CARE HOMES FOR OLDER PEOPLE
Paulmay Residential Home 17 Dukes Avenue Finchley London N3 2DE Lead Inspector
Tola Akinde-Hummel Key Unannounced Inspection 4th April 2006 09:50 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 Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Paulmay Residential Home Address 17 Dukes Avenue Finchley London N3 2DE 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) 020 8346 3642 020 8349 3424 Mr Kevin Gurry Mrs Marjorie L Gurry Mrs Marjorie L Gurry Care Home 8 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (8) of places Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st November 2005 Brief Description of the Service: Paulmay is a large, converted house situated in a quiet residential area of Finchley in North London. The home is registered to provide care for eight older people who have some form of dementia. The home has one single and one double room on the ground floor. There are three single rooms and one double room on the first floor. The home has a stair lift to the first floor. There is a large lounge/dining area on the ground floor leading to the well-maintained garden. The current fees for the home are £460.00 per week. The stated aim of the home is to provide professional and skilled care to residents. This is within a friendly, family atmosphere where freedom, choice and dignity are maintained. Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took five hours to complete. During the inspection, the inspector was able to speak to four service users, three relatives, the manager Mrs Gurry, the proprietor Mr Gurry, the deputy manager, and briefly to two other members of staff on duty. The home currently has one vacancy, as one service user is in hospital and will not be returning. Seven service users and three members of staff were in the home at the time of inspection. The inspector completed a tour of the building, looked at the care plans, examined the medication records and storage, sampled policies and procedures and addressed the requirements made at the previous inspection. The inspector would like to thank the service users, relatives’ and members of staff on duty who were helpful and available throughout the inspection. What the service does well: What has improved since the last inspection?
The redecoration programme in the home has now been completed. The home is more pleasant environment for service users to live in. The home has completed their fire risk assessment and have nearly completed the fire evacuation policy. The home has also completed the gas safety checks and Legionella testing. The home has completed a night fire drill and has repaired the carpet in the office to minimise the risk of trips and falls. Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 Page 6 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. Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 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 Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 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 the following standard(s): 3,5 All service users and their relatives have the opportunity to visit the home and receive a full assessment prior to admission. EVIDENCE: The care plans of four service users were examined. Since the last inspection, three new service users have entered the home. Records show that local authorities initially assess the needs of the service users and the home completes its own assessment prior to admission. The assessment undertaken once the service user has entered the home is detailed and informative. This includes a personal profile, past medical history and a medical care plan. All care plans examined contained relevant information. Three relatives spoken to during the inspection advised that they visited the home prior to admission. They confirmed that their relatives were assessed by the manager. The manager of PaulMay also assesses if the home is likely to meet the needs of prospective service users. Records show that all the recent admissions have a signed contract. Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 Page 9 Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9 PaulMay ensure that service users health and personal care needs are met within the home. Access to specialist healthcare is appropriately sought when required. Closer attention must be paid to the review of service user plans and the dates that medication should be administered from. EVIDENCE: The service user plans in the home contain sufficient detail regarding the health, social and emotional needs of service users. Evidence shows that GP’s and other health professionals are involved in the health care of service users where appropriate. Reviews of plans should be conducted on a monthly basis, however this has recently slipped so are not completely up to date. The manager is aware of this having given attention to other priorities in the home. This will be rectified swiftly. Four service users were spoken to during the inspection. All were well groomed open and friendly. Service users stated that the staff are very kind and they are well cared for in the home. Where possible service users stated that they have privacy in the home and are treated with respect by the staff team.
Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 Page 11 Observations of interactions between staff and service users are friendly, caring, patient and respectful. One relative stated, “ I believe that the staff really like the residents, you can see that in the way they give care and the way residents respond to them”. The medication administration records were sampled. These showed a small number of errors in the recording of medication administered. Records suggest that service users have missed or staff has mis- recorded the administration of medication. This seems to arise from some confusion about the dates of when the medication should commence. The manager and deputy manager will raise this discrepancy at team meeting on 05/04/06 and thoroughly investigate and report to the commission with the findings immediately. Although the home is small and staff team stable, it is recommended that photographs of service users be placed on their medication records. This will minimise any confusion with regards to administration. Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 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 the following standard(s): 12, 13 14, There has been positive improvement in the programme of activities for service users. This ensures that service users are adequately stimulated during the day and helps maintain a level of cognitive and physical ability. EVIDENCE: Four service user plans were sampled with attention paid to the activities organised for service users. Activities plans are individual and based on service users past interests as well as maintaining some cognitive and physical skills service users have. Three of the four care plan notes demonstrate that service users participate in activities. However the plan for one service user is not followed. This was discussed with the manager and the plan must be amended to accurately reflect what is happening and the notes should indicate why. Service users are able to practice their religion and are visited by local church volunteers and a priest comes to the home to give communion. On the day of inspection, relatives visited two service users. The relatives admitted that their family members were not always easy to engage at times and would refuse participation. They stated that staff would encourage but not force service users to join in. One relative stated “ I really enjoyed the Christmas party last year, the home had an entertainer here and we were all singing and dancing, it was wonderful”.
Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 Page 13 Service users relatives and friends are actively involved in the life of their family members that live there. With the exception of one service user all others have relatives or friends that visit regularly. Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 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 the following standard(s): 16 The system for complaints to be made and acted upon remains the same as at the previous inspection. EVIDENCE: The home has a complaints procedure in place. Following discussion with service users relatives it is clear that they know how to complain and where to go if they are not satisfied with the service. One relative of a new service user told the inspector “ The home manager told me that they are inspected by the commission and that complaints can be made to the commission if I am not satisfied with the service”. On the day of inspection, two relatives stated that they are very happy with the care provided in the home and they have so far had no reason to complain. Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 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 the following standard(s): 19,23,26 PaulMay has completed its internal decoration programme and the home is more comfortable. Service users benefit from a fresher and more homely environment. EVIDENCE: Since the previous inspection, the home has completed its redecoration programme. The loose fitting carpet in the office near the fire exit has been replaced with properly fitting carpet. Service users rooms are comfortable, personalised and clean. One relative told the inspector, “ We chose this home because we believe it is like home from home, it is small, cosy and comfortable”. The home has a number of service users unable to manage their continence. Staff assist service users to go to the toilet at regular intervals. However accidents occur. The deputy manager informed the inspector that staff have a powerful domestic carpet cleaner and wash the carpet every four days. Then on a monthly basis, have the carpet cleaned professionally. This cycle ensures offensive odours do not linger in the home. This system appears to work well.
Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 Page 16 Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 The home has adequate numbers of staff on duty during the day and night. The home must ensure that staff complete their NVQ qualification as required. EVIDENCE: The management at PaulMay remains the same since the previous inspection. Staff confirmed that they continue to have key responsibilities in the home. The manager advised the inspector that one staff member remains on long term sick leave. The manager has recently recruited a new member of staff who is completing her induction and may then complete night shifts. All staff work days and nights. This allows all staff the opportunity to care for service users at all times of the day and to work with all staff. Staff confirmed that they receive regular supervision from the manager although the supervision records were not inspected on this occasion. Staff have not completed their NVQ. It is hoped that staff will complete by August 2006. The manager has enrolled to complete the A1 assessor’s course and will be in a position to assess staff within the home. The home has a stable staff team, which, benefits service users immensely in terms of familiarity and continuity. The staff team are all African and Afro Caribbean. They are familiar with the culture of the all white service users and
Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 Page 18 ensure their religious and cultural needs are met in partnership with their families and friends. Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,38 Compliance with health and safety legislation in the home has improved since the previous inspection minimising the risks to service users, their relatives and staff. EVIDENCE: The manager of the home has many years experience and is clear about her role and responsibilities. The manager has had a vast amount of experience caring for this client group and ensures her knowledge is updated. The previous requirement to complete a fire risk assessment has been met. Upon request, the fire authority visited the home and advised the home of improvements that needed to be made to comply with fire safety regulations. The home has completed the majority of these recommendations and has two months to comply with the outstanding issues. The Inspector was able to look at the records of fire tests and fire drills. These are satisfactory. The previous
Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 Page 20 requirement relating to the testing of the water system for Legionella has also been completed. Evidence was seen to confirm this. The gas safety check has also been completed. The home has not had the fire fighting equipment tested and this is now overdue. The home must ensure this is done soon. As previously required, the home has fitted carpet in the office thereby reducing the risk of the accidents to service users and staff. Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 X 3 X X X 3 X X 3 STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 2 Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP7 OP9 Regulation 15, (2), (b) Requirement Timescale for action 24/04/06 05/04/06 3. OP12 4. 5. OP28 OP38 The registered person must ensure service user plans are reviewed on a monthly basis. 13, (2) The registered person must ensure that staff complete MAR sheets accurately and are clear about when new medication should be administered. 16, (20 The registered person must (m) amend the activity plan of one service users who is unable to take part in the activities highlighted. Reasons why this is not possible should be noted. 18, (c) The registered person must (i) (ii) ensure that at least 50 of staff undertakes NVQ training. 23, (4) (c) The registered person must (iv) ensure that fire-fighting equipment is regularly serviced. 24/04/06 30/06/06 15/05/06 Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 Page 23 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 OP7 Good Practice Recommendations The registered person should consider photographs of service users on their medication records. Paulmay Residential Home DS0000010508.V288161.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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