CARE HOMES FOR OLDER PEOPLE
Peacemills Care Home Perry Road Sherwood Nottingham NG3 3AQ Lead Inspector
Sharon Rosenfeld Unannounced 12 July 2005 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. Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Peacemills Care Home Address Perry Road Sherwood Nottingham NG3 3AQ 0115 960 2539 0115 985 6616 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) Community Care Plus Ltd Mrs Yana Susan Whitehouse Care home 40 Category(ies) of OP Old age, x 40 registration, with number of places Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Mrs Whitehouse must undertake courses facilitated by Notts Committee for the Protection of Vulnerable Adults by 31 October 2005 a) Undertanding Adult Protection and Your Role b) Investigating Officer and Interview Skills c) Managing Complex Investigations Date of last inspection 9 November 2004 Brief Description of the Service: Peacemills is a care home providing personal care and accommodation for 40 older people. The home is located on the outskirts of Sherwood, a residential district in Nottingham approximately 3 miles from the city centre. There are a small number of local community shops near to the home and Sherwood itself has many other amenities including shops, pubs and restaurants, and a community centre. The home was opened in 1991 and consists of a two-storey purpose built building. There are 36 single bedrooms (35 with en-suites) and two double bedrooms (with en-suites). There is a car park to the rear of the property and a small garden. It is owned by Community Care Plus Limited whose Managing Director is Brian Rosenburg. The Registered Manager is Yana Whitehouse. Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory inspection took place over approximately five hours and was unannounced. The inspector looked around parts of the building and a number of records were examined. Six residents, two care staff and the Registered Manager were spoken with. The inspection used ‘case tracking’ as a way of gathering information about the quality of the services provided. This involves tracking the care received by a set number of residents who are randomly selected, reading their records and talking with them, and with the carers who support them at the home. The progress of the Registered Manager to meet the requirements made at the previous inspection was discussed and assessed. What the service does well:
Many of the residents state they are happy living at Peacemills Care Home. People like the staff and say they work hard to meet their needs. One person had a birthday celebration on the previous day. She said the staff had put a lot of effort to make it an enjoyable day for her. There are clearly good relationships between many of the staff and residents. People who are confident and able to enjoy their independence away from the home for short periods of time without a staff escort do so with the support and encouragement of the staff. The Registered Manager seeks out and encompasses advice and guidance from external organisations and other professionals into everyday practice. A significant proportion of the staff team have been employed for a long period of time. The assessments of need are comprehensive and people receive written confirmation, prior to admission that the home can meet their needs. The care plans identify the care to be delivered both day and night. Where a risk has been identified there is a corresponding care plan. The programme of activities provides stimulation to many of the residents. The procedures for the recruitment of staff are robust. Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
The staffs understanding of the policies and procedures for the prevention of cross infection needs to improve. Lids were taken off the continence pad disposal unit and placed on top of clean laundry. In addition to presenting a risk of cross infections this practice also leads to offensive odours in the bathroom and corridor. This has been brought to the attention of the Registered Manager at the previous two inspections. Care planning for needs relating to cognitive impairment and communication difficulties and the attention to detail such as ensuring people have access to their spectacles every day needs to improve. The care plans also need to describe the type of pressure relieving equipment that must be provided to residents. The staff need to read the care plans so that they can understand the individual and their needs better and can therefore ensure that all care needs are met. Improvements have been made to the garden area which has now been fenced off from the car park. Uneven surfaces and trip hazards from equipment left on the ground needs to be addressed however and this is outstanding from previous inspections. Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 Page 7 All other improvements must be undertaken with due consideration for the needs of the residents. For example, a number of people have a visual impairment and the colours used on the walls in areas where there is no natural light can affect their ability to use these facilities safely. A review needs to take place about how individuals’ privacy is protected when they use bathrooms and toilets. 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. Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 Page 8 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 Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 Page 9 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. Prospective residents have their needs assessed prior to admission and receive assurances that their needs will be met by the home. EVIDENCE: Three residents files were examined. All of them contained a Community Care Assessment that described their care needs. One person’s assessment identified a problem with alcohol abuse. External health and social care professionals are supporting this specialist element of his care needs. The primary reason for this persons’ temporary admission to the home results from self-neglect. This person’s care plan had not been fully formulated as this was a new admission. Although the home can demonstrate that it can meet this person’s needs in relation to self-neglect, a clear understanding on the part of the staff needs to be evidenced regarding his alcohol abuse. Failure to do this could have serious repercussions for the health and welfare of the individual and potentially, for other residents and staff at the home. Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 Page 10 The assessment forms are comprehensive however not all sections are routinely completed. This does not therefore give a full picture of the individuals needs to enable care planning to identify how they will be met. Prospective residents receive written confirmation that the home can meet their assessed needs. Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 Page 11 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 10 Care plans identify how the majority, but not all of the assessed needs are to be met. The shortfalls in care planning do not ensure that all health care needs are understood and met. Some of the daily routines in place do not protect individuals’ privacy. EVIDENCE: Three of the resident’s files were seen. Individual care plans are available however not all aspects of health, personal and social care needs are identified and planned for. This is particularly evident for those people with a cognitive impairment, dementia or communication difficulties. One significant example concerned a gentleman who is confused and was distressed at losing his glasses. He wanted to read a newspaper to ‘keep in touch with the outside world’. His thought his glasses had been lost however, they had not been given to him when he was assisted to get dressed that morning. He was both relieved and delighted when his glasses were brought to him. At handover, the Registered Manager stated that this situation had occurred the previous day. The importance of having his glasses accessible and of reading a daily newspaper was not emphasised in the care plan.
Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 Page 12 Appropriate risk assessments are in place and where a risk has been identified there is a corresponding care plan. There is a night- time care plan and this is good practice. One night care plan contained different instructions for staff to follow than was described when the need was assessed. There are different types of pressure relieving equipment that can be used and the type ‘prescribed’ for the use of each resident must be defined in the care plan. One person cannot manage her own oral healthcare. The care plan must state how oral health care is to be a managed including planned examination by the Dentist. The care staff spoken with confirmed they have opportunities to, but do not routinely look at the care plans. These documents should describe the agreements reached with the resident about how their care is to be delivered. It is important therefore that they are working documents, and a reference point for staff. The care staff were, until recently, administering oxygen to a resident. This is a health care task that requires specific training. Nominated care staff must receive training from a heath care professional and confirm in writing that they feel competent to undertake this task. The training must be reviewed regularly. The resident, or their representative must also sign a consent form authorising the named carer(s) to administer their oxygen The Registered Manager investigated one concern received by the CSCI that the home was admitting people who had nursing care needs and that people’s dependency levels were being allowed to drift into nursing care needs without the appropriate action being taken to have people re-assessed and if necessary moved to a home that provides nursing care. These were found to be unsubstantiated. It is however important that residents dependency needs are kept under review and that referral for re-assessment is made promptly if these are assessed to be increasing. Residents are assisted to use the toilet at intervals throughout the day. The toilet doors were not locked and staff did not stand at the door to guarantee the residents privacy. Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 Page 13 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. Social activities are well organised, creative and provide stimulation and interest to people living at the home. EVIDENCE: An Activities Co-ordinator has been employed and although her hours are limited to twelve each week, this is working well. A ‘memory board’ is displayed on the wall near to the lift. Another notice board advertises forthcoming events such as bingo, a music quiz, a BBQ a sea-side themed afternoon and a home baking session. One person spends a lot of time in the garden. He has put plants in the borders and the home has purchased a Polycarbonate greenhouse that he uses to grow tomatoes and other plants. This action is commendable. Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 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) These standards were not assessed on this inspection. EVIDENCE: Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 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, 26. Some improvements to the décor have been made. There are a number of matters outstanding which may place people at risk of harm and do not provide safe surroundings in which to live. EVIDENCE: The home is continuing with a programme of re-decoration. The ground floor bathrooms and toilets are being repainted. There is no natural light in these rooms and the Registered Manager needs to ensure that the paint colours used, although an improvement, are bright enough for the visually impaired members of the resident group. There is a range of accommodation that can be used flexibly including three lounges. This allows space for people to meet in private accommodation that is separate from their bedroom. Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 Page 16 A number of other areas still require attention, in particular: • The uneven paths and trip hazards in the garden require attention. • The fitting of grab rails to the corridors. • The fitting of radiator covers that allow for temperature controls to be accessible. • The staff must act in accordance with policies and procedures to prevent cross infection. This includes the safe use of equipment for the disposal of continence pads. Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 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) 29 The procedures for the recruitment of staff are robust and therefore offer protection to people living at the home. EVIDENCE: The file of the most recently recruited staff member was seen. All of the necessary recruitment checks had been undertaken to ensure the protection of residents. Criminal Records Bureau checks had been received in advance of the person commencing in employment. Two written references were also received. Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 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) These standards were not assessed at this inspection. EVIDENCE: Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 Page 20 Yes 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 7 Regulation 12, 15 Requirement The care plans must be written in sufficient detail to provide clear guidance to staff on the actions to be taken to meet their needs in relation to Dementia, communication, oral health and the type of pressure relieving equipment to be used in the management of risk of pressure sores. The residents who use spectacles for the management of a visual impairment must have these accessible to them. The care staff must be trained by a qualified person to administer Oxygen. The training must be reviewed regularly. The resident must consent to the care staff administering this treatment. A review of the practice in place when people are assisted to use the toilet must take place to ensure residents privacy and dignity is respected. The trip hazards in the external grounds must be repaired and the paths must be kept free of obstacles. The fitting of grab rails in the corridors must be incorporated Timescale for action 30/09/05 2. 7, 8 12, 13, 14, 15 12, 13, 15, 18 03/07/05 3. 7, 8 03/07/05 4. 10 12 31/08/05 5. 19 13, 23 31/08/05 6. 22 13, 16 31/08/05
Page 21 Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 7. 26 13 into the homes maintenance plan. (This requirement remains outstanding from the inspection of 9th November 2004) All staff must understand and implement infection control procedures in everyday practice. 03/07/05 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. Refer to Standard 7, 8 Good Practice Recommendations The staff should read the care plans regularly to ensure they are aware of how to meet the residents assessed needs. Peacemills Care Home C53 C03 S2298 Peacemills V238316 120705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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