Inspection on 31/07/08 for Peartree House

This inspection was carried out on 31st July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Peartree House 02/08/07

Peartree House 23/08/06

Peartree House 07/12/05

Peartree House 09/08/05

Peartree House 02/02/05

Peartree House 23/06/04

Peartree House 17/03/04

Peartree House 17/02/04

Peartree House 11/06/02

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Peartree House 24 Gordon Road Chingford London E4 6BU Lead Inspector Rob Cole Unannounced Inspection 31st July 2008 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 House DS0000007235.V368273.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 House DS0000007235.V368273.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Peartree House Address 24 Gordon Road Chingford London E4 6BU 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) 020 8524 7680 0208 529 9773 pear_tree.house@fshc.co.uk Tamaris (South East) Limited (a wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Brenda Roach Care Home 55 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (1), Old age, not falling within any other category (0) Peartree House DS0000007235.V368273.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Total number of beds to be used flexibly between categories. As agreed on 17th July 2006, one named service user over the age of 65 years, with a mental disorder, can be accommodated. The home must advise CSCI when the service user no longer resides at the home. 2nd August 2007 Date of last inspection Brief Description of the Service: Peartree House is registered to provide accommodation and personal care to 55 elders of either gender, who may have dementia. Peartree House is not registered to provide nursing care. The registered providers are Tamaris, part of the Four Seasons Health Care Group, an organisation that operates a number of residential care homes and nursing homes across the country. The home is situated in a quiet residential area of Chingford, in the London Borough of Waltham Forest. It is close to a shopping centre, and local bus and rail transport links to London and Essex. The home is divided into five areas, comprising 3 communal areas in the main building, and two separate units known as the House and Flats. There are 45 single bedrooms, 28 of which have ensuite facilities, and 5 double bedrooms. The current range of fees charged by the home is between £550 and £595 per service user per week. Peartree House DS0000007235.V368273.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 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place on the 31/07/08 and was unannounced. The inspector had the opportunity of speaking with service users, staff, and the homes manager was present throughout the course of the inspection. The inspection also included observation of staff interaction with service users, a tour of the premisis, and an examination of documents and other records. Prior to the inspection, the home completed an Annual Quality Assurance Assessment (AQAA) at the request of the CSC. The CSCI also issued surveys to service users and their relatives to gain their feedback on the running of the home, six of these were completed and returned. The home is registered to provide care to people with dementia. Because people with dementia are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand. This is called Short Observational Framework for Inspection (SOFI). This involved the inspector observing five people who use the service for one and a half hours and recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use the service, and the environment. What the service does well: What has improved since the last inspection? There have been improvements to the home since the last inspection, and the overall number of requirements set has fallen from thirteen to four. Over 50 of care staff have achieved an NVQ Level 2 in Care or equivalent qualification. There have been improvements in the recording of medications, and CRB forms are now available for inspection within the home. Peartree House DS0000007235.V368273.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. The summary of this inspection report can be made available in other formats on request. Peartree House DS0000007235.V368273.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 House DS0000007235.V368273.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The inspector was satisfied that service users are provided with sufficient information to enable them to make an informed choice about the home before moving in. This information is provided through written documentation, and the opportunity of visiting the home. EVIDENCE: The home has both a Statement of Purpose and a Service User Guide in place. Both documents are written in plain English. The Statement says “Our aim is to provide an atmosphere in which all people in our care, whatever their needs, shall be able to live their lives contentedly in a pleasant and safe environment.” The Statement includes details of the organisational structure, Peartree House DS0000007235.V368273.R01.S.doc Version 5.2 Page 9 the staff team and their qualifications and of the services and facilities provided by the home. Service users are provided with their own copy of the Service User Guide. This includes details of the homes complaints procedure and of the home’s philosophy of care, and is in line with National Minimum Standards. Both documents have been subject to regular review. Individual contracts/statements of terms and conditions are in place for service users who are both privately and publicly funded. Contracts have been signed by the service user (or their representative where appropriate) and a representative of the home. They include details of fees payable and of the services provided. The home has an admissions procedure in place. This makes clear that prospective service users are invited to visit the home before making a decision as to move in or not, and that service users will initially move in on a trial basis. There was evidence that a senior member of staff from the home will carry out a pre admission assessment on proposed new service users. Assessments seen by the inspector were of a satisfactory standard. Assessments are completed on a standardised pro forma with various sections, for example around medication, daily live skills and mental health and well being. Each section is scored depending on the level of need for the individual service user, and there is a section to detail any further relevant information for instance around their personal history. The home does not provide intermediate care. Peartree House DS0000007235.V368273.