Inspection on 08/11/07 for Peartree Care Centre

This inspection was carried out on 8th November 2007.

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 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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Peartree Care Centre Peartree Care Centre 195-199 Sydenham Road Sydenham London SE26 5HT Lead Inspector Maria Kinson Unannounced Inspection 09:55 8 November 2007 th 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.V341681.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.V341681.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.V341681.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 1st and 2nd of November 2006 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 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. 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 by the home range from £454.00 - £670.00 per week. This does not include additional charges such as chiropody, hairdressing and newspapers. This information was supplied to the commission on 08/11/07. Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by two inspectors on 8th and 13th November 2007 and was unannounced. The inspectors spent most of their time on the first, second and third floors of the home observing care practices and examining records. All of the communal areas and a small number of bedrooms were viewed. The inspectors spoke with four people that lived in the home, three relatives and four members of staff. Written feedback about the service was obtained from eight people that lived in the home, nine relatives, eight members of staff and two health care professionals. There were eleven empty beds on the day of the inspection and two people were in hospital. What the service does well: Written information was made available to people that wanted to know more about the service and people could visit and spend time looking around the home if they wished. Staff obtained information about people’s needs and preferences before they moved into the home. People said that staff respected their privacy and treated them with respect. Relatives were able to visit when they wanted and could contribute to their relatives care if they wished. Care plans were reviewed regularly and were discussed and agreed with the resident or their relatives. Most people said they liked the food provided in the home. Staff received safeguarding training and were aware of the procedure for reporting allegations of abuse. People were able to arrange their bedrooms how they wished and bring their own furniture and personal belongings into the home. Staff received relevant training. The home had systems in place for assessing and monitoring the standard of care provided in the home. Information obtained during audits and surveys was used to improve the service. Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 6 Regular checks and inspections were carried out to ensure that equipment was in working order and safe for use. Fire safety arrangements were good. The management arrangements were stable. This provides security for staff and residents. What has improved since the last inspection? What they could do better: Care plans were mostly satisfactory but a few of the plans seen did not include important information about the persons needs. Information must be included in care plan, if the assessment identifies that a person requires mouth or nail care. Good records were maintained about medicines received and administered in the home, but the balance of some medicines were not correct. Activities were taking place but they were a little repetitive for the people on the third floor and did not always take account of people’s individual needs or interests. The menus were displayed but the information provided was not user friendly. This made it difficult for people to know what food to expect. Some people Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 7 said they were not always able to choose what they ate. Some people on the third floor unit received their meal before staff were ready to assist them to eat and one person was not supported into a suitable position to eat. Complaints were investigated thoroughly but it was not always clear from the records if the complainant received a response. Some records such as the duty roster for the third floor were difficult to read in parts or not dated and signed. The damaged fly screen in the main kitchen and the damp work surface in the kitchen on the third floor must be replaced. The chairs with torn covers should be reupholstered or replaced. Two people did not have a supply of hot water at their hand washbasin on the day of the inspection. The cause of this problem must be identified and resolved. The home was clean overall but a few areas were dusty. Staff should ensure that cleaning schedules include sluices, cupboards and skirting boards. Staff must ensure that cleaning solutions are stored safely. The third floor unit did not have any permanent nurses on day duty. The manager had arranged for staff nurses from other excelcare homes to help out and was taking action to recruit new staff. Some communication and record keeping issues were identified on this unit. The dependency of the residents on the third floor was high. Staff did not have adequate time to undertake activities or engage people and some people were still eating their breakfast at 10:30am. The home should consider purchasing additional height bedrails for use by people with a pressure-relieving mattress. 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.V341681.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.V341681.