Inspection on 10/07/08 for Peartree Care Centre

This inspection was carried out on 10th July 2008.

CSCI found this care home to be providing an Good service.

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

Other inspections for this house

Peartree Care Centre 08/11/07

Peartree Care Centre 01/11/06

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Peartree Care Centre Peartree Care Centre 195-199 Sydenham Road Sydenham London SE26 5HF Lead Inspector Pauline Lambe Unannounced Inspection 10th July 2008 09:20 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.V367048.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.V367048.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 5HF 020 8488 9000 020 8333 5399 debbieann.bailey@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) Manager post vacant 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.V367048.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 8th November 2007 Date of last inspection Brief Description of the Service: Peartree Care Centre provides personal care, nursing and accommodation for older people. The home is owned by Excelcare Holdings Ltd, a private provider with several other large homes in the nearby area, as well as outside London. The company Head Office is located in Bromley. The home is close to the centre of Sydenham high street, is easily accessed by public transport, and is close to community facilities, shops, cafes and pubs. The property is purpose built and accommodation is provided over four floors. Nursing care is provided on the top floor; the other floors provide residential care to frail older people and older people with dementia. There are 70 single bedrooms most of which have en-suite facilities. The home has a car park and a paved garden at the rear of the property. The fees charged per week ranged from £501.60 for residential care to £700.00 for nursing care. Residents paid privately for other services such chiropody, hairdressing, newspapers and personal items. Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Two inspectors from the Commission started the site visit for this unannounced inspection on 10th July 2008 and one inspector completed the site inspection on the 1st August 2008. On the first day of the inspection staff assisted with the inspection and on the second visit the manager was on duty and assisted the inspector. The service last had a key unannounced inspection on 8th November 2007. Since the last inspection a new manager was in post all other registration details remained unchanged. The inspection process included a review of information held on the service file, a tour of the premises, a review of records, spending time talking to residents, staff, management and relatives and reviewing compliance with previous requirements. An Annual Quality Assurance Assessment (AQAA) was not provided prior to this inspection. Information provided in resident, relative and surveys was also reviewed. The inspectors spent time on the ground, first and top floors during the course of this inspection. The standard of care continued to improve in this home. Staff and relatives spoken with provided positive feedback on the impact of the new manager. In the best interest of the residents, staff and others the provider must rectify the on-going problem with one passenger lift. What the service does well: Adequate information was provided about the service for prospective residents. Residents were admitted to the home based on an assessment of care needs. Residents and relatives spoken with did not raise any concerns as to how staff respected their privacy. The service had an open visiting policy which enabled relatives to visit when they wanted and they were encouraged to contribute to the care of their loved ones. A nutritious and varied diet was provided. Staff had access to training and support that enabled them to fulfil their roles. Bedrooms seen were personalised and the environment was clean and tidy. Systems were in place to review the quality of the service. Regular checks and inspections were carried out to ensure a safe environment was provided for residents and others. Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Medicine storage rooms must be kept locked when not in use, medicine administration charts must be signed at the time medicines are given, hand written entries made on administration charts by staff must be countersigned to ensure accuracy, when a variable dose is prescribed the actual dose administered must be recorded and staff must only administer homely remedy medicines agreed by the GP. Management must ensure that cooked foods are kept at a safe temperature and that residents receive hot meals. When needed food temperatures must be rechecked on the units before serving meals to residents. Management must address the issue with one passenger lift to ensure it is available to residents and others at all times. The Commission must be informed in writing of the actions taken to address this requirement. A dependency level must be completed for the residents on the top floor and this converted to nursing and care hours to ensure adequate staffing levels are provided on this unit. The Commission must be informed in writing of the outcome of the dependency review and any action taken in relation to staffing levels on the unit. References received for employees that are not on headed paper, do not have a company stamp or compliment slip must be verified as genuine. Staff must not work unsupervised with residents unless a CRB check has been received for them. The person managing the service must register with the Commission to ensure compliance with this section of the Care Standards Act. The Commission must be informed in writing of any action taken to comply with this requirement. Some good practice recommendations are included in this report for the provider to consider. Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 7 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.V367048.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.V367048.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and standard 6 did not apply to the service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were admitted to the home based on a pre-admission assessment of need. Satisfactory information about the service was provided for prospective residents and others. EVIDENCE: Care records were inspected for five residents throughout the home. All the files included a pre- admission assessment completed by staff from the home. The assessments provided comprehensive information about people’s physical, emotional and social needs and personal preferences. Additional information provided by the funding authority was seen in some of the files. Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans were prepared to show how care needs were to be met. Satisfactory systems were in place to ensure residents healthcare needs were met. Medicines were generally well managed. No concerns were raised or noted in relation to the respect and dignity of residents. EVIDENCE: Five sets of care records were inspected, two on the ground floor, two on the top floor and one on the first floor. All the care records seen included needs assessments, risk assessments and care plans. Care plans were well written, referred to management of privacy and dignity, choice and independence development. Care plans provided satisfactory information for staff as to how assessed needs were to be met for example in relation to toileting programmes, pad sizes, moving & handling equipment and the need to encourage personal choice. One set of care records seen was for a resident with a wound. Wound care information was good and showed that the care plan was followed. The records included a body chart, a wound care evaluation chart and the records provided details about the size, grade, site and Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 11 appearance of the wound, the type of dressing used and the frequency of dressing changes. The resident had been referred to the tissue viability nurse. One issue noted was in relation to the nutritional care plan for one person. The person had lost weight and although the change needed to meet their nutritional needs was included in the care plan review the actually care plan had not been amended to reflect the changes. On the first floor one resident was waiting assessment for transfer to a nursing unit. It was recommended that staff refer the person to the district nurse for assessment in relation to pressure area care and perhaps the need for them to have a more suitable mattress. There was evidence in the care records seen that care plans were discussed with residents and relatives. Feedback received from residents and relatives indicated satisfaction with the care provided. Comments made included “I am in very good hands” and “I am happy with the care provided” and a relative said they were “very happy with the care and were kept involved with the residents care planning”. Recommendation 1. There was evidence in the care records inspected that staff identified and addressed health care issues and referred people to other professionals if necessary. All the files seen included a record of health care professionals visits. Records seen showed that residents had been referred to healthcare professionals such as the GP, dentist, chiropodist, optician, district nurse and tissue viability nurse. Medicine management was inspected on the ground and top floor. Satisfactory storage was provided and the temperatures of the medicine fridges and storage rooms were monitored. Records were maintained for the receipt, administration and disposal of medicines. Medicines were supplied in blister packs and individual containers on a monthly cycle together with pre-printed administration charts. Staff who assisted with this aspect of the inspection understood and explained the systems in place to manage medicines. On the ground floor medicine management was inspected and included checking the records and medicine supplies for three people. Two were correct and one error was noted on the third record. One medicine was prescribed as a variable dose for the person and the actual dose given was not recorded. On other administration charts checked randomly it was noted that on one persons chart hand written entries made by staff had not been countersigned. This was discussed with the carer in charge and the home manager. Medicine profiles were prepared for each resident. On the top floor the medicine storage room was found to be unlocked however the nurse on duty rectified this immediately. On the second visit to complete this inspection the storage room was found locked. On medicine administration charts seen prescription changes were dated and signed, handwritten entries made by staff were counter-signed by a second member of staff and records of administration were good. Administration records for three residents were checked and one error noted. One dose of one medicine had not been signed for at the time of administration. Controlled drugs were checked, the items were stored and recorded properly and supplies found to be Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 12 correct. Homely remedy medicines were checked and found to be correct however one homely remedy administered to residents was not on the list agreed and signed by the GP in June 2008. Requirement 1. No concerns were noted in relation to how staff respected resident’s privacy and dignity. Care records seen included reference to this aspect of people’s lives. Residents were appropriately dressed, were address respectfully by staff and were offered assistance when needed. On the ground floor staff and residents were observed sharing jokes and interacting in a friendly yet professional manner. Staff called residents by their preferred name and residents seemed relaxed and comfortable in their surroundings. Residents spoken with said staff listened to them, were polite and helpful and supported them to make choices in relation to meals, activity participation and personal appearance. Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 – 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents had access to suitable activities. Residents and relatives said they were happy with the home’s visiting arrangements. Residents said and records seen showed personal choice was encouraged. The food provided in the home was satisfactory but care must be taken to ensure food it is served at the correct temperature. EVIDENCE: Two people had been recruited on a part time basis to provide and arrange social and leisure activities for residents. On the top floor two residents said that there was never anything to do in the home however records seen did not support this. Two sets of care records were inspected and showed that for one person admitted two days before the inspection there were no records of any involvement in social activities. The other social records showed that the person had been involved in some activities such as hand massage, social interaction and exercises but also had often refused to take part in activities. The records stated that this person disliked group activities and liked to watch TV. One resident said they attended the monthly mass service that was held in the home. On the ground floor residents said they enjoyed taking part in activities and could decided if they wanted to do this or spend time in their Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 14 bedrooms. Residents were encouraged to be involved in activities and residents were seen enjoying a game of skittles with the help of staff and input from the more able residents. Care records seen for three residents showed that social care plans were prepared and participation or refusal to take part in activities was recorded. One record showed the person did not take part in many activities and for the other two people records showed they had taken part in activities such as meals out, ball games, music session, exercises and attendance at the religious services held in the home. The home operated an open visiting policy. Residents spoken with said they enjoyed family visits and outings. Relatives seen were satisfied with the visiting arrangements and communication with staff about their family member. Care plans seen and people spoken with indicated that residents were supported and encouraged to make personal choices. Some residents on the ground floor were quite independent and said staff let them manage personal care and other aspects of their lives but provided support when needed. Lunch was observed on the ground and top floor units. A choice of meal was provided but the meals were not those on the menu for the day. Inspectors were told that this was because the cook was on leave and someone else had ordered the meat. Not following planned menus was noted and discussed at the last key inspection. Four weekly menus were displayed on each floor however these were in small print and as all four weeks were displayed it was not possible to know which was the current week. This was considered confusing for residents and this issue was also noted and discussed at the last inspection. Food was brought from the kitchen to the two units inspected on ordinary trolleys in stainless steel dishes covered with cling film. Heated food trolleys were not used. On the top floor the inspector tasted the food when the last person was served and it was only lukewarm. Feedback received from residents indicated that food was not always hot enough. This issue was discussed with the staff and on the second visit to complete the inspection heated food trolleys were used to serve meals. Staff served the meal and assisted residents where needed. Staff were observed encouraging residents with poor appetites to eat their meal and offered alternatives to help with this. Residents on both units said they were able to choose what they wanted to eat and alternatives were provided if they did not like the choices on the menu. On both units residents were observed having a meal choice that was not on the menu. Some residents had sandwiches, baked beans, boiled potatoes instead of mash or ham and chips. Pureed meals were served attractively to ensure they looked appetising. Residents spoken with said they enjoyed their meal and one relative said the food provided in the home was “excellent”. Management said that currently they are working on menu improvements. This will include daily menus with photos of meals to assist residents with choice and recall. An environmental inspection was carried out on the kitchen in June 2008 and the inspector was told that all recommendations had been Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 15 met and all requirements except one in relation to of the serving lift in the kitchen had been met. In view of the problems with the passenger lift the provider should consider re-commissioning this piece of equipment. Requirement 2. Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 16 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): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory systems were in place to manage complaints and safeguard adults. EVIDENCE: A complaints policy and procedure was provided and available to residents, relatives and others. A system was in place to record complaints and it was pleasing to see that all complaints made by residents were recorded together with the action taken to rectify the issue. For example one person complained that their pillows were missing and another person that other residents entered their bedroom uninvited. Other records seen included copies of the original complaint, correspondence, investigation and outcome. Records seen showed that the complaints procedure was followed. A policy and procedure was provided in relation to safeguarding adults. All allegations or suspicions of abuse were reported to the local authority for investigation. Six care staff spoken with said they had received training on safeguarding adults, displayed an understanding of this and knew what action to take if abuse was suspected or alleged. The staff training matrix provided showed that in the last 12 months 10 members of staff had received training on safeguarding adults. Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 17 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): Standards 19, 21, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall the environment was clean tidy and well maintained. However the problems with one lift did affect the lives of residents and others and added to staff workload when it was out of order. Residents were satisfied with the communal and personal space provided. EVIDENCE: The inspection included viewing the environment on the ground, first and top floor units. Communal areas, a number of toilet and bathing facilities and bedrooms were viewed. Areas seen were clean, tidy, and odour-free and decoration and furniture were of a satisfactory standard. Residents spoken with said the home was kept clean and tidy. Since the last inspection a number of communal areas and bedrooms had been repainted. Management said that bedrooms were redecorated on a rolling programme. Residents and relatives spoken with were satisfied with the environment but a number of people had concerns about the unreliability on one passenger lift. Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 18 Although there are two lifts in the home only one went up to the top floor. Relatives and staff spoken with said that the lift to the top floor was “always breaking down” and management confirmed this was the situation. Relatives also said that the lift floor was not always level with the unit floor. There were signs displayed to warn people about this issue. One resident on the top floor said they liked to visit the chapel each day and go to the garden but said they often could not do this due to the problems with the lift. We were told that a few days prior to our visit one wheelchair visitor had to be “bumped down a flight of stairs” because the lift broke during their visit. Another relative said they would like to take their family member to the garden but could not do this in case the lift broke down whilst they were there. When the lift was not working staff had to carry meals and laundry up the last flight of stairs to the top floor. The complaint records seen showed that residents and relatives had raised concerns about the unreliability of the lift. Requirement 3. There was an adequate supply of hot water in the en suite rooms and bathrooms seen and temperatures checked were within safe limits. Bathrooms were tidy and available to residents. However staff said that residents with en-suite showers preferred to use these. Bedrooms seen were spacious, comfortable, clean, tidy, personal and decorated to a satisfactory standard. A number of residents were seen in their bedrooms and said they liked to spend time peacefully on their own reading, watching TV or listening to music. Most residents said they liked to sit in the lounges for short periods and went to the dining rooms/areas for meals. Residents spoken with were satisfied with the environment and the standard of hygiene maintained. As mentioned the environment was clean, tidy and odour free. Staff had access to protective clothing and hand washing facilities were provided where waste was handled. All units seen had a sluice area. Satisfactory laundry facilities were provided and staff spoken to said they had enough hours to complete the daily laundry. Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 19 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): Standards 27 – 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In view of concerns raised management must review staffing levels on the top floor. Staff had access to training and support to help them fulfil their roles. Some improvements were needed to recruitment procedures. EVIDENCE: The staff team comprised of a full time manager, a deputy manager with allocated management time, trained nurses, care assistants and ancillary staff. Staff rosters seen showed that minimum staffing levels were maintained both in relation to skill mix and numbers. Residents, relatives and staff on the top floor felt staffing levels were inadequate in view of the high dependency of residents on this unit. In view of the concerns raised management must review resident dependency and staffing levels on this unit and inform the Commission of the outcome and any changes made to staffing levels. Staffing levels and the response to call bells on the top floor were satisfactory on the day of the inspection but there were three extra staff on duty at that time. Not all the staff rosters seen included the full name of the people on duty. This was discussed with the manager who agreed to include full details in future. Requirement 4. From information provided the service employed 48 care staff, 27 had achieved NVQ level 2 or above and one person was working towards this qualification. Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 20 Four employee recruitment files were inspected. The information included in two files complied with regulation. In one file two references, which were received by email had not been verified as genuine. In the last file a POVA first check had been obtained but not CRB check for the person. The person had commenced work and there was no evidence to show that they were being supervised when on duty, in fact the person had worked as a team member and had worked on night duty where it may not have been possible to ensure they did not have unsupervised access to residents. Requirement 5. Staff spoken with said they had access to training relevant to their role. A staff training matrix was maintained and a copy provided to the Commission. The matrix showed that in the last 12 months staff had access to training on topics such as fire safety, infection control, moving & handling, food hygiene, dementia care and safeguarding adults. In discussion with management it was suggested that individual training files are maintained for staff so that the need for updates and 3 days training in a year could be more easily monitored. Recommendation 2. Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 21 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): Standards 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The new manager must apply to register with the Commission. The standard of care continued to improve. The quality of the service was reviewed and attention given to providing a safe environment. EVIDENCE: Since the last inspection a new manager was in post. The new manager was in the process of applying to the Commission for registration. The manager had the skills and experience needed to manage the service and the regional manager and deputy manager supported her in her role. Requirement 6. An annual business plan prepared for the service was seen. This was based on information obtained through a SWOT analysis, satisfaction surveys, resident and relative meetings and in-house audits of the service. The plan included Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 22 plans for service improvements for example in relation to the quality of life for residents. The achievements and review of each service was included in the annual report for the organisation. Minutes were seen for resident, relative and staff meetings and records were seen for in-house audits on areas such as accidents to residents, medicine management, care plans and health & safety. A system was in place to review a ‘resident of the day’. This included reviewing aspects of the person’s life such as care plans, medication, satisfaction with the meals and service, their personal space and other areas as relevant. Since the last inspection no changes had been made to management of residents money. Relatives were invoiced directly for any services that were not included in the fees such as hairdressing, newspapers and chiropody care. Management did not hold any personal money for the people living in the home and staff did not handle resident’s money. A health and safety policy was provided and was signed and dated on 6/6/07. New health and safety systems had been introduced which included monthly inspection of areas such as bedrails, drug trolleys, lighting, extractor fans, nurse call system and a ‘good housekeeping’ check with included visual checks of the environment both internally and externally. Other safety records safety seen included service of fire safety equipment, moving & handling equipment and the gas certificate. All of these records were up to date. The last fire drill held for day staff was on 16/6/08 and to include night staff was on 30/7/08. On the top floor bedrails fitted to one resident’s bed did not seem to be securely fitted. This was brought to the attention of the maintenance person who was called to check these during the inspection. Accident records were completed satisfactorily and the service complied with regulation 37. Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 23 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 Requirement When a variable dose is prescribed the actual dose administered must be recorded. Staff must only administer homely remedy medicines agreed by the GP. Management must ensure that cooked foods are kept at a safe temperature and meals are hot when served to residents. Management must address the issues with one lift to ensure it is available to residents and others at all times. The Commission must be informed in writing of the actions taken to address this requirement. A dependency level must be completed for the residents on the top floor and this converted to nursing and care hours to ensure adequate staffing levels are provided on this unit. The Commission must be informed in writing of the outcome of the dependency review and any action taken in relation to staffing levels on the unit. References received for DS0000007038.V367048.R01.S.doc Timescale for action 24/09/08 2 OP15 12 24/09/08 3 OP19 23 24/09/08 4 OP27 18 22/10/08 5 OP29 19 24/09/08 Page 25 Peartree Care Centre Version 5.2 6 OP31 employees must be verified as genuine where needed. Staff must not work unsupervised with residents until a CRB check has been received for them. Care The person managing the service 24/09/08 Standards must register with the Act 2000, Commission to ensure Part II (11 compliance with this section of – (1)) the Care Standards Act. The Commission must be informed in writing of any action taken to comply with this requirement. 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 Refer to Standard OP7 OP30 Good Practice Recommendations When a resident’s care needs change the care plan should be rewritten to reflect this and ensure staff had the information needed to care for the person. Individual staff training records should be maintained. Peartree Care Centre DS0000007038.V367048.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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.V367048.R01.S.doc Version 5.2 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!