Inspection on 08/12/06 for Pear Tree Lodge

This inspection was carried out on 8th December 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

Pear Tree Lodge 30/08/07

Pear Tree Lodge 05/12/05

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Pear Tree Lodge 1-3 Beech Grove Hayling Island Hampshire PO11 9DP Lead Inspector Tim Inkson Unannounced Inspection 8th December 2006 09:30 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 Pear Tree Lodge DS0000064204.V316681.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. Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pear Tree Lodge Address 1-3 Beech Grove Hayling Island Hampshire PO11 9DP 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) 023 9246 2905 023 9263 7922 lynnmcgregor@aol.com Pear Tree Care Limited Mrs Marie Ann Abolins Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (23), Old age, not falling within any other category (23), Physical disability (4), Physical disability over 65 years of age (4) Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. All service users must be at least 60 years of age. No more than 4 service users in the PD and PD[E] categories in total may be accommodated at the home. 5th December 2005 Date of last inspection Brief Description of the Service: Pear Tree Lodge is a twenty-three bedded care home, located in a pleasant residential area of Hayling Island. The service is set up to provide accommodation and care for older people, a number of whom have dementia. The service also has service users with additional physical disabilities accommodated on the ground floor. Pear Tree Lodge may also accommodate up to four service users who have an age related mental health problem, if their care needs are similar to the needs of the existing service users. Pear Tree Lodge has six double bedrooms and eleven single bedrooms, none of which are provided with en suite toilet facilities. The home has three bathrooms and a shower room. There is a large garden, laid to lawn with various fruit trees and patio areas. There is parking area at the front of the home. Pear Tree Care Ltd is the owner of the home i.e. the registered person. Mrs Gillian Bryden is the Responsible Individual. Potential residents are provided with a copy of the home’s service users guide. There is also a copy of the guide readily available in the entrance hall of the home in a folder with a copy of the report of the most recent inspection of the home by the Commission for Social care Inspection. At the time of a fieldwork visit to the home on 8th December 2006 the homes fees ranged from £309 to £395 per week. The fees did not include the cost of hairdressing, podiatry, newspapers, magazines and transport Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork part of the key inspection of this service was unannounced and took place on Friday 8th December 2006, starting at 09:10 and finishing at 16:10 hours. The process included viewing the accommodation including bedrooms, communal/shared areas and the home’s kitchen and laundry. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. Residents, visitors and staff were spoken to and social care professionals were contacted in order to obtain their perceptions of the service that the home provided. It was difficult to have meaningful conversations with many residents because a significant number suffered from memory loss and cognitive impairment as the result dementia. At the time of the inspection the home was accommodating 23 residents, all were female and their ages ranged from 73 to 101 years. No resident was from a minority ethnic group. The home’s registered manager was unavailable during the fieldwork visit but a representative of the company that owned the home was present throughout most of the visit and was available to provide assistance and information when required. Telephone conversation took place with the registered manager subsequent to the fieldwork visit in order to clarify some matters. Other things that influenced this report included a pre-inspection questionnaire with documentation completed and provided by the registered manager. Also information that the Commission for Social Care Inspection had received since the last fieldwork visit made to the home in 2005, such as statutory notices received about incidents/accidents that had occurred. As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service users guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. What the service does well: Residents and relatives valued the friendliness and kindness of the home’s staff team. Relatives and social care professionals believed that the home “did a good job”. Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 6 The home’s routines were flexible and it promoted the right of residents to make choices for themselves and exercise personal autonomy as far as was reasonably possible. Residents were positive about the food that the home provided and were pleased with the range of activities in which they could participate. 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. Pear Tree Lodge DS0000064204.V316681.R01.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 Pear Tree Lodge DS0000064204.V316681.