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Inspection on 01/06/06 for Peartree Care Centre
Also see our care home review for Peartree Care Centre for more information
This inspection was carried out on 1st June 2006.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.
Other inspections for this house
Similar services:
What follows are excerpts from this inspection report. For more information read the full report on the next tab.
What the care home does well
What has improved since the last inspection?
What the care home could do better:
Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.
CARE HOMES FOR OLDER PEOPLE
Peartree Care Centre Peartree Care Centre 195-199 Sydenham Road Sydenham London SE26 5HT Lead Inspector
Lisa Wilde Unannounced Inspection 11:00 1 , 2 & 14th June 2006
st nd 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 Peartree Care Centre DS0000007038.V298850.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. Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Peartree Care Centre Address Peartree Care Centre 195-199 Sydenham Road Sydenham London SE26 5HT 020 8488 9000 020 8333 5399 samantha.middleton@excelcareholdings.com www.excelcareholdings.com Springmarsh Homes Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care Home 75 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Old age, not falling within any other of places category (0), Physical disability (0), Physical disability over 65 years of age (0) Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 20 patients, elderly, frail persons aged 60 years and above (female) and 65 years and above (male) 55 persons aged 65 years and above, and persons aged 60 years and above who are physically disabled, or have a mental health disorder 31st January 2006 Date of last inspection Brief Description of the Service: Peartree Care Centre is a care home providing personal care, nursing and accommodation for older people. The home is owned and run by Excelcare Holdings Ltd, a private provider with several other large homes in the nearby area, as well as outside London. The Head Office of the company is in Bromley. The home is close to the centre of Sydenham and is easily accessible by public transport. It is also close to community facilities, shops, cafes and pubs. The property is purpose built and has four floors. On one floor nursing care is provided; the other floors provide residential care to frail older people and older people with dementia. There are 65 single and five double bedrooms however the double rooms will not now be shared unless a married couple moves to the home. All but seven single rooms and one double room have en-suite facilities. There are two passenger lifts. The home has a car park and a paved garden at the rear of the property. The new Service User Guide states that fees for a place at this home are currently £475-£495 for residential and £585-£615 for nursing. The reports of the Commission’s inspections are available in the reception on the ground floor. Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place in June 2006 over two days at the home with a further two days spent telephoning the next of kin of some service users. On the first day of the inspection two inspectors arrived at lunchtime and stayed into the evening and on the second day the lead inspector arrived early, before service users were up and stayed until early afternoon. During the inspection the inspectors spoke with six service users and later the lead inspector telephoned twenty-nine of the fifty current next of kin. (The vast majority of the service users at this home either cannot speak or have significant impairment due to dementia or mental illness). Comments from these relatives are included in the main body of this report. The inspectors also spoke with senior managers, staff and visiting professionals, looked through records and documents, examined medication stocks and toured the building. The Commission is currently taking enforcement action against this home to make sure the home complies with certain areas of the National Minimum Standards and these notices are discussed along with the requirements from previous reports, in the main body of this report. Given the number of requirements from previous reports, this inspection focussed on assessing those requirements and did not look into many new areas although obviously where an issue arose as part of looking at those areas it was assessed and further requirements made as necessary. Because of the level of concern held by the Commission following the last inspection, a condition was proposed that there are no new admissions to the home until the Commission is satisfied that the home is meeting enough of the National Minimum Standards. Generally, the lead inspector found that there have been some improvements since the last inspection but there are still many areas where this home is not meeting the National Minimum Standards and a lot of work is needed to bring the standard of care at the home up to an acceptable level. Should the next inspection show that previous requirements are still unmet then the Commission will consider taking further enforcement action to try and bring this home up to the required standard. What the service does well:
Areas looked at during this inspection showed that the home makes sure that: Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 6 • • • • • • • the systems for the handling of medication in the home are effective and are being followed by most staff. relatives can visit the home when they choose and they are always made welcome by staff. formal complaints are taken seriously and investigated by senior staff. all areas of the home are large enough, well decorated and clean. there is a newly landscaped garden that some relatives said they liked and has made things more pleasant for service users when they sit outside. relatives are mostly happy with the way staff treat service users. apart from the weekly fire system tests, the health and safety procedures are being followed by staff. What has improved since the last inspection? What they could do better:
The areas looked at during this inspection showed that the home must do more work to make sure that: • the service users guide is in a format that could be understood by more of the current service users and it is given out to service users’ relatives and prospective service users who may want to live at the home. • all contracts are signed (work has been done in this area and all but four are signed), state the correct amount that the service user is expected to pay for their place at the home and a copy is given to the service user or next of kin. • care plans fully describe all areas of support that a service user needs and that they are always followed consistently by staff. • service users and their next of kin are invited to annual reviews of the service users’ life at the home. • service users’ healthcare and personal care needs are fully met.
Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 7 • • • • • • • • • • • • • • • • • • • • • staff treat service users with respect at all times. staff communicate well with service users at all times. service users privacy is protected in the communal areas of the ground floor. service users individual needs are met by the activities that are on offer. service users can go out more regularly and are more a part of the local community. service users and their relatives are given enough information in formats that they can understand, to be able to make informed choices about their lives. all service users have a social worker or an advocate who can help them and their relatives with any questions they may have and to make sure that at least annual reviews of their care take place. all service users are happy with their meals. day-to-day comments and concerns are recorded and action is taken to address them. staff understand and follow all procedures in place to protect service users from harm or abuse. all areas of the home are free from unpleasant smells. the environment helps service users with dementia to understand where they are and what is going on. service users have all the equipment they need to move and transfer service users safely. staff have the skills, awareness and ability to meet all the needs of service users. there is a Registered Manager in post who makes sure that the home is well-run. there are detailed plans in place to show that service users’ and their relatives’ views are gathered effectively and the home improves in the way that they want. service users and their relatives are told about the Commission’s inspections and the reports that are written following these inspections. that money or gifts brought into the home are recorded to make sure that they are doing everything possible to protect the financial interests of service users. all staff have receive enough supervision from senior staff who have the skills to be able to offer such supervision and staff have an at least annual appraisal of their work. record keeping is clear and effective and staff understand why they are recording issues so that they can respond properly to the information that they are recording. that the weekly tests of the fire system take place. 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. Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 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 the following standard(s): 1, 2, 3 & 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the Service User Guide has been revised and now includes the information required by the standard, this guide is not in a format that could be understood by many of the current service users and it is not given out to service users’ next of kin. This means that service users or their representatives and advocates are not given information about what they can expect from staff and the organisation while living at the home. This guide is not yet given out to prospective service users and their families so people who may want to live at the service are not being given enough information for them to be able to decide whether to move to the home. Service users now all have contracts or terms and conditions in place which means that the legal documents describing their rights and responsibilities are in place. However these documents are not all signed yet (work has been done in this area and all but four are signed), some of them do not state the correct amount that the service user is expected to pay for their place at the home and not all next of kin have been given a copy. This is another example of service users and their representatives not being given enough information about their life at the home.
Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 10 It as not possible to find out if service users have their needs fully assessed before they move to the home as no one has been admitted to this home since the last inspection. Standard 6 is not applicable as the home does not provide intermediate care. EVIDENCE: There was a previous requirement that the registered person must ensure that the statement of purpose and service user guide contain correct information and include all details as required by regulation. These documents have been revised and now meet the standard although further work should be done to make sure that more service users at this home can use them. The manager said that the guide is in service users’ rooms. All relatives who were asked said that they had not got a copy of this document. (See Requirement 1 & Recommendation 1) There was a previous requirement that the registered provider must ensure that all service users are provided with a statement of terms and conditions on admission to the home (or contract if purchasing their care privately) that includes all information listed under Standard 2.2. Work has been done in this area and all service users have terms and conditions. Four of these have still to be signed by service user relatives and these signatures are being chased by staff. It was noted throughout the inspection that the amount stated in at least one of these contracts is different to the actual amount the service user is paying. Relatives said that they had not been given a copy of the contract or terms and conditions. (See Requirement 2) There was a previous requirement that the manager must ensure that information about service users’ past lives is sought and attempts to gather this information are recorded in the service user’s file. There are now documents on file for service users called Life Reviews that are ideally to be completed by service users or their relatives and aim to assist staff in understanding the needs of service users. Some Life Reviews have not been completed and some have not been completed well, in that details are brief and some areas state ‘not applicable’ when they are obviously applicable such as financial arrangements, early life, exercise and marital status. Staff said that this is because some relatives do not want to complete the documents but staff should be able to fill in much of the detail when they have known a service user for a long time. The previous requirement is met in that attempts to gather the information have been recorded but a new requirement is made about the quality and consistency of this recording. (See Requirement 3) There was a previous immediate requirement made that the home must not admit any further service users until such a time as it can demonstrate its
Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 11 capacity to meet the needs of the existing service user group through the provision of staff training, good record keeping and competent staffing. No service users have been admitted since the last inspection and so the requirement was met. This is a wide reaching requirement, made the subject of proposal to impose a condition since the last inspection and following this inspection the proposal to impose the condition was adopted and the condition to not admit anyone further service users until the Commission is satisfied that current failures to meet standards and/or comply with regulations, have been fully rectified, was sent out separately to this report. There was a previous requirement that the registered provider/manager must ensure that the home has the required facilities and staff competencies to meet the needs of all service users. Again this is a wide reaching requirement and had to be assessed after reviewing all the evidence in this report. It is not possible to say that this requirement is met. (See Requirement 4) There was a previous requirement that the manager must ensure that the needs of service users are fully assessed prior to admission and proper provision is made to meet their requirements. There have been no admissions to the home since the last inspection so it was not possible to fully assess this requirement. The manager told the inspector that the assessment form has been reviewed and staff are practicing using this with current service users who are returning to the home following hospital admissions. The manager plans eventually for team leaders to conduct service user assessments instead of just managers of the home. (See Requirement 5) Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A lot of work has been done around care planning and the plans are better than at the last inspection but they still do not fully describe all areas of support that a service user needs and they are not always being followed consistently by staff. This means that service users are not getting all the care they need from all staff at all times. Service users and relatives are now more involved in the care plans and have had more opportunity to comment on and change them if they wish. Service users’ healthcare and personal care needs are not being fully met which means that service users may be unhappy or uncomfortable with the support they get from staff or in the worst cases may be being put at risk of harm by the actions or lack of action of staff. Next of kin are not all being invited to annual reviews of the service users’ care which means that the home cannot be sure that they are doing what service users and their relatives want. Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 13 Generally the systems for the handling of medication in the home are effective and are being followed by most staff. There have been some occasions where mistakes have been made and so work still must be done to make sure that service users are kept safe at all times with regard to their medication. Although most relatives say that staff are kind and caring there have been some comments from staff, service users and relatives that indicate that at some times staff are not treating service users with respect. It appears to be the service users who are least able to speak up about the way they are spoken to that are being treated in ways that are not acceptable. Evidence also shows that some staff are less able to communicate effectively with service users than others. It is not clear why this is the case, whether it is staff language and cultural differences or attitudes and approaches to the work but whatever the case there are some instances when service users are not able to understand what is being said to them and given that most service users at this home suffer from some level of confusion, this means that their lives are being made more difficult by staff who are there to support them. EVIDENCE: There was a previous requirement that the registered provider must ensure that care plans are drawn up in conjunction with service users or their representatives and that they cover all aspects of the service users’ individual health, personal and social care needs. The files examined during this inspection showed that care plans are now signed by service users or their representatives. The vast majority of relatives said that they had recently been shown the care plan and asked to sign it. Care plans have been updated and show that more thought is now going into which areas need to be planned around. All files examined showed that mental health needs such as depression and dementia are now being addressed which was one of the problems at the last inspection but issues such as sexuality, culture and religion were not always being usefully addressed. The manager talked about one case where she has instructed staff to work with a service users’ challenging behaviour in a particular way but this has not been recorded in the care plan. Although a lot of work has been done around care plans recently the evidence of this inspection shows that the previous requirement is not fully met and so is repeated but reduced to reflect the work that has been done. (See Requirement 6) The inspectors examined some care files in detail and followed through all areas of these service users’ care. It is not possible to mention the details of those cases in this report for reasons of confidentiality, but the inspectors found cause for concern in that records were not always maintained accurately,
Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 14 the language in some records was judgemental and the records were potentially being used to limit service users rather than support behaviour management care plans; files showed incidents being recorded that staff should have responded to, given the service users’ medical conditions, but they hadn’t and sometimes staff would make assumptions about medical conditions and act on those assumptions without first checking for factual information. Given these issues and all the evidence mentioned earlier in this section the inspector issued an immediate requirement in the week following the time at the home. (See Requirement 7) There was a previous requirement that the registered provider must ensure that reviews take place as planned (including initial 6 week review) and that service users and their representatives are involved in those reviews should they so choose. The manager told the inspector and files showed that some reviews are now taking place as required but seven relatives said that they had never been invited to any service user reviews at this home. (See Requirement 8) There was a previous requirement that the registered provider must ensure that all service users are encouraged to take part in organised exercise where they are able. There are signs on the walls of the home stating that service users can be offered gentle exercise at certain times of the day although it is unlikely that this service user group would find small written signs useful. During the inspection the inspector saw staff doing some exercise with service users in their chairs and one relative said they had seen staff using a ball with service users in the lounge. Two relatives said that they did not think service users were taken out for walks enough and they felt that their relative’s physical ability has deteriorated and they are now not able to get out of the building because they haven’t had the regular opportunity to do it. Records of exercise were not detailed enough in that they did not state what type of exercise was done or for how long. While work has been done in this area further progress is needed for the requirement to be fully met. (See Requirement 9) There was a previous requirement that the manager must ensure that advice from the general practitioner is followed and where there are concerns about service users weight, or intake of food or fluid, that this is closely monitored and formally recorded. Some files were examined and these showed that weight, food and fluid seemed to be being recorded but there were some problems with how it is being recorded. On one file staff were not recording weight as instructed. One file showed that a service user’s weight was being recorded monthly but in one month they had apparently lost over ten kilograms and this had been assessed as low risk and no further action was necessary. The manager said that she has been working with staff to get them to record the amount someone eats not just a general description of what it was. A professional who visits regularly to support service users said that weights are being recorded but nothing is done about the issues. They also
Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 15 said that when they ask, staff are unable to give details about food and fluid intake. One file showed that the care plan stated that the service user should be turned in bed every two hours but the records showed that they are being turned every four hours. The previous requirement is unmet and made the subject of a separate Enforcement notice. (See Requirement 10) Files examined showed that often care plans do not give enough detail to inform staff about exactly what they should be doing for example around the use of the drug warfarin and around monitoring diabetes. Discussions with staff showed varying levels of confidence in what to look out for in the cases of more complicated service user needs. This has led to questionable decisions being made without first checking out medical facts or seeking professional advice. (See Requirement 11) The visiting professional further said that when service users become immobile they are not being referred quickly enough to the social worker for reassessment of their needs. They said that staff do not have the skills and knowledge to look after the service users at the levels they require. They said that they had discussed these issues with the manager. There was a previous recommendation that following examination of a service user the GP be asked for more detailed instructions for how care is to be carried out. The Dr’s Book on one floor that was examined showed that on some occasions the GP is being called out to the home but records are not being made of what outcome there was in response to particular issues. This is addressed under Requirement 49. The inspector examined the medication records and stock held on two floors and found generally that there were good systems in place that were being followed by staff. On one floor the medication stock of one medication did not tally with the record of what there should be and on another floor the medication administration chart and the label on the food supplement that had been prescribed both stated ‘as directed’ instead of having explicit instructions about how and when it was to be given. (See Requirements 12 & 13) There was a previous requirement that the registered manager must ensure that there is a record of all prescribed medication, including the application of all external preparations, the administration of food supplements and medication given by the district nurse. Records showed that this is being done. There was a previous requirement that the registered manager must ensure that the temperature of all medication fridges is monitored daily, preferably using a maximum-minimum thermometer and appropriate action is taken if the temperature goes outside of limits. Records are now being kept but different staff had different ideas of what temperature was acceptable and on one Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 16 occasion when temperatures had risen too high no action had been taken to reduce it for three days. (See Requirement 14) There was a previous requirement that the Registered Manager must ensure that staff witness the administration of medication before signing that the dose has been taken. Records showed that this now occurs but one relative said that on several occasions (the last as recently as six weeks prior to the inspection) they have had to take large doses of paracetamol out of their relative’s room and give them back to staff because they have not been taking it and have been storing it. (See Requirement 15) One service user said that they are happy at the home generally but they are very afraid of becoming ill (i.e. having some sort of dementia) because they see how staff treat other service users who are ill and ‘its horrible’. They said that staff don’t seem to have the time to sit with service users and persuade them to do things calmly so they take the quicker route and shout at them. One member of staff said that some staff shout at service users. One service user and three relatives said that they sometimes could not understand what staff are saying to them. The manager talked with the inspector about the different personalities and cultures of some staff and how she feels this affects their communication with service users. (See Requirement 16) The ground floor of the home is open plan and the service users’ dining room and lounge are open to the reception area and lifts. This means that any visitors to the home have to walk through the area and see service users as they use their communal areas. This lack of privacy has been commented upon in one complaint made to the Commission. (See Requirement 17) Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Work has been done in the area of activities since the last inspection and there has been an increase in the amount of group activities that take place so service users have more chances to take part in daily activities. Service users are not however having their individual needs met by the activities that are on offer as there is little opportunity for them to take part in things that are not group based and they do not have individual programmes of activity based on what they like to do. Relatives said they can visit the home when they choose and they are always made welcome by staff. Generally service users are only part of the local community if they can get out of the home by themselves; there are occasional trips out of the home but there are not enough staff to support service users to go out by themselves regularly. There have been improvements in how service users and their relatives are involved in the home but generally service users and their relatives are not given enough information in formats that they can understand, to be able to make informed choices in their lives. Daily routines are determined by how many staff are on duty and not by service user choice. Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 18 Not all service users have a social worker or an advocate who can help them and their relatives with any questions they may have and to make sure that at least annual reviews of their care take place so again service users are not being supported as fully as possible to make decisions about their lives. Menus showed that a variety of meal is offered during the week and service users said that they can eat in their rooms if they want to. Some service users are happy with the food they get but others are a little dissatisfied. EVIDENCE: There was a previous requirement that the registered provider must ensure that organised activities offered in the home are increased to ensure that the individual needs of service users for stimulation and fulfilment are addressed. The organisation has appointed an Activities Co-ordinator for the region who is very experienced and qualified to provide activities for older people. The fulltime Activity Worker is on long-term sick leave and so a part-time worker is in post and one healthcare assistant has been asked to take on additional activities work. There are signs around the home stating different group activities that are taking place although again the usefulness of these signs in this home is questionable. Assessments of what service users like doing have taken place and these are recorded but when the daily records were checked they showed that regardless of what someone has said they like doing, everyone ends up doing the same things such as watching television, throwing a ball and taking part in the group activities. The activities staff on duty said that it is currently difficult to get staff involved in activities but this needs to happen as they cannot do all the activities in the home by themselves. The recent relative surveys showed several comments made stating that people want to see more activities in the home with one comment saying that they want activities aimed specifically at African/Caribbean service users’ needs. Two service users said that because of the significant dementia of most of the service users at this home they do not have anyone to talk to most of the time. One file showed that one service user has to stay in bed but they do not like to be alone all day. The records of the past seventeen days showed that seven of those days had been spent watching television in their room. It was not possible to say whether this was a problem with recording of activity or whether this was actually what happened. While work has been done in the area of activities it is not possible to say that the previous requirement is met. (See Requirement 18) Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 19 There was a previous recommendation that reminiscence materials, as recommended by the Occupational Therapist’s report, be purchased for the home. This had not been done although more general activity materials had been bought. Given the needs of the service users at this home and the issues that arise around dementia and early life memory the recommendation is made the subject of a requirement in this report. (See Requirement 19) Three relatives said when that they visit everyone is just in the lounge with the television playing programmes that they would not watch or in their rooms alone. They felt that their relatives would enjoy singing or listening to hymns and ‘old-time’ music a lot more than the television. During the inspection on one floor the service users were watching television and staff were playing a radio loudly next to the lounge making a very noisy atmosphere. On another occasion the inspector arrived early, before any service users were up, yet the television was on in the lounge. On another occasion one service user was in their room crying out (presumably for staff) yet staff were watching television from the staff desk. When asked they said that this service user ‘always does that’. When staff later entered the room for handover the service user stopped crying out. Three relatives said that staff watch television rather than being with or talking to service users and the programmes that are on the television are programmes for staff’s benefit rather than service users. (See Requirement 20) One relative said that when they visit and sit in the lounge they often see service users crying out to go to the toilet but staff do not take them. There was a previous requirement that the manager must ensure that service users and their families are provided with as much information as possible about life in the home so that they can make decisions about the care that they receive. This includes choices available at mealtimes. This is a wide reaching requirement and can only be assessed by reviewing different types of evidence. One service user said that their key worker has left the home but they do not know who their new key worker is and a sign on the wall of their room still says that the old member of staff is their key worker. Signs throughout the home