Inspection on 01/11/06 for Peartree Care Centre

This inspection was carried out on 1st November 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

Peartree Care Centre 10/07/08

Peartree Care Centre 08/11/07

Peartree Care Centre 17/08/06

Peartree Care Centre 07/08/06

Peartree Care Centre 01/06/06

Peartree Care Centre 31/01/06

Peartree Care Centre 13/07/05

Peartree Care Centre 08/12/04

Peartree Care Centre 13/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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 Enforcement Visit 10:00 1 & 2 November 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.V318759.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.V318759.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) Pervine King 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.V318759.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 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.V318759.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days in November 2006. (Although the inspection was technically unannounced the inspector made the managers aware that she was attending the day before the inspection.) This was the first full inspection on the home since June 2006 although there had been two inspections in August 2006 focussing on specific issues of concern. The focus of this inspection was the large number of requirements made at the June inspection and in previous inspections and to assess the standards of health and safety and care at the home to decide if an embargo that had been placed on the home preventing them accepting new service users on the first, second and third floors, could be lifted. Given the particular focus of the inspection and the number of service users and relatives that had been consulted at the June inspection, the inspector did not speak with any service users or relatives during this inspection. The inspector met with the Registered Manager, the Regional Operations Manager, the Director of Care and staff. She further examined records and medication stocks and toured the building. The inspector found that approximately 75 of the previous requirements had been met at this inspection and progress had been made on some of the remaining requirements. Although additional issues were identified during this inspection the home evidenced that significant improvements have been made in many areas of the service. Feedback received from the local authority social workers who had been conducting weekly visits to the home was that things have improved at this home to the extent that they have reduced the number of visits they will be conducting. The inspector was satisfied that at this point standards of health and safety and care have improved to the point where the embargo preventing the home from accepting new service users can be removed. The inspector will be visiting the home again in the next few months to make sure that the standards of care and health and safety continue to improve. The management and staff at the home must be highly commended for the recent efforts they have made to ensure that standards are raised at this home that has for a number of years struggled to offer an acceptable service. Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There has been significant improvement in many areas since the last full inspection in June 2006. • • • • • • • • • • Prospective service users are now given information about the home to help them decide if they want to move there. Service users are now all issued with complete terms and conditions. Senior staff assesses prospective service users’ needs before they move to the home. Service users and their relatives can come to look round the home before they decide to move in permanently. Care plans are in place that state what staff will do to support service users in all aspects of their life. Details of health care monitoring are recorded in the service user files and accurate notes kept of any day-to-day issues. Medication systems and procedures are followed effectively which means that service users are given their medication as required. Service users are treated with respect and their privacy is maintained. Service users and their families are given information in order that they can make choices. Service users are listened to and their concerns are taken seriously and acted upon. DS0000007038.V318759.R01.S.doc Version 5.2 Page 7 Peartree Care Centre • • • Service users are protected from abuse. The home is clean and hygienic throughout. There are enough staff on duty to meet the needs of service users. (This issue will be assessed again at the next inspection when more usual numbers of service users are living at the home) The required number of staff hold or are undertaking the NVQ Level 2 in Care which means that staff know what they are doing. Staff receive adequate training in order for them to be able to meet the needs of service users There is now a Registered Manager in post who has been interviewed by the Commission and who is fit to be in charge. The financial systems in operation in the home make sure that service users’ money is held safely and they are protected from abuse. Staff are now supervised regularly and effectively, which means that service users are supported by people who receive enough support and advice from managers. Recording has improved significantly and is now effective in all areas. • • • • • • What they could do better: • • • • • • • Service users must get enough exercise (or the exercise must be recorded properly). The home must offer effective end of life care that follows current best practice. Service users’ individual needs regarding stimulation and fulfilment must be met. Service users must be able to access the local community as they choose. Individual staff training needs must be assessed annually. Recruitment procedures must be improved in some areas. The home must plan for the forthcoming year based on the views of service users and make sure that things get better in ways that they want. Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 8 • Weekly fire system tests and monthly fire drills must take place as planned. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 9 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.V318759.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are given information about the home to help them decide if they want to move there. Service users are issued with terms and conditions that tell them about their rights and responsibilities so they know what is expected of them and what they can expect from the home. Senior staff assess prospective service users’ needs before they move to the home so that no one is offered a place without the staff team believing they can support someone. Service users and their relatives can come to look round the home before they decide to move in permanently. Standard 6 is not applicable as this home does not provide intermediate care. Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 11 EVIDENCE: There is new legislation in place now that came into force on 01/09/06 and other changes come into force on 01/10/06 which will require services to state exactly what fees each service user is paying and how it breaks down into different areas, in the service user guide. (See Requirement 1) There was a previous requirement that the Registered Manager must ensure that all service users, potential service users and their relatives receive a copy of the Service User’s Guide. There are notes in service users files from many relatives saying they have received a copy of the guide. The Registered Manager said that potential service users are given a copy of the guide when staff conduct their assessments, before they choose to move to the home. There was a previous recommendation that 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. There are now more pictures in the guide and the writing is in a larger font. There was a previous requirement that 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. These have all been done as far as possible. There are notes in the files of service users whose relatives have not yet signed, stating why they have not signed and what the home has done to try to get them to sign. All contracts checked included all the required details. There was a previous requirement that the Registered Individuals must ensure that the home has the required facilities and staff competencies to meet the needs of all service users. This is a very wide-ranging requirement and could only be judged after considering all the evidence gathered during the inspection. The inspector did this and deemed it to be met. 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. The senior staff at the home meet with service users and their families after a referral is received to make sure that the home can met their needs. Written needs assessments are completed and were seen on file for all new service users. Service users and their families come to the home to look around and see if they like the place before they move. The Registered Manager said that few service users want to have an overnight stay as they would rather move straight in than keep moving to and from another place. She said that overnights would be accommodated if a service user wished to have this. Peartree Care Centre DS0000007038.V318759.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are in place that state what staff will do to support service users in all aspects of their life. Staff follow these care plans and the plans are reviewed every month with service users and their family so that service users know that their changing needs are met. Details of health care monitoring are recorded in the service user files and accurate notes kept of any day-to-day issues. Service users do not get enough exercise (or the exercise is not being recorded properly) so the home is not showing that it is meeting service user needs in this area. Generally medication systems and procedures are followed effectively which means that service users are given their medication as required. Service users are treated with respect and their privacy is maintained. Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 13 Service users are cared for when they are dying but as care is not being offered according to current best practice the home may not be doing all it can to effectively offer the most effective end of life care. EVIDENCE: There was a previous requirement that 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 files checked showed that completion of Life Reviews has improved and a lot more information about service user’s history and choices is available There was a previous requirement that the Registered Manager must ensure that care plans cover all aspects of the service users’ individual health, personal and social care needs. All care plans now consistently address all areas of need. Some service users require bed rails, which is a form of restraint but the required signed consent form from relatives were not in place for all. (See Requirement 2) There was a previous requirement that the Registered Individuals must ensure that staff: • 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 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. These areas have improved significantly since the last full inspection in June and although there are still areas for improvement, staff now show enough understanding and awareness to deem the requirement met. There was a previous requirement that the Registered Manager must ensure that reviews take place as planned (including initial six week review) and that service users and their representatives are involved in those reviews should they so choose. The borough’s social services department has now completed all annual reviews in the home and there are diaries in place on all floors Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 14 highlighting when the next reviews are due. The Registered Manager knew that six-week reviews must occur for new service users and that if social services are ever not available to be at a review then the home must conduct their own review. There was a previous requirement that 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. Staff showed an awareness of the conditions of service users and there was no evidence