Inspection on 13/04/05 for Pax Hill Nursing Home

This inspection was carried out on 13th April 2005.

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

Pax Hill Nursing Home 24/08/07

Pax Hill Nursing Home 20/06/06

Pax Hill Nursing Home 13/09/05

Pax Hill Nursing Home 14/10/04

Pax Hill Nursing Home 05/04/04

Pax Hill Nursing Home 11/02/03

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Pax Hill Nursing Home Pax Hill Bentley Nr Farnham, Surrey GU10 5NG Lead Inspector Val Sevier Unannounced 13/04/05 10.00am 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. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Pax Hill Nursing Home Address Pax Hill, Bentley, Nr Farnham, Surrey, GU10 5NG 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) 01420 23786 01420 22690 Dr M Zaki Mrs Katarina Parr CRH 61 Category(ies) of DE, DE(E), MD, MD(E), OP, PD, PD(E), TI, registration, with number TI(E) of places Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 26 service users may be accommodated who are in need of nursing care. 2. All service users must be at least 55 years of age. 3. A maximum of 10 service users may be accommodated at any one time between the ages of 55 and 65. 4. A total of 6 service users in the PD and PD(E) categories may be accommodated on the residential side. 5. Service users in the categories PD and PD(E) are not to be accommodated in the area known as The Annex. 6. A total of 15 service users in the PD and PD(E0 categories may be accommodated on the nursing side. 7. A total of 10 service users may be accommodated in the MD and MD(E) categories. 8. Service users in the DE and DE(E), MD and MD(E) and TI and TI(E) categories must also be in need of nursing care. Date of last inspection 14/10/04 Brief Description of the Service: Paxhill is a 61 bedded home offering both nursing and personal care. It is situated in the village of Bentley at the end of a private road amidst farmland. The home has large grounds available to service users and many rooms overlook the countryside. The home offers accommodation in 37 single rooms and 12 double rooms. There is an activity programme available for service user participation and a quarterly newsletter, informing service users of events within the home. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. On the day of the inspector was at the home from 10 am until 4.30. During this time she was able to speak with three relatives several staff and six residents. Pax Hill is able to accommodate 61 residents there were 19 on the residential side and 26 in the nursing wing. The inspector viewed three care plans on the residential side and four from the nursing wing. A new manager has been appointed following the departure of the previous manager several months ago. The manager intends to apply to the CSCI for registration. A deputy has also been appointed to the nursing wing. The proprietor Dr Zaki, the manager and deputy on the residential side assisted throughout the inspection. What the service does well: What has improved since the last inspection? The décor of the nursing wing has improved with the corridors being painted giving a lighter atmosphere and a brightness enabling residents to move around more easily. The residents seem to be calmer and the atmosphere seemed cheerier than on previous visits, this may be due to the change in residents and staff. The heating and hot water system has been renewed and hot water is now available throughout the nursing side. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 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 Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 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) 3 and 4 Assessments for new residents have not always taken place, with a new manager employed this is expected to resolve. The new manager has considered skills and abilities of staff in the formulation of the training programme. EVIDENCE: The home has a pre admission assessment, which includes all areas from the standard. In the care plans seen on the residential side in one case an assessment had not been carried out by the home for a recent admission, they had used instead an assessment from the hospital completed by a social worker and nurse. The home admits people for short-term respite care; a care plan for a resident on short stay was seen. There was limited information available; the person was fully self-caring including medication. The third plan was an admission last year and the previous manager had completed the pre admission assessment. There was evidence on the nursing side of a pre admission assessment combined with information from other professionals. The proposed manager has identified training, which will further enhance the staff abilities to meet the needs in particular looking after those with dementia and communication. