Inspection on 20/04/06 for Peartree House Rehabilitation Centre

This inspection was carried out on 20th April 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Peartree House Rehabilitation... 28/09/09

Peartree House Rehabilitation... 22/09/09

Peartree House Rehabilitation... 09/07/09

Peartree House Rehabilitation... 19/03/09

Peartree House Rehabilitation... 30/11/05

Peartree House Rehabilitation... 23/06/05

Peartree House Rehabilitation... 17/11/04

Peartree House Rehabilitation... 11/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Peartree House Rehabilitation Centre 8a Peartree Avenue Bitterne Southampton Hampshire SO19 7JP Lead Inspector Janet Ktomi Unannounced Inspection 20th April 2006 9.15 Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 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 Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 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 Adults 18-65. 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 Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Peartree House Rehabilitation Centre Address 8a Peartree Avenue Bitterne Southampton Hampshire SO19 7JP 02380 448168 02380 434260 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) Peartree House Rehabilitation Limited Care Home 42 Category(ies) of Physical disability (34), Physical disability over registration, with number 65 years of age (8) of places Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of persons for whom accommodation and nursing care is provided at any one time shall not exceed 32. The 10 service users who are accommodated in the satellite buildings must be need of personal, emotional and living skills support only. Service users in need of nursing care must be accommodated in the main building only. No more than 8 service users may be accommodated at any one time in the category of PD(E) over the age of 65 years. 30th November 2005 2. 3. Date of last inspection Brief Description of the Service: Peartree House Rehabilitation Centre consists of an extended house, 3 twobedroom bungalows and four self-contained flats within the perimeter of the grounds. The home is situated on the outskirts of Southampton city and is within easy access of Bitterne and local amenities. The home is registered with the Commission for Social Care Inspection to provide nursing care and accommodation for up to forty-two people who have sustained brain injury. The service can accommodate service users between the age of 18 and 65 years. The home has conditions to their registration so that they can accommodate up to eight service users over the age of 65 with physical disability within the registered forty-two beds. Service users who require only personal, emotional and living skills support and have no nursing needs are housed in the flats and bungalows with a dedicated team who enable these service users to live an independent life suited to their capabilities. Peartree House employs a multidisciplinary team that comprises an occupational therapy team, physiotherapists, psychologist, speech and language therapist, a rehabilitation consultant, registered nurses and care staff as well as a full housekeeping staff. The atmosphere at the home was pleasant and the internal décor was well maintained and clean. Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspectors would like to thank the people who live at the home and all staff for their full assistance and co-operation with the unannounced inspection. The inspection was undertaken by two inspectors and lasted approximately nine hours, commencing at 9.15 in the morning and being completed at 6.00 p.m. One inspector spent the majority of their time with the people who live at the home and the various staff employed at the home. The other inspector concentrated on the home’s management, training and administration team viewing records and documentation including care records. A full tour of the building and satellite flats was undertaken. All core standards and a number of additional standards were assessed and compliance with requirements made at the previous inspection in November 2005 was assessed. The inspectors were able to spend time with all staff employed in the home and were given free access to all areas, records and documentation required. The inspectors had limited notice that they were to undertake the inspection therefore no pre-inspection information was gathered other than from the link inspector and Commission records. What the service does well: Peartree House Rehabilitation Centre provides an excellent rehabilitation service for younger adults who have sustained a serious brain injury. Individual service user focused rehabilitation programmes are created by a multi-disciplinary team and these are reviewed at least every six weeks by the team in consultation with the service user and their relatives or representatives. The home employs all the professional disciplines and assistants and has a visiting rehabilitation consultant who attends the home regularly. Health care needs are met by the qualified nurses and GP who has a weekly clinic at the home as well as providing additional consultations as required. The home has a key worker system with service users and relatives being generally able to identify their key worker. The care planning system is comprehensive and service user focused. All disciplines contribute to the care planning process and evaluate their planned care regularly. The staff team is well motivated and is provided with a variety of appropriate training to ensure service users’ needs are fully met. The atmosphere in the Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 6 home is positive and service users are encouraged to reach their full potential towards independence. The home’s environment is maintained to a high standard both in terms of fixtures and fittings and cleanliness. All equipment required for both care and rehabilitation is provided and maintained. What has improved since the last