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): 7,8,9,10 and 11. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. It is the inspector’s judgement that the home is generally meeting the personal care needs of service users. However, the inspector has serious concerns around the practice of administering medications in a covert manner within the home. EVIDENCE: Care plans are in place for all service users. The manager informed the inspector that they are currently in the process of updating care plans, and adopting a more person centred care planning approach. It was positively noted that staff have attended training around this recently. The inspector considers this to be a positive development, and there was evidence that the new care plans are of a higher standard then previous ones. However, some Peartree House DS0000007235.V368273.R01.S.doc Version 5.2 Page 11 care plans are of a better standard then others. One of the revised care plans examined stated that the service user only needed support with taking their medication and with monitoring their mood. The manager informed the inspector that in fact this service user required a lot more support then that from staff, including personal care and support getting dressed. It is a repeat requirement that care plans are comprehensive and sufficiently detailed to enable the home to meet all service users needs in a comprehensive and consistent manner. It was positively noted though that care plans are now a lot more accessible to both service users and care staff who work with them. Risk assessments are in place for all service users, and these are of a satisfactory standard. Assessments cover needs around mobility, falls and pressure ulcers. Assessments identify any particular risk, and include strategies to manage and reduce those risks. The deputy manager informed the inspector that service users are able to retain the GP they had prior to admission where practical, and that all service users are registered with a GP. Records are maintained of medical appointments, including details of any follow up action necessary. Records seen by the inspector indicated that service users have access to health care professionals as appropriate, including district nurses, dental care and chiropodists. Visiting district nurses were observed visiting the home on the day of inspection. The home carries out various health related checks, for example around weight monitoring, and service users are supported by the home with gentle exercise programmes. Used continence products in the home are disposed of appropriately. The home has a comprehensive medication policy in place, and only staff who have undertaken training are able to administer medications. Medications are stored in locked cabinets, inside a designated and locked medication room. One service user is currently prescribed a controlled medication, this is stored appropriately, the inspector carried out an audit of this medication and found everything to be in order. Records are maintained of medications entering the home, and of those that are returned to the pharmacist. The home maintains Medication Administration Record charts, those examined by the inspector appeared to be accurate and up to date. The inspector witnessed a staff member in the process of administering medications. The staff crushed up the tablets for three service users, and mixed them in with their breakfast cereal. The staff member informed the inspector that the reason for this was documented in care plans. The inspector checked one of the care plans, and there was no mention of administering medications covertly. This issue was brought to the attention of the homes manager, who checked other relevant care files, and again, no reference could be found to the administration of medications covertly. Another staff member was spoken to who administers medication to the same service users, who said they were able to administer the medications in the normal manner. A third Peartree House DS0000007235.V368273.R01.S.doc Version 5.2 Page 12 member of staff was spoken to, who said they will offer service users their medication, and then if it is refused the may administer it covertly. The inspector has very grave concerns about this practice. Service users have the right to accept or refuse medications as they choose. The home has a policy in place around covert medications, which was appropriate. This states: “A best interest declaration form must be completed prior to any covert administration taking place.” “There must be broad and open discussion amongst carers, relatives, advocates, GP’s, pharmacists, and agreement that this approach is required in the circumstances.” “The method of administration of the medicine will be agreed with the pharmacist. This will be clearly documented on the residents care plan and MAR sheet.” “The decision and the action taken, including the names of all parties concerned, will be documented in the care plan and reviewed monthly. Regular attempts should be made to encourage the resident to take their medication.” There was no evidence available to suggest that any of the above have been done. It is required that medications are only ever administered covertly when done son in line with the homes policy. The inspector was informed that service users are able to remain in the home with a terminal illness, so long as the home was able to meet their medical needs. The home has sought and recorded the wishes of service user (or their next of kin where appropriate) on the arrangements to be made in the event of their death. Through observation and discussion there was evidence that the home takes steps to promote the privacy and dignity of service users. Service users have access to a telephone that they can use in private, and the home has a visitor’s room where service users can see visitors in private. Staff were seen to interact with service users in a respectful and friendly manner. Service users have been offered keys to their bedrooms, subject to the completion of satisfactory risk assessments. Staff were observed to knock and wait before entering bedrooms. Peartree House DS0000007235.V368273.