable them to care for the residents and said that they were satisfied with the communication systems within the team. Staff meetings were held for all designations and minutes were available. Eleven newly recruited staff of various designations were participating in training on the day of the site visit as part of their induction. A certificated trainer provides moving and handling training in-house. Barchester use a CD Rom staff training programme for issues such a health and safety, food hygiene, protecting vulnerable people and customer care. Files requested for two care staff who had been in post for some months showed no, or a poorly completed, induction record and limited evidence of basic training such moving and handling. Other training files of longer serving specifically sampled showed no record of training in protecting vulnerable people. The manager states that the administrator is in now the process of producing a training matrix to inform the training plan. He states in the AQAA the plan to remain focused on staff training to ensure that staff are equipped with the appropriate skills and knowledge to meet the changing needs of the people who use the service. Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 22 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, 33, 35, 36 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Paternoster benefit from the sound management of the home that had effective procedures for gaining the views of residents and relatives. Practices in the home generally protect residents, and promote a safe environment. EVIDENCE: The current manager has recently been appointed at Paternoster and advised that he is in the process of preparing his application to the commission to be registered at this home. He confirmed in discussion and in the AQQA that he has appropriate training and in excess of 20 years experience in managing care homes. Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 23 There is a clear organisational structure within the home with the manager, matron, and head of Memory Lane (activities team) being full-time and supernumerary, to help to keep such a large home managed and organised. In the AQQA the manager states that he operates an open door policy. Staff, residents and relatives spoke with said that they find the manager approachable. The manager holds a ‘surgery’ one evening a month so that he can available to people at a time that may be more convenient for them and information telling people about this was clearly displayed in the home. The manager advised that in the last 10 days Barchester have begun their annual process of surveying all staff, service uses and relatives to gather peoples views on the service provided. An outside company is employed to collate and analyse the information which is then made available to all those who participated. Reports were available that showed regular monthly visits to the home by a representative of the registered person who assesses that the home is running properly, to help the registered person to monitor the quality of the service. A ‘ fast response feedback’ sheet was also displayed around the home that gave people an opportunity to express their views on the home in an easy and quick way. Residents meetings are held in the home as another way for residents to express their views and to have a say in the running of the home. The AQQA states that the registered persons’ policy is not to hold money for residents within the home. Services such as hairdressing are paid for via the homes administrator who then invoices the relatives on a monthly basis. This was confirmed with the manager at the site visit. There is a system for staff to be supported through clinical supervision. This is cascaded by heads of departments through to qualified staff and through them to care staff. Folders sampled showed that a supervision contract was in place and staff were offered regular supervision sessions. Records contained limited information but showed that relevant issues were discussed with staff, for example training and development, confidentiality or good practice in assisting residents with meals, and these were signed by both people involved in the session. The manager stated that Barchester employs an external body to carry out health and safety inspections at the home. Records were available that showed regular internal health and safety audits undertaken to ensure the safety and well-being of those who live and work there. These included example checks of the fire alarm and the emergency lighting system. A current certificate was available regarding the inspection of portable appliances, the fire alarm, fire extinguishers and emergency lighting system. A record of a recent fire drill showed a need for more training for staff. The training log shows that has recently been provided for several staff and several other training sessions were planned in the near future. Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 24 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 3 3 X 3 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 2 3 X X 2 X 3 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 3 3 3 x 3 3 x 3 Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A 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 OP29 Regulation 19 Sch2 Requirement The manager must ensure that all records of identification and checks undertaken on prospective staff are available to ensure that residents are safeguarded. Timescale for action 01/01/08 2. 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. 01/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP7 Good Practice Recommendations The service user guide should be available in a larger print to make it more user friendly for residents. The care plans should focus more on people’s strengths to DS0000069329.V350237.R01.S.doc Version 5.2 Page 26 Paternoster House Care Centre support person centred care. 3. OP12 Residents should be given opportunity to participate in everyday tasks in the home where possible, to support meaningful life experiences and maintain skills. Better recording of activities provided would support the staff team to monitor the effectiveness of the current plan and how much it was enjoyed by the resident. The mealtime experience offered to some residents should be reviewed to ensure that residents are offered support in a sensitive way that treats them with dignity and respect at all times. Consideration should be given to ensuring that all units include a quieter lounge area to give residents choice and meet needs. All bedrooms should be fitted with appropriate locks and keys offered to residents, based on risk assessment, to promote greater choice, privacy and dignity. The manager should continue to monitor staffing levels to ensure that residents receive the necessary support to meet al their individual needs. A minimum of 50 of care staff should achieve NVQ Level 2. 4. OP12 5. OP15 6. OP20 7. OP24 8. 9. OP27 OP28 Paternoster House Care Centre DS0000069329.V350237.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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. 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