inspection? What they could do better: Supervision is provided by the head of each multi-disciplinary team group. For the smaller therapy teams, physio and occupational therapy this is undertaken regularly, however regular planned supervision has not been occurring for the nursing and care staff. The acting manager has identified that the head nurse is unable to undertake supervision for all members of this large team and a cascade system whereby she supervises the trained nurses who in turn supervise a number of care staff is to be introduced. All staff must receive appropriate supervision from suitably trained senior staff. The home supports a small number of service users with their personal finances. The money is held in one bank account. The administrators hold records as to how much individual service users have in the account, however there is no procedure whereby the interest accrued on the account can be Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 7 divided to ensure all receive the amount they are individually due. A system must be in place in which the home can ensure that all service users receive the correct amount of interest on their savings. The medication system used in the home is appropriate except for the practice of using individual service users’ medication as ‘stock’ supplies (e.g. Paracetamol). Medication belongs to the person for whom it has been dispensed. Due to the size of the home, and all service users being registered with one GP, a bulk prescription system could be considered, alternatively medication must only be administered to the person it has been prescribed and dispensed for. The home has provided a number of new chairs in the lounge. The seat covers must be removed for washing if they become soiled. This resulted in no seat covers being provided on some of the chairs at the time of the unannounced inspection. The home must explore options whereby additional spare seat covers may be purchased. Some bedrooms had a slight unpleasant odour, probably from re-usable urinary night drainage bags. The home must consider options to eliminate unpleasant odours. 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 House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home fully assesses people before they are admitted to ensure that their needs may be fully met at the home. Prospective service users, or their relatives/representatives, are able to visit the home prior to admission. Each service user has an individual written contract. EVIDENCE: The head nurse explained the home’s admission procedure to the inspectors. The pre-admission assessments and care plans for recent admissions were viewed during the inspection. Pre admission assessments are undertaken by at least two members of the multi-disciplinary team. These indicated that potential service users were fully assessed prior to admission and that this information was then used to formulate care plans. Assessments were based on a standardised format that covers all the relevant areas identified in the standards and includes specific assessments in relation to rehabilitation, manual handling, nutrition, mobility, continence and pressure area needs. Following completion of the pre-admission assessment the information gained is presented at the multi-disciplinary team meeting and the team decides if they are able to meet the referred person’s needs and support their rehabilitation. Relatives and representatives are invited to visit the home and discussions are held with funding authorities. Once funding is agreed arrangements are made, where possible, for the prospective service user to Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 10 visit the home. Referrals are received from a wide geographical area and, due to the level of disability, it is not possible for all people to visit the home prior to admission. Where the service user is not able to visit they are able to meet staff during assessment and relatives/representatives are invited to visit the home. The inspectors were able to speak with some visitors during the unannounced inspection who confirmed that they had been given enough information prior to their relative’s admission and had been involved in the assessment and care planning process. Therapy, care and nursing staff stated to the inspectors that they felt able to meet the needs of existing service users and that appropriate numbers of staff are employed to ensure needs are promptly met. Due to the level of disability it was not possible to talk with all service users, however during a tour of the building the majority of service users were seen and all appeared happy and well cared for. Service users spoken with stated that they felt their needs were met and that appropriate numbers of care staff are employed at the home. The inspector was able to meet a number of visitors and these confirmed that they believed their relatives’ care needs were being appropriately met. The home employs an appropriate multi-disciplinary team that has all the necessary equipment and training to meet service users’ needs. All service users have individual written contracts with funding being predominately via health and social services of their home area. Samples of contracts were seen during the inspection and these contained relevant information. Where possible service users are encouraged to sign contracts and are provided with copies of contracts. Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. All service users have individual care plans detailing how rehabilitation, health, personal and social needs will be met. Care plans, service users and staff spoken with confirmed that health needs are met, that staff treat service users with respect and that privacy and confidentiality are upheld. Service users make decisions about their lives and are supported to take risks as part of an independent lifestyle. EVIDENCE: The inspectors viewed a number of care plans for people recently admitted to the home and those who have been resident for a number of years. The care planning system in place is multi-disciplinary focused and records can be documented by any member of the multi-disciplinary team. Pre-admission assessments are completed by at least two members of the multi-disciplinary team. Discharge information from the placing authority and information gained following admission are used to formulate the care plan. The home’s aim is to maximise a person’s abilities via intensive rehabilitation and to enable people to live as independent a lifestyle as possible. The home undertakes Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 12 appropriate risk assessments that are reviewed as part of care plan reviews and when risks change. Risk assessments are aimed to maximise service users’ opportunities not to restrict their lifestyles and choices. The system of care planning is service user focused, with all disciplines involved in the service user’s rehabilitation programme. A multi-disciplinary meeting is held every week, the minutes of which were seen during the inspection. Each week a number of service users are reviewed and discussed with all service users’ care plans being reviewed at least every six weeks. Care plans were seen to have been signed by service users or their representative. A number of service users and their visitors were spoken with and confirmed that they are involved in care planning and reviews. The home has a key-worker system. The key worker may be any member of the multi-disciplinary team with specific involvement with the service user. Key workers spoken with were clear about their roles and responsibilities and attend reviews. Service users are actively encouraged to make choices and decisions. The home employs a speech and language therapist. Staff were able to discuss specific communication needs for individual service users. Where necessary special communication equipment had been provided for service users. Care plans contained information about communication and decision making needs. A number of service users were able to confirm that they are able to make decisions about their daily lives. There is flexibility as to times for people to get up, activities, meals and where in the home people spend their time. People living in the satellite flats and bungalows are encouraged to take greater responsibility for their lives and support as needed is provided. The home has appropriate general and specific procedures to cope with unexplained absences of service users. The inspector discussed with the acting manager specific plans in relation to one service user. The staff handbook contains a section on confidentiality. Confidentiality and sharing of information is discussed during the formal sessions of the staff induction course undertaken by all staff at the home. The confidentiality policy and procedure has recently been reviewed by the acting manager. Copies of this were seen with copies being provided to all staff and signed for on receipt. All information was seen to be stored appropriately with access available only to people who should have access to records. Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home provides service users’ social and leisure activities in a flexible and varied manner. Service users are provided with opportunities to make choices and to have control over their lives. Service users are provided with excellent meals. EVIDENCE: Service users are admitted to the home for rehabilitation. Staff enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. The home has an occupational therapy kitchen where practical life skills can be practised and re-learnt. The home provides a range of relevant activities both as part of their rehabilitation programme and to meet social and emotional needs. Care plans and pre-admission assessments contained information about the service users’ interests and work prior to their brain injury. Where possible these interests are maintained and developed. The home provides lots of activities suitable for Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 14 younger adults. During the inspection service users were seen going out on outings in the local community and engaging in meaningful activity in the home. A service user living in the satellite flats described his weekly plan, which is written down, and was seen to include two days a week of a work placement as well as daily living activities. The home has two cars capable of transporting people in wheelchairs. Records of personal finances and the car log books indicate that service users are provided with free transport for health appointments and charged a standard mileage rate for social and leisure transport. Throughout the unannounced inspection a number of service users had visitors. One of the inspectors was able to talk with some of the visitors. Those spoken with stated that they are able to visit whenever they wish and are always made to feel welcome. The home has internet and telephone systems available for use by service users to enable them to maintain contact with family and friends, some of whom may live a considerable distance from the home. The internet also provides opportunities for people to make new friends and chat on line. As required following the previous inspection the acting manager has reviewed a number of policies concerning relationships. All staff are provided with copies of updated policies and procedures and the list which they have signed to confirm receipt was seen. The acting manager is reviewing some additional policies and procedures concerning relationships and will forward copies of these to the Commission once completed. Service users informed the inspectors that they are able to go out with their friends and other service users who live at the home. As previously stated service users are actively encouraged to make choices and decisions with communication assessments and equipment provided where necessary. Service users are provided with keys to their bedrooms if