Inspection on 13/02/09 for Pembroke Lodge

This inspection was carried out on 13th February 2009.

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

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 Lodge 01/03/10

Pembroke Lodge 29/11/07

Pembroke Lodge 27/06/06

Pembroke Lodge 13/03/06

Pembroke Lodge 19/04/05

Pembroke Lodge 28/09/04

Pembroke Lodge 19/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Pembroke Lodge 32 Alexandra Road Reading Berkshire RG1 5PF     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mark Hemmings     Date: 1 3 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Pembroke Lodge 32 Alexandra Road Reading Berkshire RG1 5PF 01189414200 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) : enquiries@pembrokelodge.net Mr Charles D`Cruz care home 20 Number of places (if applicable): Under 65 Over 65 20 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 20 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Up to 20 older can make their home in Pembroke Lodge (the Service). The people who live in the Service need various amounts of support with things like dressing, using the bathroom and managing medicines. The property is a three storey detached house thats been adapted for its present use. Although three of the bedrooms can be shared by two people each, all of them are now being used as singles. This means that everyone has their own bedroom. Each of these has their own wash hand basin. There are various things to help people who are having difficulties getting about. Theres a passenger lift between the floors. This gives step-free access around the place. Another thing is a bath that has a special hoist. Theres a call bell system. This has call points in each of the bathrooms and toilets as well as in all of the bedrooms. This Care Homes for Older People Page 4 of 35 Brief description of the care home means that people can ring for assistance. The Service is in a residential area thats quite close to Reading town centre. There are shops and public transport services quite near by. The Registered Provider is a private individual. People who want to find out more about the Service and about the fees charged, can phone the Service and speak with the Registered Provider. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this Service is 2 Star. This means that the people who use this service experience good quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of care services. This inspection of the Service was an unannounced Key Inspection. We arrived at the Service at about quarter past eight in the morning and we were there for about seven hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in his self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. During the inspection, we spoke with five of the people who live in the Service. We also Care Homes for Older People Page 6 of 35 spoke with the Registered Provider, with the Senior Care Worker and with the Training Coordinator. We spoke with the four care workers and with the housekeeper. We walked around parts of the accommodation and we looked at a selection of key records and documents. Before we called to the Service, we asked ten of the people who live there and 10 members of staff to fill out a questionnaire for us. We wanted them to tell us what they think of Pembroke Lodge. Seven people who live in the Service and eight members of staff kindly filled them in for us. As we go through our report, well tell some of the things that people are saying in their answers. The Registered Provider has also recently asked people who live in the Service to fill out a questionnaire for him. We picked three of these questionnaires at random. Again, well tell you whats been said. What the care home does well: What has improved since the last inspection? 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 4. Care Homes for Older People Page 8 of 35 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 1, 3 and 6. People who are thinking of moving in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods will be helped to go back home. Evidence: The Registered Provider asks people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that moving into Pembroke Lodge is the right thing for them. He also talks with family members and with people like nurses and care managers (social workers). All of this is done so that he can build up a really good picture of how the person can best be supported. After he has got all of this information, he can then decide if Pembroke Lodge can meet the persons needs for help. Care Homes for Older People Page 11 of 35 Evidence: We looked at the information that has been collected for one person who has recently moved into the Service. We wanted to see what sorts of things were considered. There is lots of useful information. There is stuff about practical things such as the help needed in the bathroom. But there is also other information that shows that a forward looking approach is being used. For example, there is a note about the person not having had their flu vaccination and about the need to arrange this. The Registered Provider says that after he gets the information he shares it with care workers. This is done so that care workers know in advance about what support they will need to provide. We asked two care workers about how all of this works out in practice. They say that they are indeed told about people who are about to move in. They say that as a team they discuss how best to help the person in the first few days, while they get to know them better. The Registered Provider recognises that moving into a residential care setting is a big step for anyone to take. He says that he wants to do everything possible to put the persons mind at rest. We agree that this is really important. He says that as part of the assessment process people are invited whenever possible to visit Pembroke Lodge. This is so that they can see what the place is like first hand. During these visits, people can ask any questions they want. There are also some written documents that say about the Service in quite a lot of detail. These are called the Service Users Guide and the