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): 12,13,14 and 15. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. It is the view of the inspector that service users are generally supported to live valued and fulfilling lives. Food was of a satisfactory standard, and the home provides a varied activities programme. EVIDENCE: Care plans include information on needs around social and leisure activities. The home employs a full time activities coordinator, and an activities programme was on display within the home. The home has a designated activities room. A small shop is run selling sweets, cards, papers etc, and any profits made go into providing further activities. Each weekday morning an activity session is held in the activities room, this may include quizzes, puzzles and activities. In addition to this, the activities coordinator tours the premises, providing activities for service users who do not use the activities room. Peartree House DS0000007235.V368273.R01.S.doc Version 5.2 Page 14 As part of the SOFI carried out during this inspection, the inspector was able to witness the activities coordinator provide a session for approximately ten service users in one of the lounges. The session comprised of a game with a ball and net, along with music and a sing-a-long. It was positively noted that service users were encouraged to participate, and that they were observed to be enjoying this activity. However, after the activity coordinator left, there was far less interaction with the service users, and they became less engaged with their surroundings. Surveys provided by relatives also echoed this, suggesting that at some times there was very little opportunities for activities, one wrote “More encouragement needed for residents to socialise, and more organised entertainment/stimulation would be helpful.” This was discussed with the homes manager, and consideration should be given to encouraging care staff to engage with service users in activities throughout the course of the day. Later on in the day the inspector observed a staff member holding a quiz with service users in another lounge, and service users were seen to be playing a board game in an outside area. Other service users were seen to be watching television, listening to music and reading books. The deputy manager informed the inspector that the home books occasional professional entertainers, for instance musical sing-a-longs, and church musicians visit weekly and play music. Representatives of the Methodist Church, and Church of England and the Church of Rome all visit the home, helping to meet service users equality and diversity needs around religion. One service user visits a local church. They also visit the Strokes Association, which is a social club, where they are able to have a meal and socialize. The SOFI also included an observation of service users around lunchtime in one of the dining areas. There were eleven service users supported by two members of staff. Before the meal arrived, service users were observed to be sitting waiting at the dining tables for approximately twenty minutes. During this time they were seen to be engaged with various objects, such as beakers, cutlery and napkins. It had been noted earlier in the inspection that there were not any objects for service users to engage with. This was brought to the attention of the homes manager, who subsequently arranged for various objects of differing sizes, shapes, textures and colours to be left in the relevant unit. Service users were observed to be served either a fish or a meat dish. The manager informed the inspector that in the morning all service users are asked what they would like for lunch. However, service users in the home often have issues around memory, and in order to promote a meaningful choice it is Peartree House DS0000007235.V368273.R01.S.doc Version 5.2 Page 15 recommended that the home enables service users to make a choice at the actual mealtime, perhaps by showing them the different options available. Food was attractively presented, and appeared to be appetizing. Records of menus indicated that service users are offered a varied and balanced diet, and that fresh produce is used. The kitchen was clean and tidy, and food was stored appropriately. The inspector was pleased to note that the cracked kitchen floor has been repaired since the previous inspection. During the SOFI, it was noted that two of the eleven service users required one to one support with eating their meal. This was provided in a sensitive and patient manner. However, as there were only two staff on duty in the unit at the time, it was also noted that this meant staff had very little opportunity to interact and support other service users at mealtimes, and consideration should be given to the provision of extra staff during mealtimes and other busy periods in the dementia unit. Peartree House DS0000007235.V368273.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): 16,17 and 18. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. It is the inspector’s judgement that the home has appropriate procedures in place around complaints and protection. However, to help safeguard service users, any allegations of abuse must be reported to the host Local Authority who have legal responsibility over such matters. EVIDENCE: The home has a complaints log in place. The manager informed the inspector that no complaints have been received since the previous inspection. There is also a complaints procedure, a copy of which was on display within the home, and all service users are given their own copy included in the Service User Guide. The policy includes timescales for responding to any complaints received, and contact details of the CSCI. There was evidence that service users legal rights are protected. For example, service users are registered with health care professionals as appropriate. The manager informed the inspector that all service