Inspection on 07/07/06 for Paxton Hall Care Home

This inspection was carried out on 7th July 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

Paxton Hall Care Home 28/10/08

Paxton Hall Care Home 08/06/07

Paxton Hall Care Home 11/01/06

Paxton Hall Care Home 24/11/04

Paxton Hall Care Home 22/06/04

Paxton Hall Care Home 21/01/04

Similar services:

Bilney Hall

Claremont House

Oak Ridge

Coopers Mill Ltd

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Paradise Lodge

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

CARE HOMES FOR OLDER PEOPLE Paxton Hall Care Home Rampley Lane Little Paxton St Neots Cambridgeshire PE19 6EL Lead Inspector Joanne Pawson Unannounced Inspection 7th July 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.V304061.R03.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. Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Paxton Hall Care Home Address Rampley Lane Little Paxton St Neots Cambridgeshire PE19 6EL 01480 213036 01480 477811 paxtonhall@kelam.com www.paxtonhall.co.uk Kelam Health Care Limited 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) Care Home 39 Category(ies) of Dementia - over 65 years of age (16), Learning registration, with number disability over 65 years of age (3), Old age, not of places falling within any other category (39) Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th January 2006 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 residents 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 accommodation for two care assistants. 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 residents 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.V304061.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 7th July 2006 for seven hours. Methods used for the inspection included speaking to the acting manager, staff and residents, observation of care, reading documentation and a tour of the home. There was not a registered manager at the time of the inspection. The acting manager will be submitting an application to the commission to become the registered manager. One of the requirements from the last inspection had not been met. What the service does well: What has improved since the last inspection? The service users guide and statement of purpose have been updated to reflect the services currently being offered. The acting manager stated that the provision of meals had improved so that there is more flexibility of where residents choose to have them and what time and a wider choice of food. Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 Page 6 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.V304061.R03.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 Paxton Hall Care Home DS0000015114.V304061.R03.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): 1,3,4,5,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the information they need to make an informed choice about moving into the home. EVIDENCE: All residents have full assessments by care managers and/or the home manager before moving into the home to ensure the home is able to meet their needs. One relative of a resident living at the home stated that he visited about ten homes before helping his relative to choose Paxton Hall and that he had been provided with all the information he needed. The home does not offer intermediate care. Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care staff have the information they need to meet the residents needs. Residents are treated with respect and there dignity is promoted. EVIDENCE: Three care plans were tracked. The care plans encouraged residents to be as independent as possible but recognised the need for support at certain times. One of the care plans included advice from healthcare professionals for one resident to have bed rest each afternoon to prevent pressure sores. However there was no record of this being done in the resident’s daily notes. The acting manager and care staff confirmed that this was being done but not recorded. The care plans contained a section on what factors needed to be considered to maximise the resident’s contentment. This was a personal fact about each Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 Page 10 service user that the staff could talk to them about. For example one resident enjoyed talking about her time working for the royal family. None of the care plans tracked had been signed by the resident or their representative. Residents spoken to stated that they were not aware of the care plans and some residents said they would like to know what was written about them. Care staff write daily notes for residents. One member of staff had written that she had spent time with the resident that she key worked and explained what a key worker was and asked if the resident was happy living in the home. Residents are weighed monthly and there are clear records about visits from health care professionals. All of the residents spoken to on the day of the inspection said that they felt staff treated them with respect and dignity. One resident stated ‘staff treat you how they would like to be treated’. One resident who cannot communicate verbally indicated that the staff treat her well and they always take the time to try and understand what she wants. One resident who was confused was reading the previous days newspaper and kept asking staff and other residents if it was the right day. When other people told her it wasn’t the right day she got agitated. The inspector asked a member of staff to bring the resident the correct newspaper. The resident seemed to relax when she knew she had the right paper with the correct day and date on. The acting manager has stated that she will ensure that the resident is given the correct paper earlier in the day. There were still errors in the recording of the administration of medication. An immediate requirement was issued stating that there must be accurate recording and administration of medication. There was no clear audit trail of medication so that the number of signatures and tablets remaining could not be counted to ensure the accuracy of recording. Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The range and frequency of organised activities is excellent. Residents can make choices about their lives and are encouraged to maintain their independence. Dietary needs are well catered for, with a balanced and varied selection of food available to meet residents’ individual tastes and choices. EVIDENCE: The three care plans the inspector tracked contained records of the residents taking part in various activities including: craft work, food tasting, singing, flower arranging, cookery, beanbag game and a quiz. On the day of the inspection the activities co-ordinator was leading a session of singing and a ball game. The residents said that they really enjoyed it. When the activities co-ordinator isn’t working the care staff support the residents to sit outside in the grounds of the home or to go for a walk. The food looked and smelt appetising. The menu was fish and chips and strawberries and meringues for dessert. The fish had been brought in fresh Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 Page 12 from a local supplier. All of the residents spoken to at dinnertime said they enjoyed their meal. One resident stated that he liked all of the food apart from when they had cabbage. The acting manager stated that the resident liked the cabbage cooked for longer so his is always cooked separately the way he likes it. Resident’s relatives stated that they are always made welcome by the staff and can help themselves to drinks and can stay for meals if they wish to. The relatives also stated they would speak to the acting manager if they had any concerns. Residents are helped to make choices even about the little issues for example one resident didn’t like the colour of the socks she was wearing so a carer helped her to her bedroom and helped her to change her socks. The resident then asked for a cup of tea and was brought one straightaway. Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 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): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s systems for dealing with complaints are satisfactory EVIDENCE: The home has procedures for residents or their representatives to follow, should they need to make a complaint about the service; the procedures are included in the service user guide and displayed in the home. The acting manager stated that the home has not received any complaints since the previous inspection. The home only holds minimal amounts of money for residents. The records need to be improved to record how much money is being looked after and when money is taken out. The home has a policy for dealing with the suspected abuse of a resident. Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 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): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is suitable for the needs of those living there, and sufficient equipment is provided so that residents’ independence is maximised. The home is clean and hygienic and there are no unpleasant odours. EVIDENCE: Residents have access to a range of safe and comfortable communal areas. Furnishings and fittings provided, are clean, domestic in scale and design, and appear both comfortable and suitable for their purpose. The home is set in large grounds, which the residents are encouraged to use in the warm weather. A few residents told the inspector that they had a planted the flowers and tomato plants in the courtyard. Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 Page 15 Two members of care staff stated that they would like more stand aids. The acting manager stated that there are sufficient aids. The acting manager stated that there are sufficient aids but one of them sometimes gets left upstairs. Residents personalise their own bedrooms. On the day of inspection the home was clean and appeared hygienic, and there were no unpleasant smells. Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 Page 16 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Thorough recruitment procedures are not being followed which could lead to residents being put at risk. Not all staff have the specialist training so that they are aware of best practice when working with residents with dementia. EVIDENCE: Residents said that they were happy with the staff and it was evident that they had developed relationships with residents that were warm and friendly. Care staff are commencing work at the care home before the receipt of satisfactory references, Pova First and Criminal Records Bureau check. The acting manager stated that she thought this was acceptable as they could potentially lose staff when waiting several weeks for CRB results. An Immediate requirement was issued stating that the home must receive satisfactory recruitment checks before employing care staff. Care staff may commence work in exceptional circumstances before the receipt of a CRB bust must be supervised. The manager stated that the home has minimal staff turnover. There are a high percentage of residents living in the home who have dementia but not all of the staff have completed training in dementia care. The acting Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 Page 17 manager stated that she planned to arrange training in dementia care during the year. New staff are required to work through a period of induction training so that they get to know how care is provided, how to work safely, and other aspects of working in the home, including treating residents with respect and maintaining confidentiality. Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 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 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): 31,32,33,35,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to ensure the health and safety of residents and staff. EVIDENCE: All of the care staff and residents spoken to said that they could discuss any concerns with the acting manager. The acting manager has made a number of positive changes since managing the home. An application to register the manager must be submitted to the Commission by the 1st September 2006. The acting manager stated that she intends to hold senior staff meetings weekly, supervisor meeting every 6 to 8 weeks and full staff team meetings every 6 to 8 weeks. Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 Page 19 Not all staff are receiving regular supervision. The acting manager stated that she was aware of this. All staff must be supervised on a regular basis. The home sends out quality assurance questionnaires to all stakeholders of the service once a year. This includes residents, as many family members as possible, health care professionals and regular visitor’s to the home such as the hairdresser. A satisfaction questionnaire is also sent to residents and their families one month after moving into the home. Residents meetings are held monthly and minutes are taken. Money held on behalf of residents was checked and found to be accurate. However there needs to be clear records of when money is deposited and withdrawn. Accident forms are being completed. Staff have training in the correct moving and handling techniques. The fire book was inspected and fire alarm tests were up to date. Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 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. 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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 2 2 X 3 Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 Page 21 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. 1. Standard OP9 OP9 Regulation 17(1)(a) 17(1)(a) Requirement A record should be kept off any medication received into the home or disposed of. Records of the administration of medication must be completed correctly. A thorough recruitment procedure must be followed to ensure that care staff do not commence employment in the home until the receipt of satisfactory references, Pova First. If staff commence work before the receipt of the CRB they must be supervised. An application by the person proposing to be registered as the Manager of the home must be submitted to the CSCI. There must be clear records of money or valuables deposited by a service user for safekeeping. Arrangements must be made for care staff to receive regular supervision. Timescale for action 07/07/06 07/07/06 2 OP29 19 07/07/06 3. OP31 8(1) 01/09/06 4. 5. OP35 OP36 17(2) 18(2) 01/08/06 01/08/06 Paxton Hall Care Home DS0000015114.V304061.R03.S.doc Version 5.2 Page 22 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.V304061.R03.S.doc Version 5.2 Page 23 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. 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