that they are acting without thinking about the care plans in place. Inventories are done but when new clothes or belongings are brought into the home some inventories are changed sometime new ones are done which means that no one complete record of service users’ belongings is kept which shows exactly what someone owns. (See Requirement 3) There was a previous requirement that the Registered Manager must ensure that all service users are encouraged to take part in organised exercise where they are able. Service users have care plans that talk about the need for exercise. There is an activities co-ordinator in the home but she is due to leave at the end of the month. Daily records showed that exercise is being recorded without saying what type of exercise or for how long it went on and often service users are going for significant numbers of days without any exercise. The inspector could not know whether the exercise is not taking place or whether it is not being recorded. There has been improvement in this area but further work is needed to fully meet the requirement. (See Requirement 4) There was a previous requirement 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. There were no problems with the health care records examined. The inspector checked the medication stocks and records on all floors. There was a previous requirement that the Registered Manager must ensure that the medication stock checking systems in place are effective. All stocks checked tallied with the records. There was a previous requirement that 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. All records and labelled stated how medication was to be given. There was a previous requirement that the Registered Manager must ensure that the temperature of all medication fridges is monitored daily, preferably Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 15 using a maximum-minimum thermometer and appropriate action is taken if the temperature goes outside of limits. On one floor the fridge temperature had been recorded as below the acceptable range for two days but no action had been taken. (See Requirement 5) 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. All medication had been signed for. There was a previous requirement that the Registered Manager must ensure that all staff show respect and communicate with service users effectively and appropriately at all times. The inspector did not witness any lack of respect from any staff. The inspector discussed the issues of communication with the Registered Manager who admitted that there is still work to do as for some staff, English is not their first language and they need to work on their written and verbal communication. Much of the evidence for this requirement came from service users and relatives at the last full inspection. The inspector had decided not to speak with relatives during this inspection and so will assess this further at the next inspection. There was a previous requirement that 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. This work had not been done as the Registered Manager said that they have consulted with service users who have said they like the open plan layout of the ground floor as they can watch people coming and going. The inspector was concerned that privacy is being compromised by all visitors being able to see the ground floor service users when they are eating and watching television but accepted the service users’ choice. Should some service users decide that they do not like this layout and want more privacy then the home will have to consider this issue again. Care plans are drawn up when someone begins to die and one was seen on file for a service user who had died on the first day of the inspection. Service users are asked what they want in the event of death in terms of practical arrangements. The home does not yet work within the Gold Standard Framework or the Liverpool Care Pathway systems, which would assist with ensuring that all needs in the event of serious illness and death are met. The home is starting to access training and is working with the local St Christopher’s nurses to develop in this area. (See Requirement 6) Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 14 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is not yet doing enough to make sure that service users’ individual needs regarding stimulation and fulfilment are being met. The home is not yet doing enough to make sure that service users can access the local community as they choose. Family and friends can visit as they choose. Service users and their families are given information in order that they can make choices. EVIDENCE: There was a previous requirement that the Registered Manager must 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 Registered Manager has spoken with Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 17 staff and told them that they are not to spend time at the nurses’ station unless necessary and they must be with service users otherwise. There was a previous requirement that 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. Activities have increased and there is an activities co-ordinator in post although she is due to leave at the end of the month. Life Reviews and social care assessments show what service users particularly like to do but records do not show that they do these things and all activities offered in the home cater for the general needs. While there have been improvements in this area, there is more work that could be done and this will be assessed further at the next inspection when more service users have moved to the home. (See Requirement 7) There was a previous requirement that 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. Efforts have been made to meet this requirement but it has become somewhat confused with other issues. There is a reminiscence room on one floor and reminiscence areas on the other floors. Posters and ornaments have been bought to remind service users of past eras but these things have also been placed on the walls around communal areas which some service users have said they do not want and which is starting to make the home look a little cluttered. The Registered Manager said she is looking to bring in training for staff and will be seeking a trained activities co-ordinator to help with this work. Following discussions the Registered Manager said she was clearer about what was required. (See Requirement 8) Family and friends can visit the home as they choose unless there are particular restrictions in place around certain visitors. Service users do not go out in the community often if they cannot do so without staff. The Registered Manager talked about how a few homes in the area have been discussing buying transport for them to share to help service users be part of the local community. (See Requirement 9) There was a previous requirement that 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. A social worker has taken over the role of advocate for the one service user who does not have family. Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 18 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. Evidence throughout the inspection showed that more efforts are being made to involve and inform service users’ relatives. Each service user has a day each month when their family are invited in and their care reviewed with staff. There was a previous requirement that the Registered Manager must ensure that meals meet the needs of service users and a previous recommendation that the Registered Manager should ensure that service users be asked details about their needs and preferences in the food surveys. The food survey now includes a question asking what else they would like to eat and the recent survey shows that many service users are happy with the food but a number want fruit and yoghurts for breakfast. The Registered Manager said that she is aiming to change the chef to improve the food provision. This area will be fully assessed at the next inspection when service users and their families will be consulted. Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are listened to and their concerns are taken seriously and acted upon. Service users are protected from abuse by staff being trained in the issues and systems in place for the protection of service users being operated effectively. EVIDENCE: There was a previous requirement that the Registered Individuals must ensure that all complaints received about the service, from any source, are recorded in the homes complaints record. This is now being done. There was a previous requirement that 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 at the time of the event. This was done. There was a previous requirement that the Registered Manager must 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. Staff could describe the procedures in place and why they were necessary. Staff have all recently been trained in adult Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 20 protection issues and there is now a rolling programme of updating the training. Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has adequate living and dining areas on each floor. There is a pleasant landscaped garden to the rear of the home and a chapel. Service users have their own en-suite rooms which are large enough and which they can decorate as they choose. Service users have the specialist equipment they need to live safely in the home. On the day of the inspection, the home was clean and hygienic throughout. EVIDENCE: Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 22 There was a previous requirement that 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. Apparently this had been done but the report was not available during the inspection and needed to be sent onto the Commission. Some signs have been removed and the toilet doors have been painted orange to help service users recognise them. Staff reported that this has helped most service users. There was a previous requirement that 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. An occupational therapist report had been completed in 2005 and the requirements of this report had been met. The wheelchairs in the home have been inspected and are now regularly checked. Hoists are serviced regularly and falls and mobility assessments are conducted for all service users. There was a previous recommendation that 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. This was another area that had been confused and some photocopied images of famous black people had been placed around the home, which made the home look cluttered. Again following discussions the Registered Manager said she further understood the aim of this recommendation. (See Recommendation 1) There was a previous requirement that the Registered Manager must ensure that sluice doors are kept locked when not in use. This is now being done. Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are enough staff on duty to meet the needs of service users. (This issue will be assessed again at the next inspection when more usual numbers of service users are living at the home) The required number of staff hold or are undertaking the NVQ Level 2 in Care which means that staff know what they are doing. Staff receive adequate training in order for them to be able to meet the needs of service users although their training needs are not assessed annually which means they may not be receiving the best training to develop their practice. Recruitment procedures have improved significantly but there are still a few issues to address to make sure that effective checks are in place to make sure staff are who they say they are and can do the job they are hired to do. EVIDENCE: There was a previous requirement that the Registered Individual must ensure that there is never one carer, alone on duty on any floor at any time. The Registered Manager and staff reported that when they go for their breaks now Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 24 they will call the supernumerary member of staff to cover the floor so that no one is left alone. There was a previous requirement that 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. The two handovers seen during the inspection showed that they are now planned more, privacy and confidentiality is respected and there is some consideration of basic care plan issues although in future more time could be spent planning what service users will do in the following shift. 