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 Page 9 Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 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 and 10. Care plans and medication management at the home need to be improved in order to safely meet the needs of the residents. Personal support in the home is offered in such a way that it promotes an protects residents privacy and dignity. EVIDENCE: The care plans on the residential side had been reviewed monthly with the exception of March. It was seen that on one plan no daily notes had been written since the 28th March. There was evidence of improved practice observed on the nursing side of the interaction between staff and residents and the general demeanour of the residents. Relatives spoken with were generally happy with the care at the home although comments were made about some staff being ‘short’ when talking to residents. This was discussed with Dr Zaki. Staff spoken with said that they feel confident with the new manager. Relatives commented on communication with some staff and had concerns that confused residents had difficulty making their needs known and understanding what was said to them. This was discussed with the manager who felt that this Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 Page 11 was not the case and that the level of English speaking ability of overseas staff was good. The short stay resident is self-caring and therefore had no care plan, the individual looks after his or her own medication, there was no evidence of a risk assessment or record of medication bought into the home. Staff were unaware of what medicines were being taken. On the third plan the resident was having problems with their skin with a sore area being dressed by the district nurse, there were other areas that required care and this care plan had not been reviewed since 2/12/04. There was no record in the daily notes that the care issues had been addressed. On the nursing side the care plans had been reviewed and daily notes written. The manager told the inspector that he plans to review the current care plans and has identified training needs for staff in documentation and records. There were currently two residents receiving care from the district nurses for pressure areas. There were no pressure care sores on the nursing side. It was noted that on the nursing side one resident needed care of a catheter, there was no plan for this. The manager says he has identified this with staff and that training will be organised for this. It was noted that on the nursing side there was a list on display of resident’s personal habits. This issue of privacy was discussed with both the manager and Dr Zaki. Residents where glasses and aids were needed were seen to be wearing them and glasses were clean. Medication records and stock were seen on both the residential and nursing side. It was noted that there were 22 gaps in the medication administration records on the residential side the majority being night time. No returns book was available on the residential side the manager said that he would rectify this as he had recently established one on the nursing side. This had been an issue at a previous inspection. The stock cupboard on the residential side was not lockable. There were medication bottles prescribed to residents no longer at the home with the name crossed out by the GP and being used as stock. Out of date items found, are to be returned to the chemist. Privacy and dignity were seen to be observed by staff when speaking with residents and carrying out personal care. One comments from a relatives was that there was nowhere quite to be on the nursing side if a resident did not want to join in activities or watch the television. Screens were available in double rooms. Lockable storage is available on request. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 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 and15. Activities on the nursing side seem well received and organised although not adequate for everyone. Dietary needs on the whole were well catered for. Families and representatives are welcome at the home. EVIDENCE: The nursing side of the home has an activity person and activities take place daily. She was seen to move between lounges enabling a number of people to participate is they wished. Newspapers were seen to be available on both sides of the home. Comments from relatives indicated that the type of television programme and music playing was not always appropriate to the residents for example children’s television and cartoons. Residents spoken with on the nursing side appeared content and enjoyed discussing a couple of books. They were seen to move around the home and chatted to staff and each other. The residents on the residential side are more independent and many sit in the entranceway where they watch staff and others walking about. Music was playing and there are several areas to sit and be quiet read, do jigsaws or watch television. Although residents are more independent on the residential side, there were several residents who may have benefited from a having something to do, one resident is distracted by being given bubble wrap daily. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 Page 13 There are no specific visiting times to the home and relatives told the inspector they come and visit when they want. Due to the situation of the home and individuals needs few residents handle their own affairs. Those spoken with felt happy with arrangements on the whole with their respective representatives. There is a planned menu at the home. The chef explained that there were alternatives and changes were made to the menu as need either seasonally or when residents asked for something to be provided. The inspector spoke with the chef, relatives and resident about the meals. Most were happy with the food. Comments were received about the apparent lack of availability of fruit and the presentation of the meals. These were passed to the chef. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 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 and 18. The home has a satisfactory complaints procedure with some evidence that relatives and residents have their views listened to and acted upon. There is knowledge and commitment to adult protection however; yearly training is considered good practice. EVIDENCE: There have been no complaints received at the home since the last inspection. Relatives spoken with were aware of the complaints procedure and felt that they were ably to approach staff and the manager with any concerns. Training is available in adult protection the manager stated his conviction to continue with updating staff regularly. All required documentation and advice literature is available Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 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, 26 The decoration on the nursing side has improved the environment it is no longer dull and dark. This is a positive outcome for the residents. EVIDENCE: A partial tour of the home was undertaken. It was noted that several areas have been painted since the past inspection especially in the nursing wing, which has given it a brighter look, and the corridors are now lighter. The beds highlighted at the previous inspection have been replaced. The heating and hot water has been addressed and the inspector tested several rooms particularly on the nursing side and found all to have hot water. A handy person has been employed at the home and issues re daily maintenance are being addressed. There was a detectable odour in two rooms on the nursing side. The laundry was not seen on this occasion. A relative commented that the stair lift had been out of commission for two weeks. This had led to concerns that the resident would not receive adequate care and fluids etc., the stair lift is now repaired. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 Page 16 Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 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 and 30 The manager seems to have established needs for staff already and these will be monitored at forthcoming inspections. Staffing on the day appeared to meet the needs of the residents, however this needs to be monitored in the evenings. EVIDENCE: The rotas for both sides of the home were seen and staffing discussed with the deputy and manager. The main are of concern with staff continues to be the kitchen despite attempts by Dr Zaki to secure staffing on two days a week when the second cook finishes at 2pm care staff from the residential side where there are three staff on from 8-8, have to leave care and cook tea for the whole home, clear away and wash up. A full time psychiatric nurse has been employed as the deputy at the home. The manager has already asked that training in dementia and communication be carried out with all staff in the home. The new manager has already set up a monitoring tool for training. He has also established what training is needed in excess of the mandatory areas. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 Page 18 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, 35 and 38 The manager has a good understanding of the areas in which the home needs to improve and being new in post this will be monitored at future inspections. Health and safety for residents could be an issue if training is not undertaken regularly. EVIDENCE: The home has been without a manager for several months although this has not made a big impact on the home due to other staff being there such as the deputy, some things have not been carried out for example the pre admission assessment. The new manager in conversation, has spoken with staff and observed care at the home, and has formulated plans for staff training. The inspector will monitor this at the next inspection The new manager is to start a mentoring course soon enabling the home to have adaptation nurses. This is all a positive outcome for the home as it has been without a manager since last July. A new deputy has been appointed to the nursing side and the acting deputy has been made permanent on the residential side. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 Page 19 The home manages personal monies only when a resident is unable to do so for themselves. The deputy oversees this. The marketing person undertakes surveys of relative’s thoughts about the home and residents are also involved in this. The fire records were seen and all checks were seen to have been undertaken. Fire training has just been resumed (February 2005) having fallen behind with only one training session having been held last year. This will be monitored. Records were seen that the nurse call system is checked daily with one room being activated at a time. The first aid boxes are checked monthly. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 x x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 x 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 x x x 3 x x 2 Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 Page 21 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 7 Regulation 15 Sch 3 Requirement Care plans must reflect the needs of the residents and be reviewed on a regular basis. Daily records must be an account of residents daily lives and care that has taken place as well as other significant events. Information should be trackable. Timescale for action 30/06/05 2. 9 13 (2) 3. 4. 26 38 16 (2) 13 (3) 23 (4) There should be a record of 31/05/05 medication administered to each individual with reasons why it has not. There must be a record of medication returned to the chemist. The cupboard used for holding stock in the residential side of the home must be locked. All areas of the home must be 31/05/05 odour free. All staff must receive fire training 30/06/05 twice a year. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 Page 22 Pax Hill Nursing Home 1. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V220873 130405.doc Version 1.20 Page 23 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton Hants, SO15 1GW 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. 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