they wish one. Service users in the satellite flats were clear about their responsibilities for domestic and cooking activities. The arrangements for meals and food at the home were assessed. The range and quality of food available was considered excellent. A copy of the menus for two weeks were viewed and seen to contain a varied nutritious diet appropriate for a younger adult group. All food is freshly cooked at the home therefore menus may change depending on availability of fresh ingredients. Two main meal options, including a vegetarian choice, are available every day. Alternatives such as jacket potatoes, omelettes, sandwiches, etc. are also available. Good food stocks with lots of fresh produce, meat, fish, vegetables and fruit were seen. Service users and staff can have snacks at any time with main meals being held over if they are out of the home at meal times. The head chef consults with the dietician to discuss menus and nutritional needs of specific service users. Service users and visitors were very positive about the Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 15 food provided and stated that they are consulted about menus and asked their opinions. The home employs a speech and language therapist who assesses service users’ eating and drinking needs, the results of which are incorporated into care plans. Special equipment is provided when required and food and drink can be provided at the required consistency for service users with swallowing difficulties. As part of the induction process all staff attend an empathy workshop that includes being assisted to eat and trying thickened fluids. Some service users are unable to eat or drink and are fed via PEG systems. Discussions with the qualified nurses, care practices witnessed and documented in care plans indicate that they are fully aware of how to support people with PEG systems. Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Staff provide personal support to service users and ensure that dignity and privacy are maintained. Dignity for some service users is compromised by the lack of spare lounge seat covers and the use of re-usable night drainage bags. Health care needs of service users are assessed and recognised with procedures in place to address them. The arrangements for medication within the home are generally appropriate although the home must not use individual service users’ medication as a stock supply (e.g. Paracetamol). EVIDENCE: The privacy of service users is seen as a right by the staff. All bedrooms are single ensuring privacy and dignity during personal care tasks. Care plans contained moving and handling assessments and details as to how individual service users should be moved and what equipment should be used. As previously stated the home has a key worker system with key workers spoken with being clear about their roles and responsibilities. Service users stated that staff support their personal care needs in a caring and dignified manner and feel the staff respect their privacy. All staff undertake an empathy workshop as Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 17 part of their induction training which enables them to experience receiving various care situations. The home’s environment is of a high standard however the dignity of some service users may be compromised by the unpleasant odour in some bedrooms. The inspectors believe this may be due to the reusable night drainage bags kept in the rooms. The home should consider alternatives or minimise the unpleasant odour. The home has provided a number of new lounge chairs. A number were noted to be without seat covers as these were being laundered. Again dignity could be compromised by service users having to sit on lounge chairs without seat covers and diminishes the overall appearance of an otherwise pleasant lounge. The home employs a full multi-disciplinary team of rehabilitation therapists and assistants including, rehabilitation consultant, physiotherapist, occupational therapists, speech and language therapists, GP, psychologist, aromatherapist, qualified nurses and care staff. Service users have the technical aids and equipment needed to maximise their independence. Healthcare needs are fully assessed following admission by the local GP who is contracted to provide a clinic one day per week to the home. At other times the nurse in charge can arrange for service users to see the GP at the local health centre or a home visit can be arranged. The home provides transport and escorts for GP or hospital appointments free of charge in one of the two house cars. Specific health needs are recorded in care plans and service users’ weight is monitored on a regular basis. The handover from the morning qualified nurse to the afternoon qualified nurse was observed and contained information about changes in health needs of service users. The head nurse informed the inspectors that no service users within the home have pressure injuries. The inspector viewed the policies and procedures for the home with regards to the ordering, receiving, administration and disposal of medication. Medication received into the home is booked in via the MAR sheets stating quantity, date and signature of nurse checking medication into the home. As with all care homes with nursing the home is no longer able to return unused medication to the pharmacy and has organised disposal contracts with an external company who provide the destruction kits for the home. Medication, including controlled drugs and those that require to be kept cool, were found to be appropriately stored within the home. Fridge temperatures were seen to be recorded. The home maintains information on the medication held in the home with a copy of MIMMS seen during the inspection. The head nurses stated that the GP has confirmed that medication that is not available in liquid form can be crushed for administration via PEGS. During the inspection of the medication it was noted that Parecetamol prescribed and dispensed for one service user was being used as a stock Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 18 supply and administered to other service users. This practice must stop and the home must only administer medication to service users for whom it has been dispensed. The home may wish to consult their GP and pharmacist with a view to bulk prescribing of frequently used ‘as required’ medications such as analgesics and laxatives. Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home has a complaints policy with service users’ opinions sought and respected by staff. The home protects service users from abuse. EVIDENCE: The home has a clear and thorough complaints procedure, information about which is available in the service users’ guide and residence agreement. Staff have been provided with a copy of the recently revised complaints procedure and signed to confirm that they have received a copy. Service users and visitors spoken to stated that if they had any concerns they would feel happy to raise these with their key worker or another member of staff. Care staff spoken with were aware of the action they should take should a service user or one of their relatives wish to make a complaint. The administrator informed the inspector that there had been no complaints since the previous unannounced inspection. Interactions observed between service users and staff during this unannounced inspection were warm and positive and it is the inspector’s opinion that service users or their relatives would feel able to express concerns to staff or the manager. As required following the previous unannounced inspection undertaken in November 2005, the acting manager has undertaken CPD Accredited adult protection training provided by The Royal Society, London in February 2006. The content of the course was provided to the inspector and contained both general and specific information relevant to protecting people in residential settings. The acting manager stated that this information is now being cascaded to all other staff employed in the home. The acting manager has Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 20 further developed her knowledge of the local procedures for adult protection with joint working with the local social services team as part of a recent investigation. Training programmes for 2006 were supplied to the inspector. These detailed adult protection and whistle blowing training (afternoon, evening and night) sessions were planned monthly from May 06 and would be available for all staff. The policy and procedure for accidents and incidents has been updated and directs staff to consider if an incident may constitute adult protection and the action that may be required. Care plans were seen to contain risk assessments and management plans for individuals whose behaviour may be challenging to staff or behaviours that may place the service user at high risk. The home has a full and comprehensive recruitment procedure that should ensure that unsuitable people are not employed in the home. The home has relevant policies and procedures related to adult protection such as whistle blowing, confidentiality and gifts to staff. The acting manager is currently completing a review of a number of policies and procedures concerning relationships. The home does not generally become involved in service users’ personal finances, however it does support a small number of people for whom there is no other option. The records and arrangements for service users’ personal finances should ensure that they cannot be financially abused with the exception of interest in a bank account holding six people’s savings. The home must identify an alternative savings account that will ensure individual service users receive the interest gained on their own savings. Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home provides an appropriate individual, communal, therapy and ancillary environment for service users and staff. A slight unpleasant odour was noted in some bedrooms, possibly due to the night drainage bags and alternative options or methods to reduce odours must be considered. The home must consider purchasing additional lounge seat covers to use when covers are being laundered. EVIDENCE: One inspector undertook a full tour of the home with a member of staff and discussed the environment with some service users, visitors and staff. The home comprises of a large older house that has been extended to provide a purpose built environment for the service user group accommodated at the home. The home also occupies another house providing more independent flats and three bungalows in the road beside the home. All buildings that comprise the service can be accessed from the grounds. The home has pleasant flat gardens to the rear and adequate parking to the front of the Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 22 home. All areas of the home are accessible to service users with a lift provided to first floor bedrooms. The home was found to be well maintained throughout and provides all single bedrooms, appropriate communal areas and space for therapist, nursing, ancillary and administration staff. Furnishings, fittings, adaptations and equipment are good quality and are as domestic, unobtrusive and ordinary as is compatible with fulfilling their purpose. The home has a planned maintenance and renewal programme for the fabric and decoration of the premises. Nursing staff stated that bedrooms are redecorated prior to new service users moving into the home. The inspectors noted a large quantity of equipment as required by the service users, however storage for (especially moving and handling) equipment is limited. As stated all bedrooms are for single occupancy and meet the space required by the service users. Discussions with the acting manager indicated that consideration is given as to where in the home vacant rooms are located when a new service user is considered for admission. All bedroom doors are fitted with locks and service users are