Inspection on 24/08/07 for Pax Hill Nursing Home

This inspection was carried out on 24th August 2007.

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 20/06/06

Pax Hill Nursing Home 13/09/05

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 Jan Everitt Unannounced Inspection 24th August 2007 09:15 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 Pax Hill Nursing Home DS0000012225.V342775.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 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 DS0000012225.V342775.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pax Hill Nursing Home Address Pax Hill Bentley Nr Farnham Surrey GU10 5NG 01420 23786 01420 22690 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) Dr M Zaki Dr N Zaki Ms Deborah Lydia Davies Care Home 61 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0), Old age, not of places falling within any other category (0), Physical disability (0) Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Old age, not falling within any other category (OP) 2. 3. 4. Physical disability (PD). A maximum of 26 service users may be accommodated in the nursing wing. A total of 6 service users in the PD category may be accommodated on the residential wing. The maximum number of service users to be accommodated is 61. Date of last inspection 20th June 2006 Brief Description of the Service: Paxhill Nursing Home 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. The home scale of fees for this home range from £515 to £800 per week. Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 5 Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The site inspection visit to Pax Hill Nursing and Residential Home, which was unannounced, took place over a one-day period on the 24th August 2007 and was attended by one inspector. The registered manager, Ms. Deborah Davies and the registered provider, Dr. Zaki assisted the inspector throughout the visit and was available to provide assistance and information when required The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The manager had returned the Annual Quality Assurance Assessment (AQAA) to the CSCI and the focus of this visit to the home was to support the information stated in this document and other information received by the CSCI since the last fieldwork visit, which was an key inspection, made to the home in June 2006. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. The inspector toured the home and spoke to most of the residents and staff in order to obtain their perceptions of the service the home provides. Those spoken to were very satisfied with the care and services that were being provided. Surveys had been distributed to service users, relatives, care managers, GP and other visiting professionals. Eleven service user surveys, seven relative/carer surveys and three visiting professional surveys were returned to the CSCI. There was no response from care manager surveys. The outcome of the surveys indicated that there was a high level of satisfaction with the services and that generally residents and relatives were pleased with the care the home provides. At the time of the inspection the home was accommodating 33 residents, seventeen of which, needed nursing care. A number of the residents were unable to communicate effectively with the inspector to gain their views of the service. There were no residents from an ethnic minority group. The registered provider of the home discussed with the inspector the proposed commencement of the building of the new home that will provide modern accommodation for existing residents to move across to. The old house will remain but will not be used to accommodate residents. The logistics of this large project has involved a great deal of planning and many of the existing trees in the grounds have been felled in preparation of the site. Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 7 What the service does well: The home provides a clean, homely environment for service users. The surveys returned to the CSCI confirm this: ‘My room is cleaned every day’. ‘No complaints, always fresh and clean’. ‘There are no offensive smells at the home and they must work hard to keep it so clean’. The manager has worked hard at implementing a whole range of new systems in the home one being the assessment and care planning system, which is now thorough and well documented with information to support each person. The home has an activity programme for service users, which is monitored and reviewed by a member of staff nominated each day. Activities are arranged daily and people who do not wish to join in big groups or are unable to participate due to being unable to come downstairs be catered for. Residents are encouraged and supported to go out into the community and be independent and make choices. Outdoor spaces are very attractive and extensive and service users commented that they enjoyed sitting outdoors and going for walks in the warmer weather. A well-balanced and varied diet is offered to service users and this can be adjusted to meet their own needs and requirements. Resident’s comments on the food were very positive: ‘Excellent food treated better than at the Ritz’. ‘I get whatever I want to eat the chef is very good’. Whilst talking to service users and surveys received from relatives, all provided positive comments about living at the home and how the staff are: ‘Caring and supportive and do their best under some difficult circumstances’. ‘Very happy with the home and it feels like home’. ‘I would not want to be anywhere else’. ‘My mother has not looked so well in a long time’. I am very happy with her care and so is she’. The manager has implemented a quality assurance system that monitors all areas of the home and records, appertaining to the care of the residents. She has analysed results from satisfaction surveys, which she has used to plan improvements in the home. Relative/residents meetings have been instigated Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 8 and this will also contribute to the quality assurance and development planning for the home. What has improved since the last inspection? What they could do better: The recruitment of a new activities organiser will compliment and support the existing staff that undertake this role. A comment on a service user survey stated that ‘the evenings are long and there is a long wait to go to bed, but generally the home meets my needs.’ Lockable storage must be made available to all service users who wish to maintain and manage their own medication. The visits by the representative or registered provider must be recorded as part of the quality assurance of the home. All chemicals hazardous to health must be maintained in the locked environment when not in use or being supervised. Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 9 The registered provider must ensure that service users and staff are consulted and kept informed about the details of the new building and the anticipated programme. This will ensure that transparency and openness is maintained, which will make residents and staff feel involved and secure with the change. 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 Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 10 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 Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Standard 6 is not applicable to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are fully assessed prior to moving into the home. The home can demonstrate that all privately funded service users/representative sign a contract that states the terms and condition of residency. EVIDENCE: The inspector viewed a sample of contracts. Service users who are privately funded have a contract of terms and conditions of residency that is signed by them/representative. The contract states what the fees cover and what room will be occupied and also that the resident can be asked to move rooms at the home’s discretion ie if a resident becomes more infirm, it may be necessary to move them to a ground floor room for their safety. This would not be done Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 12 until it had been discussed with them or their relatives, and an agreement reached. For the people who are social service funded, the home has a contract with various district social services departments. The fee and contractual responsibilities are dictated by the Councils and are not part of the agreement with the service user and therefore they do not sign a contract of terms and condition of residency with the home, but a copy of this is included in the statement of purpose/service user guide. Five of the eleven service user surveys returned indicated that they had not received a copy of terms and conditions of residency but some commented that families were involved and they were not aware of contacts. The manager has introduced a new pre-admission assessment tool and undertakes all assessments of potential service users, prior to admission to the home to ensure their needs can be met. The inspector viewed a sample of service user’s pre-admission assessment records. These demonstrated a comprehensive assessment and covered all aspects of the person’s care needs. Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users health, personal and social care needs are set out in individual care plans. The medication administration procedures are satisfactory and demonstrate that safe practice exists in the home. The practices of the home mean that service users are treated with respect and their dignity is maintained. EVIDENCE: The manager has introduced and trained staff to use a new care planning system. The inspector viewed a sample of three service users care plans. The records examined had care plans for main areas of personal care and nursing Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 14 support. The inspector noted that the assessments and care plans are detailed and are being reviewed monthly with a documented record of these reviews. The previous report had identified areas in the care planning strategies that needed to be addressed. The introduction of the new system has addressed these issues and the inspector observed a very thorough assessment of service users personal needs, identification of risks and nursing interventions, these included moving and handling which is documented in each care plan and the required level of support the service user needs. The daily notes evaluated in detail the care that had been delivered during the day. Monthly weights and general observations are recorded to monitor any changes in resident’s health and well-being. The inspector observed that residents/ representative sign the care plans. The care plans also demonstrated signed agreement for the use of any forms of restraint. One service user had a lap strap in place and a number of bedrails were being used. The inspector audit trailed the risk assessments and care plans that validated the necessity for their use. The manager audits the care plans monthly and maintains records of the outcome of these audits. She reports that generally the staff have embraced the new system and are using it effectively. The home engages the services of one GP who visits the home weekly to review residents if requested. A GP returned a comment card, which indicated that he considered the home works in partnership with him and is generally satisfied with the overall care provided to his patients living in the home. Another GP said that generally there was good communication between him and the home but there have been problems that have resulted through poor understanding of spoken English. The community psychiatric nurse (CPN) who visits the home returned the survey and commented that the staff do contact her for advice and try to support the service users with dementia as best they can. The district nurse attended the home during this visit to monitor a wound dressing. The manager told the inspector that they attend the residents in the residential wing but the district nurses will give advice at any