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 and 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. Due to the reduced numbers of service users, staffing levels are not what they would normally be so it was not possible to fully assess is staffing levels would be adequate once the home was full. There was no evidence found during this inspection that staffing levels were not adequate apart from possibly in the area of activities mentioned previously. This area will be fully assessed at the next inspection. Over 50 of non-nursing staff hold or are undertaking the required NVQ in Care Level 2. 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. This has been done. There was a previous recommendation that 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. There is now a written procedure but records do not show that this has been followed as a recent CRB check with an offence on it has not triggered a discussion of that offence or recording of the decision. (See Recommendation 2) There was a previous recommendation that the Registered Individuals should ensure that Equal Opportunity monitoring forms are made anonymous and taken out of the staff files. Although one file had these forms still on it, the Registered Manager said that this was a mistake and the inspector saw that other files had them removed. Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 25 There was a previous recommendation that 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. The Registered Manager said that they no longer use any agency staff but would check their procedures if they did. Personnel files examined during this inspection showed a few further areas for improvement with regard to the use of POVAFirst, the number of people interviewing applicants, the completion of application forms and the completion of the interview records. (See Requirements 10, 11 & 12) There was a previous requirement that the Registered Individuals must ensure that all staff have appropriate training in infection control. Some staff are still to complete the distance learning element of the training but the requirement has been met. There was a previous requirement that 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. These have been planned but have not yet been done. (See Requirement 13) There was a previous requirement that the Registered Manager must ensure that all staff receive induction and foundation training in line with standards. The three new staff have competed checklist on file but have not been completing the required workbooks, which show the evidence gathered and assessment made. (See Requirement 14) There was a previous recommendation that 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. This had been done before the inspection and the Registered Manager will need to do this again when the staff appraisals have been completed. Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is now a Registered Manager in post who has been interviewed by the Commission and who is fit to be in charge. The home is not doing all it can to plan for the forthcoming year based on the views of service users and make sure that things get better in ways that they want. The financial systems in operation in the home make sure that service users’ money is held safely and they are protected from abuse. Staff are now supervised regularly and effectively, which means that service users are supported by people who receive enough support and advice from managers. Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 27 Recording has improved significantly and is now effective in all areas. Health and safety systems are operated as they should be apart from in the areas of weekly fire system tests and fire drills. EVIDENCE: There is now a Registered Manager in post who has been interviewed by the Commission. Throughout the inspection she evidenced her awareness of the needs of service users and how the home should 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 surveys or other more effective means and the results of this feedback is published and made available to all stakeholders. While this is done the inspector was not satisfied with how it is being done. To aid future understanding the previous long-standing requirement is reworded to be clearer about what is required. (See Requirement 15) There was a previous requirement 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 business plan for the group of homes to which this home belongs and the Registered Manager has begun to draft a business and development plan for the home. The organisation has employed a new senior member of staff who will be working with staff to review and drawing up and individual plan for the home. (See Requirement 16) There was a previous requirement that the Registered Individuals must review the competency assessment procedure and ensure that competency assessments are conducted effectively and consistently and action plans drawn up and reviewed to address any competency gaps. These now get used as part of someone’s supervision if required. There was a previous requirement that the Registered Manager must ensure that service users and their next of kin are made aware of the Commission’s inspection and told they can read the reports held in the home or on the Commissions’ website. There are signs telling service users and their relatives how they can access the report and the Registered Manager said that she had told relatives in the last relatives’ meeting. There was a previous requirement that 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. All supervising staff have received Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 28 training together from the Regional Operations Manager and records showed that the standard of supervision offered has improved. There was a previous recommendation that the Registered Individuals should ensure that staff are given a copy of their supervision record in accordance with good practice. Staff are now offered copies. There was a