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had procedures in place to ensure that potential residents were given information about the service the home provided to enable them to make an informed choice. Residents were issued with terms and conditions of accommodation and informed about any changes to those terms. The assistance and support that potential residents required was identified before they moved into the home to ensure that their needs could be met. EVIDENCE: The home’s statement of purpose included the following paragraph: “We recognise that prospective residents should have the opportunity to choose a home, which suits their needs and abilities. To facilitate that choice Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 9 and to ensure that our residents know precisely what services we offer, we will do the following. • Provide detailed information on the home by publishing a statement of purpose and a detailed service users guide. • Give each resident a contract or a statement of terms and conditions specifying the details of the relationship • Ensure that prospective residents have their needs expertly assessed before a decision on admission is taken. • Demonstrate to people about to be admitted to the home that we are confident that we can meet their needs as assessed. • Offer introductory visits to prospective residents and avoid unplanned admissions. There was evidence from discussion with residents, relatives and documents examined that the home adhered to its stated intentions. A sample of the records of 3 residents was examined. It was apparent that the help and support that the individuals’ needed was identified by care managers working for local authorities before the persons concerned had moved into the home. There was also evidence that the home’s registered manager also identified the needs of potential residents before they moved into the home. All individuals concerned had been provided with a copy of the home’s statement of purpose, a service users guide and issued with terms and conditions of residence/contract. It was noted that these were provided to individuals or their representatives some time after they had moved into the home. The representative of the company that owned the home said that this was because the first 4 weeks that a resident was accommodated was regarded as a trial period. In discussion it was stressed that a contract was established from the first day a resident moved into the home and that the expectation set out in the National Minimum Standards for care Homes for Older People at 2.1 is that each resident “is provided with a statement of terms and conditions at the point of moving into the home”. One resident spoken to confirmed documentary evidence that was seen that the home notified her of any planned increase in the home’s fees in accordance with the notice period that was set out in her terms and conditions. The registered manager said that she would consider producing information about the home in a format that would assist individuals with a visual impairment. The home does not provide intermediate care. Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had systems in place intended to ensure that the personal and healthcare needs of residents were met. Care plans however were not person centered and lacked sufficient detail about the actions staff needed to take to fully meet residents needs. Residents’ medication was managed safely and effectively. Among other things staff working practice helped to ensure that residents’ privacy and dignity was promoted. EVIDENCE: The home’s statement of purpose included the following paragraphs: “At the time of a new resident’s admission to the home, we work with the service user, and their friend, relative or representative if appropriate to draw up a written plan of care we will aim to provide. The plan sets out objectives for the care and how we hope to achieve those objectives, and incorporate any necessary risk assessments. Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 11 At least once a month, we review each service user’s plan together, setting out whatever changes have occurred and need to occur in the future. From time to time further assessments of elements of the service user’s needs are required to ensure that the care we are providing is relevant to helping the resident achieve their full potential. Each service user has access to their care plan and is encouraged to participate as fully as possible in the care planning process”. Care plans were examined of the same sample of 3 residents as in the section above at page 10, as well as some others that were looked at to follow up on matters of concern identified during the visit. In the plans that were seen there was little explicit information describing the actions staff needed to take to meet the needs of the residents concerned. The detail was very general and not specific enough. Several important aspects of the help and support individuals needed were either not referred to or were omitted. • In the care plans of the 3 residents that were “case tracked” there was no reference to how their oral hygiene would be met. • There was no link between assessments of the risk of the individuals developing pressure sores and the plans of care. It was noted that at least one resident had an air mattress on her bed, but there was no reference to that in their care plan or why it was required. In the records of 2 of the 3 residents who were “case tracked” assessments of the potential for them to develop pressure sores were described as “high”, but there were no corresponding plans as to how the risk would be reduced or eliminated. • The plan to address the social and emotional needs of some individuals’ set out in their plans stated “encourage to join activities”. There was no reference to the person’s particular interests and how they could be promoted or encouraged. • There was no documentary evidence of either the individual’s involvement or their representatives in the care planning process. • There was no assessment of an individuals’ ability to manage their medication (see also below). Daily notes contained examined contained some inappropriate entries of the opinions of staff such as describing the mood of an individual as “good” or behaviour as “aggressive” instead of recording facts. Despite this it was noted that entries in care plans and daily records also indicated that staff were promoting the fundamental principles that underpin social care e.g. “Can go to the toilet on her own; walks with a frame; eats and drinks on her own; likes coffee; prompted her to wash herself; helped to make bed; ate breakfast and dinner with little assistance”. The records examined indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for