time to the trained nurses if they request it. The inspector spoke to a number of service users and they told the inspector that they can see a doctor if they request this. The survey comments received by the CSCI indicated that in general service users consider their health care needs are met. The home has reviewed medication policies and procedures. The inspector observed the nurse administering medication following correct procedures. The inspector examined the medication records for both the residential and Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 15 nursing wings of the home and found accurate records and correctly stored medication. The home is using a blister pack system, and although the storage room where medication is kept is small, it was found to be well organised and tidy. Because there is no shaft lift the medicine trolley cannot be taken to the first floor and the medication has to be administered on an individual basis to those residents who are unable to negotiate the stairs to come down. This is not ideal but many systems in the home will change when the new building is completed and residents move across to it. Staff receive training on medication administration before they can carry out this practice on the residential side and only trained nurses dispense medication in the nursing wing. At the time of this visit one service user was self-medicating an inhaler and there was oxygen stored in the bedroom. The inspector noted that there was a notice on the door indicating oxygen was in use. The three oxygen cylinders that were stored in this room were free standing and not secured. This was discussed with the manager and she had them removed to a more secure and appropriate area leaving just the one cylinder in use. Although there were no service users choosing to manage their medication, the inspector observed no lockable storage facility in the bedrooms. This was discussed with the manager as to service users choice of self-medicating and if they chose to do so, the home must provide safe secure facilities to enable the medication to be stored in individual rooms. The inspector met with a number of service users during the visit to the home and talked to them about their experiences in the home. Service users confirmed that they are always treated with respect and their dignity and privacy is maintained. Examples given included staff always knocking on doors and waiting for permission to enter a service user’s room. The service user and relative’s comments returned from the survey also indicated that they consider the staff to be excellent and look after the residents in a ‘caring manner’. The core values of care are contained in the induction programme and form part of the induction standards that all staff undertake. Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive a service that meets their social and leisure needs and this is enhanced by a service that welcomes and encourages family contact and contact with the local community. The practices in the home support service users to make decisions about their lives. Service users receive a well-balanced and varied diet reflecting their likes and dislikes EVIDENCE: The activities organiser has left the home’s employ and the provider is in the process of recruiting an experienced and trained activities organiser. In the interim the manager has organised that one carer each day is nominated to organise activities for the service users. Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 17 Concerns had been raised at a previous inspection about the potential isolation of service users upstairs in the nursing wing. The inspector observed that there were two residents upstairs on the day of this visit and there was a carer in attendance going through a magazine and talking to them. The inspector viewed the records that demonstrated the nominated activity worker for the day is spending time with service users on this floor. Records are also maintained of the activities that have taken place and the service user’s level of participation and enjoyment The service user’s surveys returned by them indicated that there are activities arranged for them to take part in if they choose. One comment from a service user stated that ‘we have occupational therapy Mon-Friday and she makes you feel welcome’. A number of the residents are independent and one resident continues to drive her own car around the local area and go on foreign holidays. Many of the residents are active and the staff support the independence of a number of residents who are still able to go out into the community. On the day of this visit a number of residents told the inspector that they were going for a walk in the lovely surrounding grounds of the home and do so on a daily basis, weather permitting. The old house, which is the residential wing, has a large lounge area and a resident told the inspector that this is the place that most activities take place. A comment received from a visiting professional considered that the home could improve, by providing more activity time for service users, especially on a one to one basis, if need dictated. The AQQA stated that the manager will be implementing a new activities programme and there are plans for a sensory garden to be built when the new building is completed. The assessment does record a social history of the service users, which is gained from them or their relatives and the manager informed the inspector that past hobbies and recreation are taken into account when choosing activities. Unfortunately, at the present time, because of the lack of an activities organiser and the layout of the building, which accommodates a wide spectrum of care needs, it is difficult to ascertain if the activities programme meets all service user’s needs. Conversely, the inspector only received praise and positive remarks from residents, who were able to communicate with her, about their social lives. Some service users saying they choose not to take part in activities as they ‘enjoy their own company’. All visitors sign the visitor’s book. The inspector did not meet any visitors on the day of this visit. Comments on surveys returned from relatives stated that they are made welcome in the home and there are no restrictions on visiting. Contact details for families, friends and representatives are recorded in the service user’s plan. Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 18 The inspector spoke to a number of residents who were able to make choices and decide how they wish to live their lives. One resident said she had lived in the home for a number of years and it had been her choice after the first visit. She said she was very well supported and that she had a lovely spacious room with a little annex kitchen area that allowed her full autonomy over her daily activities of living. This was supported by a number of people living in the residential wing of the home who were able to choose to come and go as they wish. The home has one smoker in residence that has been given a designated outdoor covered area situated close to the front door to smoke in. The inspector visited the kitchen and spoke with the chef. The kitchen was observed to be clean and well organised. The menu was provided for the inspector and this demonstrated that a wide variety of meals are offered to service users. The chef told the inspector that he would provide any meals the service user wishes and often does alternative meals. This was demonstrated when the inspector spoke to a resident who said she did not like fish and had chosen an omelette that day. A mealtime was observed and this was relaxed and unhurried, the meal was presented well and looked and smelt appetising. Some service users require help and support with eating and staff attended this to in a sensitive way. Many of the service user and relative’s surveys stated that they considered the food to be excellent, one commenting ‘treated better than the Ritz’. The chef is qualified and holds the intermediate food handling and hygiene certificate. The records demonstrated that he undertakes regular audits of the equipment and systems in the kitchen area. Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident that the home has systems in place to acknowledge and respond to their concerns and procedures are in place to protect service users from abuse. EVIDENCE: A complaints policy and procedure are in place and available to all service users and visitors to the home. The inspector viewed the home’s complaints record. This demonstrated that the complaints received have been responded to promptly and appropriately, with action outcomes documented. Residents spoken with, and comments on the returned surveys, confirmed that people know how to complain if needed and to whom and are confident that something will be done to respond to this. One commenting ‘If I have a problem it is dealt with’. The inspector viewed the home’s policy for safeguarding adults. Training in abuse awareness and how to report this, is part of the induction training. The Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 20 inspector evidenced staff training certificates on abuse awareness and also the training matrix evidenced that all staff have received this training. Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a clean homely environment for service users. However, there are areas of the home that need redecoration and attention and with no passenger lift, the environment does not meet all service users needs. The home has an infection control policy in place that is adhered to. EVIDENCE: The residential wing of the home is a large old house and is very homely and comfortable and well liked by the current residents living there. The nursing wing is a newer addition to the house and was not designed to be a nursing home and therefore is not conducive to nursing people with physical and mental disabilities. The providers have acknowledged this and plans are in place to demolish this area and a complete new care home is being built in the Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 22 grounds next to the existing home. The provider reports that the commence date of this build is imminent, but the exact date has not been established. The inspector looked round the home with the manager. The home was generally clean and tidy during the visit. The home has a number of large lounges and smaller lounge sitting areas and these were generally in a good state of repair and decoration. Service users commented on these spaces being comfortable. The inspector observed that there was no passenger lift to the first floor in any of the building and in the nursing wing only chair lifts fitted to the stairs. These are used by most of the service users but for those who are physically disabled, it has been assessed as too high a risk to transfer people from a hoist into a chair lift in the confined area of the first floor landing. This has been a reason why some residents have changed rooms to move downstairs, as their condition deteriorates, to avoid being isolated on the first floor. The manager identified in the AQQA that this is a barrier to improvement that the building is not ‘user friendly’ and the way to reduce the impact of this is to only admit service users who are mobile. The provider reports that this is not ideal but will be addressed once the new building is commissioned. The outdoor spaces and surrounding grounds are very attractive and extensive and service users commented that they enjoyed sitting outdoors in the warmer weather. The carpets identified in the previous report as being frayed, have been replaced. The inspector observed that the housekeeper was cleaning carpets, which she said they do on a regular basis. The sluice room on the first floor, which was identified at the last inspection as being full of boxes and being used as storage, has been cleaned out and is now empty. The other sluice room is in use and a new bedpan sanitizer has been installed. The equipment in the home was examined during the tour of the home this included