are small and written in English with small pictures. The issue of communication through the environment is addressed in the environment section of this report. One service user said that they do not know about the Commission’s reports of inspections. Ten relatives said they had not been told about inspections or reports. As mentioned earlier, contracts do not necessarily state the right amount that service users have to pay for their place. Service users and relatives are not given a copy of their care plans and most service users at this home would not understand the current format of their plan anyway. Given these examples of the range of evidence it is not possible to say the previous requirement is met. (See Requirement 21) Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 20 The organisation has paid for the service of an agency called Care Watch which advocates for older people. As yet this service has not been used in the home but there are service users who do not have family or do not have family who are involved in their care. A number of relatives said that their service user does not have a social worker or they have not spoken to one yet they had some questions that a social worker should answer. (See Requirement 22) The inspector did not spend a large amount of time assessing food at this inspection but one service user said that they liked the food and they were particularly happy that staff gave them extra sandwiches in the evening to take to their room and eat in bed. One service user however said that they eat in their room and the food is sometimes cold when it gets to them. They said they cannot chew the meat and when they mentioned this to staff they got meat that they could eat for two days and were then told that they could have it once a month. They also said that although they choose their meals the day before as per the procedure, often they do not get what they choose. Most relatives did not have any comment on the food as they were not around when meals were being served but most of those who did comment said that it was ok and that there seemed to be enough of it. Two relatives said that it was not up to scratch and was bland and boring. (See Requirement 23) There was a previous recommendation that service users be asked details about their needs and preferences in the food surveys. This has not happened. (See Recommendation 3.) Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 21 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Formal complaints are taken seriously and investigated by senior staff. The day-to-day comments and concerns are not seen as complaints and so are not recorded or treated in the same way. This means that patterns of concern may arise and are not picked up on by managers or issues are not addressed and reoccur so service users do not see improvement in the way that they want. Service users are being protected from abuse because all staff have now received training around protection of vulnerable adults. However all procedures in place to protect service users are not being followed by all staff and some staff do not understand the reasons for some of these procedures so there may be occasions where service users are put at risk of harm. EVIDENCE: There have been three complaints made or copied to the Commission since the last inspection. One has been referred back to the home’s complaints procedure for investigation and the borough’s adult protection team are following up the other two. There was a previous requirement that the registered provider must ensure that all complaints received about the service, from any source, are recorded in the homes complaints record. Records showed that formal complaints are being recorded but the day-to-day complaints such as comments about food are not seen as complaints and so are not recorded. Relatives talked about
Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 22 problems that they have discussed with staff that, while not major formal complaints should have been recorded as dissatisfaction with the service. This means that patterns of complaint or concern can not be audited by managers and action is not being taken to address certain areas. (See Requirement 24) There was a previous requirement that the registered provider must ensure that all complaints are fully and promptly investigated. All complaints that are recorded are being addressed but as stated above, issues that are not recorded are not being managed well. If the previous requirement were addressed then this requirement should be fully met and so is taken out of this report. Records showed that one service user has had some money go missing recently but had asked the manager to do nothing about it. The manager had agreed to do nothing and paid them their money back out of the home’s petty cash. While the manager was operating out of a principle of service user choice it appeared that had the money been taken it could only have been taken by a member of staff which if proven could have led to dismissal and a referral to the Protection of Vulnerable Adults list. Given that, this becomes one of the situations when protection of vulnerable adults overrides service user preference. (See Requirement 25) There was a previous requirement that the registered provider must ensure that all staff have appropriate training in adult protection. Staff have all had training in this area now. There is a Training Co-ordinator now in the organisation who offers all the training to staff. There is also a newly appointed Adult Protection Co-ordinator in the organisation and it would seem that she may be better qualified to offer training that is in line with current guidance and best practice. The course content for the training that is offered showed that the required areas are discussed during the training session. There was a previous requirement that the manager must ensure that a record is kept of cases referred for investigation under adult protection procedures. This is now being done and the appointment of someone to oversee all investigations means that vulnerable adult issues generally are being addressed more thoroughly. Accident records showed that sometimes unexplained bruises are not being managed appropriately. Staff do not always call the GP for advice when they find a unexplained injury. A visiting professional stated that staff do not call anyone when they find bruises or cuts. One senior member of staff said that the procedure when staff find an injury is to call the GP who will send a nurse or diagnose over the phone and staff then follow their instructions, however they talked about this being necessary for reasons of potential medication and blood clotting problems and showed no awareness that these situations may be potential vulnerable adults cases. (See Requirement 26) Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 23 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All areas of the home are large enough, well decorated in pastel colours and clean, although two areas smelled unpleasant on the days of inspection. More can be done with regard to the environment to make it more useful for people who may have dementia in helping them to understand where they are and what is going on. There is a newly landscaped garden that some relatives said they liked and has made things more pleasant for service users when they sit outside. Although it was not assessed in detail at this inspection there were comments made to the inspector about the equipment in use at the home and there must now be an assessment made of all equipment used to make sure that service users have all they need to move and transfer service users safely. Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 24 EVIDENCE: There was a previous requirement that the registered person must review the need for hearing loops in some rooms, and ensure that the signs on doors are designed to maximise the independence of service users with dementia. The hearing loops had been installed at the last inspection. The Occupational Therapist’s report did not discuss signage throughout the home, it only talked about the bathroom signs and staff were not sure if the recommended work had been done. This requirement is a long standing one from several reports ago and it is now reworded into a broader requirement about all signs in the home and a review of the environment generally with regard to better meeting the needs of people with dementia. (See Requirement 27) The pictures and images throughout the home do not reflect the different cultures and ethnicity of the people at the home and so the environment does not immediately welcome people of those cultures and ethnicities. While ordinarily this may not have been the time for the home to begin to consider issues of diversity such as this, given that the home is now being required to review the environment with regard to meeting the needs of service users with dementia they should also include within this review a consideration of the other needs of service users. (See Recommendation 3) As discussed under Standard 10, the ground floor environment does not protect the privacy of service users and this is addressed under Requirement 18. A visiting professional said that the home does not have the necessary equipment to move and transfer service users and they have to bring their own when they visit. One relative said that their service user has a wheelchair which looks old and which never has the required footrest in place when they visit. The inspector did not assess the issue of equipment but given this information the home must now conduct a review of all service users’ needs in this area and the equipment used to meet those needs. (See Requirement 28) There was a previous requirement that the manager must ensure that hot water to which service users have access is maintained at a temperature close to 43ºC and that service users are able to control the heating level in their bedrooms. The last report stated that radiators could be controlled in service users’ rooms and records now showed that temperatures are being recorded and are within acceptable levels. There was a previous requirement that the manager must ensure that in hot weather, practices in the home comply with current DoH guidance. This could not be assessed as the weather during this inspection was cool. (See Requirement 29) Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 25 There was a previous requirement that the registered provider must ensure that showers are tested and action taken where they are not working. Staff said all showers were now working and the one shower that had been broken for two inspections was checked by the inspector and was working. There was a previous requirement that the manager must ensure that sluice doors are kept locked when not in use. This was not assessed during this inspection and will be checked at the next inspection. (See Requirement 30) There was a previous requirement that the registered provider must ensure that the home is free from unpleasant odours and underlying causes of such odours are addressed. Two different areas of the home smelled unpleasant during this inspection. The manager said that she had attempted to get a new