Inspection on 13/09/05 for Pax Hill Nursing Home

This inspection was carried out on 13th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Pax Hill Nursing Home 24/08/07

Pax Hill Nursing Home 20/06/06

Pax Hill Nursing Home 13/04/05

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 September 2005 10:00am th 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 V245915 130905.doc Version 1.40 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 Dr M Zaki CRH - PC 61 Category(ies) of DE - 10, DE(E) - 26, MD - 10, MD(E) - 10, OP registration, with number 61, PD - 21, PD(E) - 21, TI - 10, TI(E) - 26 of places Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.doc Version 1.40 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 Annexe. 6. A total of 15 service users in the PD and PD(E) categories may be accommodated on the nursing side. 7. A total of 10 service users may be accommodated MD and MD(E) categories. 8. Service users in the DE and DE(E), MD and MD(E), TI and TI(E) categories must also be in need of nursing care. Date of last inspection 13th April 2005 Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.doc Version 1.40 Page 5 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. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.doc Version 1.40 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 5 hours and was unannounced. The inspector was able to speak with several staff members, a relative and 8 residents. The manager was available, however during the inspection the inspector was advised that he was leaving at the end of the month. The inspector had been able to speak with the proprietor the previous week regarding the home and documentation was also reviewed. The report reflects the two parts of the home the residential side and the nursing side. What the service does well: What has improved since the last inspection? The care plans on the residential side were seen to have improved since the last inspection with information about the needs of residents and how staff should assist with them. The records regarding the management and storage of medication have improved on both sides of the home. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.doc Version 1.40 Page 7 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. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.doc Version 1.40 Page 8 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 V245915 130905.doc Version 1.40 Page 9 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 5. 6 is not applicable at this home. The absence of important information in the needs assessment potentially puts residents at risk of harm and means that resident’s needs may not be met. There is not consistent evidence that staff have a full understanding of residents needs EVIDENCE: The home has a pre admission assessment, which includes all areas from the standard. In the care plans seen on the residential side there was no evidence that an assessment had 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 nursing side had information on three recent admissions from health, it was difficult to ascertain if the staff had carried out a pre admission assessment or completed the form with the written information available. Staff gave verbal information to the inspector about residents needs that was not evident on the pre inspection assessment or care plans Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.doc Version 1.40 Page 10 Relatives spoken with indicated that information was available for them to make a decision about the home. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.doc Version 1.40 Page 11 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 and 11. There is a lack of a clear or consistent care planning system, which means that residents are at risk of not having their needs met. The system for the ordering of medication and recording of administration has improved in some areas. Poor communication and understanding of residents needs potentially places residents at risk. EVIDENCE: The inspector viewed care plans on both sides of the home and they had been reviewed monthly. The care plans on the nursing side were poor with little information in addition to the assessment form regarding the care needs of residents and action to be taken by staff. This was apparent on one where they are accommodated on the residential side, the staff were able to tell the inspector that the individual was insulin diabetic, there was no plan regarding this, nor was it written in the care plan. The care plans on the residential side although they are similar in content, were laid out differently and staff had completed them with action to be taken by them to meet identified needs. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.doc Version 1.40 Page 12 There was evidence of deterioration since the last inspection of interaction between staff and residents and the general demeanour of the residents on the nursing side. The residents seemed lost and without purpose, many were asleep and there was no conversation taking place amongst them or between staff and residents. This was particularly evident with those residents upstairs that did not have any input from staff for two or three hours. This may be for several reasons, no activity person, and new staff with difficulties in communication. There was no evidence that staff had undertaken the training that the manager had identified to assist them in meeting needs. The inspector expressed concern to the manager that residents seemed to be spending long periods with no input from staff and were too frail to be able to summon help if needed. The manager explained that staff attended to residents upstairs at key points of the day, this still left sometimes two hours when no care staff appeared to be available. This was not so much of an issue on the residential side where residents are mobile and able to speak for themselves. The exception being two nursing beds situated on the residential side where one individual spends all their time in their room, with only input from staff at key times. There were currently two residents receiving care from the district nurses for pressure areas. There were no pressure care sores on the nursing side, although dressings were needed for other issues. It was noted again that on the nursing side one resident needed care of a catheter, there was no plan for this. There was some equipment, special mattresses being used on the nursing side for pressure relief, that were not working properly and the inspector was told that they needed repairing or replacing. Medication records and stock were seen on both the residential and nursing side. It was noted that there were 8 gaps in the medication administration records on the residential side an improvement since the last inspection. A returns book was available on both the residential side and the nursing side. The stock cupboard on the residential side was not lockable, although the staff sad it had been until recently. The controlled drugs book on the nursing wing was an A5 ruled book, which although completed doesn’t meet requirements. There did appear to be too much Ora Morph medication for one individual, when records of administration were seen. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 The lack of positive activity for the residents may have a detrimental affect on them the home is encouraged to seek a method of alleviating this. EVIDENCE: The activity person has left the nursing side since the last inspection; this may be the reason for a noted deterioration in the atmosphere and well being of the residents. It would seem that the staff do not have the time between caring, laundry and washing up to also carry out activities. This is particularly noticeable with those residents upstairs at the home who are unable to summon assistance due to their frailty. Staff also explained how difficult it was to take them down stairs with only the use of a stair lift. The residential side is expecting an activity person to start later this month four hours a day. This is in addition to some established things such as the visiting pat dog. There were a few comments from relatives about the lack of fresh fruit particularly for those that are unable to ask for it. It was also noted that meals were taken around the nursing wing uncovered. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.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) EVIDENCE: These standards were not seen on this occasion please refer to the last report. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.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) 20,21,22,23,24,25,26 The standard of the equipment and environment on the nursing side is poor and potentially places residents at risk. However the residential side is homely and comfortable. EVIDENCE: The inspector walked around both side of the home. There was a strong musty smell in the dinning room of the nursing side and very strong smells in some rooms and a corridor. The domestic that day was working hard to alleviate these odours. From the rota it appeared that the second domestic had not come in that day and that there was no one at the weekends. The residential side had no smell and appeared clean, tidy and homely. The nursing equipment such as beds on the nursing side seemed to be alright but it then became apparent for some that they were broken, such as beds didn’t go up and down, air mattresses did not inflate fully so pressure areas were not protected. Some rooms seemed full and cluttered making it difficult for staff to move round and assist with residents needs. One double room in Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.doc Version 1.40 Page 16 particular seemed quite tight on space. The curtaining which separated the two beds smelt and had stains on them, the domestic offered that she would try an change them that day. The water was hand tested on the day upstairs and was found to be very hot, possibly over 45 degrees C and downstairs it was cold, the handyperson was trying to resolve this. There had been issues on the residential side also but these had been seen to. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.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, 29,30 The standard of vetting and recruitment was adequate on this occasion. Residents are at risk where staff have had no training or have little understanding of issues regarding health and safety and care. The level of staffing must be appropriate to residents needs. EVIDENCE: The inspector viewed four staff files and was seen that all staff had been recruited using the homes procedure. Relatives again 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. Although the staff are receiving English lessons the inspector also had some difficulty in communicating with some staff having to rephrase sentences until comprehended. There was some evidence on the residential side that written English also proved difficult for some staff. It was observed that three residents on the nursing side were upstairs on asking the inspector was told that these residents once up were only assisted with meals and going to the toilet and were left for long periods. At the last inspection the manager stated that training issues had been identified and would be prioritised. There was little evidence from the interaction seen between the staff and residents particularly on the nursing side, that this had taken place. On the residential side although there was Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.doc Version 1.40 Page 18 more communication taking place there was some difficulty in understanding the accents of the staff for the residents. From the training files available it would seem that staff are also out of date for mandatory training such as moving and handling and fire. This was further supported by observing staff moving people about by leading them at arms length backwards and with communication with staff where it was difficult to ascertain their understanding. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.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, 32,33,36, and 38 Changes of management means the home cannot demonstrate the service is well run and managed. This is affecting the care offered and the well being of the residents. There is concern that the lack of leadership particularly on the nursing side will lead to a deterioration of service for the residents. EVIDENCE: The manager, who was to have applied to CSCI for registration, has decided to leave and the home will be without a manager again at the end of the month. A deputy has been appointed but was on leave on the day of the inspection. The proprietor told the inspector the week previously that she is happy that the deputy will be able to oversee the home whilst adverts are placed again for a manager. The current manager it seems had not undertaken any meetings with staff and supervision, at the time of the inspection. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.doc Version 1.40 Page 20 The training in health and safety and mandatory areas have not been addressed and the action required regarding fire training and moving and handling for staff in particular. Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.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 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION x 2 2 2 2 2 2 1 STAFFING Standard No Score 27 1 28 x 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 1 1 1 x x 1 x 2 Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.doc Version 1.40 Page 22 Yes 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 3 Regulation 14 Sch 3(1)(a) 15 Sch 3(1)(b) Timescale for action A pre admission assessment is to 30/11/05 be carried out by the home to ensure that the needs of the potential resident can be met. Care plans must reflect the 30/11/05 needs of the residents and be reviewed on a regular basis and contain action to be taken by staff to meet needs. (This is a partial repeat requiremnt of 13/4/05) Equipment must be provided 30/11/05 that assists with the promotion of tissue viability and this equipment must be maintained. An appropriate controlled drugs 1/10/05 record book is to be bought and used. The cupboard used for holding 1/10/05 stock in the residential side of the home must be locked. (This is a repeat requirement of 13/4/05) The registered person must 30/11/05 ensure that the home provides activities and stimulation according to individual needs and wishes. There must be appropraite 15/10/05 provision of nursing beds for those that need it and they must Version 1.40 Page 23 Requirement 2. 7 3. 8.5 Sch 3 4. 5. 9 9 13(2) 13(2) 6. 10 16(2) 7. 24(3) 26 Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.doc be serviced and maintained. 8. 9. 10. 11. 27 18(1)(2) The registered person must ensure that at all times there are enough skilled and supervised staff on duty to meet the needs of service users health and welfare including activities and social interaction. This includes nurses, carers domestic and kitchen staff. The registered person must ensure that staff are able to communicate with residents effectively. 2) That staff are able to maintain care plans and other documents related to the well being of residents and the policies and procedures of the home. 3) That staff are able to understand and carry out the policies and procedures of the home. All staff must receive fire training twice a year. (This is a repeat requirment of 13/04/05) All staff must have yearly training in the safe moving and handling or residents 30/11/05 26 16(2) 13(3) All areas of the home must be odour free. (This is a repeat requirement of 13/04/05) 1/10/05 12. 30 12 (1), 13 (4) 18 30/11/05 13. 14. 38 38 23(4) 13(5) 30/11/05 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard Good Practice Recommendations Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.doc Version 1.40 Page 24 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton 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. Extracts may not be used or reproduced without the express permission of CSCI Pax Hill Nursing Home H54 S12225 Pax Hill Nursing Home V245915 130905.doc Version 1.40 Page 25 - 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. 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