supplied with keys should ability and risk assessment indicate this is appropriate. The dignity of some service users may be compromised by the unpleasant odour in some bedrooms. The inspectors believe this may be due to the reusable night drainage bags kept in the rooms. The home should consider alternatives or minimise the unpleasant odour. A requirement in respect of this has been made under Standard 18 as this compromises the dignity of service users. All bedrooms are fitted with a suitable call system. The satellite flats and bedrooms are linked to the main house via a call system should staff working in these areas require additional assistance. The home provides a range of comfortable, safe and fully accessible communal space for relaxing and activities. The home has provided new lounge chairs. A number were noted to be without seat covers as these were being laundered. Again dignity could be compromised by service users having to sit on lounge chairs without seat covers and diminishes the overall appearance of an otherwise pleasant lounge. A requirement has been made under Standard 18 that the home must purchase a supply of spare seat covers so that covers may be replaced when one is removed for laundering. Externally the home has pleasant rear gardens that staff stated are popular in the warmer months, with level pathways allowing service users independent or supported access to all areas of the garden. The home provides a wide range of specialist equipment and environmental adaptations appropriate for the service users. Some of this equipment is general whilst other is specific to individual people living at the home. The home employs its own physio, speech and occupational therapist who undertake assessments for the most appropriate equipment to maximise Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 23 independence for service users. Servicing arrangements for equipment were seen during the inspection. With the exception of some bedrooms already described the home was found to be very clean and free from offensive odours. The home employs housekeeping staff responsible for domestic and laundry activities. All laundry is done on site at the home with the laundry facilities being appropriate and able to wash to high temperatures if required for infection control. The home has the necessary equipment, policies and procedures for infection control, with all new staff receiving training in infection control as part of their induction training. Update training in infection control is also provided and seen on the 2006 training programme. Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home employs appropriate numbers of registered nurses, therapists, care staff and ancillary staff to meet the needs of service users. A comprehensive recruitment, induction and training programme should ensure that unsuitable people do not work in the home and staff have the necessary skills required to meet service users’ needs. The home must ensure that all staff have formal supervision. EVIDENCE: The Department of Health has yet to publish staffing guidelines for care homes with nursing as provided at Peartree House Rehabilitation Centre. Nursing and care duty rotas confirmed the acting manager and head nurse’s opinion that the home provides sufficient staff numbers to meet the needs of service users. The home provides twelve nursing/care staff throughout the day (two or three of whom are qualified nurses) in the main house with the satellite units having their own staff teams. In addition to the nursing/care staff employed the home also employs a wide range of therapists, activities, catering, domestic, maintenance and administrative support staff. Service users and visitors spoken with during the inspection reported that staff were prompt in answering call bells and that they felt care staff had sufficient time to meet their needs. Care and nursing staff stated that there were adequate numbers of staff Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 25 employed at the home to meet service users’ needs and that everybody worked together as a team. The home operates a key worker system, the key worker being any member of the multi-disciplinary team. Key workers were clear about their roles and responsibilities and stated that they attend reviews for their named service user. The inspector was able to talk with the home’s training co-ordinator who supplied information as requested in respect of NVQs, induction and staff training undertaken and planned for 2006. 2006 training costs budget information for external courses was also supplied to the inspectors. The inspectors discussed training with staff during the inspection. All staff are provided with opportunities to undertake NVQs which are offered in Domestic (level 1), Hotel and Hospitality (level 2 and 3), Health and Social care (level 2 and 3) and NVQ level 4 Registered Manager’s Award which the acting manager was undertaking. The home employs a total of forty-five care staff, thirty of whom have at least NVQ level 2 in Care (two with level 3). This equates to 66 . Planned training budget indicated that eight additional care staff are undertaking NVQ level 2 with further training included in the budget for 2006. Training records supplied indicate that all mandatory and relevant additional training is provided to all staff to ensure they are able to meet service users’ needs. The home employs a training co-ordinator who organises the training programme and has access to a specific budget for purchasing external training and NVQs. Care, nursing and therapy staff confirmed that there is lots of training available and this is of good quality and relevant to their work. The home’s recruitment procedure was discussed with the acting manager and records of newly recruited staff viewed. Service users are informally involved in the recruitment process and meet applicants whilst they are shown around the home. The acting manager stated that she observes interactions between