carpet in one area but the wrong area had been re-carpeted. Two next of kin said that their relative’s bedrooms smelled when they visited but the vast majority of relatives said that the home was always clean and hygienic when they visited. (See Requirement 31) There was a previous requirement that the registered provider must ensure that all staff have appropriate training in infection control. Staff have had a session with the Training Co-ordinator but are still waiting to start the organisation’s planned distance learning model of the training. Work has been done but the requirement is not fully met. (See Requirement 32) Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 26 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Commission and the organisation are discussing the issue of numbers of staff on duty in all their homes and so this was not assessed during this inspection. There is now a training plan in place that shows that staff have been trained in a lot of areas since the last inspection and there are plans in place for them to receive further training in all required areas over the next year. However during the course of the inspection it became clear that staff do not have the knowledge or ability to meet all the needs of service users and in some cases there have been mistakes made that have placed service users at risk of harm. The organisation’s recruitment procedures have improved since the last inspection and now service users are protected because the home does all it can to make sure that applicants are who they say they are and have the experience they need, before they start working at the home. EVIDENCE: The staffing levels are under discussion between the Commission and the organisation currently and so were not assessed during this inspection. However, two relatives said that they did not feel there were enough staff on duty and one said that on several occasions they have to wait about fifteen minutes to be let into the home in the evenings because there are no reception
Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 27 staff at that time and there are no other staff available to answer the door. One relative independently contacted the Commission during the inspection stating that they were very concerned that staffing levels were too low. There was a previous requirement that the registered provider must ensure that staffing levels at the home are sufficient to meet service users stimulation, supervision and personal care needs. Contingency plans must be in place to ensure that staff absences can be covered. As stated above, this requirement was not assessed. (See Requirement 33) There was a previous requirement that the registered provider must increase staffing levels, particularly on the second floor, to reflect the needs of service users. There must never be one carer, alone, on duty at any time. The manager reported one instance where she had investigated senior staff letting staff leave before their replacement had arrived and so one member of staff had been left on duty and staff reported that this happened frequently so this part of the requirement is not met and is now made the subject of a separate requirement. (See Requirements 34 & 35) The majority of relatives who spoke about staff said that they were very kind, caring and polite. Phrases like “They’re worth their weight in gold” and “They can’t do enough for us” were used. There was a previous requirement that the registered provider must develop a more effective handover system between shifts and ensure that this is reflected in the duty rotas for nursing and care staff. The manager said that there are now fifteen minutes for the handover that are recorded on the rota and part of staff’s paid hours. The inspector saw two handovers. The handovers were very brief with little consideration of care plan issues and no planning for the shift ahead. Part of one handover was done in front of service users in the lounge while they were watching television and another handover did not include all staff members with some staff going round rooms to handover each issue while other staff stayed at the staff desk. There has been a recent serious incident at the home that was made worse because of a confused handover between staff. This requirement is unmet but reworded. (See Requirement 36) There were previous requirements that the registered provider must ensure that no new staff commence employment in the home before the receipt of a satisfactory Criminal Record Bureau (CRB) disclosure at the appropriate level and CRB checks that are still outstanding for existing staff are actively pursued and that the registered provider must ensure that new staff do not commence employment in the home before a negative result has been received from a check against the POVA list. Two staff have been recruited since the last inspection with some staff being taken from an agency. Files showed that these two staff have had CRB checks returned to the home before they started employment (One form did have a spelling mistake on one of the names and
Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 28 this must be checked with the disclosure agency to make sure that the correct person has been checked. Staff started this checking process on the second day of the inspection.) The manager said that she did not know if there was a written procedure for assessing offences that may be on staff’s CRB checks and no statements are sent to potential candidates telling them what the procedure would be should they wish to apply for a post but know that they have previous convictions. (See Recommendation 4) There was a previous requirement that the registered provider must ensure that all staff files include proof of identity and a recent photograph. This is now done. The recruitment files showed that Equal Opportunities forms currently identify who the person is and are kept in their files when they should be held anonymously for monitoring purposes. (See Recommendation 5) When staff are taken from a recruitment agency the home relies on their system of receiving documentation and checking identity and references. While it should be a reasonable assumption that this would be done effectively, the home must ensure that the agency’s systems are effective. Staff reported that they do not intend to use agency staff again but will be conducting their own recruitment. (See Recommendation 6) There was a previous requirement that the registered provider must ensure that those responsible for the recruitment of new staff have appropriate training to do so. The manager who recruited recently has left the home now and the other member of staff who recruited is in the human resources department. It is possible to assume that they have had training in recruitment but the manager needs to check this before the requirement can be fully met. (See Requirement 37) Generally the recruitment procedures have been altered so that all documentation is requested and received at head office and then sent through to the home. Staff reported that this has improved the system. There were previous requirements that the registered provider/manager must ensure all staff receive appropriate assessment of their training and professional development needs to help ensure they are able to fully meet the changing physical and mental health care needs of service users and that the registered provider must ensure that all staff undergo an at least annual appraisal of their work and their training needs. The manager has not had the time yet to conduct appraisals with staff but these two requirements are so similar they are merged into one in this report. (See Requirement 38) There was a previous requirement that the registered person must ensure that staff receive induction and foundation training in line with standards. There is a
Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 29 new induction format that is in line with Skills For Care standards but as yet it has not been used. One member of staff recruited from an agency has the form but is so new that she was going to start going through the form with her supervisor on the day of the inspection. The two other new staff are nurses so the manager had not thought they needed to do the induction. While there are certainly areas of the Skills For Care induction that would not be useful for qualified nurses to undertake, certain areas of the induction are necessary for all staff and the nurses should go through this induction and foundation process as well. (See Requirement 39) There was a previous requirement that the manager must ensure that there is a training and development plan for the home to ensure that staff fulfil the aims of the home. This was made the subject of an enforcement notice. There has been a review of what training all staff have done and what they still require. A training plan is in place that states what training will be done over the next year. While this plan can be improved the intent of the previous requirement and enforcement notice have been met. (See Recommendation 7) The training plan showed that staff have attended a lot of training recently but there are still some areas where they need further training. While this training is necessary there is the possibility that staff can receive too much training in too short a time so that it stops being effective. To avoid this happening, no requirements are made around the training that still needs to be done following this inspection as there are plans in place for all staff to attend the training over the next year but this area will be further assessed at the next inspection. There was a previous requirement that the registered provider must ensure that competency assessments are conducted effectively and consistently and action plans drawn up and reviewed to address any competency gaps. The manager has used the competency assessments to assess individual staff’s performance around particular issues, the forms have not been used for everyone for all areas. If regular effective supervision and comprehensive appraisals were being carried out these forms may not be necessary, the problem at the last inspection had been that there was a system in operation at the home that was not being used as it was supposed to be used. The requirement is not met but the home must review the use of these forms and decide if they are to be used around individual issues or if they are to be used regularly as part of an ongoing assessment of staff competency leading up to the annual appraisal. (See Requirement 40) Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 30 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There have been many changes of manager at this home in the last few years. There is no Registered Manager in post at the moment. There has been someone recruited who is due to start at the home in early July and in the meantime there is a new interim manager who will be taking the Regional Operations Manager post (senior manager for the home) when the new manager is in place. This interim manager showed that she understood the needs of the service users and how staff should work to meet those needs and since she has been in post she has already made some positive changes. Given the number of requirements in place and the problems described throughout this report it is not yet possible to say that the home is well-run but this will be assessed again at the next inspection when the new manager is in post. The home does do quarterly surveys of relatives views of the home but no plan is drawn up after these surveys that states what action will be taken to make sure that the home will improve in the way that relatives want. There are no
Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 31 systems in place for gathering service users’ views of the home or the views of other stakeholders such as district nurses, social workers and GPs. It is not possible to say that the home is run in the best interests of the service users as the service users’ views are not put at the centre of decisions that are made. The home is not doing enough to tell service users and the relatives about the Commission’s inspections and the reports that are written following these inspections. This means that service users and their relatives are not being given enough information about the home and whether it is meeting the required standards. Most service users have family members who are responsible for their finances and so the home does not get involved in dealing with the money or benefits of most people. Generally the systems in place for monitoring service users’ money are effective but the home could do more to make sure that money or gifts brought into the home are recorded to make sure that they are doing everything possible to protect the financial interests of service users. Work has been done to supervise and support staff since the last inspection but all staff have not yet received enough supervision from senior staff who have the skills to be able to offer such supervision and staff have not yet had annual appraisals of their work. This means that service users are not being supported by staff who are getting the right amount of advice from their managers. Record keeping has improved since the last inspection but is still not good enough and they show many occasions where staff have made mistakes in recording or have recorded something but not then reacted to it as they should. This means that service users are being put at risk of harm because issues that need to be monitored in detail are not being effectively written down and communicated to staff, managers and external professionals. Generally the health and safety procedures are being followed by staff which means that service users are protected from harm. There were again some problems with making sure that the weekly tests of the fire system take place. EVIDENCE: There was a previous requirement that the registered provider must ensure that the home has a manager who is registered with CSCI. This was made the subject of an enforcement notice. A new manager has been recruited and she is currently submitting her CRB application ready for her start date in early July. She has not yet applied to be registered with the Commission. This requirement is made the subject of a separate Enforcement notice. (See Requirement 41) There is an interim manager in place who, on arrival of the
Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 32 new manager will take on the post of Regional Operations Manager for this home. Throughout the inspection this interim manager evidenced her understanding of the needs of the service users and how staff should work to meet those needs. There was a previous requirement that the registered provider must ensure that feedback is actively sought from service users, their representatives, and visiting professionals via satisfaction questionnaires, and the results of these surveys are published and made available to all stakeholders. There are quarterly surveys done of relatives’ views and the last quarter’s showed that a reasonable amount of forms had been returned. The statistical results of these surveys are drawn up into tables but the comments on the forms (arguably the most useful type of feedback) are not included in this report. There is no ongoing annual report or action plan that draws up targets and plans to make sure that issues raised in these reports are addressed and improved upon. The views of service users (or other stakeholders such as GPs, social workers and district nurses) are not sought formally and while a survey would not be the most useful way of gathering these service users’ views, some way of finding out what they think of the home must be found. The previous requirement is not met and is slightly reworded in this report. (See Requirement 42) There was a previous requirement that the registered provider must ensure that there is an annual development plan based on the views of service users, their relatives and other stakeholders that shows how the home intends to improve and develop over the forthcoming year. There is a now a document that describes in general terms how the organisation aims to make the home better but this is not the annual development plan that takes specific views on the home and identifies the money, staffing and other resources necessary to make the home better in the ways service users and other stakeholders want. (See Requirement 43) There was a previous recommendation that a professionally recognised quality assurance tool be used in accordance with best practice. This has not been done. (See Recommendation 8) While this home eventually may benefit from a quality assurance system that brings together all the many monitoring systems currently operated in this home, right now the focus of the managers and staff must be on improving the basic level of care offered to service users, so this issue will be further assessed and discussed at a later date. As mentioned earlier in this report, ten relatives said that they were not told about any inspections and did not know about the Commission’s reports on the home. (See Requirement 44) There was a previous requirement that the registered provider must ensure that a review of service users’ finances is conducted and anyone not receiving any income must be referred to social services or an independent advocate as a matter of urgency. This review had not taken place although the manager
Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 33 stated that no service user is without money. There has been a recent complaint forwarded to the Commission that included concerns about lack of funds for one service user so it is necessary for this full review of all service users be undertaken to make sure that all service users are receiving the money to which they are entitled. (See Requirement 45) The inspector examined the financial records held for service users whose money is managed by the organisation. There are very few people whose families do not support them with their finances. The organisation does generate monthly accounts of these service users’ money but does not currently give the service user a copy. There is no system for recording money or cheques that are given to the home for the service users (although staff reported that this rarely happens). (See Requirement 46) If the service users’ family handle their money the home does not monitor whether service users are receiving the personal allowance part of their benefits. While this is a sensitive area it may be necessary for the home to be sure that service user are not being financially abused and are all receiving money to which they are entitled (especially as there has been a recent complaint at this home that involved problems with one service user apparently not being able to get money from their relative). There has been a previous requirement made that the home undertakes a review of all service users’ finances to make sure they are all receiving money. When this requirement has been met the inspector will then speak with the manager about what next to do to make sure that service users’ finances are adequately protected. There was a previous requirement that the registered provider must ensure that all nursing and care staff receive supervision at least six times per year. The manager has focussed on this area since she arrived and a lot of staff have now received supervision but some still have not had it for several months. The manager said that she has not received supervision since she started at the home in March. While it could be assumed that the manager of a home has the necessary experience to manage their own workload this home has had many difficulties with managers performing badly or leaving and the organisation is not learning from its experience and making sure that managers it employs can do the job they are employed to do in the early stages of their employment. On viewing the records of supervision it was evident that some senior staff who are offering supervision do not have the required skills and awareness to do this. The manager agreed with this and said that although apparently they have been on supervision training it does not appear to have assisted staff in offering this support. (See Requirements 47 & 48) There was a previous recommendation that staff are given a copy of their supervision record in accordance with good practice. This does not always occur. (See Recommendation 9) Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 34 There was a previous requirement that the registered provider must ensure that outdated assessments are identified as such in service users files, updated or removed. The manager is currently reviewing all care plans and care files and the files that were examined during this inspection did not have outdated information in them (Except where specifically mentioned under the health and personal care section of this report) There was a previous requirement that the registered provider must ensure that all action taken in response to concerns is recorded and that the Dr’s book includes date and time of contact as well as outcome. The manager said that this system is being changed and all records should now be made in the service users’ care file. One floor did have the book in operation and it showed that occasionally the outcome is still not being recorded. This requirement is merged with the following requirement in this report. There was a previous requirement that the registered provider must ensure that records are maintained of all monitoring of service users health status. On initial examination it appeared that records are now being maintained but the quality of these records was then questioned. The details of problems with recording in this area have been discussed under Standard 8. (See Requirement 49) Evidence throughout the inspection showed that there are differing levels of ability of staff to understand what information needs to be recorded and how to record information accurately and consistently. The manager agreed with this and said that some staff are currently doing literacy training but not enough. The language of care plans shows that some judgements are being made around service user issues and reflected in the documentation. (See Requirement 50) There was a previous requirement that the registered provider must ensure that fire alarm tests are carried out weekly and that the times of fire drills are also recorded. Record since the last inspection showed that between 23/02/06 and 21/03/06 no tests had been carried out. (See Requirement 51) All other required health and safety checks and documentation were in place and in order. There were previous requirements that the manager must ensure that notifications of all incidents and accidents are made to relatives and CSCI without delay and that the registered provider must ensure that staff are clear of the distinction between accidents and other incidents, that all occurrences and actions are recorded in the appropriate format and that CSCI is notified of all incidents covered under Regulation 37. The information in the files was similar to that at the last inspection. Records showed that issues such as falls are sometimes being recorded as accidents and not reported to CSCI. The file itself keeps accidents and critical incidents together by month, which would not
Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 35 help staff to make the distinction between the two types of issue. (See Requirement 52) Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 36 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 X 2 X X X 2 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 2 2 1 2 Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 37 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 (2) Requirement The Registered Manager must ensure that all service users, potential service users and their next of kin receive a copy of the Service User’s Guide. The Registered Individuals must ensure that all service user contracts or statements of terms and conditions are signed by the service user or their representative, that they state the correct current fee for their placement and a copy is given to the service user or their representative. The Registered Manager must ensure that the Life Reviews are completed as fully as possible (by staff if not the service user or their relatives) for all service users and relevant sections do not state “Not Applicable”. The Registered Individuals must ensure that the home has the required facilities and staff competencies to meet the needs of all service users. Previous requirement: Unmet timescales 01/04/04, 01/08/04, 31/03/05,
DS0000007038.V298850.R01.S.doc Timescale for action 30/09/06 2. OP2 5 (b) (c) 30/09/06 3. OP3 14 (1) (c) 30/09/06 4. OP4 12 (1) (d) 30/09/06 Peartree Care Centre Version 5.2 Page 38 5. OP4 12 (1) (b) 6. OP7 15 (1) 7. OP7 OP8 12 (1) 31/10/05 & 30/04/06 The manager must ensure that 30/09/06 the needs of service users are fully assessed prior to admission and proper provision is made to meet their requirements. Ongoing requirement (not possible to assess at this inspection due to no service users being admitted): Unmet timescales 01/04/04, 01/08/04, 31/03/05, 31/10/05 & 30/04/06 The Registered Manager must 30/09/06 ensure that care plans cover all aspects of the service users individual health, personal and social care needs. Part of a previous requirement: Unmet timescales 31/10/04, 31/03/05, 31/10/05 & 30/04/06 The Registered Individual must 16/06/06 employ a full-time suitably qualified, experienced and skilled practitioner to work on the second floor of the home to effectively review all service users’ health and personal care needs and ensure that clear, detailed instructions for staff on how to offer care and support are in place. Following this the practitioner should remain on the second floor to offer ongoing supervision, training and advice to staff to ensure that they: • understand the illness and conditions of all service users, how these conditions present and what action staff should take to manage these conditions. • understand the other health and personal care needs of all service users and how they are to meet Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 39 • • • • • those needs. understand the purpose of the written tools they are using. understand what information to record, when and how to record it. understand what information should be shared with other professionals and when it should be shared. can respond appropriately and effectively to situations to proactively avoid further deterioration in service users’ health and well being. can be certain that their behaviour minimises and does not escalate situations of challenging behaviour and potential aggression. 8. OP7 15 (2) (b) & (c) 9. OP8 16 (2) (n) This person must be in post by 16th June 2006 and must remain in post for a period of six weeks, at which point the issues on this floor will again be reviewed by the Commission to assess if further employment is required. The registered provider must ensure that reviews take place as planned (including initial 6 week review) and that service users and their representatives are involved in those reviews should they so choose. Previous requirement: Unmet timescale 30/04/06 The Registered Manager must ensure that all service users are encouraged to take part in organised exercise where they are able. Previous requirement: Unmet timescales 31/10/04, 31/03/05 30/09/05 & 30/04/06
DS0000007038.V298850.R01.S.doc 30/09/06 31/07/06 Peartree Care Centre Version 5.2 Page 40 10. OP8 17 (1) (a) The manager must ensure that advice from the general practitioner is followed and where there are concerns about service users weight, or intake of food or fluid, this is closely monitored and formally recorded. Previous requirement: Unmet timescales 31/08/05 & 14/04/06. This requirement is now made the subject of separate enforcement notice stating that: The Registered Individuals must ensure that all fluid, nutrition, weight and wound care records relating to all relevant service users, are kept contemporaneously, in sufficient detail and are accurate. The Registered Manager must ensure that all staff understand the particular conditions and illnesses of service users and that all action taken to treat those conditions and illnesses is part of the established care plan and offered following evidence gathering and not on staff assumptions. The Registered Manager must ensure that the medication stock checking systems in place are effective. The Registered Manager must ensure that all medication labels and medication administration charts state specific directions as to how medication (including prescribed food supplements) are to be given. The Registered Manager must ensure that the temperature of all medication fridges is monitored daily, preferably using a maximum-minimum
DS0000007038.V298850.R01.S.doc 07/08/06 11. OP8 12 (1) 30/09/06 12. OP9 13 (2) 14/07/06 13. OP9 13 (2) 14/07/06 14. OP9 13 (2) 14/07/06 Peartree Care Centre Version 5.2 Page 41 15. OP9 13 (2) 16. OP10 12 (4) & (5) 17. OP10 12 1) (4) (a) & 23 (2) (a) 18. OP12 16 (2) (m) & (n) 19. OP12 16 (2) (m) & (n) 20. OP12 12 (1) thermometer and appropriate action is taken if the temperature goes outside of limits. Previous requirement: Unmet timescales 31/08/06 & 28/02/06 The Registered Manager must ensure that staff witness the administration of medication before signing that the dose has been taken. Previous requirement: Unmet timescale 28/02/06 The Registered Manager must ensure that all staff show respect and communicate with service users effectively and appropriately at all times. The Registered Individuals must ensure that steps are taken on the ground floor (such as the use of appropriate screens) to ensure the privacy of service users as they use the dining room and lounge. The Registered Individuals must ensure that organised activities offered in the home are increased to ensure that the individual needs of service users for stimulation and fulfilment are addressed. Previous requirement: Unmet timescales 31/10/04, 31/03/05, 30/09/05 & 30/04/06 The Registered Manager must ensure that there is a frequent, regular reminiscence group and/or reminiscence sessions are offered by appropriately trained staff who are supplied with sufficient materials to support service users to remember their early lives. This work must also meet the specific needs of service users from different cultures and ethnicity. The Registered Manager must
DS0000007038.V298850.R01.S.doc 14/07/06 14/07/06 31/07/06 30/09/06 30/09/06 14/07/06
Page 42 Peartree Care Centre Version 5.2 21. OP14 12 (2) 22. OP14 15 (2) 23. 24. OP15 OP16 16 (2) (i) 17 (2) 25. OP18 13 (6) ensure that the television (and all other facilities) are at all times used for the benefit of service users and not staff. The Registered Manager must ensure that staff are aware that when they are on duty they must be working to support service users and not watching television. The manager must ensure that service users and their families are provided with as much information as possible about life in the home so that they can make decisions about the care that they receive. Previous requirement: Unmet timescales 01/03/04, 31/10/04, 31/03/05, 30/09/05 & 30/04/06 The Registered Manager must ensure that social services are made aware of any service users who do not have an allocated social worker and that next of kin are made aware of the contact details of the social workers. Any service users who do not have family involved in their care must be referred to Care Watch to be allocated an advocate. The Registered Manager must ensure that meals meet the needs of service users. The Registered Individuals must ensure that all complaints received about the service, from any source, are recorded in the homes complaints record. Previous requirement: Unmet timescales 31/08/05 & 28/02/06 The Registered Manager must ensure that the identified issue of potential theft is appropriately and sensitively investigated (as far as is possible at this date) and any further issues of this type are investigated promptly
DS0000007038.V298850.R01.S.doc 30/09/06 30/09/06 31/07/06 31/07/06 31/07/06 Peartree Care Centre Version 5.2 Page 43 26. OP18 13 (6) 27. OP22 23 (2) (a) (n) at the time of the event. The Registered Manager must 31/07/06 ensure that all staff are clear about the procedure in event of finding an unexplained bruise or injury on a service user and that they understand the potential abuse/protection issues involved. The registered person must 30/09/06 review the need for hearing loops in some rooms, and ensure that the signs on doors are designed to maximise the independence of service users with dementia. Previous requirement: Unmet timescales 1/06/04, 30/11/04, 31/03/05, 30/09/05 & 31/05/06 (though hearing loops now provided) Now reworded to: The Registered Individuals must ensure that appropriate specialist advice is sought to review all signs, posters and environmental communication in the home with the aim of best meeting the needs of older people with dementia. This advice must further include a review of the decoration and layout of the home with the same aim in mind. Any recommendations following this advice must be carried out. The Registered Individuals must ensure that appropriate specialist advice is sought to undertake a review of all equipment in use in the home to make sure that all service users are being moved and transferred safely at all times. The Registered Manager must ensure that in hot weather, practices in the home comply with current DoH guidance.
