Inspection on 25/10/05 for Pembroke House

This inspection was carried out on 25th October 2005.

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

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

Other inspections for this house

Pembroke House 30/05/07

Pembroke House 10/02/06

Pembroke House 21/03/05

Pembroke House 26/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Pembroke House 11 Oxford Road Gillingham Kent ME7 4BS Lead Inspector Anne Butts Announced 25 October 2005 09:30 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 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. Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Pembroke House Address 11 Oxford Road Gillingham Kent ME7 4BS 01634 852431 01634 281709 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Royal Naval Benevolent Trust Mrs Carole Lilian Mary Davis Care Home with Nursing 50 Category(ies) of Old Age (50) registration, with number of places Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1) 44 bedspaces are suitable for the accommodation of service users requiring nursing care. 2) The remaining 6 bedspaces to accommmodate service users with social care needs only. Date of last inspection 21 March 2005 Brief Description of the Service: Pembroke House provides residential and nursing care for former sailors, Royal Marines, their wives and widows. The Royal Navel Benevolant Trust owns and manages the home and is a non-profit organisation. It is a large detached property located in a residential area of Gillingham, Kent and is within walking distance of shops and a large local park. Public transport, (rail and bus) are located approximately half a mile away. The home was originally built in the 1920s, and was extended and modernised in 2000 and offers accommodation for fifty service users. All rooms have en suite toilet facilities and are fitted with television and telephone points. Accommodation is on three floors and is served by two lift shafts. Each level has its own dining room and day rooms. On the ground floor the three day rooms can be opened up to provide a large function room with a purpose built bar. There is a library on the first floor and two conservatories, overlooking the gardens. On the top floor there is a large day room, which is known as The Bridge, which provides impressive views over the river. The gardens are wheel chair accessible, and there is parking to the side of the home. The home employs care and nursing staff that work a roster that gives twentyfour hour cover, and they are supported by a full time activities co-ordinator and staff for catering, domestic and maintenance tasks. Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 25th October 2005 and it found that the overall quality of care was excellent. The focus of this visit was to concentrate on standards not inspected at the previous inspection as all were either met or exceeded at this time. Service users and their families were spoken to during the day, as well as members of staff. A tour of the home was undertaken and records were viewed. A full pharmaceutical inspection was also carried out, and as this was the first the home had undergone this resulted in some requirements and recommendations being made, and this was treated as a positive move by the home and does not detract in anyway from the overall care. What the service does well: What has improved since the last inspection? As this was the first inspection carried out by this inspector and the aim to cover the standards that had not been focused on in the previous inspection – it is difficult to pinpoint any particular areas of improvement. However it was Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 6 noted that the home is continually striving and looking for ways to improve its’ practices and is looking to further improve it’s quality assurance process’s for the benefit of the service users. 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. Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 Service users and their families are given a range of appropriate information to make an informed decision about moving into the home. This information provides a clear and accurate view of the services provided. EVIDENCE: The statement of purpose has recently been reviewed, and this covers all the information that prospective service users and their families would need to know about the home. It also contains comments from service users and their families about the care provided by the managers and staff at Pembroke House, and all these were very complimentary, however these would benefit form being updated with more recent comments that have been made. A welcome pack is issued to all service users and this contains a brochure on the home, a service users guide that includes a summary of the statement of purpose, complaints procedure, resident’s charter, and homes philosophy and fire instructions. A copy of the last report is also made available. Families of service users confirmed that prior to moving into the home they were given full information about the support that would be provided and one family member stated, “We have been fully supported through a traumatic period of our lives”. Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 9 and 10 Whilst the service users are very largely protected by the home’s policy and procedures with regard the management of medicines some slight improvements in this area are needed. The care needs of service users are well met, promoting and protecting their privacy, dignity and independence. EVIDENCE: The home has comprehensive policies and procedures for medicine handling and administration. Self-administering service users are provided with a lockable space for their medicines. Service users visited were generally coping well. Receipt, administration and disposal was well recorded throughout the home and hand transcriptions were clear and double signed. Each floor has a fully equipped clinical room for storing medicine but it was noted that the airconditioning temperature was set to be too cold. Keys are kept securely. Medicine timing was appropriate in most cases but not for two antibiotics that had to be administered an hour before food. There was a lack of criteria in the care plan for administering some “as required” medicine. An altered dose on a medicine label was observed, but the manager was aware of this and had taken steps with the pharmacist for this to be amended. The Controlled Drug (CD) cupboards were not bolted to the wall. Training has been provided by Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 10 West Kent College and there are regular monthly audits with regards to medication and appraisals are carried out on a yearly basis where training is reviewed. Staff are instructed as part of their induction process on how to treat service users with respect and dignity at all times. During the course of the inspection process staff were observed inter-acting well with service users. Discussions with relatives and service users also re-iterated this, and one comment was “part of the care, here, is to listen to needs and they promote dignity. It is always a priority”. Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 Social activities are provided with a wide range of choices available that are well organised, creative and provide stimulation and interest for people living in the home. Service users are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. Service users benefit from meals that support choice and offer a balanced and nutritious diet EVIDENCE: It was clearly observed that daily living and social activities are a high priority within the home. There is a full time activities co-ordinator who concentrates on a full and varied programme. These include in-house activities such as arts and crafts, bingo, light exercises, quizzes and entertainment from singers. One relative also stated “staff spend quality time with the residents, including reading the newspaper to anyone who wants”. There are also a variety of external trips including going to concerts, trips to London and local sights. The home is fortunate in that the Royal Navel Benevolent Trust supports it and many of the activities are supported and sponsored by them and outside organisations – as all service users have navel connections many activities are geared towards these interests. There was an arts and crafts group, who were working on gifts and crafts, which they intended to sell at their Christmas Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 12 Bazaar. This was a happy noisy group, who were listening to music and laughing and joking and thoroughly enjoying themselves. A weekly list of activities is placed around the home so people can choose which activities they would like to join in. One relative spoken to stated that “her mother had recently moved into the home, and was shy about taking part in trips, as she felt that other people would have priority as they have been here longer.” She went to state that after having spoken to the manager “the staff were now promoting and encouraging her mother in taking part in some activities”. Evidence was seen on the day, and gained through talking to relatives that their participation in the home is promoted and supported. Comments from relatives included “We are always made welcome and the staff are very friendly and make time to talk to us. This is very unusual in this day and age” “We are completely involved in our … care, and we can join in some of the activities”. “We can visit whenever we want, and we feel that we are part of the home” The home also provides private areas for visitors, and also will arrange for visitors to have a meal with their relatives if they wish. Menus were varied, and also cater for differing tastes and choices. The menu was quite extensive and all main meals offered a choice of starter, main course and dessert. Service users spoken to confirmed that the meals were always very nice, and also if they did not want anything on the menu an alternative would be offered. Service users can choose as to which dining room they prefer to have their meals, and the food is appropriately transported to the different dining areas. Menus are also discussed at meetings with service users which enables them to have an input into the choice of meals which are available. Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Service users and their relatives can be confident that their concerns are listened to and acted upon appropriately, and that confidentiality is protected. EVIDENCE: There is a full complaints policy and procedure in place, and is in the Service Users Guide. There are timescales in place and includes how to speak to outside organisations if it is felt that the complaint has not been dealt with appropriately in house. Although this standard was not fully inspected it was noted through talking to a relative that the home had dealt with some concerns that had been raised by the family. The family felt that their concerns were listened to and acted upon. On raising their concerns immediate action was taken, and fully investigated and also dealt with in an appropriate and sensitive manner, which protected the confidentiality of the relative and did not distress the person living in the home. They felt that the outcomes were more than satisfactory and it was dealt with in a professional manner – in which they were kept fully involved. Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 25 and 26. Service users benefit from living in a pleasant, largely well-maintained, clean and homely environment that offers privacy and comfort and caters for their needs. Service users can be confident that those are areas of the home that require refurbishment are being addressed to ensure that they have safe access to all indoor and outdoor communal areas. EVIDENCE: A tour of the environment was undertaken – although service users bedrooms were not viewed at these were inspected on the previous occasion. There is currently some environmental work being carried out as it has been identified that some areas of the home may pose a risk to service users – namely the floor in the corridor near the main entrance area is uneven, a rear balcony has been identified as in need of attention and some pathways at the side of the home are uneven. All areas which have been identified as posing a risk to service users have been either partitioned off or warning signs have been placed and at the time of inspection workmen were in evidence carrying out Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 15 repairs. It was also evidenced that the workmen were always appropriately supervised, and that a risk assessment has been carried out with regards to their working in the home. The home is set out over three floors and provides a range of communal areas that service users can use at any time. There are two lifts –leading from the ground to the third floor. This provides safe and easy access to all areas of the home for all service users. All communal areas were nicely furnished and offered convivial and pleasant surroundings, which were homely and comfortable. There is a large room on the ground floor that can be partitioned off into separate areas and is also used as a function room and has bar facilities. The large lounge area on the top floor overlooks the river and offers a relaxing area for people to spend time. There are large gardens to the rear of the property and these are well maintained – as previously stated there are some areas that the home have identified as being of some concern, and these are currently being addressed. All areas of the home were seen to be clean and hygienic, relatives spoken to confirmed “the home is always spotless and that there are never any smells”. The home has also had a visit from the environmental health office as part of their quality assurance check and any issues raised have been dealt with appropriately. There are sluice facilities for dealing with any clinical waste on all floors and a random inspection showed them to be clean, hygienic and well maintained. Laundry facilities are well organised and they follow a well maintained and organised routine – and use a system which ensures that all washing is cleaned, dried and stored appropriately. Laundry areas were also seen to be well organised and tidy – areas around the machines were clean and dry, and separate hand washing facilities were available. CoSHH (which is how the home deals with substances which may be hazardous to health for example bleach) regulations were seen to be adhered to – and copies of all appropriate data relating to CoSHH are held and made available to all staff. Records viewed also demonstrated regular checks carried out with regards to health and hygiene issues. Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 28 The service users benefit from being cared for by staff who have a good understanding of their needs and are in sufficient numbers in order to meet these needs. EVIDENCE: The home employs a large staff compliment with a varied skill mix in order to ensure that the needs of the service users are met. There is a variety of job roles including clinical nurses, healthcare assistants, catering, cleaning and maintenance staff, and the home also employs a full time activities coordinator. Staff ratios are in accordance with the guidelines recommended in the Residential Forum. Agency staff are only used to cover shortfalls due to sickness or annual leave, and the home is also supported by groups associated with the R.N.A. The manager is currently rotating staff, so that they work within different areas of the home and are familiar with the different level of needs of the various service users – this will promote continuity of care to all service users. Staff are supported in learning new skills, and senior staff are trainers for different areas including manual handling and adult protection. There is a full training programme in place and staff wages are linked to qualifications. NVQ’s are promoted although the percentage of care staff who hold an NVQ is not yet at the level recommended within the National Minimum Standards, and it is recommended that this continues to be addressed. Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36 and 38 Service users benefit from having a manager who has a clear development plan and vision for the home, which she effectively communicates to the residents, staff and relatives, and is well supported by the larger organisation. EVIDENCE: The home is run in order to meet the best interests of the people who live there, and participation and input from service users and their families or advocates is encouraged and promoted. Surveys are sent out on a regular basis to service users, relatives and professionals and the results are published. The surveys are aimed at covering all aspects of care, support, facilities and general outcomes of the home – and used to make sure that they meet needs and are able to address any concerns. Residents meetings are held on a regular basis. Quality audits are also in place and this includes health and safety checks around the home and also a random check on care plans to ensure that they are maintained appropriately and promote the care for the service users. The home is still aiming to further improve its’ quality Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 18 assurance processes and continues to seek further ways that this may be enhanced. Regular staff meetings are held, with an agenda, minutes and agreed outcomes, as many issues are discussed including updates and introductions of policies and procedures and there is such a large staff compliment it was recommended that an attendance sheet is signed by all members of staff who are at the meeting and minutes are issued to those who did not attend. This is a good practice recommendation to ensure that the manager and senior staff can be confident that staff are aware of the issues which affect everyday good practice. Overall the manager and senior staff are committed to ensuring that staff are supported and that the needs of the service users are paramount, and this was reflected throughout the inspection process by positive comments made and the care provided by the home was summed up by one relative who stated: “This can be classed as a 5* hotel, with professional, caring and friendly staff”. Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 x x x x 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 4 x x x x 3 x x 3 x 3 Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 20 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 9 Regulation 13 (2) Requirement Only medicine requiring cold storage is stored in a fridge and both the minimum and maximum temperature is recorded and action is taken to ensure they are within the normal range of 2°to 8°C. The home has a contract for the disposal of pharmaceutical waste CD cupboards are bolted to the wall to meet the Regulations Timescale for action 15 December 2005 2. 3. 4. 5. 6. 7. 8. 9 9 13 (2) 13 (2) 30 November 2005 15 December 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 3 Good Practice Recommendations It is a good practice recommendation that the statement of purpose reflects up to date comments made by service H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 21 Pembroke House 2. 3. 4. 5. 6. 7. 9.1 9.3 9.3 9.4 9.4 9 8. 9. 10. 11. 19 28 36 users and their families. Medication procedures have more detail to guide staff using them e.g. temperature of fridge, keeping medicine for 7 days when service user dies All medicine administered (including Homely Remedies) is recorded on the front of MAR charts and the time of administration is recorded The pharmacy is asked to update MAR charts regularly and detail all current medication to avoid the need for hand transcribing Clinical rooms are maintained at an ambient temperature below 25°C The list of Homely Remedies is reviewed Pharmaceutical guidelines are followed for providing medicine for leave and ensuring that medicines are given at the appropriate times as recommended by the manufacturer. It is recommended that identified areas of maintenance are completed. It is strongly recommended that the home ensures that the percentage of staff who hold an NVQ is in line with guidelines set out in the National Minimum Standards. It is a good practice recommendation that staff sign an attendance sheet when attending meetings. Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 22 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pembroke House H56-H06 S37718 Pembroke House V247453 251005 Stage 3.doc Version 1.40 Page 23 - 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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