Inspection on 23/10/06 for Pax Hill Residential Home EMF Unit

This inspection was carried out on 23rd October 2006.

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 Residential Home EMF... 07/09/05

Pax Hill Residential Home EMF... 26/04/05

Pax Hill Residential Home EMF... 26/10/04

Pax Hill Residential Home EMF... 17/05/04

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

CARE HOMES FOR OLDER PEOPLE Pax Hill Residential Home EMF Unit Pax Hill Bentley Farnham Surrey GU10 5NG Lead Inspector John Vaughan Unannounced Inspection 10:10 23 October 2006 rd 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 Residential Home EMF Unit DS0000039926.V292251.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 Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pax Hill Residential Home EMF Unit Address Pax Hill Bentley Farnham Surrey GU10 5NG 01420 23782 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 Nuzahat Nasreen Zaki Dr Mohammed Zaki Care Home 26 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (26) of places Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the DE category can be admitted from 55 years of age. 7th September 2005 Date of last inspection Brief Description of the Service: Paxhill EMF is registered to accommodate 26 service users with mental health frailty mainly dementia. The home is situated in the grounds of the larger home with the same name, in the village of Bentley. The home is situated over ground and first floor levels with a passenger lift. There are 26 bedrooms all are en-suite with either a shower or bath. There is a garden, which is secure, and views from all rooms across the countryside. The weekly fee for a place in this home is £750.00. Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included two visits to the home the second visit was arranged to speak to service users and to talk to the provider. The inspector met with service users and family members over both days. The deputy manager of the home met with the inspector during the visit. Staff were interviewed and observed and records held in the home were sampled. The inspector also toured the home. What the service does well: What has improved since the last inspection? What they could do better: Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 6 The provider has been asked to make sure a member of staff has an up to date Criminal Records Bureau (CRB). 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 Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. The home can demonstrate that service users needs will be correctly identified and acknowledged. This home does not provide intermediate care. EVIDENCE: The inspector looked at four service user’s records during visit to the home. Detailed assessments were seen on service user’s files with information on their healthcare, social, mobility and personal care needs documented in the assessment. The inspector was also able to see care plans linked to the assessed needs. Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 9 The inspector was told that all but one of the service users currently living in the home are privately funding their placements. Evidence of the assessment and involvement of a care manager was seen on this service user’s file. The inspector also had the opportunity to talk to service users and their family members who said that the home provided opportunities for them to visit the service and an information pack was also provided to help them to know what would be provided in the home. The home does not provide intermediate care. Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. The practice of the home demonstrates that service users needs and wishes are acknowledged and responded to. The medication administration procedures are satisfactory and demonstrate that safe practice exists in the home. The home provides support for service users to access health care professionals to meet their needs and the practices of the home mean that service users are treated with respect and their dignity is maintained. EVIDENCE: All four service user’s files had clear assessments of need and a care plan. The care plan contains support information covering areas of personal care, health, mobility, communication and likes and dislikes. A moving and handling assessment is in place, falls assessment and a general risk assessment are on file to support service users to keep safe. Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 11 The staff member in charge on the first day of the visit to the home discussed a recent incident with a service user when they left the home unobserved. The inspector noted involvement from this person’s General Practitioner to review medication and staff are monitoring the person’s behaviour and keeping a record to assist with future reviews. The inspector advised the deputy manager that they should update the care plan with the actions they are taking and the risk assessment requires updating to draw attention to the possibility of the service user leaving the home during periods of extreme anxiety and the need for closer supervision during these times. The files examined provided evidence of health care professionals in the care of service users. Service users told the inspector that they see their GP when needed and there are places that they can see visitors in private. The medication practices were examined and this included looking at the storage and administration of medication. Records were up to date and completed accurately. Medication is stored securely and staff members were clear on their responsibilities. The inspector was told that the pharmacy provided training to staff, a booklet is completed and sent back to the pharmacy for assessment and then a certificate is issued to that member of staff. Service users said that they felt well cared for by the staff and they feel that they are treated with respect. A family member said that they have never had any concerns and staff have always been welcoming and polite. The inspector observed staff talking to a supporting service users and this was carried out with sensitivity and respect. Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including visits 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. The practices in the home support service users to make decisions about their lives. Service users receive a balanced and varied diet reflecting their likes and dislikes. EVIDENCE: The home has an activity worker who provides daily group activities. Service users were observed engaging in these activities, which included a crossword competition, skittles and dancing to music. Service users commented positively on the activity worker and her activities. One service user said that they enjoyed a trip to a pub and a garden centre and other service users said they enjoyed taking part in the activities. A member of the clergy visits monthly and service users are able to take communion if the wish. The home ask service users or their representative to Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 13 complete a questionnaire as part of the admission process and this includes questions on the individuals spiritual needs, their wishes in the event of the becoming seriously ill and what they wish to happen in the event of their death. Family members 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. During the visits to the home the inspector noted family members coming and going and the home was very relaxed. The menu was provided for the inspector to see and this showed that a wide variety of meals are offered to service users. Service users told the inspector that they are very happy with the meals provided and if they do not want what is offered they can have an alternative. Meals are cooked and delivered from the nursing home close by and a service area is provided to keep meals hot. A kitchen in the home is used for the preparation of breakfast and light snacks. 