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Inspection on 28/09/09 for Peartree House Rehabilitation Centre

Also see our care home review for Peartree House Rehabilitation Centre for more information

This inspection was carried out on 28th September 2009.

CQC 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service has done well to address the management and organisational issues which have resulted in the initial non-compliance and serviing of the Statutory Requirement Notice. Nursing and care staff spoken with were positive about the changes that have been made and felt that training received had equipped them to meet people`s needs and increase their confidence.

What the care home could do better:

The service must ensure that that the improvements that have been made as a result of the external consultants and short term managers are embedded in practise. The service has been without a registered manager since December 2008 and must ensure that the manager who is due to join the home at the end of October 2009 registers with the commission.

Random inspection report Care homes for adults (18-65 years) Name: Address: Peartree House Rehabilitation Centre 8a Peartree Avenue Bitterne Southampton Hampshire SO19 7JP one star adequate service 19/03/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Janet Ktomi Date: 2 8 0 9 2 0 0 9 Information about the care home Name of care home: Address: Peartree House Rehabilitation Centre 8a Peartree Avenue Bitterne Southampton Hampshire SO19 7JP 02380448168 02380434260 lesley.humphrey@peartreerehab.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Peartree House Rehabilitation Limited care home 46 Number of places (if applicable): Under 65 Over 65 0 physical disability Conditions of registration: 46 The maximum number of service users to be accommodated is 46. The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Physical disability (PD) Date of last inspection Brief description of the care home Peartree House Rehabilitation Centre consists of an extended house, 3 two-bedroomed bungalows and four self-contained flats and a four bedroomed house 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 Care Quality Commission to provide nursing care and Care Homes for Adults (18-65 years) Page 2 of 10 0 9 0 7 2 0 0 9 Brief description of the care home accommodation for up to forty-six people who have sustained an acquired brain injury. The service can accommodate people over the age of 18 years who have a physical disability on admisison. 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 according to to their capabilities. Service users who need nursing care are accommodated in the main house and the four bedroomed house named Wyncroft. Peartree House employs a multidisciplinary team that comprises an occupational therapy team, physiotherapy, psychology, speech and language therapist, a rehabilitation consultant, dietician, registered nurses and care staff as well as a full housekeeping, maintenance and administration staff. The home is owned by Peartree House Rehabilitation Limited and does not have a registered manager. Care Homes for Adults (18-65 years) Page 3 of 10 What we found: Two inspectors visited the home on the 28th September 2009 to undertake an unannounced random inspection to assess compliance with a Statutory Requirement Notice. The home had a key unannounced inspection in March 2009 when seven requirements were made. A random inspection was undertaken in July 2009 to assess compliance with the requirements made following the key inspection. This identified that only one of the seven requirements had been met. A Statutory Requirement Notice was issued on the 4th September 2009 with a compliance date of the 17th September 2009. A pharmacy inspector was present at the random inspection in July 2009 and undertook a random inspection on the 22nd September 2009 to assess compliance with the medication requirements on the Statutory Requirement Notice. The pharmacy inspector found that the requirements in respect of medication had been met. A separate random inspection report was written to report the findings of the pharmacists inspection visit. The Statutory Requirement Notice made requirements in respect of the homes care planning and risk assessments. The home was required to:(i) Ensure that all service users care needs are fully identified and documented in a care plan, which contains sufficient detailed information on their care needs and guidance necessary for staff to support service users and minimise risk and fully meet their needs. (ii) Have a system in place to ensure that care plans for service users are kept under review and updated when necessary to reflect the changing and current needs of individuals. The temporary manager informed the inspectors that the care planning and risk assessment process has been completely revised with support from an external clinical nurse specialist. The temporary manager stated that the majority of the care plans were now in the new format and she anticipated that the remainder would all be completed by the end of October 2009. The temporary manager stated that there had been work on the care plans that remained in the original format such that they also now contain all the required information. We looked at four care plans, three in the new format and one in the old format. The new format care plans contained combined care plans and risk assessments making it clearer and easier to follow. Care plans are produced on computers and therefore easier to read than the previous hand written format. Care plans viewed were individual and personalised and the previous generic forms had been removed with individualised support plans and risk assessments now in place. Care plans contained clear guidance for staff as to how peoples needs, including those related to personal, health and behavior needs should be met. There was also evidence that peoples wishes were being considered in care planning and risk assessment. Care plans contained review dates although most were too new to have been reviewed at the time of the unannounced inspection. Nursing and care staff stated that they had received training in the use of the new care Care Homes for Adults (18-65 years) Page 4 of 10 plans and were positive about the new formats stating care plans are much more detailed and have more information. The old ones were not clear. Another staff member commenting we were shown all care plans, how they work and where they are kept. training in this subject was very good. I now feel confident to use them. The old ones were very hard to understand, handwritten and