service users when it was necessary. Residents said that they saw and received treatment from among others, doctors and podiatrists. One the day of the fieldwork visit Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 12 a resident said that she was going to a local hospital for an outpatient appointment at an eye clinic. A social care professional manager spoken to said the following about the home: • “The home wants to work with us and are also on the ball about health issues and contact us if they have any concerns”. One resident described how the home promoted her health care: • “A chiropodist comes once every 7 weeks. I only see the doctor when I need to. I am being booked into to see a consultant. They send for the doctor if they think it is necessary or if I want one”. The home monitored the weight of residents and noted what meals individuals consumed. The home had written policies and procedures concerned with the management and administration of medication. Medication was kept in a locked and secured medicine trolley and a metal cabinet that was secured to a wall. Controlled drugs were stored securely and appropriately. A refrigerator was used for some medicines requiring such storage conditions. The manager was made aware of the need to record the temperature of the fridge to ensure that it was working effectively. The home operated a monitored dosage system. A local pharmacist provided most prescribed medication every 28 days in blister packs for each person concerned. Other medicines that could not be put into blister packs because they could spoil, such as liquids or those that were to be taken only when required were dispensed from their original containers. Records were kept of the ordering, receipt, administration and the disposal of medicines and these were accurate and up to date. The home purported to promote the independence of residents and their right to self medicate. At the time of the fieldwork visit however no resident was managing his or her own medication and there was no evidence that the abilities or desire for anyone to look after their own medication had been assessed. Good practice noted concerning the management of medication in the home included: • Dating containers of certain medications when they were opened. • The availability of copies of signatures of the staff that had received appropriate training and took responsibility for dispensing medication. The home had 6 double bedrooms and 5 of these were provided with screens to promote privacy and the configuration/design of the other bedroom ensured that the two occupants had privacy. Residents spoken to that were able to have a meaningful conversation indicated that staff treated them with respect and ensured that their privacy was promoted as far as was reasonably possible. One resident said: Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 13 • “They preserve my modesty when they bath me. They knock on my door before they come into my room”. Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 14 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home organised a range of social activities that provided stimulation. It also promoted residents self-determination, enabling residents to exercise choice about aspects of their daily life. Residents were able to maintain links with relatives and representatives. The dietary needs of residents were catered for with a balanced and varied selection of food available that met their tastes and choices. EVIDENCE: In the entrance hall of the home and in the large communal lounge there were details about social events taking place during the month in which this fieldwork visit took place. They included; keep fit; bingo; videos; sing a long; horse racing; parachute game; cake making; and a Christmas choir. There were televisions in the home’s communal lounge and there was evidence that a visiting/mobile library service called at the home. The building was decorated for the Christmas celebrations that would be taking place including a party to which relative and friends had been invited. Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 15 There was also evidence from discussion with residents that the home organised a range of activities in which they could participate. Comments included: • “We do exercises and things. We have 2 televisions. We have a singsong now and again. I get books and have plenty to read”. • “I prefer my own company. I get asked if I want to join in activities, but they are not my cup of tea at all”. • “We have entertainment, all sorts”. • “They take me out when they go shopping and so on”. The registered manager said that she obtained “talking books” for residents who had a visual impairment. Residents spoken to indicated that the routines in the home were relaxed and that they were able to exercise choice and determine their preferred lifestyles. • “I go down for meals but not for activities”. • “I can get up and go to bed when I want”. • “I choose when I get up and go to bed more or less. It is pretty easy going here”. The home had a written policy about visitors to the home and residents and visiting relatives spoken to confirmed that contact could be maintained with the families and friends and that there were no restrictions on visiting arrangements. The was a large folder in the entrance hall of the home that contained a copy of the home’s statement of purpose and service users guide and also information about the local area including its amenities and organisations that could provided advice to residents and their representatives. The home’s statement of purpose included the following information: “Residents are encouraged to personalise their rooms with small items of furniture and other possessions or bring their own furniture for their room if they so wish. The home can accommodate small pets, cats, birds and fish and if a resident wishes to bring in their own pets then this can be discussed prior to admission”. It was apparent from a tour of the building and bedrooms that were seen that many residents and/or their relatives/representatives had taken the opportunity to personalise bedroom accommodation. One resident had a pet bird in her room and there were two cats that roamed the home and it was apparent from observing the reaction of residents to their presence that they provided interest, stimulation and enjoyment. The home did not look after any money or manage the financial affaires of any residents. Due to the high incidence of enduring mental health problems among the residents accommodated at the home most were assisted by either their relatives or other representatives. Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 16 All residents spoken to were complimentary about the food provided and confirmed that they had 3 meals a day and could have snacks and drinks at other times. One resident had a kettle in her room and was able to make drinks for herself when she wanted and the home provided her with milk, sugar and tea bags. The food that was provided was based on the knowledge that the home’s staff had of the things that the residents living in the home liked. Menus and records of food provided indicated that the food was nutritious and there was a wide range of meals provided and residents were able to exercise an option if they did not like the main meal provided. On the day of the fieldwork visit the main meal at lunchtime was breaded fish, with chips and peas, some individuals had smoked haddock because it was their preference and others had fish fingers. The latter enabled individuals who were unable to use cutlery because of their dementia to eat independently using their hands. Special diets and individual preferences and needs were catered for e.g. soft meals and diabetics. Fresh ingredients were used in the preparation of meals and the ready availability of fluids was noted. The ingredients for soft meals were prepared separately. Residents could choose where to eat and some preferred to eat in their rooms. The details of the meals of the day were on display on a board in the dining room. Individuals’ food preferences were recorded in their care plan documents. Comments from residents and relatives about the food provided included the following: • “The food is very good, if I don’t like anything the cook will give me something that I like. There is a good selection and most days we have a choice”. • “The food is nice there is plenty of it”. • “It is very friendly, mother is very happy. She says the food is nice and the carers are kind”. Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 17 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had a clear and satisfactory complaints procedure to address the concerns of residents and relatives/representatives. Procedures were in place to protect service users from the risk of abuse but need reviewing to ensure that residents’ civil liberties are properly protected. EVIDENCE: The home had a written policy and procedures about how complaints could be made about the service that it provided. A copy was clearly displayed in the home’s entrance hall. All residents that were able to have meaningful conversations and also relatives spoken to confirmed that they had been provided with a copy of the home’s complaints procedure and were confident about raising any concerns with the home’s manager or a representative of the company that owned the home. The home kept records of complaints that detailed the issue, and set out any agreed action to remedy the matter and its outcome. There had been no complaint made to the home since the last inspection on 5th December 2005, and the Commission for Social Care Inspection (CSCI) had received no complaints about the home during that time. The home had written procedures available that were concerned with adult protection. These were intended to provide guidance and ensure as far as reasonably possible that the risk of residents suffering harm was prevented. Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 18 Staff spoken to said that they received training about protecting vulnerable to were also able to demonstrate an awareness of the different types of abuse and the action they would take if they suspected or knew that it had occurred. It was noted that the use of a special chair with strap and provision of a very low divan bed in order to prevent injury had not been recorded with sufficient detail in care plans and records. The use of any form of restraint must be based on a recoded risk assessment and its use agreed by all interested parties. There must be evidence that that all options to reduce the risk of harm for the person concerned were considered and the choice that was made was the least restrictive option. The agreement must be recorded Full details of how the restraint is to be used and any time limits, etc, must be set out in the relevant care plan. Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 19 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were plans in place to ensure that home’s environment would be improved to make sure that it would be safer and better maintained. There was an infection control policy and procedures in place and staff practice ensured that as far was reasonably possible residents were protected from the risk of infection EVIDENCE: At the time of this fieldwork visit it was apparent that there were some problems with the exterior of the property as there was evidence of water penetration through a flat roof extension at the rear of the building. This resulted in water leaking into the communal lounge when there was heavy rain and one bedroom was temporarily out of use having been redecorated following water damage. A representative of the company that owned the Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 20 home stressed that roofing contractors had been attempting to repair the roof and prevent further leaks. It was noted that some internal areas of the