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): 1, 3 and 5. Standard 6 does not apply to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff obtained information about peoples needs before they moved into the home. EVIDENCE: A copy of the recently updated ‘Statement of Purpose’ and ‘Service User Guide’ were supplied to the commission. These documents were nicely laid out, easy to follow and included adequate information about the service. Some information such as the frequency of CSCI inspections and staff details should be updated. A copy of the Service User Guide was displayed in each bedroom. People said that they received adequate information about the service and were able to visit and ask questions before they made a decision to move into the home. Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 10 Four files were examined on the top floor and one on the second floor. All of the files included a pre- admission assessment that was completed by staff from the home. The assessments were completed before the person moved into the home, except in emergencies. Additional information was obtained from the funding authority. Assessments were satisfactory but a few sections in one of the documents seen on the third floor was only partially completed and was not signed or dated. See requirement 8. Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s care needs were identified but were not always included in their care plan. This could mean that some people may not receive timely or adequate care. The management of medicines was variable. Action must be taken to ensure that accurate records are maintained on all of the units in the home. EVIDENCE: Four sets of care records were examined on the top floor unit and one file on the second floor. All of the files included assessments; risk assessments, a care plan and daily care records. Three plans provided good information about the action that staff should take to meet people’s individual needs and preferences. For instance one plan specified what time the person liked to go to bed and about the creams the person wanted staff to apply to their skin. The remaining plans did not include adequate information about the use of a prosthesis and management of a bowel problem or acknowledge that one person may have difficulty consuming adequate food. See requirement 1. Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 12 Care plans were reviewed regularly and there was evidence that plans were discussed with the people living in the home or their family members. Records indicated that people had access to community health care services and most people were satisfied with the medical support they received in the home. The commission obtained written feedback about the service from two health care professionals that were in regular contact with the home. Feedback indicated that staff usually sought advice about health care issues but one person said staff should respond quicker in some instances. Residents said they usually received appropriate care and support. One person with a poor appetite and some weight loss was referred to the GP and Dietician for advice. Staff were not monitoring what the person was eating or drinking although there was evidence in the records that they were advised to do this. See requirement 2. This person subsequently developed a small pressure sore. Staff received conflicting advice from two health care professionals about the use of a pressure- relieving mattress for this resident. Difficulties such as this should be referred to the team leader or manager for resolution. Some people on the top floor were not receiving support to keep their fingernails clean and tidy. Staff should ensure that care plans address this issue. See requirement 1. Staff identified potential hazards and recorded strategies to maintain peoples safety. Assessments were seen for people that were at risk of developing pressure sores, becoming malnourished and falling. Medication was assessed on two of the four units. Adequate storage space was provided for medicines and dressings. The temperature in the medicine room and medication refrigerator was monitored. Good records were maintained about medicines received in the home and administered to residents but some discrepancies were noted on the top floor when the amount of medicine given to the resident was deducted from the amount received in the home. See requirement 3. Staff on the second floor took prompt action to try to establish why one medicine was not dispensed. Records of medicines sent for disposal were maintained but did not always include a date. There were systems in place to manage controlled drugs safely. A list of ‘over the counter’ or homely remedy medicines was agreed and signed by the GP. The list included topical applications such as creams. Topical medicines are not normally recommended for use as homely remedies as they are for single person use only. Staff were administering one persons medicines in drinks, on the second floor. This issue had been discussed with their relatives and the Psychiatrist and a risk assessment was in place. Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 13 The manager checked that staff were competent to administer medicines and a number of staff were completing distance learning medication training workbooks. All of the bedrooms were single occupancy. Bathroom doors had locks fitted and care plans provided guidance for staff about promoting personal choice. Health care professionals gave examples of how staff maintained people’s privacy and dignity during their visits, such as taking people to their rooms for consultations. Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities were provided but they did not always meet people’s individual needs and expectations. Relatives said they were able to visit the home when they wanted and were able to contribute to their family members care. The food provided in the home was satisfactory but people said they were not always able to choose what they ate. EVIDENCE: The home had a full time activities coordinator who was responsible for planning a weekly programme of activities and supporting people to take part in activities and outings. The activity programme included some sessions led by external people such as tai chi classes and other sessions led by care staff or the activity coordinator. There had been some outings to a local lunch club and pub and parties were held to celebrate people’s birthdays or special events. Four care plans that were viewed on the third floor provided little information about people’s individual interests and hobbies. For example one care plan Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 15 said ‘tell the resident what is on’ and ‘encourage involvement’ but there was no reference to the persons likes or dislikes. Records indicated that some of the people on the top floor unit had played ball games, completed crosswords, visited the hairdresser, watched television and taken part in some light exercise. The range of activities provided on this floor was poor and there was little evidence of ‘one to one’ sessions for people that were confined to bed or their rooms. People were encouraged to take part in group activities but if they refused staff respected their decision. During the inspection a number of people on the top floor were taking part in a ball game and people from other floors attended a music, dancing and quiz session. People confirmed that activities were taking place but said “there needs to be more regular activities”. Some relatives expressed similar concerns stating that there “needs to be more mental stimulation” and “it would be nice if residents could get out occasionally”. See recommendation 1. People said that they were able to visit the hairdressing salon or attend religious services if they wanted. The home has its own chapel, which can be used by residents, staff and visitors. Relatives said they could visit the home when they wanted and were made to feel welcome. Some relatives liked to come in at mealtimes to assist their family member to eat and said staff were happy for them to do this. Written comments about the service were obtained from nine relatives. Feedback was variable. A number of relatives said most of the staff were “caring” but some “seem unhappy in their work” and spend little time talking to residents. 80 of relatives said staff ‘always’ or ‘usually’ informed them about important issues. A relatives meeting was held in September 2007. There was evidence in the minutes that relatives and residents were able to express their views about the service. A four weekly menu plan was displayed in a glass showcase on the wall. The position of the menus and the amount of information displayed made it difficult for people to know which menu was being followed. The meal served on the day of the inspection did not correspond with the food listed on the menu. Lunch was observed on the second and third floor units. Most people had their meal in the dining room but a small number of people ate in their room through choice. People on the second floor were offered a choice of food but there was little evidence of choice on the third floor. The cook said that information about resident’s food choices was not always sent to the kitchen. See recommendation 2. People were seen eating a number of different foods such as steamed fish, meatballs and sandwiches. Feedback about the food provided in the home was mostly good. Some people said the food provided was “excellent” and we get “a good variety of food, including fresh vegetables”. A number of people on the third floor unit required assistance to eat. Some meals were served before staff were ready to assist people to eat. A member Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 16 of staff assisted one person to eat in their bedroom. The resident was lying down in the bed although the staff member said the person had difficulty swallowing. See requirement 4. Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff had procedures to follow when responding to complaints, concerns and allegations. It was not possible to assess if the complaints procedure was always followed, as some information was not recorded. EVIDENCE: Most people said they knew how to make a complaint and would speak to their relatives or staff if they were unhappy. A summary of the complaints procedure was included in the ‘Service User Guide’. The commission had received two complaints and two concerns about the service since the last inspection. The findings from two of these issues indicated that staff did not always maintain adequate records or communicate effectively. See requirement 2. There were sixteen complaints recorded in the complaints log for 2007. Complaints were investigated promptly. Some complaints were about issues such missing clothing and were resolved very quickly by the manager or staff. It was not always clear from the records if the complainant was notified about the outcome of investigations and about the action, if any that the home was taking to address their concerns. See requirement 5. Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 18 Records were kept about allegations of abuse. Information sent to the commission indicated that the home had made six referrals to the local authority safeguarding adult’s team over the past year. Staff had access to safeguarding procedures and completed relevant training. Staff said they would report concerns or allegations to the manager or senior staff and were aware of the company whistle blowing policy. The manager notified the commission about significant events that occurred in the home. Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 23, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home provides a comfortable environment for people that use the service and their visitors. EVIDENCE: The home was clean and tidy overall but some concerns were identified regarding attention to detail. On the second floor the windowsill in the medicine room, the area behind the sluice disinfector and the lower surfaces in the communal toilets were grubby and dusty. The surfaces under the sink in the kitchen on the third floor were dirty. See recommendation 3. It was difficult to gain access to the bathroom on the top floor as there were three hoists, a mattress, two zimmer frames, one toilet surround, one shower chair, a linen trolley and various other items stored in the room. The bath was Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 20 stained and dusty. Staff took action to address this issue at the time of the inspection. Hand washing facilities were good and protective clothing was provided for staff. Efforts had been made to make the communal areas homely and to personalise people’s bedrooms. Some of the rooms included personal photographs, pictures and small items of furniture from the person’s family home. The home was maintained to a satisfactory standard overall but a small number of health and safety issues were identified. The covering on some of the chairs in the lounge on the top floor were split, the area behind the sink unit on the top floor was damp and worn and the fly screen in main kitchen was damaged. See requirement 6. There was no running hot water to the hand basin in two en suite rooms on the top floor. See requirement 7. Staff recorded maintenance issues in a book. These issues were then passed to the maintenance department to address. Two relatives expressed concerns about the time that it took for small issues such as hanging pictures to be addressed. As the maintenance book did not include information about the date that work was completed, it was not possible to assess this issue. The maintenance manager said he would ensure that this information was recorded in future. Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing levels on the nursing floor did not enable staff to spend quality time with residents or to support them to undertake activities. The home undertook thorough checks when recruiting new staff to ensure that applicants did not pose a risk to the people living in the home. Staff received support to update their knowledge and skills and to gain recognised qualifications. EVIDENCE: The duty roster was difficult to read in parts due to shift changes. Staff must ensure the roster is legible and up to date. See requirement 8. The roster indicated that there was one trained nurse and four care staff on the third floor unit during the day and one trained nurse and two care staff over night. The third floor unit did not have a team leader or any permanent staff nurses on day duty. The manager had recruited some new staff for this unit but they were currently working their notice period or undergoing pre- employment checks. To provide continuity of care the deputy manager was working some shifts on the unit and staff from other excelcare homes were providing support. There had been no staff meetings on this unit for some months. The relatives spoken with on this unit were generally satisfied with the care provided but did raise some concerns about staffing levels. It was evident that the absence of a Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 22 permanent team leader and staff team was causing some communication problems. A number of residents were still eating their breakfast at 10:30am when the inspectors arrived and senior staff were not always aware of current issues. People said that staff were always in a rush and spent little time talking to residents. See requirement 9. Relatives said that most of the staff that worked in the home were kind and caring. 87 of care staff had a recognised care qualification. This exceeds the standard set by the Department of Health. Seven staff were currently registered to complete this programme of training. Three staff recruitment files were examined. The home had obtained copies of all of the necessary documents such as references and criminal record bureau checks and issues such as gaps in employment history were followed up with the applicant during the interview. The manager checked that nursing staff were registered with the Nursing and Midwifery Council and had relevant qualifications. The staff training matrix showed that staff had access to mandatory training sessions such as fire safety, infection control, moving and handling and health and safety. Some staff had attended dementia care, customer care and safeguarding adults training since the last inspection. Staff were satisfied with the training they received in the home and said that it helped them to meet peoples needs. The manager advised the commission that individual staff portfolios would be developed in 2008. There was evidence that staff received induction training but the training programmes were not available to view. The manager said staff were responsible for holding their induction training workbook and confirmed that all of the common induction standards were included in the booklet. New staff were employed on a three-month probation period. This provided time for senior staff and the manager to assess their suitability. Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of care provided in this home has improved under the guidance of the current manager. Health and safety issues were monitored and addressed promptly but staff did not always store cleaning products securely. EVIDENCE: The manager is a trained nurse and has a recognised management qualification. The manager was assessed by CSCI to have suitable experience and skills to manage a care home for older people. The manager told the inspectors about the improvements that had been made in the home and about some of the work that was in progress. Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 24 Staff said the manager and deputy manager visited the units regularly and were supportive. There was a quality assurance system in place. This included regular audits, satisfaction surveys and meetings to obtain feedback about the service. Medication, care plan, health and safety and general audits were undertaken and copies of the findings were kept in the home. Action plans were prepared to address areas that required improvement. Resident and relative satisfaction surveys were sent out annually. A report was seen in the front entrance for a satisfaction survey that was completed in 2005. The manager said that the results from the most recent survey were being collated. The manager agreed to forward a copy to CSCI. Relatives were invoiced directly for any services that were not included in the fees. The home does not hold any personal money for the people living in the home. Head office received and sent cheques to one person that lives in the home. Staff that work in the home do not handle residents money. A fire safety policy and procedure was provided. The fire safety file included a plan of the building with fire zones and a fire action plan. Records showed that the fire alarm was tested weekly by activating different points. Fire drills were held regularly and included times when the night staff were on duty. Comments were recorded about how staff responded to the fire alarm and action was taken to improve awareness if necessary. The cleaning cupboard on the third floor unit was unlocked. The staff member that was notified about this locked the door and placed the key on the bookcase. See requirement 10. Health and safety records were sampled. This included hot water temperatures, passenger lifts, hoists, gas appliances, portable electrical items and the mains electrical installation. Equipment was serviced and inspected regularly to ensure that it was safe for use and working properly. There was a system in place to ensure that staff received regular support and supervision. A supervision plan was seen that included dates for sessions and supervision records were maintained. Documentation was completed but some records were not signed or dated. Staff confirmed that they were receiving regular supervision and said the sessions provided an opportunity to discuss their work and personal development or training issues. Accident records were well completed with the time, date and details of the event. Records seen showed that some residents were monitored following falls. The accident record for one resident indicated the person had injured themselves on bedrails. The follow up action to this incident did not include appropriate action such as a review of the bedrail risk assessment. See The manager completed a monthly accident report, which she forwarded to head Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 25 office. This included basic information such as the number of accidents that had occurred in the home but did not include details about the time or location of accidents. This information may help to identify trends. Risk assessments were seen in the care plans viewed for people that were using bedrails. Bedrails were seen on a number of beds on the nursing floor. Staff must ensure that suitable height bedrails are used when the person uses an inflatable mattress. See recommendation 4. Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 26 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 X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 2 X 3 3 X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 2 Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 27 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. 2. Standard OP7 OP8 Regulation 15 12 Requirement The Registered Person must ensure that care plans reflect people’s needs. The Registered Person must take action to improve staff communication and record keeping on the third floor unit. This includes maintaining food and fluid charts and reporting changes in peoples skin integrity. The Registered Person must ensure that there are systems in place to identify and address medication recording or administration errors. The Registered Person must ensure that residents receive prompt assistance to eat and are positioned correctly. The Registered Person must ensure that adequate records are maintained about complaints. The Registered Person must replace any chairs that have split or damaged covers, replace the damp surface behind the sink in the third floor kitchen and replace the damaged fly screen DS0000007038.V341681.R01.S.doc Timescale for action 21/03/08 22/02/08 3. OP9 13 22/02/08 4. OP15 12 22/02/08 5. 6. OP16 OP19 22 23 22/02/08 18/04/08 Peartree Care Centre Version 5.2 Page 28 7. 8. OP21 OP37 23 17 9. OP27 18 10. OP38 13 11. OP38 13 in the main kitchen. The Registered Person must ensure that the home has a constant supply of hot water. The Registered Person must ensure that all records, including the staffing roster are up to date and legible. The staffing levels on the nursing floor must be reviewed or additional staff must be provided to undertake activities with residents. The commission must be notified about the action that has been taken to address this requirement. The Registered Person must ensure that chemicals or equipment that may pose a risk to residents are stored securely. The Registered Person must ensure that following an accident staff take appropriate action to maintain the persons safety and to prevent a reoccurrence. 18/04/08 22/02/08 22/02/08 22/02/08 22/02/08 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 OP12 Good Practice Recommendations The Registered Person should ensure that all residents have access to a regular and varied programme of activities and outings. Activities should be based on people’s individual interests. The Registered Person should ensure that all residents are able to choose what they eat and the menu reflects the food provided. The Registered Person should ensure that all parts of the home are kept clean. The Registered Person should consider purchasing a supply of extra height bedrails. DS0000007038.V341681.R01.S.doc Version 5.2 Page 29 2. 3. 4. OP15 OP26 OP38 Peartree Care Centre Peartree Care Centre DS0000007038.V341681.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH 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.V341681.R01.S.doc Version 5.2 Page 31 - 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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