Inspection on 07/08/06 for Peartree Care Centre

This inspection was carried out on 7th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Peartree Care Centre 10/07/08

Peartree Care Centre 08/11/07

Peartree Care Centre 01/11/06

Peartree Care Centre 17/08/06

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 07th August 2006 10:00 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.V307336.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.V307336.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Peartree Care Centre Address Peartree Care Centre 195-199 Sydenham Road Sydenham London SE26 5HT 020 8488 9000 020 8333 5399 samantha.middleton@excelcareholdings.com www.excelcareholdings.com Springmarsh Homes Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care Home 75 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Old age, not falling within any other of places category (0), Physical disability (0), Physical disability over 65 years of age (0) Peartree Care Centre DS0000007038.V307336.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.V307336.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 07/08/06 because at the last full inspection on 01/06/06 concerns had been high about the second floor of the home which lead to an immediate requirement had been made for the organisation to employ additional senior staff for six weeks on that floor to make sure that standards of care on the floor were raised. This inspection was to assess the impact of that work and decide if further action was required. The inspector also took the opportunity to conduct a general assessment of basic standards of care and health and safety on the ground floor to see if the current embargo that is in place preventing any admissions to this home could safely be lifted on the ground floor. The evidence gathered during this inspection is detailed for simplicity in this report under Standards 7-11. No other requirements or standards were assessed so most areas of this report have been left blank. All the previous requirements at the end of this report will be assessed at the next full inspection of the home. What the service does well: What has improved since the last inspection? Staff on the second floor have worked hard with the interim senior to make sure that all service users have in place useful and clear care plans. Staff now read care plans more often and make sure that they understand what they have to do to support service users. Staff have a greater understanding of what the records they are using are for and how they have to complete them. Generally service users are being offered better care on the second floor than they were at the last inspection and service users are safer. The ground floor has improved to the point where although there may be additional work to do which will be assessed at the next inspection, the general standards of health and safety and care are adequate to allow service users to be admitted. Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: The inspector examined three care files and associated records and spoke with staff on the second floor in order to assess the previous immediate requirement (Requirement 5 in the list of requirements at the end of this report) and found that: Two staff reported that the previous six weeks of training and general support from the senior member of staff had helped them understand what they needed to do for each service user. A member of staff admitted that previously she had not really understood what some of the records were for, but now she felt entirely confident that she had read all the documents and understood how to use them. Interviews with two staff evidenced that staff had a deeper understanding of service users needs and the records that were in place, although there were still some areas where staff were not entirely clear about what the records meant. Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 10 Service users now had new, reviewed care plans in place for all areas of need and risk. Two service users had care plans that were being reviewed every month as required. All three service users had their weight monitored every month or every week as required. One Falls risk assessment had not been fully completed and staff had reviewed this form at least twice and not picked up on the gaps. A manager had not signed one care plan confirmation form as required by the home’s form. One service user had two care plans around continence one of which said that they were incontinent the other said they were not incontinent. One service user’s continence assessment was not completed. Two Pain assessments had not been completed. One care plan showed that a relative had asked for a medication review. This request had not been dated in the record so it was not possible to check if this had been followed up. There was one instance in December 05 when staff had asked the GP for a medication review for this service user but the GP had said that he needed the medical records to conduct the review. There was then no evidence of whether the records had been given or if the review had taken place. One service user had fallen on 19/07/06 and hit and cut their head. The incident record said to review the general falls risk assessment, which was done on 26/07/06. A note on the falls risk assessment made on 20/07/06 said to make a referral to hospital because of the hit to the head but the record of the referral being made said that this was being made because of a sore toe as a result of the fall. The sore toe was in fact a pressure ulcer that is currently being treated separately. One note had been made on 21/07/06 for the GP to examine the service user another note had been made on 25/07/06 to see the GP on 26/07/06. Neither note had an accompanying comment to say what the GP had recommended. One service user had a general care plan around tissue viability and how to prevent sores but this plan had not been changed when the service user had developed a pressure sore on 19/07/06. Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 11 One service user had not had their care plans reviewed in the previous month of July. On 12/07/07 the keyworker had recorded on one service user’s communication care plan that staff needed to spend more time with them to assist with confusion and associated aggressive behaviour. There was no record being maintained of staff recording time they spent with the service user in order to be able to assess the impact of staff spending more time with them. On 28/07/06 the psychologist had made a note requiring that one service user’s activities care plan be reviewed but this had not happened. There had been one incident of physical aggression but it was unclear what had happened and it was only recorded in the service users’ daily notes and not as a separate incident. Incident records are not held on service user files, only held centrally in the manager’s office in a general incident file. There had been one recent incident on 27/07/06 that would have required an emergency interim action plan to be put in place to make sure staff understood how to act to prevent a repetition of the incident. This action plan was not in place. This incident had not been reported to the Commission as required. On two occasions creams that had been prescribed by the GP had been transferred as required to the medication administration chart but the chart stated for them to be applied “as directed” and did not give specific instructions. On 12/07/06 the GP had instructed staff to apply cream that he had already prescribed for one reason, to a different area of the service users’ body. There was no record of this cream from when it had first been prescribed in March 06 or whether it was then applied on 12/07/06. The borough’s podiatry nurse attended the second floor during this inspection on this floor and said that there had been no dressing, as she had required, on the service user’s wound that she was there to look after. Staff said that the service user regularly takes off their own dressing but no records were being maintained of this. The inspector examined three care files and associated records on the ground floor, along with the medication stocks and records and accident/incident reports and spoke with staff in order to conduct a Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 12 basic assessment of standards of health and safety and care, and found that: All three service users had care plans and risk assessment/management plans in place for all areas of need or risk. Service users or their relatives had been involved in the drawing up of these plans. These plans were usefully reviewed every month. One service user’s care plans had been reviewed and changed following a recent hospital admission. Reviews had taken place with social services in the past year. Weight was being monitored monthly or weekly as required and staff could describe how and when they would alert the dietician or the GP if there was cause for concern about weight loss. A recent referral has been made for a new assessment of one service user’s mobility. Accident and incident records showed that issues were monitored, recorded and acted upon as required. Medication was being administered and recorded effectively apart from creams which were just recorded as “used by staff” and “use as directed” instead of being signed for by staff when it had been applied in line with GPs instructions. Peartree Care Centre DS0000007038.V307336.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 18 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 (2) Requirement The Registered Manager must ensure that all service users, potential service users and their relatives receive a copy of the Service User’s Guide. The Registered Individuals must ensure that all service user contracts or statements of terms and conditions are signed by the service user or their representative, that they state the correct current fee for their placement and a copy is given to the service user or their representative. The Registered Manager must ensure that the Life Reviews are completed as fully as possible (by staff if not the service user or their relatives) for all service users and relevant sections do not state Not Applicable. The Registered Individuals must ensure that the home has the required facilities and staff competencies to meet the needs of all service users. Previous requirement: Unmet timescales 01/04/04, 01/08/04, 31/03/05, DS0000007038.V307336.R01.S.doc Timescale for action 30/09/06 2. OP2 5 (b) (c) 30/09/06 3. OP3 14 (1) (c) 30/09/06 4. OP4 12 (1) (d) 30/09/06 Peartree Care Centre Version 5.2 Page 20 5. OP4 12 (1) (b) 6. OP7 15 (1) 7. OP7 12 (1) 31/10/05 & 30/04/06 The manager must ensure that 30/09/06 the needs of service users are fully assessed prior to admission and proper provision is made to meet their requirements. Ongoing requirement (not possible to assess at this inspection