Inspection on 26/04/05 for Pax Hill Residential Home EMF Unit

This inspection was carried out on 26th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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... 23/10/06

Pax Hill Residential Home EMF... 07/09/05

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 Val Sevier Unannounced 26/04/05, 10.00am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Pax Hill Residential Home EMF Unit Address Pax Hill, Bentley, 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) 01483 760791 Dr Nuzahat Nasreen Zaki Miss Daryl Perry CRH 26 Category(ies) of DE, DE(E) registration, with number of places Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the DE category can be admitted from 55 years of age. Date of last inspection 26/10/04 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 ensuite with either a shower or bath. There is a garden, which is secure, and views from all rooms across the countryside. Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 5.5 hours. There is currently no registered manager at the home it is hoped this position will be filled in August. The owner Dr Zaki and the deputy helped the inspector during the day. The inspector was able to speak with five staff, three relatives and several residents. What the service does well: What has improved since the last inspection? The home was asked to fix a shower and ensure safety in not having windows open too wide. These actions have been completed. Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4. 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 comprehensive pre admission assessment form. The inspector saw four care plans two of which belonged to residents who had recently moved to the home. In one case the assessment had been carried out before they moved to the home, in the other it had been completed on the day the person moved in. in one case supporting reports where available from health and social services. When looking at the care plans related to these assessments there was information in them that had not been written in both. For example one said that the individual had a tendency to fall whilst the care plan had no note of this. The manager had completed the assessments previously; the deputy is doing them until there is a new manager. The assessment was new to the person who has only been in the role for a short time. Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 9 A relative spoken with said that the resident needed help with getting dressed but had been told that the staff were seeing what they could do in the first week. It led to the individual not changing their clothes for that week. Staff have taken part in training that is specific to the needs of the group as a whole using training available from the Alzheimers Society. Training has also been given to staff on moving and handling. It was observed that poor and unsafe assistance was offered to a resident on the day. Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9, and10. 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 is poor and potentially place residents at risk. Some staff communicated well with residents promoting and protecting residents privacy and dignity. However poor oral hygiene and hand care could easily be resolved by staff. EVIDENCE: The inspector looked at four care plans. The deputy told the inspector one individual’s needs had changed now and they needed to move to a nursing home. When looking at the care plan the needs of the individual were not clear and the actions that staff should take were also not clearly written. There was no indication of what care and support the individual now needed. It was also noted that pressure care was needed and there was no plan of care for this. This was also seen on another care plan, that needs had been identified and no plan of care had been written. The writing and spelling in two plans seen was very poor and the inspector was unable to understand what the needs were or what action staff should take. Not all care plans seen had risk assessments and two were due to be reviewed this month. Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 11 The staff were seen interacting with the residents and they communicated well with them and with privacy when assisting them to the bathroom. Residents because of their mental health frailty were not able to convey fully their feelings but many seemed content. Visually they were wearing clean clothes and those that needed glasses had them on their person, some of the glasses were dirty. Fingernails in some cases had faeces under them and there could be a cross infection issue. Residents teeth either their own or dentures, were not clean and some had poor breathe possibly due to this. The medication administration records were seen, there were 8 gaps where nothing had bee written so it was not possible to ascertain if medication had been given or not. Where medicine was ‘as needed’, there was no reason written as to why it had been given. The eye drops are kept on a shelf in the fridge in the kitchen. The temperature for this fridge is recorded daily. The storage of medication was seen to be appropriate although the space is small and the cupboard was full as there were medicines to be returned. There is a returns record which the chemist signs. There was no record relating to the quantity of medication that comes into the home, this was discussed with the deputy manager. Privacy is maintained at the home with doors being lockable should residents wish. A relative did comment however that residents could go into each other’s rooms and some removed things from rooms that were not theirs. She had observed however that this did not upset the residents. Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15. The activities were seen to appropriate to service users needs and they had choice about what they did and if they joined in. There are links with the community and they support social opportunities for residents. The meals in the home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: The home has an activity coordinator who is there five days a week. Time was taken to observe and interact with the group by the inspector as most residents participate either actively or by observation. The morning session was physical playing hoopla and ball; the lady concerned encouraged people to participate but allowed passive participation, by talking to those individuals about the activity that was taking place. After lunch there was a quiz which consisted of some puzzle work and singing a song with a male or female name in it, this led to people getting up to dance and laughter was heard both for the singing and dancing. Those residents spoken with indicated that they enjoyed Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 13 the time playing and singing, and some games evoked many happy memories and healthy competition. On talking to the activities coordinator she gave good understanding of the needs of the residents and was seen to diffuse possible situations by the manner in which she communicated with those concerned. Relatives both verbally on the day and through comment cards have commented very positively about the stimulation that their relative receives with the activities provided at the home. This is to be commended. There are no formal visiting times at the home and relatives spoken with said that they were able to come and go and could have a meal if they wished with their relatives. There are no residents at the home currently able to manager their own affairs. However it was seen that many rooms had been personalised with personal possessions including pictures, televisions and the door to the bedroom. The meals are cooked in the main homes kitchen and transported over to the unit. The inspector was able to observe at a distance the residents enjoying their meals and after they commented that it ‘was nice’. Residents can eat in their rooms if they wish and a couple prefer this. Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. The complaint process in the home is satisfactory with some evidence that relatives and advocates views are listened to. The home has a satisfactory adult protection policy, with evidence that staff have an awareness of it. EVIDENCE: The home has a complaints policy and there is a record of complaint received an action taken by the management to answer these concerns. Relatives spoken with said that they knew of the complaints policy and had their concerns answered verbally or in writing. Staff spoken with knew about the action they should take if they were concerned about how residents were cared for. They had received training within the last six months. Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,25 and 26. The standard of the environment within the home on the whole is good providing residents with an attractive and homely place to live. EVIDENCE: The home is well maintained. Some rooms have balconies all rooms have views over the countryside. Residents have been able to bring possessions and furniture with them if they wish. There is a lounge and dinning are and a conservatory downstairs. There is an addition al lounge upstairs which is also used for hairdressing. The personal laundry is carried out at the home whilst bedding is sent to a commercial laundry. The home was clean with the exception of two bedrooms, which had a very stale odour; these were discussed with the owner. The action asked for from the previous inspection has been carried out. Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 16 Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30. There is a basic stability of staffing at the home offering a continuity and consistency in care this is good practice for dementia care. Basic training needs are being met. EVIDENCE: The rota for the home was seen for the months up to, including and after the inspection. It was seen that there are two staff and a senior on each day 8 – 8 and two staff at night. The home has additional housekeeping staff in the kitchen and cleaning. It was seen if staff were absent then a replacement was found, agency staff have been used, although looking at the rotas, for continuity the same staff names occurred. Training has been planned for the year and this is mandatory training only. Appraisals are yet to be carried out to ascertain if other training is needed. This will be monitored at following inspections. Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,35 and 38. The home lacks leadership with no manager. The owner has a good understanding of the areas in which the home needs to improve. There is a lack of understanding of moving and handling techniques and standards which may put residents at risk. EVIDENCE: The registered manager left the home in March. The owner Dr Zaki stated that someone has been offered the post and she is waiting for confirmation and for the person to move to the area. This is expected to be August. Dr Zaki is asked to keep CSCI advised. Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 19 The home has a marketing person who undertakes surveys of relatives views of the services provided, as residents are not all able to participate in this process. The fire records were seen and all records regarding fire safety have been maintained, the home also checks call bells daily to ensure that they work. There is an incident accident procedure and book, this was seen and the deputy was reminded that once completed the forms should be filed on personal files, as they are confidential. There was concern on the day where staff were seen assisting one resident in a manner in that could have caused harm. Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x 3 x x x 3 2 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x 2 x 3 x x 2 Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14 Sch3(1) 18 13 (5) 15 Sch 3 Requirement Pre admission assessments must be completed prior to an individuals admission to the home. Staff must be able to meet the physical and mental needs of residents. The care plans mut be a record of identified needs and action to be taken to support those needs, based on pre admission assessments and supporting evidence from other professionals. There must be a record of medication that is ordered and arrives at the home. Timescale for action 31/07/05 2. 3. 4 7 31/08/05 31/08/05 4. 5. 6. 9 13(2) 31/07/05 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. Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 22 Refer to Standard Good Practice Recommendations Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton Hants, SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pax Hill Residential Home EMF Unit H54 s39926 Pax Hill EMF v221415 260405.doc Version 1.20 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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