Inspection on 18/05/07 for Pax Care Home

This inspection was carried out on 18th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pax Care Home 06/06/06

Pax Care Home 25/11/05

Pax Care Home 08/06/05

Pax Care Home 01/03/05

Pax Care Home 03/06/04

Pax Care Home 20/01/04

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

CARE HOME ADULTS 18-65 Pax Care Home 132-134 Pytchley Road Rugby Warwickshire CV22 5NG Lead Inspector Patricia Flanaghan Unannounced Inspection 18th May 2007 1.30 Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 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 Pax Care Home DS0000004354.V335220.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 Adults 18-65. 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. Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pax Care Home Address 132-134 Pytchley Road Rugby Warwickshire CV22 5NG 01788 575009 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) Mrs A H Ribeiro Alvin Anthony Ribeiro Care Home 2 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (2) of places Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The Registration The registration relates to being the registered manager for Pax Care Home accommodating two service users only. Hours worked per week That the registered manager, Alvin Ribeiro, works no more than twenty one hours per week as a medical practitioner and one day per week at Minster Care Home in Coventry. Training That Alvin Ribeiro undertakes training in the following subjects within 12 months from the date of registration: Mental health awareness Management and supervision Person-centred care Evidence of the training must be provided to the Commission for Social Care Inspection. 4. Service User Category Registration is for a maximum of two service users in the category mental disorder, excluding learning disability or dementia. Service users may be of either gender 6th June 2006 3. Date of last inspec Brief Description of the Service: Pax Care Home provides accommodation for 2 service users who have enduring mental health needs. The accommodation is half of the ground floor of a detached house offering single bedrooms, a dining room and small lounge area, as well as access to a large lawned garden. This is part of providers family home where they live with their two grown up children. A majority of the care is provided by family members and by three care staff who are employed Monday to Friday 8 am to 5 pm. The property is within walking distance of Rugby town centre, as well as situated on a bus route. The current weekly fees for a place in the home is £336.00. Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection visit took place on Friday 18th May 2007 between 1:30pm and 5.00pm. The registered person of the home completed and returned a pre-inspection questionnaire containing further information about the home as part of the inspection process. Some of the information contained within this document has been used in assessing actions taken by the home to meet the care standards. Both people who use the service were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, discussing their care with the owners, looking at their care files, and focusing on outcomes. A number of records, such as care plans, risk assessments and fire safety records were also examined during the course of the inspection. The registered manager was available throughout the inspection and the inspector was able to tour the home and spend time speaking with the two residents and a member of staff. The inspector would like to thank the people who live in the home and staff for their cooperation and hospitality. What the service does well: The staff member on duty was friendly and respectful and the people at the home looked happy and at ease when seeking her support. People were well groomed and dressed in age appropriate clothing. There have been no complaints at the home since the last inspection. Staff at the home are provided with training so that they know how to report any suspicions of abuse or any concerns they may have about the running of the Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 6 home. The manager has ensured that the complaints policy is available in a format suitable for both people living in the home. Staff are provided with a very good range of training courses to equip them for their work. As well as courses to support safe practice and sensitive care, staff are also being provided with courses that are designed to help them recognise people’s individuality for example, equality and diversity training is being arranged through a local training organisation. 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. Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This outcome group was not inspected on this occasion. EVIDENCE: No new people have moved into the home since the last inspection on 6 June 2006, therefore key standard 2 was not applicable on this occasion. Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. Comprehensive care plans and risk assessments ensure that the service meets the service users individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both people who live in this home continue to have a care plan which is reviewed on a regular basis. The last recorded review dates within the two care plans confirmed that they had both had care reviews within the previous six months. Interpreters also attend formal reviews. Areas of care and support covered within the care plans included such things as general health, medication, exercise and diet, and leisure. Also detailed within the plans were individual identified areas of need, the aim of the care plan and the action to be taken to meet the need. It was also noted that the people are involved in their care planning. Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 10 Risk assessments are in place and are updated regularly in line with the person’s care plans. The homes approach to risk management ensures that there is a balance between enabling the individual to retain their levels of independence within a safe framework. Areas covered by the risk assessments in the two care plans included such things as travel and mobility, fire, security of medication, health and personal hygiene. Residents’ care plans contain satisfactory information about their daily routines and their likes and dislikes which enables them exercise some control over the way in which their care is provided by staff. One of the people living at the home confirmed that they take part in shopping for groceries and for personal items, such as clothing, with support from staff. This enables this resident to choose the things they like. Information in care files and discussions with the registered manager confirmed that the residents are able to access support external to the home, which include social services, or in the case of one of the people, staff at the day centre. Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. Opportunities are available in the home to ensure that people living in the home experience a daily life, which offers a positive and varied lifestyle. A healthy nutritious diet, which meets the cultural needs of the people, is provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One of the people living in the home attends two different day centres four days a week. This person enjoys activities undertaken by one of the day centres and told the inspector he is going on a shopping trip to Northampton shortly. Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 12 The other resident prefers to remain in the home watching Asian programmes on satellite television and chatting to staff. A review of this resident’s file evidenced that at all recent reviews she has told her social worker and other healthcare professionals present that she does not wish to leave the home and participate in social and community activities. She has also specifically said that she does not want a ‘befriender’ to visit her in the home. A member of staff from the same ethnic background told the inspector that she brings in Asian magazines for her and spends time chatting with her, which the resident clearly enjoyed. The home encourages people to maintain contact with friends and relatives. While the inspector was in the home a relative of one of the residents rang from Canada to speak with them. A menu is in place based on residents’ preferences, which are recorded in their care planning documentation. All the meals provided are suitable for vegetarians and the main meal is prepared which is appropriate to resident’s cultural needs. Comments made by one of the residents indicate that they enjoy the food provided and they were seen to enjoy their evening meal, commenting “the food is good.” Suitable records are in place for monitoring the dietary intake of both residents. A fruit bowl was available in the kitchen for the residents to help themselves to fresh fruit. Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. Residents are provided with appropriate support to meet their personal care and health needs. Medication policies and procedures ensure that medication is managed safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both people living in the home have minimal personal care needs, being independent in this area for much of the time. However, the increasing age of one of the people and the physical disability of the other person requires staff to be available to provide support and assistance as required. At the time of the inspection the personal care needs for one of the people related to prompting only with some assistance with bathing. The current level of personal support required by both residents was detailed in their care plans. Discussion with the residents and staff plus entries in individual health records indicate that the home supports people to access appropriate healthcare Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 14 support where required. One person’s records demonstrate that he has been supported to access an extensive range of consultants and health professionals and provided with specialist equipment to meet his changing mental and physical health needs. Information was available within both care plans to confirm that their routine and more specialised healthcare needs are met. Visits to the Dentist and Opticians were recorded, as were visits to specialist clinics, the GP and hospital appointments. A chiropodist visits six monthly. Day to day life in the home is flexible, both residents spoken with indicated that they choose when they go to bed at night and get up in the morning. During the inspection visit one of the residents went and lay on their bed as they felt sleepy. Medicines were contained in a locked cupboard. All medication administered are recorded on medication administration records (MAR) charts and systems are in place for booking medication into and out of the home so that it is properly accounted for. The medication in the cabinet was found to be correctly labelled so that it is clear whom the medication belongs to. Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. The homes policies, procedures and practices on complaints and abuse ensure that service users views are listened to and acted upon, and help to protect service uses from potential harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has both complaints and protection form abuse policies and procedures in place. Since the last inspection the registered manager has had copies of the complaints procedure translated into Gujarati and Punjabi, which is the first languages of the two residents. This ensures that the residents have the complaints procedure in a format they can readily understand. No complaints have been received by the home or the Commission for Social Care Inspection since the last inspection. Discussions with the member of staff on duty demonstrated that staff are provided with adult abuse training. She was clear about her responsibilities should abuse be suspected or disclosed. Observation during the course of the inspection showed that both residents were relaxed in the environment in which they live. Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. The standard of the environment within the home is good providing service users with an attractive and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is intended to provide a small domestic home-like environment reflecting the small number of residents accommodated and their particular needs. Situated in a residential area, reasonably close to the town centre and its amenities, the home is in a quiet location with little traffic. The premises are detached and serve both as the Registered Persons’ family home and a care home. Resident’s accommodation is distinct and completely selfcontained providing them with adequate bedroom and communal space. Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 17 The home continues to provide people living there with a reasonably comfortable and safe environment in which to live. It is constructed in a style compatible with those that surround it thus making it largely indistinguishable and it is being maintained in good structural and decorative order. New carpets have been fitted in all areas of the home including the bedrooms. The manager said that the two people living in the home were choosing furniture to replace the existing bedroom furniture, which is quite worn and shabby. This will ensure their bedrooms are furnished to their personal taste. It was noted at the last inspection that there are no restrictors on the window openings in resident’s bedrooms. Even though these rooms are on the ground floor, fitting restrictors, which enables sufficient ventilation but would deter residents attempts to climb out or intruders to enter, is likely to improve safety and security. The manager agreed to risk assess the situation and if necessary, fit restrictors on the bedroom windows. The laundry facility was clean and tidy and there is documented evidence to show that monthly maintenance checks on the environment are taking place. On the day of the inspection the home was clean and tidy with no offensive odours apparent. Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome group is good. Service users benefit from sufficient numbers of competent, knowledgeable staff who have been recruited appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No new staff have been employed by the home since the last inspection visit. Documentation was available at the last inspection to confirm that satisfactory recruitment processes are in place that safeguard the people who live in the home. The member of staff on duty told the inspector of the training she had completed in the past year. She is in the process of completing a National Vocational Qualification (NVQ) at Level 2 in Care. Other training undertaken includes, first aid, moving and handling, managing challenging behaviour and food hygiene. Copies of her certificates are held on file in the home. Another member of staff is currently undertaking an NVQ Level 3 in Care. Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 19 The staff member on duty speaks both Gujarati and Hindi and is therefore able to communicate with both people living in the home. This is particularly important for the person who prefers to remain in the home and it was evident that a good relationship has developed between the resident and the staff member. Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. Management and operation of the home ensures the safety of residents at all times, which supports and increases their self-worth and quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is a qualified and practising medical doctor who has had some supervisory experience in residential care in his capacity of registered provider of a care home for older people. He has completed the final module in the Certificate in Management Studies (CMS). This qualification will be accepted as meeting the management component of Standard 37. Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 21 The pre-inspection questionnaire completed by the manager shows that all the essential health and safety checks are being routinely carried out at the home. Fire records were examined and there was evidence that fire equipment is being appropriately tested and checked to ensure it is maintained in good order and suitable arrangements are in place for the testing of electrical equipment so that it is safe to use. The COSHH (Control Of Substances Hazardous to Health) cupboard was unlocked at the time of the visit and the washing powder was in an open container on a work surface. The manager immediately locked the cupboard thereby ensuring the health and safety of the residents. A pane of glass was broken in a window in the dining room. The broken area had jagged edges and may cut a resident or staff member if they accidentally touched or brushed against the glass. The manager said he would have the glass replaced as soon as possible. This home provides a homely family environment for the people who live there. Procedures seen and examined include safe handling of medicines and fire safety. Both residents indicated that they felt comfortable in the home and a positive relationship was observed between the people living in the home and the manager and staff member present on the day of the inspection. Support received from external agencies ensures that the individual holistic care needs of both people living in the home are acted on, monitored and reviewed. There is currently no formal process for getting the views of people at the home, their relatives and visiting professionals about the way in which the home is run, which could contribute to future developments in the home. The registered manager has developed a quality assurance system and expected to be implementing this in the coming months. Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 N/A 2 N/A 3 N/A 4 N/A 5 N/A INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 23 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 YA42 Regulation 13(4) Requirement Chemical products used in the home must be stored in suitable containers and in an appropriate lockable storage facility. This will ensure the safety of people who use the service. Timescale for action 31/05/07 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 YA24 Good Practice Recommendations The registered person should risk assess peoples’ bedrooms to ascertain if window restrictors need be fitted to reduce the risk of intruders attempting to enter the bedrooms. The registered provider should replace the shabby furniture in peoples’ bedrooms, which will ensure their personal environment is comfortable and homely. Action should be taken to seek the views of the people at the home, their relatives and other visitors so that these views may be considered in the home’s development plan. 2 3 YA24 YA39 Pax Care Home DS0000004354.V335220.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Birmingham 1st Floor Ladywood House 45-46 Stephenson Street Birmingham West Midlands B2 4UZ 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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