due to no service users being admitted): Unmet timescales 01/04/04, 01/08/04, 31/03/05, 31/10/05 & 30/04/06 The Registered Manager must 30/09/06 ensure that care plans cover all aspects of the service users’ individual health, personal and social care needs. Part of a previous requirement: Unmet timescales 31/10/04, 31/03/05, 31/10/05 & 30/04/06 The Registered Individual must 31/08/06 employ a full-time suitably qualified, experienced and skilled practitioner to work on the second floor of the home to effectively review all service users’ health and personal care needs and ensure that clear, detailed instructions for staff on how to offer care and support are in place. Following this the practitioner should remain on the second floor to offer ongoing supervision, training and advice to staff to ensure that they: understand the illness and conditions of all service users, how these conditions present and what action staff should take to manage these conditions. understand the other health and personal care needs of all service users and how they are to meet those needs. understand the purpose of the written tools they are using. Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 21 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. This person must be in post by 16th June 2006 and must remain in post for a period of six weeks, at which point the issues on this floor will again be reviewed by the Commission to assess if further employment is required. Previous requirement which had been partly met in terms of the practitioner being put in place but while there was some progress the outcomes were not fully met. Unmet timescale 07/08/06. 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. Previous requirement: Unmet timescale 30/04/06 The Registered Manager must ensure that all service users are encouraged to take part in organised exercise where they are able. Previous requirement: Unmet timescales 31/10/04, DS0000007038.V307336.R01.S.doc 8. OP7 15 (2) (b) & (c) 30/09/06 9. OP8 16 (2) (n) 07/08/06 Peartree Care Centre Version 5.2 Page 22 10. OP8 17 (1) (a) 31/03/05 30/09/05 & 30/04/06 The manager must ensure that advice from the general practitioner is followed and where there are concerns about service users weight, or intake of food or fluid, this is closely monitored and formally recorded. Previous requirement: Unmet timescales 31/08/05 & 14/04/06. This requirement is now made the subject of separate enforcement notice stating that: The Registered Individuals must ensure that all fluid, nutrition, weight and wound care records relating to all relevant service users, are kept contemporaneously, in sufficient detail and are accurate. The Registered Manager must ensure that all staff understand the particular conditions and illnesses of service users and that all action taken to treat those conditions and illnesses is part of the established care plan and offered following evidence gathering and not on staff assumptions. The Registered Manager must ensure that the medication stock checking systems in place are effective. The Registered Manager must ensure that all medication labels and medication administration charts state specific directions as to how medication (including prescribed food supplements) are to be given. The Registered Manager must ensure that the temperature of all medication fridges is monitored daily, preferably using DS0000007038.V307336.R01.S.doc 07/08/06 11. OP8 12 (1) 30/09/06 12. OP9 13 (2) 07/08/06 13. OP9 13 (2) 07/08/06 14. OP9 13 (2) 07/08/06 Peartree Care Centre Version 5.2 Page 23 15. OP9 13 (2) 16. OP10 12 (4) & (5) 17. OP10 12 1) (4) (a) & 23 (2) (a) 18. OP12 16 (2) (m) & (n) 19. OP12 16 (2) (m) & (n) a maximum-minimum thermometer and appropriate action is taken if the temperature goes outside of limits. Previous requirement: Unmet timescales 31/08/06 & 28/02/06 The Registered Manager must ensure that staff witness the administration of medication before signing that the dose has been taken. Previous requirement: Unmet timescale 28/02/06 The Registered Manager must ensure that all staff show respect and communicate with service users effectively and appropriately at all times. The Registered Individuals must ensure that steps are taken on the ground floor (such as the use of appropriate screens) to ensure the privacy of service users as they use the dining room and lounge. The Registered Individuals must ensure that organised activities offered in the home are increased to ensure that the individual needs of service users for stimulation and fulfilment are addressed. Previous requirement: Unmet timescale 31/10;04, 31/03/05, 30/09/05 7 30/04/05 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. DS0000007038.V307336.R01.S.doc 07/08/06 07/08/06 07/08/06 30/09/06 30/09/06 Peartree Care Centre Version 5.2 Page 24 20. OP12 12 (1) 21. OP14 15 (2) 22. OP14 12 (2) 23. 