DS0000007038.V298850.R01.S.doc 28. OP22 23 (2) (c) & (n) 30/09/06 29. OP25 23 (2) (p) 30/09/06 Peartree Care Centre Version 5.2 Page 44 30. OP26 13(4)(a) 31. OP25 16 (2) (k) 32. OP26 13 (3) 33. OP27 18(1)(a) 34. OP27 18(1)(a) Previous requirements with timescales of 31/08/05 & 30/06/06 but this requirement could not be assessed at this inspection) The Registered Manager must ensure that sluice doors are kept locked when not in use. Previous requirement: Initial unmet timescale 31/08/05 but this requirement was not assessed at this inspection so is carried over to the next. The Registered Individuals must ensure that the home is free from unpleasant odours and underlying causes of such odours are addressed. Previous requirement: Unmet timescale 30/04/06 The Registered Individuals must ensure that all staff have appropriate training in infection control. Previous requirement: Unmet timescale 31/05/05 The registered provider must ensure that staffing levels at the home are sufficient to meet service users stimulation, supervision and personal care needs. Contingency plans must be in place to ensure that staff absences can be covered. Previous requirement: Unmet timescales 31/10/04, 31/03/05, 31/08/05 & 28/02/06 (This requirement was not assessed during the inspection as it is under ongoing discussion between the organisation and the Commission) The registered provider must increase staffing levels, particularly on the second floor, to reflect the needs of service users. Previous requirement: Timescale 28/02/06 (This requirement was not assessed
DS0000007038.V298850.R01.S.doc 31/07/06 31/07/06 30/09/06 31/07/06 31/07/06 Peartree Care Centre Version 5.2 Page 45 35. OP27 18 (1) (a) & 13 (c) 36. OP27 18 (1) (a) during the inspection as it is under ongoing discussion between the organisation and the Commission) The Registered Individual must ensure that there is never one carer, alone on duty on any floor at any time. Previous requirement: Unmet timescales 30/06/05, 31/08/05 28/02/06. The registered provider must develop a more effective handover system between shifts and ensure that this is reflected in the duty rotas for nursing and care staff. Previous requirement: Unmet timescale 31/03/06 Now reworded to: 14/07/07 31/07/06 37. OP29 38. OP30 The Registered Manager must ensure that handovers are effective and include consideration of service users care plan issues. Handovers must respect service users’ privacy and confidentiality of information. 18 (1) (a) The registered provider must ensure that those responsible for the recruitment of new staff have appropriate training to do so. Previous requirement with timescale 31/05/06. Insufficient evidence available at the inspection to assess if this requirement was met. 18(1)(a)(c The registered provider/manager ) (i) & (ii) must ensure all staff receive appropriate assessment of their training and professional development needs to help ensure they are able to fully meet the changing physical and mental health care needs of service users. (Previous timescales of 01/08/04,
DS0000007038.V298850.R01.S.doc 31/07/06 30/09/06 Peartree Care Centre Version 5.2 Page 46 31/03/05 and 30/11/05 not met) and The registered provider must ensure that all staff undergo at least annual appraisal of their work and their training needs. Now merged into one requirement: The Registered Individuals must ensure all staff receive an at least annual appraisal of their work, training and professional development needs to help ensure they are able to fully meet the changing physical and mental health care needs of service users. Previous requirement: Unmet timescales 01/08/04, 31/03/05, 30/11/05 & 28/04/06 The Registered Manager must ensure that all staff receive induction and foundation training in line with standards. Previous requirement: Unmet timescales 31/01/04, 31/10/04, 31/03/05, 30/09/05 & 28/04/06 The registered provider must ensure that competency assessments are conducted effectively and consistently and action plans drawn up and reviewed to address any competency gaps. Previous requirement: Unmet timescale 31/05/06 Now reworded to: The Registered Individuals must review the competency assessment procedure and ensure that competency assessments are conducted
Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 47 39. OP30 18 (1) (a) 31/07/06 40. OP30 18 (1) (a) 30/09/06 41. OP31 8 (1) (a) 42. OP33 24 43. OP33 24 44. OP33 24 45. OP35 12 (1) (a) effectively and consistently and action plans drawn up and reviewed to address any competency gaps. The Registered Individual must ensure that the home has a manager who is registered with CSCI. Previous requirement made the subject of a separate enforcement notice: Unmet timescale 31/05/06 The registered provider must ensure that feedback is actively sought from service users, their representatives, and visiting professionals via satisfaction questionnaires or other more effective means and the results of this feedback is published and made available to all stakeholders. Previous requirement: Unmet timescales 31/12/05 & 31/05/06 The Registered Individuals must ensure that there is an annual development plan based on the views of service users, their relatives and other stakeholders that shows how the home intends to improve and develop over the forthcoming year. Previous requirement: Unmet timescale 30/04/06 The Registered Manager must ensure that service users and their next of kin are made aware of the Commissions’ inspections and told they can read the reports held in the home or on the Commission’s website. The Registered Individuals must ensure that a review of service users finances is conducted and anyone not receiving any income must be referred to social services or an independent advocate as a matter of urgency. Previous requirement: Unmet
DS0000007038.V298850.R01.S.doc 05/11/06 30/09/06 30/09/06 31/07/06 31/07/06 Peartree Care Centre Version 5.2 Page 48 46. OP35 13 (6) 47. OP36 18 (2) 48. OP36 18 (2) 49. OP37 17 (1) & (2) 50. OP37 12 (1) 51. OP38 23 (4) (c) (v) & 23(4)(e) timescale 31/03/06 The Registered Individuals must ensure that service users whose money is managed by the organisation are issued with monthly statements of their accounts and that there is an effective system for recording money, cheques and gifts that are brought to the home by relatives. The Registered Individuals must ensure that all nursing and care staff (including the home manager) receive supervision at least six times per year. Previous requirement: Unmet timescales 31/10/04, 31/03/05, 31/10/05 & 31/05/06 The Registered Individual must ensure that all staff who offer supervision have received training and have the competencies to be able to do so effectively. The Registered Manager must ensure that records are maintained of all monitoring of service users health status including all contact with and required action from the G.P. Previous requirement: Unmet timescale 31/03/06 The Registered Manager must ensure that all staff understand the purpose of each record they are using, what information to record and how to record it. Language used in records must be fit for purpose and appropriate. The registered provider must ensure that fire alarm tests are carried out weekly and that the times of fire drills are also recorded. Previous requirement: Unmet timescales 31/08/05 & 31/03/06
DS0000007038.V298850.R01.S.doc 31/07/06 30/09/06 30/09/06 14/07/06 31/07/06 14/07/06 Peartree Care Centre Version 5.2 Page 49 52. OP38 37 The registered provider must ensure that staff are clear of the distinction between accidents and other incidents, that all occurrences and actions are recorded in the appropriate format and that CSCI is notified of all incidents covered under Regulation 37. Previous requirement: Unmet timescale 31/03/06 14/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP1 OP15 OP22 Good Practice Recommendations The Registered Individuals should review the format of the Service User Guide to make it more understandable for older people and older people with dementia. The Registered Manager should ensure that service users be asked details about their needs and preferences in the food surveys. Previous recommendation. The Registered Individuals should ensure that the review of the decoration in the home includes a review of the images in communal areas to make sure that all the cultures and ethnicities of service users are equally reflected. The Registered Individuals should ensure that there is a written procedure for assessing the suitability of applicants for employment who have offences on their Criminal Records Bureau check and that applicants are made aware of this procedure when they apply for a post. The Registered Individuals should ensure that Equal Opportunity monitoring forms are made anonymous and taken out of the staff files. The Registered Individuals should assess the recruitment procedure of staffing agencies that they use to ensure that sufficient, effective checks are in place to verify the identify and suitability of staff they receive from the agency. Should the procedure be insufficient then the home must conduct its own additional checks.
DS0000007038.V298850.R01.S.doc Version 5.2 Page 50 4. OP29 5. 6. OP29 OP29 Peartree Care Centre 7. OP30 8. 9. OP33 OP36 The Registered Manager should review the Training and Development Plan to ensure that the training, experience, skill and competency requirements of each role in the home are identified. The Registered Individuals should consider using a professionally recognised quality assurance tool in accordance with best practice. Previous recommendation. The Registered Individuals should ensure that staff are given a copy of their supervision record in accordance with good practice. Previous recommendation. Peartree Care Centre DS0000007038.V298850.R01.S.doc Version 5.2 Page 51 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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