Inspection on 09/08/05 for Patron House

This inspection was carried out on 9th August 2005.

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

The inspector 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

Patron House 21/09/06

Patron House 24/02/06

Patron House 12/02/05

Patron House 06/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Patron House 212 Stoke Lane Westbury On Trym Bristol BS9 3RU Lead Inspector Helen Taylor Announced 9 August 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Patron House Address 212 Stoke Lane Westbury On Trym Bristol BS9 3RU 01179682583 01179691973 mail@ablecare-homes.co.uk Ablecare Homes Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Miss Emma Marshall Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. may accommodate up to 12 persons aged 65 years and over requiring personal care. 2.The flat should be shared by couples who have expressed a clear wish to share and who are: a). married couples b). living as a couple prior to admission c). living together in the community prior to admission. Date of last inspection 12 February 2005 Unannounced Brief Description of the Service: Patron House is a residential care home providing accommodation and personal care for a maximum of 12 persons aged 65 years and over. A recent increase in the numbers is a result of a variation agreed in relation to a flat within the premises to be offered for couples needing care who wish to share. The home is set in a detached property in a residential suburb in the city of Bristol. Accommodation is arranged over two floors, and a stair lift is provided. Well kept gardens surround the property. Ablecare Homes Ltd. own and operate four homes in the Bristol area, Patron House being one of those. The business is a family concern overseen by Mr and Mrs Wilcox (owners) and Mrs Sam Hawker is a director of the company. The registered manager of the home is Miss Emma Marshall. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection as part of the annual inspection programme to examine the standard of care provided and review progress in relation to the requirement made during the previous inspection conducted in February 2005. This inspection took place over one day and not all standards were assessed on this occasion. Through observation, discussion with residents, staff, the manager and director, and a review of records held, it was evident individuals accommodated benefit from good standards of care at Patron House. Further evidence was gathered from the pre-inspection questionnaire, reports of monthly monitoring visits, and one comment card was received from a relative. What the service does well: What has improved since the last inspection? The manager Miss Emma Marshall has recently successfully completed the registered manager process, and has achieved NVQ level 4 and the Registered Manager Award. The organisation have worked diligently to ensure a robust recruitment procedure is implemented and all appropriate information is in place for staff prior to the start of employment. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 6 The manager, in consultation with the residents, has reviewed the menus to provide more home cooked meals and fresh vegetables. Residents commented on the improvements made. 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. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5. Information is available to enable prospective service users and their representatives to make an informed choice about moving into the home. The admission procedure provides assurance that individual needs will be met. EVIDENCE: A statement of purpose and service user guide was available in the home. A copy is provided to all service users, and the documents contain all information as detailed in the National Minimum Standards, including a sample copy of the contract of terms and conditions. The admission procedure includes initial assessment, and the manager explained part of this process would include visiting individuals in their own homes or in hospital. Local authority assessments are also used in the development of an individual care plan. The admission procedure encourages trial visits to the home, prior to permanent placements being offered. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 9 Records reviewed provided evidence that family members are involved in the assessment and care planning process. Contracts have previously been viewed and comply with the National Minimum Standards; a sample is contained in the service user guide. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10. Clear information is held demonstrating each residents assessed and individual needs are identified. The arrangements for the administration of medication are poor and potentially place residents at risk. EVIDENCE: Care file information examined provided evidence that each resident had the following information in relation to health care and personal needs: • Local authority assessments • Initial needs assessments • Healthcare records • Manual handling assessments • Risk assessments • Plan of care • Social activity record In conjunction with the daily record sheets the care files indicated a high standard of care provision. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 11 The Inspector had the opportunity to speak with residents who confirmed they were happy with the standard of care provided. The residents confirmed good relationships with the staff team, and conveyed to the inspector they felt at home in Patron House. Observations of staff interactions with the residents confirmed positive, respectful relationships. The home have in place policies and procedures for the administration and storage of medication, however the Inspector observed a staff member administering medication by leaving it on the dining tables in plastic pots. A risk assessment in place for one resident referred to the possibility of this person storing medication, and provided specific guidance in relation to this risk. The staff member confirmed medication training from the pharmacist, however was unable to demonstrate a good understanding of the risks involved, or the possible consequences from administering medication in this way. The manager agreed further training and guidance would be provided. A requirement will form part of this report in relation to this issue. The director explained a change of pharmacist was presently being investigated, as the organisation was unhappy with the service provided. A review of the record and storage of medication revealed an error in the recording process. Most medication was dispensed from a monitored dosage system, however there were various items of medication for different residents held in the same container. Each item was labelled with the residents name. The Inspector recommended medication for each resident should be held in separate containers to minimise the risk of errors. The manager agreed this would be implemented. The medication was stored in a locked room in locked cabinets. A requirement from the previous inspection that the person making the entry should sign handwritten entries on Medication Administration Records has been complied with, and all entries were appropriately signed and dated. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15. The residents health and well being is maintained through the supply of nutritious, well presented meals. Social and recreational activities are organised which satisfy the interests of the individuals accommodated. EVIDENCE: The Inspector had lunch with the residents and the meal was tasty and well presented. The residents commented that a recent change to the menus had improved the supply of fresh vegetables during mealtimes. The new manager and relatively new staff team have encouraged residents to make their views known. Records of residents meetings, and recordings in the daily observation sheets indicate this has been a positive change. The home now has a designated cook who prepares all meals, and interaction with the residents is seen as part of this role. The inspector observed the cook chatting to the residents, and those residents spoken with confirmed good relationships with all staff. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 13 The residents explained there had recently been a garden party, and friends and family members were invited. The garden party included a musician and the residents were very vocal about how enjoyable it had been. Comments about the garden party included: very enjoyable lovely to meet so many people I enjoyed the dancing my family came to the party, it was great. Similarly the residents told the Inspector of in-house entertainment on a regular basis, and a recent trip to a local seaside resort. A trip to a local beauty spot had been planned for the week of the inspection, and the residents were eagerly looking forward to it. Some residents commented they would like to take part in some exercise type activity, with a focus on improving mobility. The manager explained sessions could be organised as the home had a video as a prompt, and a staff member would guide the residents. Friends and family members are encouraged to visit the home, and the Inspector observed visitors coming and going confidently. The home does not handle the financial affairs of any residents. Small amounts of personal money may be held at the request of relatives; those records were not reviewed on this occasion. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18. A clear complaints system is in place and residents are encouraged to air their views. The risk of residents suffering any form of abuse is appropriately minimised. EVIDENCE: A comprehensive complaints policy was displayed in the entrance hallway. The policy is also contained in the service user guide. Regular residents meetings are held and a review of the minutes indicated a vocal group of residents who felt able to air their views. Those residents spoken with confirmed they would feel able to approach the manager or any staff member if they had concerns about anything. This was evident from observations during the inspection process. Information provided in the form of reports of monthly provider monitoring visits, indicates that residents views are sought during these visits. There had been no complaints since the last inspection. Policies and procedures are in place to ensure residents are protected from any form of abuse. Pre-inspection information showed that all staff have not yet attended abuse training, although the director was able to provide evidence that a training programme is in place, and all staff will attend as places become available. The training is organised by the local authority. Abuse training certificates were seen during a review of staffing information. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,25. The quality of the furniture and fittings is good, and overall a warm, homely, comfortable environment has been created. EVIDENCE: The Inspector did not conduct a full environmental check, however a cursory review of the shared space and cleanliness of the environment was undertaken. The inspector viewed the lounge, dining room, study area and patio. All areas viewed were clean, tidy and domestically furnished. New garden furniture has recently been provided, and the inspector observed residents making full use of the patio to enjoy the warm weather. A stair lift provides access to the first floor, and the Inspector observed residents using it confidently. Information provided as part of the monthly monitoring visits by the provider indicated that continual maintenance and a review of adaptations needed is completed on a regular basis. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 16 Recently a mirror has been fitted on the stairway to enable residents who wished to use the stair lift, to see if anyone was about to use it at the top of the stairs. This is a recently fitted stair lift, which turns the bend at the top of the stairs, and therefore the chair is not in view from ground floor level. This action provides evidence that the manager and director continually review and upgrade the premises to meet the needs of the people accommodated. The residents spoken with conveyed to the inspector that they were happy with the furniture and fittings and felt comfortable. The Inspector noted the toilet on the upstairs landing was designated a staff toilet and a notice was prominent on the door. The communal toilet on the ground floor was fitted with a raiser, this had been provided for a resident who had now left the home. The Inspector suggested all toilets should be available to the residents and the sign should be removed. The director advised that all residents had toilet facilities in their own rooms, and a further toilet was located in the bathroom on the first floor. A review of health and safety information in relation to care homes stated that in general terms staff should have a designated toilet where this is not detrimental to the residents. After a review of this information and discussion with the director, it was decided that adequate facilities are provided for the residents. Individual rooms were not viewed on this occasion. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30. Improvements in the recruitment practice, and opportunities for training ensure residents receive support from competent staff. EVIDENCE: A review of staffing information held provided evidence that a robust recruitment process is being adhered to. Staffing files sampled contained the following information: • Evidence of Identity • CRB checks • Application forms • Signed terms and conditions • References • Personal development plans • Supervision records The home has in place an induction programme for new staff members, and evidence of this process was noted in the files. Training records sampled contained the following certificates: • Appointed First Aid • Manual handling • Dementia Awareness • Food hygiene • POVA • Induction records Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 18 This is not an exhaustive list but provides and insight into the organisations commitment to developing staff potential, and ensuring staff understand and are competent in meeting the needs of the residents. A programme of NVQ training is also in place with support being provided by the manager and an external assessor. The manager provides regular supervision and support, and a staff member spoken with confirmed this. The supervision records were comprehensive and indicated a commitment from the manager to ensure staff feel valued and ultimately deliver a good service to the residents. Residents spoken with confirmed the staff were sensitive, and treated them with respect. Good relationships had been developed with the staff team, and this was evident from observations during the inspection process. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36,37. The newly registered manager has a clear vision for the home, and she is well supported by the organisation, ensuring the residents health, welfare and safety needs are the primary focus of care provision. EVIDENCE: Miss Emma Marshall has recently successfully completed the registered manager process. The manager has also achieved the NVQ level 4 and Registered Manager Award, which were framed and displayed in the entrance hallway. Throughout the inspection process the manager demonstrated a good understanding of her role, with a commitment to providing individualised care for the residents. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 20 The atmosphere in the home was calm and relaxed, with residents looking at ease and at home. Notes from a recent residents meeting indicated that the manager has effectively communicated to the residents her vision for a home, which mirrors family life. The residents conveyed to the Inspector a sense of belonging in the home, and were able to express their views and felt they would be listened to. The home has policies and procedures in place, which are robust and provide sufficient information to direct and guide staff practice. The Inspector noted during supervision sessions, policies are discussed and this is fully recorded. Staff members receive policies and procedures during the induction process, and sign to acknowledge their understanding of the contents. The Inspector noted there was no written evidence of handovers between day staff and night staff, or between manager and all staff. The Inspector recommended information between the staff team should be in written format to ensure all staff are aware of any important changes in care for any individual. The implementation of a communication book would provide evidence of the managers interaction, direction and support of the staff team and in turn indicate staff members awareness of important issues relating to the day-today care practice in the home. Comprehensive risk assessments were in place covering residents identified needs, environmental risks and a fire safety assessment. A requirement from the previous inspection in relation to fire safety equipment checks has been met. A certificate was seen to confirm an annual check by an external contractor, and weekly equipment checks had been carried out regularly by the manager. The records relating to fire training and fire drills for staff however, were incomplete. The inspector noted for three staff members there was no recorded entry of a fire drill having taken place. The records showed that fire training had been carried out for two of these staff soon after appointment in November and September 2004. No training or fire drills had been recorded since that time. Fire drills were being held on a regular basis, however the regulations require that all staff attend fire drills and practices at intervals as advised by the local fire authority. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 x x x x x 3 x STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x 3 2 x Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13.2 Requirement To ensure all staff who administer medication adhere to the policies and procedures for the administration and recording of medicines. Medication training must be adequate and provide guidance that prevents harm to resdients. To ensure all stafff attend fire drills at suitable intervals, and records are kept. Timescale for action 30th September 2005 30th September 2005 30th September 2005 2. 3. 9 38 13.6 23.4 e RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 9 12 37 Good Practice Recommendations To store each residents medication in individually named containers. Develop excersise bsed activities to suit the needs of individuals accommodated. Provide a communication book to record staff handovers, and genereal informaton between staff and manager, particularly during evenings and weekends. Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos. BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Patron House D56_D05_26513_PatronHse_V235805_090805_Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!