24. OP15 OP16 16 (2) (i) 17 (2) 25. OP18 13 (6) 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 must ensure that social services are made aware of any service users who do not have an allocated social worker and that next of kin are made aware of the contact details of the social workers. Any service users who do not have family involved in their care must be referred to Care Watch to be allocated an advocate. The manager must ensure that service users and their families are provided with as much information as possible about life in the home so that they can make decisions about the care that they receive. Previous requirement: Unmet timescales 01/03/04, 31/10/04, 31/03/05, 30/09/05 & 30/04/06 The Registered Manager must ensure that meals meet the needs of service users. The Registered Individuals must ensure that all complaints received about the service, from any source, are recorded in the homes complaints record. Previous requirement: Unmet timescales 31/08/05 & 28/02/06 The Registered Manager must ensure that the identified issue of potential theft is appropriately and sensitively investigated (as far as is possible at this date) and any further issues of this DS0000007038.V307336.R01.S.doc 07/08/06 30/09/06 30/09/06 07/08/06 07/08/06 07/08/06 Peartree Care Centre Version 5.2 Page 25 26. OP18 13 (6) 27. OP22 23 (2) (a) (n) type are investigated promptly at the time of the event. The Registered Manager must 07/08/06 ensure that all staff are clear about the procedure in event of finding an unexplained bruise or injury on a service user and that they understand the potential abuse/protection issues involved. The registered person must 30/09/06 review the need for hearing loops in some rooms, and ensure that the signs on doors are designed to maximise the independence of service users with dementia. Previous requirement: Unmet timescales 1/06/04, 30/11/04, 31/03/05, 30/09/05 & 31/05/06 (though hearing loops now provided) Now reworded to: The Registered Individuals must ensure that appropriate specialist advice is sought to review all signs, posters and environmental communication in the home with the aim of best meeting the needs of older people with dementia. This advice must further include a review of the decoration and layout of the home with the same aim in mind. Any recommendations following this advice must be carried out. The Registered Individuals must ensure that appropriate specialist advice is sought to undertake a review of all equipment in use in the home to make sure that all service users are being moved and transferred safely at all times. The Registered Manager must ensure that sluice doors are kept locked when not in use. Previous DS0000007038.V307336.R01.S.doc 28. OP22 23 (2) (c) & (n) 30/09/06 29. OP26 13(4)(a) 07/08/06 Peartree Care Centre Version 5.2 Page 26 30. OP25 16 (2) (k) 31. OP26 13 (3) 32. OP27 18(1)(a) 33. OP27 18(1)(a) 34. OP27 18 (1) (a) & 13 (c) 35. OP27 18 (1) (a) requirement: Initial unmet timescale 31/08/05 but this requirement was not assessed at this inspection so is carried over to the next. The Registered Individuals must ensure that the home is free from unpleasant odours and underlying causes of such odours are addressed. Previous requirement: Unmet timescale 30/04/06 The Registered Individuals must ensure that all staff have appropriate training in infection control. Previous requirement: Unmet timescale 31/05/05 The registered provider must ensure that staffing levels at the home are sufficient to meet service users stimulation, supervision and personal care needs. Contingency plans must be in place to ensure that staff absences can be covered. Previous requirement: Unmet timescales 31/10/04, 31/03/05, 31/08/05 & 28/02/06 The registered provider must increase staffing levels, particularly on the second floor, to reflect the needs of service users. Previous requirement: Timescale 28/02/06 (This requirement was not assessed during the inspection) The Registered Individual must ensure that there is never one carer, alone on duty on any floor at any time. Previous requirement: Unmet timescales 30/06/05, 31/08/05 28/02/06. The registered provider must develop a more effective handover system between shifts and ensure that this is reflected in the duty rotas for nursing and care staff. Previous DS0000007038.V307336.R01.S.doc 07/08/06 30/09/06 07/08/06 07/08/06 07/08/06 07/08/06 Peartree Care Centre Version 5.2 Page 27 requirement: Unmet timescale 31/03/06 Now reworded to: The Registered Manager must ensure that handovers are effective and include consideration of service users care plan issues. Handovers must respect service users’ privacy and confidentiality of information. 18 (1) (a) The registered provider must 07/08/06 ensure that those responsible for the recruitment of new staff have appropriate training to do so. Previous requirement with timescale 31/05/06. 18(1)(a)(c The registered provider/manager 30/09/06 ) (i) & (ii) must ensure all staff receive appropriate assessment of their training and professional development needs to help ensure they are able to fully meet the changing physical and mental health care needs of service users. (Previous timescales of 01/08/04, 31/03/05 and 30/11/05 not met) and The registered provider must ensure that all staff undergo at least annual appraisal of their work and their training needs. Now merged into one requirement: The Registered Individuals must ensure all staff receive an at least annual appraisal of their work, training and professional development needs to help ensure they are able to fully meet the changing physical and Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 28 36. OP29 37. OP30 38. OP30 18 (1) (a) 39. OP30 18 (1) (a) mental health care needs of service users. Previous requirement: Unmet timescales 01/08/04, 31/03/05, 30/11/05 & 28/04/06 The Registered Manger 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 The registered provider must ensure that competency assessments are conducted effectively and consistently and action plans drawn up and reviewed to address any competency gaps. Previous