service users and applicants and asks service users their opinions. All the required pre-employment checks were seen to have been completed in the staff files viewed. The training co-ordinator described the induction procedure and the training programme for 2006 included dates of induction for new staff. This comprises of a two day course in the home covering all mandatory and supplemental induction training required. All staff, care, domestic and therapy undertake the same induction training. Staff receive additional supervision during the induction period and have a six month probationary period before a full contract is supplied. Staff files seen contained job descriptions and information for staff about essential policies and procedures. Supervision is provided via the heads of the various multi-disciplinary teams. The home has a set format and recording tool available for supervision, this Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 26 was seen. Supervision has presented some problems for the larger nursing and care team for whom regular supervision has not been provided. The home is waiting for the new manager to commence employment as acting manger and head nurse have insufficient time to undertake all supervision for the large nursing and care team. The home plans to introduce a cascade system for this team, with the head nurse supervising the qualified nurses and qualified nurses supervising an allocated number of care staff. This should resolve the problem of supervising a large team however it is essential that qualified nurses not previously undertaking this role are provided with training in supervision. Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 39, 40, 41, 42 and 43 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home has a management structure which all staff are aware of and creates an open, positive and inclusive atmosphere. The home must initiate a procedure to ensure that all staff have an annual appraisal and supervision sessions at least every two months. All records within the home were found to be well maintained and appropriately stored. The home provides a safe place for service users, visitors and staff. EVIDENCE: The acting manager has successfully managed the home since the previous manager left at the start of January 2006. A new manager has been appointed and should commence employment in May 2006. The new manager is aware of the recent changes in the registration process with the Commission. The acting manager provided the inspector with copies of the questionnaire provided to relatives and visitors in November 2005 and the service users’ Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 28 questionnaire and responses undertaken at the same time. Service users stated that they are involved in discussions about their care plans and involved in reviews. The chef stated that he regularly consults with service users about meals provided and menu options. Regulation 26 reports are received monthly at the Commission. These are appropriately recorded and indicate that service users, visitors and staff are provided with opportunities to discuss any concerns with the representative of the provider. The acting manager has reviewed a number of policies and procedures as required following the last inspection undertaken in November 2005. Copies of revised policies and procedures were seen during the inspection, these being abuse, record keeping, complaints, confidentiality, whistle blowing and data protection. Copies of revised policies are provided to staff who sign to confirm that they have received the new documents. The acting manager intends to review some more procedures (relationships) as part of the ongoing monitoring of policies and procedures. Some policies and procedures were viewed and these appeared appropriate. Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. The home has recently reviewed its record keeping policy and procedure and training in record keeping is planned for 2006. The home is a safe place for service users, visitors and staff. The home provides a clear set of health and safety guidelines, copies of which are available for staff. Staff training records confirmed that staff receive induction and update training in moving and handling, fire safety, food hygiene and infection control. The servicing records for equipment and service (gas and electric) were seen. The home has improved its systems for notification of incidents to the Commission. The home would appear to be financially viable, with a high occupancy level, and referrals waiting to be admitted. The home’s insurance certificate was seen and provides the necessary cover for the business. Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 2 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 4 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 3 3 3 3 3 Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 30 no 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 YA18 Regulation 12(4)(a) Requirement The home must ensure that there are no unpleasant odours in bedrooms and that a supply of spare lounge seat covers are available. Medication prescribed and dispensed for one service user must not be used as a stock supply and administered to other service users. Consideration of bulk prescriptions should be undertaken. The home must ensure that service users receive the interest due to them from their savings and money held in the pooled service users’ account. All staff must receive supervision from appropriately trained senior staff. Timescale for action 01/06/06 2. YA20 13(2) 01/05/06 3. YA23 20(1) 01/07/06 4. YA36 18(2) 01/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000011441.V291729.R01.S.doc Version 5.1 Page 31 Peartree House Rehabilitation Centre Standard Peartree House Rehabilitation Centre DS0000011441.V291729.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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. 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