electric beds, chair lift and pressure relieving equipment. These were all found to be operating and the home provided service information confirming repairs and maintenance is carried out. The inspector visited a number of resident’s rooms on both the residential wing and nursing wing. The rooms in the old house vary in size but in general they are spacious and some having lounge areas and en-suite facilities. The rooms on the nursing wing are all the same size and are less homely than on the residential wing with some in need of decoration, but service users have bought with them some personal items to individualise the rooms. The inspector visited the laundry area. This was fit for purpose. There is no designated laundry person employed but carers take it in turns to organise the Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 23 washing. The home only launders personal clothes with all other laundry going to an outside contractor. The service users have no complaints about their laundry and all looked well presented. Some residents were choosing to wash their own woollens. The home has an infection control policy and procedures in place and training for this is provided by the home. Records of this training was evidenced on the training matrix and training certificates, held in training files. The inspector observed that in one bathroom on the first floor there was no hand washing facilities. i.e. soap dispenser and disposable towels. This was discussed with the manager and she is in discussion with the provider to ensure that these facilities are available. The manager acknowledged in the AQQA that the home would improve their infection control procedures if soap dispensers and disposable hand towels were to be fitted in all rooms, especially on the nursing wing. Gloves and aprons are available for staff to use. The inspector spoke to staff that demonstrated they were aware of the procedures for handling soiled linen, which was observed to be bagged and stored appropriately. Surveys returned from relatives indicate that they are happy with the services and the home in general. Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home can now demonstrate that staff have received appropriate training and have mixed skills and the ability to ensure they can meet service users needs. Service users are protected by the home’s recruitment policy and practices. EVIDENCE: The staff rotas demonstrated that one trained nurse and six care staff are on duty during the day and one trained and 2 care staff at night. At the time of this visit there were seventeen (17) nursing and sixteen residential service users in residence. The AQQA states that there are sufficient numbers of staff on duty to meet the current needs of the service users. The pace of work in the home at the time of this visit, demonstrated this and many of the residential clients were very independent with little care input required. There was no evidence of people having to wait a long time for a response from a bell. The manager assesses the dependencies of the service users frequently and reports that the provider will employ more staff if the dependency levels increase significantly. Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 25 Service users spoken to say that the staff are ‘ very good’. Comments from surveys in general are positive about the staff. One commenting that ‘carers work hard and are well supervised’ another saying ‘staff are more helpful than I could wish for’. The AQQA demonstrates that the home employs a multicultural staff group of mixed gender. Some service users commented that at times it is difficult to communicate with staff members due to their limited comprehension of English. Service users emphasised that this did not take away from the caring and supportive nature of the individuals. Relative survey comments also support this. This was discussed with the manager who said foreign staff are supported to attend English classes in their spare time. The home has a twelve-week induction programme that is based on the Common Induction Standards that meets the National Training Organisation Standards. The inspector viewed a completed workbook for induction and this demonstrated a comprehensive programme. All newly employed staff undertake an induction programme. The manager has created a training matrix and this easily identifies what training has taken place and by whom. It also identifies when mandatory training is due for all staff. The inspector viewed the matrix and also the training certificates to support this. The manager has also comprised a training plan for the coming year. The previous inspection required that training be given to staff to manage challenging behaviour. Staff have now done this and the staff training certificates evidenced this. There is nine staff that have achieved their NVQ level 2 qualifications. A further eight are undertaking it currently. A number of staff are qualified nurses in their own country and are currently applying to register with the Nurses & Midwifery Council (NMC). The manager identifies in the AQQA that she wishes to improve the scope of training with a wider variety of topics. The registered manager is not involved with the recruitment of the staff, this is undertaken solely by the provider. A sample of recruitment files was viewed of more recently recruited staff. The previous inspection report highlighted some poor recruitment practices, with not all information having been obtained before the person commenced employment. The files viewed by the inspector on this visit demonstrated that all appropriate checks and information is recorded in staff personnel files. Many of the personnel recruited are from overseas and live on or around the Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 26 premises. The manager said that it is very difficult to recruit local staff because the home is in such an isolated area. Staff spoken with were satisfied with their recruitment and said they are enjoying their jobs. Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is now being effectively managed and the manager has a good understanding of the areas in which the home needs to improve. Staff are supervised appropriately. The home now reviews all aspects of its performance through an effective programme of quality assurance, which includes consultation with service user and relatives. The health and safety of the service users and staff are promoted EVIDENCE: Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 28 The manager is a registered nurse and has a number of years experience in managing a care home. She has achieved the Registered Managers Award. The was evidence in training files that the manager maintains her professional skills and portfolio by attending training sessions appertaining to the client group who she cares for. She has also undertaken a number of train the trainer courses that enable her to train the staff ‘in house’. There is evidence that the current registered manager has worked on introducing new systems such as care planning, environmental risk assessments, fire risk assessment, training records, supervision and appraisal, the induction programme and quality assurance. The inspector observed that there was and easy relationship between the staff and manager and staff spoke highly of the manager. The manager has a quality assurance system in place. She has created a folder that is indexed with all the systems she audits monthly. The inspector viewed the folder and evidenced the results of care planning audits, MAR sheet audits, risk assessments, complaints, maintenance issues, housekeeping and personal monies kept in the home. The manager has also distributed service user and relative’s questionnaires and has analysed the results and written a report and any action taken from the outcomes, which, in general, were observed to be very positive. The manager is holding resident’s meetings once quarterly to discuss any issues. The provider has held a meeting to reassure the residents about the new building or though could not give any timescales to them. Two service users who spoke to the inspector voiced their worries about the new build, would they get such nice rooms? would they be with their friends? This indicated that service users are apprehensive and the provider must regularly consult with the residents to reassure them. The provider has not undertaken any Regulation 26 reports for some months and therefore the inspector could not evidence that these had taken place. This was discussed with her and she will recommence this as part of her quality assurance of the home. Policies and procedures have been reviewed this year. The home does hold monies for a number of service users. This is stored in a secure environment and is administered by the administrator. The inspector observed that monies were being stored separately and that the sample checked by her were in order and recorded balances were in accordance with the monies held. Receipts for purchases are kept in these records. The staff files demonstrated that the manager has a supervision and appraisal programme in place. Staff are supervised six times a year and appraised once Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 29 a year. There was evidence of records of supervision sessions and learning outcomes. Staff spoken to confirmed they do receive supervision and are supported with their training needs. The training matrix demonstrated that all staff have received updated training for health and safety i.e. moving and handling, first aid, fire training, infection control and food hygiene. The inspector observed that an air freshener was stored in a bathroom, which could be hazardous to residents. This was discussed with the manager as to any COSSH chemicals should be stored in a locked environment when not being supervised. She immediately instructed a carer to remove this and store it appropriately. The inspector observed that the manager had undertaken a thorough risk assessment of the environment. It has been established that there was a risk to service users being transferred from a hoist to a chair lift on a small landing and therefore some residents have to remain upstairs in the absence of a passenger lift. This situation is not ideal but will be resolved once the new building is operational. The inspector viewed the fire log and this was completed fully with the system undergoing regular tests, which are recorded. The home has had a recent fire drill and this was recorded with the action taken to ensure staff were aware of their roles. The accident book was viewed and audit trailed. The records are well maintained and the manager audits the accidents monthly to ascertain any emerging themes that may identify risks. The inspector viewed a sample of servicing certificates and found them to be current. Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 30 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 31 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. Standard OP9 Regulation 16 (2) 23(m) Requirement The registered person must ensure that lockable storage space is available in service user’s rooms for the safe keeping of medications that are being self-administered. The registered person must ensure that all toilets and bathrooms used by the service users be fitted with soap dispensers and paper hand towels to aid infection control The registered person must ensure that monthly visits take place by the nominated responsible individual and a report of this visit given to the manager and made available for inspection. The registered person must ensure that all cleaning materials and hazardous chemicals are kept in a secure environment when not being used. Timescale for action 30/10/07 2. OP26 13(3) 30/11/07 3. OP33 26 30/10/07 4. OP38 13 (4) 30/09/07 Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 32 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 Pax Hill Nursing Home DS0000012225.V342775.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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