Statement of Purpose. People can ask to see these if they want. The Registered Provider is quite happy for them to take away a copy if they want to have a look at them at their leisure. We asked one person about their experience of moving in. They say that the care workers did know about the support they need from the start. They also say that they were made welcome and that this made a big difference for them. In their own words, they say, Oh, I met (the Registered Provider) and he told me all about the place and he asked me what help I need and the things I like to do. I came to have a look around and thought Id move in because all the staff were so kind. Ive been quite happy since and I made the right decision. In our questionnaire for people who live in the Service we ask, did you receive enough information about this home before you moved in so you could decide if it was the right place for you? Everyone says that yes they did. Nearly all of the people who move into the Service do so with the intention of making it their longer term home. However, there is the chance that someone will only want to stay for a shorter period. This might be so that someone who cares for them at home can have some time to themselves. Or, someone might move in because theyve been Care Homes for Older People Page 12 of 35 Evidence: in hospital and arent quite ready to go home yet. When someone moves into a residential care setting theres always the risk that their stay might become longer than is necessary. The Registered Provider is aware of this. He says that members of staff will help people make any arrangements that are necessary for them to go home as planned. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 and 10. People are provided with the personal and health care they need. Medicines are handled safely. People are treated with kindness and respect. Evidence: The people who live in the Service say that the care workers offer them all the assistance they need. There is a written individual plan of care for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to care workers so that they know what to do. We looked at three of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as helping people in the bathroom, about health care and about keeping people safe. In more detail, one person doesnt have very good hearing and so needs to have things said in a clear and slow way. Another person needs considerable reassurance when they become anxious about things. Someone Care Homes for Older People Page 14 of 35 Evidence: else needs to be supported to manage their continence. We asked three care workers about some of these things. We wanted to know what all of this written information means in practice. Whether its used or not. They know all about it and we saw them using it in practice. For example, when speaking to the person with bad hearing they spoke slowly and repeated things until they were sure that they had been understood. They werent impatient at all. It was done with kindness and understanding. The Registered Provider says that the plans are kept up to date so that they are accurate. This involves care workers making daily notes about how things are going. We checked these and they are being done. There are also more detailed reviews. This is when care workers check out with each other and with the person concerned, how things are going and what might need to be changed. When we were last in the Service, we thought that the plans of care could do with being a bit more detailed in general. Since then, a good deal of work has been done to achieve this. All in all, theres a good deal of written information. We think that because of all this detail more might now need to be done to help people find out whats in their records. Were not surprised to hear that people dont really bother much about whats written in their plans at the moment. The Assessment says that the Service wants to encourage people to take an increasingly active part in planning the care they receive. In line with this, the Registered Provider and the Senior Care Worker are going to look into what can be done to make process more user friendly. Sensible steps are taken to ensure that people do not have any avoidable accidents. For example, some people are a bit unsteady on their feet. They are accompanied by a care worker so that they dont lose their balance. People are helped to keep healthy. Care workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, a number of people have seen their doctors, some on more than one occasion. There have also been visits by other professionals such as district nurses. We looked at some of the records about how quickly doctors are being called after the need for medical attention is first noted. Its being done straightaway. We spoke with a district nurse who regularly visits the Service to provide medical treatment for a number of people. We asked her how things are going. She says, I think that this is a really good care home. They tell me promptly if someone is not well and then they carefully follow any management details I give them. The residents are always clean and well cared for and the place really is spot on in all respects. People can do their own medication if they want to but at the moment everyone has asked that the Service do it for them. There is a system to check that the correct medicines are received from the chemist. Once in the Service, they are stored securely. There is a procedure for administering Care Homes for Older People Page 15 of 35 Evidence: medicines. This is designed to double check that the right medicines are given to the right people at the right time. There is a record that is completed on each occasion that a medicine is given. We examined three sets of these records. They are correctly completed. We looked at four medicines in more detail. This was done to see if the remaining stock matches what should be there. Again, we found things to be in order. When we were in the Service, we asked a number of people what they think of the care workers. They praise them saying that they are courteous and attentive. One person summarises the general mood when