Inspection on 08/06/07 for Paxton Hall Care Home

This inspection was carried out on 8th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Paxton Hall Care Home 28/10/08

Paxton Hall Care Home 07/07/06

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 Andy Green Key Unannounced Inspection 8th June 2007 10:30 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.V342743.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. Paxton Hall Care Home DS0000015114.V342743.R01.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) Mrs Karen Louise Napier 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.V342743.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th July 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, and 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. The current charges range from £485 to £550 per week. CSCI inspection reports are readily available to residents and their relatives on request. Paxton Hall Care Home DS0000015114.V342743.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Regulation Inspector, Andy Green carried out this unannounced key inspection, on 8th June 2007. The inspector met with the manager, providers, care staff, relatives and residents. A variety of records were inspected including care plans, medication records, fire records, resident finances, supervision records and training files. A tour of the building and grounds was also undertaken. What the service does well: 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. The summary of this inspection report can be made available in other formats on request. Paxton Hall Care Home DS0000015114.V342743.R01.S.doc Version 5.2 Page 6 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.V342743.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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: The home receives full assessment information regarding prospective residents from care managers before moving into the home to ensure that the home can meet their assessed needs. The manager stated that relevant reports are also received from GP’s or District Nurses where appropriate. Families are also asked to provide personal profile/history and any other helpful information to ensure that the home has a good all round knowledge of the individual resident. Paxton Hall Care Home DS0000015114.V342743.R01.S.doc Version 5.2 Page 8 Visits to the home can be arranged for the prospective resident, which can also include their relatives and friends. The manager and a senior carer carry out assessment visits to the prospective residents in their home or hospital to gauge the person’s needs. Evidence of assessments was seen on resident’s files. There were 34 residents living in the home at the home during the inspection. One relative spoken to stated that he visited three other homes before assisting his mother moving in to Paxton Hall. He stated that he had been provided with all the information he needed to help in making an informed decision. The home does not offer intermediate care. Paxton Hall Care Home DS0000015114.V342743.R01.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. 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 resident files were inspected and they contained clear guidelines to meet the assessed needs of residents. There were personal profiles, mobility assessments, weight charts, records of contact with healthcare professionals and likes and dislikes recorded in each file. Regular reviews are carried out on a monthly basis or more often as necessary with the resident and their key worker to monitor/record any changes in care that may be required. Notes of recent reviews were seen in the resident’s files. Short-term care plans are also used to monitor a particular healthcare issue eg nutrition monitoring where appropriate. Paxton Hall Care Home DS0000015114.V342743.R01.S.doc Version 5.2 Page 10 There is a key worker system and staff are involved in reviews of care, the completion of daily notes and reviews of care and support required. Residents continue to receive input from a variety of healthcare professionals including GPs, chiropodist, opticians and a dentist as required. The care staff in the home assist residents with personal care and there is continuous recording of dependency levels to track and respond to the changing needs of residents. The home promotes independence as much as possible and residents are encouraged to safely do as much as possible for themselves. This is included in the guidelines in care plans. Records of medication administered were inspected and they are accurately recorded. The administration processes have been improved since the last inspection to provide a clear audit trail. It was clear from observations made during the inspection that the dignity of residents is preserved and the manager and care staff were observed to interact with residents in a friendly and caring manner. Five residents were met during the day and they were positive and complimentary about the care and the support they received. They were pleased with their bedrooms and surroundings and found the quality of the meals provided to be of a good standard. This was further confirmed through a conversation with a relative who was satisfied with the care his mother received in the home. Paxton Hall Care Home DS0000015114.V342743.R01.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. 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. Residents have access to a wide range of organised activities and 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: There is a comprehensive activities programme organised by the activities coordinator. This includes activities in-house and access to the community. Activities include singing, skittles, quizzes, craftwork, collages, flower arranging, chair exercises, reminiscence sessions and cookery sessions. On the day of the inspection the activities co-ordinator was leading a reminiscence session in the lounge. Paid entertainers also provide a variety of sessions, which has included music, bell ringing, organ and a visit from the local birds of prey centre to give a display of owls. Paxton Hall Care Home DS0000015114.V342743.R01.S.doc Version 5.2 Page 12 Visits to the local community are regularly arranged including visits to garden centres. The mobility needs of residents are taken in account prior to day trips. When the activities co-ordinator isn’t on duty the care staff support the residents with activities including sitting outside in the grounds of the home or to go for a walk. A hairdresser regularly visits the home and care staff often provide manicures. It was noted that the activities co-ordinator is retiring in the next few months and the home is undertaking recruitment to ensure that activities remain a high priority in the home. The lunch was of good quality and looked appetising. The lunch menu was fish and chips and the fish had been home cooked and brought in fresh from a local supplier. All of the residents spoken to at lunchtime said they enjoyed their meal. The cook regularly discusses meal options with residents and there are meal alternatives to the menu. Relatives are always made welcome by the staff and can stay for meals if they wish to. The relative spoken to stated they he would speak to the manager if he had any concerns or issues regarding the care and support provided in the home. Paxton Hall Care Home DS0000015114.V342743.