CARE HOMES FOR OLDER PEOPLE
Paxton Hall Care Home Rampley Lane Little Paxton, St Neots Cambridgeshire PE19 6EL Lead Inspector
Nicky Hone Unannounced Inspection 11 January 2006 10:00 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 Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 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. Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Paxton Hall Care Home Address Rampley Lane Little Paxton, St Neots Cambridgeshire PE19 6EL 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) 01480 213036 01480 477811 paxtonhall@kelam.com www.paxtonhall.co.uk Kelam Health Care Limited Care Home 39 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (39) of places Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th August 2005 Brief Description of the Service: Paxton Hall is a listed building, dating back to Elizabethan times, on the outskirts of Little Paxton, between St Neots and Huntingdon. The old house was rebuilt and renovated in 1738 and converted into a care home in the early 1980s. The visitors entrance to the building is now through the entrance porch at the front of the house, into the impressive entrance hall with its wide, sweeping staircase and galleried landing. Accommodation for service users in the old house is on two floors, and consists of 20 single bedrooms, 4 double bedrooms (currently used as single rooms), and three large lounge/dining rooms. The upper floors are accessed by a shaft lift and a stair lift. There are bathroom and toilet facilities and an office. The third floor of the house is used for staff training and accomodation for the acting manager and her family. A single floor extension at the back of the house, built at the end of the 1980s, has 11 single bedrooms, a lounge, a large conservatory used as a dining and activities area, and bathroom and toilet facilities. There is a laundry, main kitchen, scullery and staff facilities. The house has large gardens, mainly to the front, attractively landscaped with trees, shrubs and areas of lawn. A closed courtyard between the old house and the extension provides a warm sheltered area for service users to sit in and is kept colourful and interesting with an array of flowering plants. Village shops are within walking distance of the home, and the market towns of St Neots and Huntingdon are a short drive away. Both these towns have good road and rail links to London and the Midlands. Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second inspection of this service carried out in the 2005/06 inspection year, and was unannounced: an unannounced inspection was carried out on 15/08/05. The inspector was accompanied by a research student. The acting manager, Karen Napier, was on duty during this inspection, and one of the directors of Kelam Healthcare arrived, unannounced, shortly after the inspection started. At this inspection a tour of the building was undertaken, and several residents and staff were spoken to briefly. One resident agreed to have a longer discussion with the inspector. The majority of the inspection was spent with the acting manager, and a few minutes with the provider. Service users with learning disabilities who are over 65 have been offered accommodation at the home, but currently the home is not registered for this client group. What the service does well:
Paxton Hall continues to offer a high standard of care in a clean, comfortable and homely environment which is well maintained. The acting manager provides good leadership for a staff team who are well trained and committed to offering a good service. Care plans continue to improve, and this home takes pride in striving to offer the best possible end-of-life care. Activities are arranged regularly, and the quality of the food is appreciated by everyone. One service user spoken to said “I love it here…they’ve been very good to me. The care here couldn’t get any better”. Before the inspection, questionnaires were sent on behalf of the CSCI to service users and their relatives. Twenty-three responses were received: three completed by service users and twenty completed by relatives. There were only three (out of 230) questions answered negatively: every other response was positive, and all written comments were complimentary. Comments from relatives included: “Little Paxton Hall is a wonderful place, the care is excellent, staff are always welcoming, I wouldn’t have our relative placed anywhere else!”; “My sisters and I are delighted with the atmosphere, care and kindness shown to our relative”; “We are very happy with the care of our relative, the staff always make us feel welcome. We have recommended this care home to other people.”; “I am completely satisfied with the superb service of Paxton Hall. My every requirement has been met at all times and my relative’s health has improved since being admitted”.
Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 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 Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 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): 1, 4 The statement of purpose and service user guide do not currently accurately reflect the services offered by the home. Staff receive appropriate training, and equipment is available so that service users know their needs can be met. EVIDENCE: The home has been approached by the Cambridgeshire Learning Disability Partnership to accommodate service users with learning disabilities who are over 65 years of age: a variation to registration must be applied for, and the statement of purpose and service user guide must be revised to reflect the changes. The acting manager has organised training for staff in care of older people with learning disabilities as this is a service user group who are now being assessed as in need of care. The provider confirmed that a new assisted bath and a new hoist are due to be delivered on 06/03/06. The company delivering and installing them will also carry out staff training on the same day.
Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 9 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, 11 Care plans contain adequate information so that staff can meet residents’ personal, social and healthcare needs, and end of life care is given a high level of attention. Records of administration of medication to one resident were not satisfactory to show the medication that had been administered. EVIDENCE: Care plans are improving at each inspection. The plans contain detailed information on the way in which residents’ personal, social and healthcare needs are to be met. Staff explained that additional information sheets are being added to the plans to record activities. Medication is now administered from the original containers, by staff who have completed training in administration of medication. Records of administration (MAR sheets) were checked for two residents: they were completed correctly for one resident. There were several gaps in recording, incorrect codes used, and alterations to MAR sheets made which were not clear and not signed or dated, for a resident who is currently refusing much of the medication offered. This was discussed with the acting manager and the supervisor who both
Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 10 agreed that this is not acceptable, and said that the problem would be rectified immediately. The acting manager and staff team work closely with the GP and district nursing team to provide care for as long as residents wish to remain at Paxton Hall. The acting manager is investigating training in end of life care to ensure that residents who are dying get the best possible care. Thank you letters and cards from relatives show that they are very appreciative of the care that is given to their relative at the end of their life. Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 11 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, 15 The lifestyle in the home satisfies residents’ interests and the food is of a good standard. EVIDENCE: One resident spoken to talked enthusiastically about the activities that take place on three afternoons a week, and was happy that her family and friends can visit whenever they want to. She explained that she has a keyworker who will take her out when she asks, to the village shops or into the garden, and helps her with tasks such as writing Christmas cards and letters. This resident confirmed that she has choice and control over most aspects of her life. This resident was very complimentary about the food. She explained that she is diabetic and doesn’t eat certain foods: the kitchen staff always offer her an alternative if the meal on the menu is not to her taste. She said sandwiches and other snacks are made on request. She particularly said how much she had enjoyed the lunch that was provided on Christmas day. Since the last inspection the kitchen and scullery have been completely refurbished: the domestic-style chipboard kitchen cupboards have been replaced with stainless steel commercial shelving and work tables. These
Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 12 areas now look clean and professional: staff said how much better this is, and how the areas are now so much easier to keep clean. Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 13 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): EVIDENCE: These standards were not assessed in full on this occasion. Since the last inspection, the member of staff found guilty of starting the fire in the home in 2004 has been referred to the POVA list. Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 14 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, 20, 23, 26 The standard of the environment in this home is very good, providing residents with a clean, comfortable and homely place to live. EVIDENCE: The areas of the home seen were well-maintained, pleasantly decorated, and comfortably furnished. One resident spoken to has recently moved into a large single room in which a new ensuite has been fitted: the room had been decorated before she moved in. She was very pleased that she had been able to bring as much of her own furniture as would fit into the room, including her own wardrobe, cabinets, chairs, tables and bed. She said she was very comfortable in the room. All areas of the home seen were clean and odour-free. Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 15 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, 30 Residents benefit from a well-trained, committed and enthusiastic staff team who work together to ensure a high standard of care is provided at all times. EVIDENCE: On the day of the inspection there seemed to be a large number of staff on duty, and the needs of the residents were being met well. The acting manager said there are always six care staff on duty in the morning, plus a supervisor. Domestic staff, cooks and maintenance men are also employed, as well as the acting manager and an administrator. According to information in a pre-inspection questionnaire, thirteen staff have been awarded a National Vocational Qualification (NVQ) in care level 2. The acting manager said that some of these staff now want to register to undertake NVQ level 3, and a provider for this training is being sought. A range of other training courses is offered. Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 16 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, 32, 33, 36, 37, 38 The home has good leadership and the views of all parties interested in the home are sought and acted on to ensure the high standard of care is maintained. EVIDENCE: The home has been without a registered manager since February 2005. The acting manager, in post since that date, has yet to complete an application for registration. She is attempting to register to undertake the Registered Manager Award. The atmosphere in the home, as well as comments from staff, residents and relatives, indicated that the acting manager is offering clear, effective leadership. The home’s quality assurance system includes sending questionnaires annually to service users and to everyone with an interest in the home: relatives, friends, GP surgeries, district nurses, social workers and so on. At the time of
Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 17 the inspection the provider was in the process of collating the responses and compiling a report. The acting manager said that she had carried out one supervision session with all staff before the end of November 2005 and was planning dates for the next session. She was very pleased with the sessions: she said there had been some positive and some negative issues that had been discussed, and some of the issues raised had already been sorted out. Each new staff member is given their own copy of the policy and procedures manual. The pre-inspection information completed by the manager highlighted that two of the required policies were missing: these were sent to the inspector immediately after the inspection. Tests of the fire alarm and emergency lighting systems have been carried out as required, and there is evidence that an external contractor also carries out regular tests. The majority of bedroom doors have been fitted with a Dorgard, a device which holds the door open and is approved by the fire authority. Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 18 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 2 X X 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X X 3 X 3 Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 19 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 OP1 Regulation 4 and 5 Requirement The statement of purpose and service user guide must be updated to reflect the services currently being offered. A copy must be submitted to the Commission for Social Care Inspection (CSCI) within the timescale. Records of the administration of medication must be completed correctly. An application by the person proposing to be registered as the Manager of the home must be submitted to the CSCI. Timescale for action 28/02/06 2. 3. OP9 OP31 13(2) 8(1) 11/01/06 28/02/06 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 Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE 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 Paxton Hall Care Home DS0000015114.V267352.R01.S.doc Version 5.0 Page 21 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