difficult to follow. Nursing and care staff were also aware of the need to ensure that accurate records are maintained and that it is important to ensure that action if required is taken, things have improved I am more aware of what to do now, for example we just kept recording things like the fridge temperatures without doing anything. The home will need to ensure that the improvements in respect of the homes care planning and risk assessment processes are sustained and embedded in practice. The requirements in respect of care planning and risk assessments have therefore been complied with. The Statutory Requirement Notice contained a requirement in respect of safeguarding and protecting service users from abuse in that it must:(i) ensure a system is in place to ensure that all staff members receive training in protecting service users from abuse. (ii) Ensure a system is in place to ensure all staff are fully aware of the policy and procedures for the reporting and responding to allegations of abuse. And (iii) Ensure a system is in place that ensures all allegations or suspicions of abuse are fully documented and reported to the local authority safeguarding team without delay. The temporary manager explained the approach that had been taken to ensuring that staff are fully aware of all safeguarding issues. She stated that meetings have taken place to emphasis the importance of reporting all incidents. Reporting procedures have been circulated to all staff. The temporary manager provided evidence of meetings and memorandums to support this. Information provided to staff contained the contact address of Southampton social services safeguarding team and it is advised that the telephone number be added to this. The temporary manager showed the inspectors the homes training matrix which evidenced that staff have all received safeguarding training. Additional training in other topics related to safeguarding including challenging behaviour have also occurred and more training was planned for October and November 2009. Nursing and care staff confirmed that they had received safeguarding training and were clear on reporting procedures for any allegation of abuse and clear about the need to report to social services. The requirement in respect of safeguarding has therefore been met. The Statutory Requirement Notice also made a requirement in respect of the food provided at the home as it had been identified in previous inspections that there was a long gap between the last meal at about 5pm and breakfast the next morning. The Service was required to:(i) ensure a system is in place to provide service users with suitable wholesome food at Care Homes for Adults (18-65 years) Page 5 of 10 all times. (ii) Ensure service users wishes in respect of their dietary requirements in the evening are fully recorded in their care plan and kept under review. We were shown the supper and snack menus. These listed an extensive range of hot and cold snacks and drinks available to service users. Since the previous random inspection in July 2009 the home has introduced a new recording system for supper and evening snacks. This record clearly shows what people have had for supper. We saw that some service users had refused the offer of supper and this was recorded on the chart together with the snacks that the individual was offered. This record demonstrated that a variety of different food options are being provided to service users including sandwiches with various fillings, fruit and yoghurts. The care plans we looked at now contained information on service users wishes in respect of nutrition. This included their mealtime preferences, for example; the plan of a service user detailed the particular food likes and dislikes including healthy eating options. The recently introduced supper record showed that this person was offered snacks each evening in keeping with their wishes as recorded in their care plan. We spoke to the temporary manager who told us that this now part of the evening tasks for night staff who ask each service user what they want and then prepare what has been requested. The temporary manager told us that the night staff are responsible for keeping the record up to date. Nursing and care staff that we spoke to knew about this new recording system and confirmed that people are now provided with a supper by the night staff. For the purposes of the statutory requirement notice this requirement is met however it would be of direct benefit where supper meals and snacks are refused that regular evaluations of the nutritional well being of those individuals is undertaken to ensure all options are considered and any action is taken as needed. The Statutory Requirement Notice also required that staff receive training;(i) Ensure a system is in place to provide all staff working in the home with training in all mandatory areas including first aid, health and safety, moving and handling, food hygiene and protection from abuse. (ii)Ensure staff have specific training in areas to meet the assessed needs of service users including acquired brain injury and challenging behaviour. The temporary manager showed the inspectors a copy of the up to date training matrix and training plan up to December 2009. The training matrix evidenced that staff have now completed all mandatory and some service specific training and that further service specific training is planned for October and November 2009. The temporary manager stated that in December 2009 a training plan for 2010 would be produced which would show when individual staff require updates. Nursing and care staff confirmed that they had received lots of training and that more was scheduled for the coming months. Staff were positive about the training they had received and stated that this had given them more confidence to complete their jobs and to understand why they had to do certain things. Staff were able to demonstrate knowledge gained from training they had undertaken. Care Homes for Adults (18-65 years) Page 6 of 10 The requirement in respect of staff training has therefore been met. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 19 12 The responsible person must 15/08/2009 ensure that all health and personal care needs are met and that there is evidence to demonstrate that this is the case. So that people are safe and have their needs met. 2 41 12 The responsible person must 15/08/2009 ensure that all records are accurately and fully completed. So that people are safe. Care Homes for Adults (18-65 years) Page 8 of 10 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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