requirement: Unmet timescale 31/05/06 Now reworded to: The Registered Individuals must review the competency assessment procedure and ensure that competency assessments are conducted effectively and consistently and action plans drawn up and reviewed to address any competency gaps. The Registered Individual must ensure that the home has a manager who is registered with CSCI. Previous requirement made the subject of a separate enforcement notice: Unmet timescale 31/05/06 The Registered Individuals 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 are published and DS0000007038.V307336.R01.S.doc 07/08/06 30/09/06 40. OP31 8 (1) (a) 07/08/06 41. OP33 24 30/09/06 Peartree Care Centre Version 5.2 Page 29 42. OP33 24 43. OP33 24 44. OP35 12 (1) (a) 45. OP35 13 (6) 46. OP36 18 (2) made available to all stakeholders. Previous requirement: Unmet timescale 30/04/06 The Registered individuals must ensure there is an annual development plan based on the views of service users, their relatives and other stakeholders that shows how the home intends to improve and develop over the forthcoming year. Previous requirement: Unmet timescale 30/04/06 The Registered Manager must ensure that service users and their next if 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. The Registered Individuals must ensure that a review of service users finances is conducted and anyone not receiving any income must be referred to social services or an independent advocate as a matter of urgency. Previous requirement: Unmet timescale 31/03/06 The Registered Individuals must ensure that service users whose money is managed by the organisation are issued with monthly statements of their accounts and that there is an effective system for recording money, cheques and gifts that are brought to the home by relatives. The Registered Individuals must ensure that all nursing and care staff (including the home manager) receive supervision at least six times per year. Pervious requirement: Unmet timescales 31/10/04, 31/03/05, 31/10/05 & 31/05/06 DS0000007038.V307336.R01.S.doc 30/09/06 07/08/06 07/08/06 07/08/06 30/09/06 Peartree Care Centre Version 5.2 Page 30 47. OP36 18 (2) 48. OP37 17 (1) & (2) 49. OP37 12 (1) 50. OP38 23 (4) (c) (v) & 23(4)(e) 51. OP38 37 The Registered Individual must ensure that all staff who offer supervision have received training and have the competencies to be able to do so effectively. The Registered Manager must ensure that records are maintained of all monitoring of service users health status including all contact with and required action from the G.P. Previous requirement: Unmet timescale 31/03/06 The Registered Manager must ensure that all staff understand the purpose of each record they are using, what information to record and how to record it. Language used in records must be fit for purpose and appropriate. The registered provider must ensure that fire alarm tests are carried out weekly and that the times of fire drills are also recorded. Previous requirement: Unmet timescales 31/08/05 & 31/03/06 The registered provider must ensure that staff are clear of the distinction between accidents and other incidents, that all occurrences and actions are recorded in the appropriate format and that CSCI is notified of all incidents covered under Regulation 37. Previous requirement: Unmet timescale 31/03/06 30/09/06 07/08/06 07/08/06 07/08/06 07/08/06 Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 31 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 OP15 Good Practice Recommendations The Registered Manager should ensure that service users be asked details about their needs and preferences in the food surveys. Previous recommendation. The Registered Individuals should consider using a professionally recognised quality assurance tool in accordance with best practice. Previous recommendation. The Registered Individuals should ensure that staff are given a copy of their supervision record in accordance with good practice. Previous recommendation. The Registered Individuals should review the format of the Service User Guide to make it more understandable for older people and older people with dementia. The Registered Individuals should ensure that the review of the decoration in the home includes a review of the images in communal areas to make sure that all the cultures and ethnicities of service users are equally reflected. The Registered Individuals should ensure that there is a written procedure for assessing the suitability of applicants for employment who have offences on their Criminal Records Bureau check and that applicants are made aware of this procedure when they apply for a post. The Registered Individuals should ensure that Equal Opportunity monitoring forms are made anonymous and taken out of the staff files. The Registered Individuals should assess the recruitment procedure of staffing agencies that they use to ensure that sufficient, effective checks are in place to verify the identify and suitability of staff they receive from the agency. Should the procedure be insufficient then the home must conduct its own additional checks. DS0000007038.V307336.R01.S.doc Version 5.2 Page 32 2. OP33 3. OP36 4. OP1 5. OP22 6. OP29 7. OP29 8. OP29 Peartree Care Centre 9. OP30 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. Peartree Care Centre DS0000007038.V307336.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V307336.R01.S.doc Version 5.2 Page 34 - 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!