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints process to make sure that residents have their complaints or concerns listened to and acted upon properly. EVIDENCE: The home has a clear complaints procedure to ensure that complaints are investigated and actioned appropriately. Neither the home nor the CSCI have received any complaints regarding the home since the last inspection. However a complaints book needs to be in place to ensure that all issues are recorded. The home has a satisfactory policy regarding Adult Protection. Training in the protection of vulnerable adults has been completed for all staff to ensure that residents are protected from abuse. Training records confirmed this to be the case. Residents or their relatives raised no concerns during the inspection of the home. The home holds small amounts of ‘pocket money’ for residents and records have been improved since the last inspection to record all transactions including receipts. One of the records was inspected and was accurate. Paxton Hall Care Home DS0000015114.V342743.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is suitable for the needs of those living in the home. The home is clean and hygienic and there are no unpleasant odours. EVIDENCE: Residents continue to 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 well maintained grounds, which the residents have access to at all times and especially in the warmer weather. Resident’s bedrooms are well decorated, personalised and furnished reflecting the preferences of residents. Residents are encouraged bring their own Paxton Hall Care Home DS0000015114.V342743.R01.S.doc Version 5.2 Page 15 possessions and items of furniture in accordance with health and safety requirements. The home is decorated throughout the year on an ongoing basis and the manager stated that the lounge has been redecorated since the last inspection and a new freezer and two profile beds have recently been purchased. A number of carpets have also been replaced in bedrooms. There is a full time maintenance person who carries out decoration and minor repairs and a part time gardener maintains the grounds. The exterior of the home needs to be redecorated and quotes for these works have been received. The manager stated that it was anticipated that the decoration work would be carried during the summer months. The manager also stated that dining tables and chairs for the dining areas have also been ordered. The home is kept in a clean and hygienic condition and there were no unpleasant smells. Cleaners were seen to be carrying out detailed cleaning in the communal areas, corridors and in a resident ‘s bedroom. Paxton Hall Care Home DS0000015114.V342743.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A thorough recruitment and training process is in place to prevent residents being put at risk. EVIDENCE: There are sufficient staff to deliver the required level of care and support. The home has a thorough recruitment process and three staff files were seen. They all contained evidence of application forms, CRB/POVA checks, two references and proof of identity. The home’s training file was also seen and records showed that there had been a wide range of training since the last inspection including; dementia, POVA, moving and handling, health and safety, fire, infection control, food hygiene, continence, safe handling of medicines and ongoing NVQ at Levels 2 and 3. Updates and refreshers are planned throughout the year. This was confirmed through interviews with five staff during the day. Staff spoken to confirmed that they received regular training and they were particularly enthusiastic regarding the recent dementia training which had given them a greater understanding and strategies for supporting residents with dementia care needs. Paxton Hall Care Home DS0000015114.V342743.R01.S.doc Version 5.2 Page 17 New staff receive a period of induction training to ensure they understand how care is provided and how to work safely. Other aspects of working in the home, including treating residents with respect and maintaining confidentiality are also explained during this time. Paxton Hall Care Home DS0000015114.V342743.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34,35,36,38 Quality in this outcome area is good. 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: Since the last inspection a manager has been appointed in the home and she has successfully became registered with CSCI. She is currently working towards the completion of the Registered Managers Award. The manager has a good working relationship with the providers and she feels appropriately supported by them. It was clear during observations and discussions that the manager is an experienced and capable person and that the resident’s care is well managed Paxton Hall Care Home DS0000015114.V342743.R01.S.doc Version 5.2 Page 19 and safely delivered. The staff confirmed that the manager’s style was inclusive and that the staff were encouraged to take an active part in the development of the home and its services. Supervision has improved and evidence of recorded sessions was seen in staff files. There is a list of supervision dates displayed in the office. The manager undertakes the majority of the supervision sessions and one of the senior staff supervises a group of 6 carers. The manager stated that she is aware of the need to maintain regular supervisions to ensure that staff’s practice and development are regularly monitored. There are also regular staff meetings to discuss care and management issues. Staff confirmed that they were regularly supervised and that they were able to raise issues in the staff meetings. The home continues to send out quality assurance questionnaires during the year. This includes residents, as many family members as possible, health care professionals and regular visitor’s to the home. A satisfaction questionnaire continues to be sent to residents and their families one month after moving into the home. The fire safety records were inspected and fire alarm and emergency lighting tests were up to date. Paxton Hall Care Home DS0000015114.V342743.R01.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 3 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 X 18 3 3 3 X X 3 X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 3 3 3 X 3 Paxton Hall Care Home DS0000015114.V342743.R01.S.doc Version 5.2 Page 21 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. Standard Regulation Requirement Timescale for action 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.V342743.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Cambridgeshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Paxton Hall Care Home DS0000015114.V342743.R01.S.doc Version 5.2 Page 23 - 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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