previous recommendation that the Registered Individuals should consider using a professionally recognised quality assurance tool in accordance with best practice. This is not yet being operated. (See Recommendation 3) There was a previous requirement that 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. This has been done. There was a previous requirement that 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 home no longer accepts money or cheques from relatives. The records and systems for giving money to service users from their accounts is open and robust with two staff checking and signing for the amounts when service users are unable. There was a previous requirement that 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. Staff now show a significantly higher understanding of the records they are using and all language in the files examined was appropriate. There was a previous requirement that 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. This now occurs. 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. Times of drills are recorded but there were no fire drill records for June or August and several weekly fire test records were missing from the last few months. (See Requirements 17 & 18) All other health and safety documentation and checks were in place and in order. There were no health and safety issues noted on the tour of the building. Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 29 There was a previous requirement 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. Records showed that these are now being completed more consistently. Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 3 2 Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 31 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 4&5 Requirement The Registered Individuals must ensure that the breakdown of each service users’ fees is put these in the service user guide/statement of purpose as required by the new legislation. The Registered Manager must ensure that all service users requiring bed rails have in place assigned consent form from their next of kin. The Registered Manager must ensure that there is one up-todate inventory that accurately records a service user’s belongings in the home. 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 & 07/08/06 The Registered Manager must ensure that appropriate action is taken if the temperature or medication fridges is outside of acceptable limits. Part of DS0000007038.V318759.R01.S.doc Timescale for action 31/12/06 2. OP7 13 (6) 31/12/06 3. OP7 13 (6) 31/12/06 4. OP8 16 (2) (n) 31/01/07 5. OP9 13 (2) 06/11/07 Peartree Care Centre Version 5.2 Page 32 6. OP11 15 7. OP12 16 (2) (m) & (n) 8. OP12 16 (2) (m) & (n) 9. OP13 16 (2) (m) & (n) 10. OP29 13 (6) 11. OP29 13 (6) & previous requirement: Unmet timescales 31/08/06, 28/02/06 & 07/08/06 The Registered Individual must ensure that staff are trained in and the home operates such systems as the gold standard Framework and the Liverpool Care Pathway to fully support someone according to best practice when dying. 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, 30/04/05 & 30/09/06 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. Previous requirement: Unmet timescale 30/09/06 The Registered Individuals must ensure that service users can access the local community as they choose, possibly by the purchase of transport for the home. The Registered Individuals must ensure that the POVAFirst check is only used in emergency situations and not to start staff as a matter of course without a CRB check. The Registered Individuals must DS0000007038.V318759.R01.S.doc 28/02/07 31/01/07 31/01/07 31/01/07 06/11/06 06/11/06 Page 33 Peartree Care Centre Version 5.2 19 (1) & (4) 12. OP29 13 (6) 13. OP30 OP36 18(1)(a)(c ) (i) & (ii) 14. OP30 18 (1) (a) 15. OP33 24 ensure that at least two staff interview all applicants and that all interviewers keep accurate records of the interview and why the decision was taken to employ the applicant. The Registered Individuals must ensure that all details of the application form are completed particularly, a full employment history (with details of any gaps in employment) and dates of all employment, education and on the final declaration. 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 & 30/09/06 The Registered Manager must ensure that all staff receive induction and foundation training in line with standards. Previous requirement: Unmet timescales 31/10/04, 31/10/04, 31/03/05, 30/09/05, 28/04/06 & 07/08/06 The Registered Individuals must ensure that the most effective means are used for gathering service users’ and their relatives’ views on all aspects of the service. These views must be drawn up into at least annual reports (including any qualitative comments, not just results of tick box questions) and action plans put in place to improve on these areas each year. Previous requirement reworded DS0000007038.V318759.R01.S.doc 06/11/06 06/11/06 31/12/06 28/02/07 Peartree Care Centre Version 5.2 Page 34 16. OP33 24 17. OP38 23 (4) (c) (v) & 23(4)(e) 18. OP38 23 (4) in this report. The Registered Individual 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 timescales 30/04/06 & 30/09/06 The Registered Individuals 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 & 07/08/06 The Registered Individuals must ensure that fire drills are carried out as per policy i.e. once per month. 28/02/07 06/11/06 06/11/06 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. Refer to Standard OP22 Good Practice Recommendations 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. Previous recommendation. The Registered Individuals should ensure that the procedure for assessing the suitability of applicants for employment who have offences on their Criminal Records Bureau check is followed. The Registered Individuals should consider using a professionally recognised quality assurance tool in accordance with best practice. Previous recommendation. 2. OP29 3. OP33 Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Peartree Care Centre DS0000007038.V318759.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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