home were in need of redecoration and refurbishment, such as bathrooms and floor covering throughout the ground floor corridor. The representative of the company that owned the home stated that planning permission had been granted to extend the building and that work would start in the Spring of 2007. The building would be totally refurbished and improved as a result. During this work, problems such as those potentially caused by the current stair lift that required residents accommodated on the first floor to negotiate a small number of stairs would be eliminated, as the first floor would be level. It was also the stated intention to install a passenger/shaft lift. It was said that other improvements that would be made as a result of the refurbishment would include: • Bathroom updating • More handrails • Loop system to enhance matters for individuals with a hearing impairment • En-suite WCs • Installation of a commercial washing machine Staff spoken to were very enthusiastic about the planned refurbishment and commented about how it would improve the residents’ accommodation and the home’s facilities. The home had procedures in place concerned with infection control. It was noted that in accordance with best practice all communal WCs that were seen were provided with liquid soap dispensers (that were full and working) and paper towels. There were gel disinfectant dispensers located strategically throughout the building. Protective clothing was readily available and staff were observed using gloves, aprons and hair nets appropriately. The home was clean and mainly odour free at the time of the fieldwork visit and one resident said, “They clean my room, they have a good housekeeper and keep it all clean”. The home’s laundry was equipped with domestic washing machines and only dealt with residents’ personal clothing. Bed linen was sent to a commercial laundry contractor. The location of the home’s laundry was not ideal as it was situated close to the kitchen and food preparation areas. This would be remedied when the building was refurbished, as would the lack of a lobby on the staff WC that was located in the same area. This latter matter had been identified in a report by the local environmental health officer dated 28th February 2006. The home had effective procedures in place for the management of soiled laundry items. Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 21 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There was an appropriate and satisfactory level and mix of staff that ensured the needs of residents were met. The home’s recruitment and staff induction training procedures were poor and failed to ensure that residents were properly protected from the risk of harm. EVIDENCE: The care team working in the home comprised, the registered manager and 11 care assistants and of the latter 7 (i.e. 64 ) had obtained at least a National Vocational Qualification in care, at level 2. At the time of the fieldwork visit the care staff rota setting out the minimum number deployed at any time in the home was as follows: 08:00 to 20:00 3 20:00 to 08:00 2 wakeful Apart from the staff responsible for providing personal care to residents there were the following staff working in the home: Cook; kitchen assistant; housekeeper; and cleaner Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 22 Comments from residents, relatives and social care professionals about the sufficiency and competence of staff included the following: • • “There are plenty of nurses, I think that there are enough, they are very good” (resident). “On the whole the staff are pleasant and helpful, there is no domineering or cruelty here ….. If I want help there is a buzzer I can use and they come quickly … So far they have been able to look after me all right” (resident). “The home are coping with her beautifully and the daughter has nothing but praise for the home and feels well supported. I have had another client there and they managed with his behaviour brilliantly and his family were very pleased” (social care professional). “There seem to be enough staff, although I am a novice at this sort of thing” (visiting relative). • • One member of staff spoken to said, “I think that we have enough staff on duty”. The records were examined of 5 staff that had started work in the home since the last inspection of the establishment on 5th December 2005. In all cases it was apparent from the evidence available at the time of the fieldwork visit, that all of them had started work, before satisfactory enhanced Criminal Record Bureau (CRB) certificates had been received or Protection of Vulnerable Adults (POVAfirst) checks had been completed. There was no evidence of references having been received for one of them and only evidence of the receipt of one reference for two of the others. The representative of the company that owned the home was made aware of the written guidance concerning staff recruitment re-issued by the Department of Health in May 2006. It was stressed that only in exceptional circumstances could a person start work in the home without the receipt of a satisfactory enhanced CRB certificate and this was only provided that a satisfactory POVAfirst clearance had been obtained as well as two satisfactory written references. Also that the person must work under supervision to ensure that they had no unsupervised access to vulnerable adults. An immediate requirement form was left with the representative of the company that owned the home concerning among other things this matter. It included a requirement that all statutory pre-employment checks had to be completed before any person started work in the home. New care staff who have not obtained any formal/appropriate qualification as evidence of their competence to provide personal care are required to complete a comprehensive induction programme. The standards required of the induction training are set out by “Skills for Care”. This is the social care workforce development body that became responsible for the standard of training of the adult social care workforce from April 2005. The expectation was that until September 2006, the induction programme was completed Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 23 within 6 weeks and a foundation programme within 6 months. From September 2006 a Common Induction Standard programme was to be completed within 12 weeks. The available records of the same staff (see above) indicated that the required induction training had not been completed for 2 care assistants who had been working in the home for some 8 and 9 months respectively. There was no evidence that another care assistant who had started work in October had started on a formal induction programme. Care staff seen and spoken to during the fieldwork visit had all obtained an NVQ in care to at least level 2, and all had attended some training in dementia care. Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 24 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, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s manager was providing leadership but was not wholly effective in carrying out all her legal responsibilities. The home had a quality monitoring system but audits of the home’s systems and procedures were not always accurate. Systems and procedures for promoting the safety and welfare of everyone living and working in the home were not operating properly. EVIDENCE: At the time of this fieldwork visit the registered manager had been working in the home for some 14 months. She had some 24 years experience of working in the care industry and approximately 3 years experience of managing a care Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 25 home because she had been employed in that capacity prior to working at Pear Tree Lodge. She had an NVQ at level 4 in management and the Registered Managers Award. She was also an accredited NVQ assessor and a moving and handling trainer. She had attending recent training events in challenging behaviour, dementia care and was attending a local college to train in interpersonal skills/counselling. Staff spoken to during the fieldwork visit expressed confidence in the ability of the registered manager, one said, “The manager is very good. She is approachable, she is fun but she tells us what we need to know”. Relatives spoken to described her as confident. Despite the perceptions of the people referred to above there was evidence that some of the home’s procedures and systems were weak, ineffective or not being implemented properly e.g. plans of care, staff recruitment and induction training (see above sections concerning health and Personal Care and Staffing). The registered manager was ultimately accountable for these matters. The home’s quality monitoring system included the use of audits of the home’s systems, including staff recruitment and the safety of the premises the outcomes of audits of this indicated that everything in these areas was being managed properly (but see section on Staffing above, and paragraph below concerning health and safety). The home had recently used questionnaires to obtain the views of residents and relatives about the quality of the service the home and was collating the results. The home had a range of written policies and procedures and they were reviewed regularly and amended as necessary. Relatives spoken to expressed satisfaction with the care that the home was providing and all residents spoken to that were able to converse meaningfully expressed contentment with their lives in the home. The home did not look after any money on behalf of residents. Records examined indicated that the home’s equipment, plant and systems were checked and serviced at appropriate intervals i.e. stair lift and hoists; fire safety equipment portable electrical equipment; hot water system; etc. Records were kept of accidents. Staff said that they attended regular and compulsory fire and other health and safety training. There was a fire risk assessment for the premises and regular risk assessments of the premises and working practices were undertaken. Guards covered all radiators in the home and all windows above the ground floor were fitted with restrictors. The home’s manager was an accredited moving and handling trainer and there were hoists, and other equipment in the home to promote safe working practices Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 26 There were two matters of health and safety that were noted during the fieldwork inspection. • The restrictors on some of the windows above the ground floor were inadequate as they could easily be removed. • A wardrobe was obstructing a fire escape in a bedroom on the first floor. An immediate requirement form was left with the representative of the company that owned the home about the obstruction of the fire exit because the safety of residents and staff was being avoidably undermined. Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 27 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement The registered persons must ensure that plans of care are clearly linked to assessments of service users needs and contain sufficient detail to enable staff to meet those needs. The registered persons must ensure that no person starts work in the home until all statutorily required preemployment checks are complete. The registered persons must ensure that all new care staff receive and complete induction training to the standard required by “Skills for Care”, the social care workforce development body. The registered person must ensure that the obstruction to the fire escape in a first floor bedroom is removed. Timescale for action 31/03/07 2 OP29 19 08/12/06 3 OP30 18 31/03/07 4 OP38 23(4) 08/12/06 Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 29 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 Pear Tree Lodge DS0000064204.V316681.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. 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