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. Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. Service users can be confident that the home has systems in place to acknowledge and respond to their concerns and procedures to protect service users from abuse are in place EVIDENCE: A complaints policy and procedure are in place and available to all service users and visitors to the home. Service users and family members said that they knew how to raise a concern if the needed to and would talk to staff or the manager if they were unhappy. They were confident that the staff team and the manager would listen them to. Staff have received training in the protection of vulnerable adults and another training session is booked for November. Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. Service users are provided with an environment that is clean, comfortable and spacious and each service user has bedrooms that have been arranged to meet their needs. EVIDENCE: The inspector toured the home with the assistance of a member of staff. The home is spacious with a number of rooms over the two floors that can be used by service users. During the visit the inspector had the opportunity to view a number of service users rooms and these were clean and in a good state of repair. Most rooms had been furnished with personal items and belongings and all rooms have an en-suite bath or shower room. Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 16 The home was clean and tidy and free from any unpleasant smells. The laundry room was examined and this was clean however the washing machine was reported to be out of order at present and all laundry was going to the nursing home until the machine is repaired. The inspector was told that staff members adhere to good practice when moving soiled laundry including the use of dissolvable bags. Aprons and gloves were seen in use in the home and hand-washing facilities are available in the laundry. Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. The home can demonstrate that their current recruitment practice is thorough and ensures only suitable staff are employed in the home. Service users receive support from a staff team that are trained and supervised to meet their needs. EVIDENCE: The staff records provided evidence that mandatory training in areas such as first aid, health and safety and fire safety have been updated and a training record is in place to support this. The manager of has provided moving and handling training and a session took place last week. Staff members have also attended training in protecting service users from abuse. Inductions take place in the home and staff are also obtaining National Vocational Qualification (NVQ) awards. The inspector interviewed a two staff and they confirmed that this training has taken place. Staff members that do not have English as a first language attending English classes at a local language college and in the home to improve communication. Staff also told the inspector that they have Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 18 supervision and support sessions to help them understand and develop their role. The home provides support to service users who can be very confused and at times aggressive. Staff reported that they had undertaken training in supporting people with dementia and training is due to take place in managing aggression. The inspector examined the records of all new staff who have been recruited to the home since the last key inspection. All files contained information on the individual. Two written references and proof of identity was also in place. The records of one staff member recruited nearly a year ago had a Criminal record Bureau (CRB) check from their previous employer. The provider had not completed a new check and this is consistent with similar findings at the provider’s other service inspected earlier in the year. The provider DR Zaki and her administrator demonstrated a change in practice since this time and provided evidence that since that time new staff have not been appointed without a satisfactory CRB in place. The provider agreed that they would update the individuals CRB immediately to ensure accurate records are in place. Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. The provider can demonstrate that the home has been well managed however the recruitment of a new manager will be essential to maintaining the effectiveness of the management. Systems are in place to obtain the views of service users however further work is needed to implement these and demonstrate that these have any impact on the service. EVIDENCE: The inspection found evidence through examination of records and talking to staff and service users that the home is organised and well run. However the manager resigned last month and the deputy manager has also left recently. Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 20 A senior member of staff has been appointed to the position of deputy manager and through discussions with the provider the inspector confirmed that a new manager is being actively recruited. The new deputy manager said that they would be continuing with agreed approaches to care planning and management of the home already in place. The previous manager provided a significant amount of training in the home and the provider stated that they have secured this person’s services for future training. The home has developed a quality assurance programme. This includes a set of quality procedures and practices that have been put in place in the home. A procedure for involving service users and their representations, regular quality reviews, consultation with staff and others and the development of an improvement plan are all included in this policy. The inspector confirmed that this has not yet implemented as the manager was responsible for its development and the provider stated that it would be a priority for the new manager to put this in place. Service users leave money for safe keeping with the home and this is held in the office. A record is maintained for each person with receipts for transactions. The provider does not act as an appointee for any service users. The home provided records to demonstrate that fire checks and tests are carried out regularly. A fire drill and practice was carried out on the day of the inspection. Certificated and records are in place to demonstrate that heating and alarms systems are serviced appropriately and moving and handling equipment is also serviced. Portable appliance check was carried out in November 2005. Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Pax Hill Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 22 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 OP29 Regulation 19 Requirement The registered person must ensure that all staff recruited to work in the home do not start without a full CRB or a POVAfirst check. Timescale for action 20/11/06 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 Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hampshire Office 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 Residential Home EMF Unit DS0000039926.V292251.R01.S.doc Version 5.2 Page 24 - 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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