users are on the electoral register, and that they are able to vote in elections if they so choose. Peartree House DS0000007235.V368273.R01.S.doc Version 5.2 Page 17 The home has a copy of the Local Authorities adult protection procedure, and also its own policy on adult protection. All but the most recent member of staff to join the home have undertaken adult protection training, and the manager informed the inspector that adult protection issues are discussed as part of the induction procedure for new staff. During the course of the inspection, the inspector asked the manager if the home had received any complaints recently. The manager replied that the daughter of one of the service users had complained to the manager that her mother had said a member of the staff team had hit her, and was able to identify that staff member. The home has treated this as a complaint. However, this is a clear allegation of abuse made by a service user, and the home has a legal responsibility to report any such allegations to both the CSCI, and the host Local Authority. Neither of these things have been done, despite the fact that the manager informed the inspector that the allegation was made about four weeks ago. The inspector informed the manager that they would need to refer this issue to the Local Authority safeguarding adults team and make a Regulation 37 Notification for the CSCI as soon as possible. In order to help ensure that service users are safeguarded from the risk of abuse, and to ensure that any allegations of abuse are investigated appropriately, it is required that the home refer any allegations of abuse to the Local Authority as appropriate, and notify the CSCI. Peartree House DS0000007235.V368273.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 and 26. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. It is the inspector’s judgement that service users are provided with adequate communal and private space. It was noted that although there have been improvements to the décor of the home, there still remains more work to be done before the homes environment is fully in line with National Minimum Standards. EVIDENCE: The home is situated in the Chingford area of the London Borough of Waltham Forest, close to shops, transport networks and other local amenities. The home provides a number of communal lounges, and also a specific area for activities. Peartree House DS0000007235.V368273.R01.S.doc Version 5.2 Page 19 In addition there are a number of places were service users can sit and meet with visitors. All areas of the home are adequately lit. There is a courtyard that is attractively maintained with flowers that service users can enjoy. There is a second courtyard at the rear of the building, which contains plants, flowers and seating, and is accessible to service users. The home has a spacious garden. Thirty-two of the fifty bedrooms are ensuite, and the remaining bedrooms all have hand basins. Toilets, bathrooms and shower rooms are situated throughout the home, in sufficient numbers to meet service users needs. At the last inspection it was found that toilets were dirty and in a poor state of repair. The inspector was pleased to note that this issue has been satisfactorily addressed, and toilets were found to be clean, tidy and free from offensive odour. Bedrooms inspected were decorated to service users personal tastes, and service users were able to bring their personal belongings into the home. Rooms had furniture including wardrobes and chest of draws and chairs. Hand basins are provided in those rooms which are not ensuite. However, as with the rest of the home, several bedrooms are in need of redecorating, and several items of furniture were coming towards the end of their useful life. It was also noted that some bedroom carpets were threadbare. It was positively noted however that several bedrooms have been decorated since the previous inspection, and the manager informed the inspector that there is a rolling programme in place to redecorate all bedrooms to a reasonable standard as they become empty. Bedrooms meet National Minimum Standards on size requirements. All bedrooms have central heating, and all heating appliances in bedrooms are appropriately boxed in. Bedrooms have adequate natural light and ventilation, and lighting was domestic in character. Again, as with bedrooms, there have been some improvements made to the décor of communal areas since the last inspection. There is still more work that needs to be done, for example around the home there are instances of peeling wallpaper and furniture that is coming towards the end of its useful life. One service user commented in their survey that the home “Badly needs decorating/refurbishment.” However, the manager informed the inspector that Four Seasons, the organisation that runs the home, have agreed to ensure that all communal areas are to be decorated to a reasonable and satisfactory standard, and that a programme of works has been drawn up, detailing what needs to be done, and including timescales for this work. The manager further said that it was envisaged that this programme will be completed by the end of 2008, and this is required. Peartree House DS0000007235.V368273.R01.S.doc Version 5.2 Page 20 The home has a policy on infection control, and staff are provided with protective clothing such as aprons and latex gloves. Hand washing facilities are situated throughout the home, and records are kept of water temperatures. The home has a designated storage cupboard for COSHH products, and this was found to be securely locked on the day of inspection. The laundry room was well maintained, with appropriate clothes washing facilities for the home, and each service user has their own clothes basket in the laundry room to help ensure they always only wear their own clothing. At the previous inspection it was noted that service users were able to smoke cigarettes in indoor communal areas of the home. The inspector was pleased to note this practice has since stopped. Peartree House DS0000007235.V368273.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. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. It is the view of the inspector that staff are sufficiently experienced and qualified, and that they have a satisfactory understanding of their roles and responsibilities. EVIDENCE: The home provides 24-hour support, including waking night staff and an emergency on-call procedure. There was a staffing rota, and this accurately reflected the staffing situation on the day of inspection. As part of the SOFI, staff interaction with service users was observed. Positive examples of staff interaction were observed, for example around the provision of activities. Staff were seen to interact with service users in a friendly and respectful manner. Service users spoken to gave positive feedback about the staff, one said “I like them”, while a relative wrote in their survey “I think the manager and the staff are very helpful.” Although another relative wrote “Interaction between carers and residents is not as much as it could be.” Peartree House DS0000007235.V368273.R01.S.doc Version 5.2 Page 22 The AQAA supplied by the home indicates that the home has appropriate employment related policies in place, including on recruitment and selection and equal opportunities. Staff employment files were checked, and these were found to contain all required documentation, including proof of ID, references and enhanced CRB checks. All staff undertake a structured induction programme on commencing work at the home, this includes three days working supernumery shadowing more experienced members of staff in their duties. The AQAA provided by the home indicates that over 50 of care staff employed at the home have obtained a relevant care qualification. Records are maintained of staff training, recent training has included POVA, dementia, IT, infection control, record keeping and pressure ulcers. Peartree House DS0000007235.V368273.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): 31,32,33,37 and 38. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. It is the inspector’s judgement that the homes manager is suitably experienced and qualified, and that appropriate health and safety management systems are in place. EVIDENCE: The home has appointed a new manager since the previous inspection. They informed the inspector that they had very recently completed their probationary period, and that they intended to apply for registration with the CSCI within two weeks of the inspection date. The manager has thirty years Peartree House DS0000007235.V368273.R01.S.doc Version 5.2 Page 24 experience of working in a care setting, including seven years in a managerial capacity. They have successfully completed the Registered Managers Award and an NVQ Level 4 in Care. Staff and service users informed the inspector that they found the manager to be approachable, and staff were observed to interact with the manager in a relaxed manner. A deputy manager has also recently been appointed to the home to support the manager in the running of the home. Various quality assurance systems are in place. The home has copies of previous inspection reports available to view, and there was evidence of monthly unannounced Regulation 26 visits taking place. The home carries out a six monthly Team Audit Process, whereby members of staff in the home audit various areas such as care planning, medication and maintenance. This is then reviewed by the homes manager and senior managers within the organisation. Record keeping in the home was of a generally satisfactory standard, and confidential records are stored securely. Staff and service users can access their records as appropriate. According to the AQAA supplied by the home, the home has all necessary policies and procedures in place in line with National Minimum Standards. Those checked by the inspector, including admissions and medication, appeared satisfactory. Training records indicated that staff have received health and safety training as appropriate, including manual handling and infection control. Fire extinguishers were situated around the home, these were last serviced in November 2007. Fire exits were clearly signed and free from obstruction. Fire alarms are checked weekly, and have been serviced within the past twelve months. The home has emergency call point alarms fitted in all bedrooms, and these have been serviced within the past twelve months. The home has in date safety certificates for PAT testing, gas safety and electrical installation. COSHH products in the home are stored securely, and hot water temperatures are checked. The home has in date employer’s liability insurance cover in place. Peartree House DS0000007235.V368273.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 2 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X 3 3 Peartree House DS0000007235.V368273.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Timescale for action 30/09/08 2. OP9 13 3. OP18 13 4. OP19 OP24 23 The registered person must ensure that all service users have comprehensive individual care plans in place, covering all areas of needs. (Timescale 31/10/07 not met) The registered person must 05/08/08 ensure that medications are not administered in a covert manner, unless it is fully in line with the homes policy on the administration of medications covertly. The registered person must 05/08/08 ensure that the host Local Authorities safeguarding team are notified of any allegations of abuse in the home, as are the CSCI. The registered person must 31/12/08 ensure that the homes plan to redecorate the home is fully implemented, and that all communal areas are decorated to a reasonable and satisfactory standard. Peartree House DS0000007235.V368273.R01.S.doc Version 5.2 Page 27 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 OP12 OP15 Good Practice Recommendations It is recommended that the home give consideration to providing more activities throughout the day and during weekends. It is recommended that the home gives consideration to introducing ways of enabling service users to make a more informed choice around meals, and that extra staffing is provided in the dementia unit during mealtimes. Peartree House DS0000007235.V368273.R01.S.doc Version 5.2 Page 28 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 House DS0000007235.V368273.R01.S.doc Version 5.2 Page 29 - 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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