they say, the staff are really, really good here. I have a chat and a laugh with them like now. All of this hasnt been put on for your (the Inspectors) benefit you know, this is how the place is everyday. Its lively and how home should be. The staff are always having a chat and just being themselves. In our questionnaire we ask, do you receive the care and support you need? Six people say that they always do and one person says usually. We also ask, do the staff listen and act on what you say? Everyone says yes. Care workers are relaxed and informal in how they are. The Assessment emphasises that while there is an overall pattern to each day, things arent rigid. For example, someone can have a lie in if they want. We arrived at the Service quite early in the morning when most people were just sitting down to their breakfast. Things werent rushed at all. Care workers chatted with people about things like the weather and last nights television. They then went away and came back with things like toast and porridge and then chatted with people some more. Later in the day we saw people being helped to use the bathroom. They are helped to leave the lounge without drawing attention to themselves. Then they are helped in the bathroom with the door closed so that they can have privacy. People are helped to wear neat and clean clothes so that they can present themselves how they want. They are given their post promptly. Also, they are helped to deal with it if something is difficult for them. People can use the phone if they want. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15. There are some interesting things for people to do. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: The plan is that each weekday there is a social thing that people can do. These things include doing armchair exercises, playing games and doing quizzes. There isnt an activities person as such and so the care workers organise the activities when theyve finished their other work. However, the arrangement seems to work well. On the day of our visit, most of the people who live in the Service were doing armchair exercises in the morning. In the afternoon, most were playing a hotly contested game of musical bingo. Three people didnt take part in either of the events and we asked two of them about this. They say that they were invited but on this occasion they preferred to spend time in their bedroom. About once a month there is an outside entertainer who comes in to play music. In our questionnaires we ask, are there activities arranged by the home that you can Care Homes for Older People Page 17 of 35 Evidence: take part in? Two people say that there always are, four people say usually and one person says sometimes. One of the people who replies usually, then says there are activities nearly every day but sometimes I do not feel quite up to joining in. I like the music performers, music quiz, exercises but especially I like visitors. Another person says that there is, a month on month programme of activities (that) generally have taken place (and) have generally been enjoyable and entertaining. Keep up the good work! People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Registered Provider keeps in touch with family members so that they know how things are going. For example, if someone is not well or if they are admitted to hospital. He phones them or sends them emails. The Registered Provider doesnt get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Its a good idea not to get involved in this way. This is because it avoids conflicts of interests. These can sometimes lead to complicated misunderstandings about who has the right to do what. Instead, most people get help from members of their family. People say that they receive good quality meals and that they have enough to eat. The Assessment says that recently the menu has been changed. This has been done to enable a wider range of dishes to be served. People consider meal times to be a relaxed and pleasant affair. One of the questions we ask in our questionnaire for people who live in the Service is, do you like the meals? Three people say that they always do and four people say that they usually do. One of the latter people adds that, If I dont like something I am usually offered something else, mostly I really like the breakfasts, lunches and teas. We asked people about this when we were in the Service. One person sums up the general mood when they say, the meals are really good here and we can have what we want. I never feel hungry and you can ask for a drink whenever you want one. The staff are really good about that. Theres no problem at all with the food here. The Registered Providers questionnaire asks about the catering too. It says, how satisfied are you with the choice, variety and amount of food provided? Two people say that they are very satisfied and one person replies very good. There is a choice of dish at each meal time. We looked at the records of the meals provided over a two day period. We wanted to see if different people are actually having different things. They are. We also looked at the variety of meals provided over a period of two or three days. There is reasonable balance, the main lunchtime dishes including things like chicken and mushroom pie, casserole and sausages and onions. Care Homes for Older People Page 18 of 35 Evidence: We asked care workers about the arrangements for doing snacks and drinks in between meal times. This is important because its a part of normal living. Also, it can be a long time for some people between the late evening milky drink and breakfast the next day. Care workers say that they are quite happy to do drinks and snacks whenever. One of them said to us that, of course people can have what they want. The problem is that often people dont really get that hungry because theyre indoors and its about trying to make sure that they eat and drink enough. Later on well tell you about the meetings that people who live in the Service have so that they can say what they think. Here we just note that at the last one of these meetings the Registered Provider reminded people that they can have snacks and drinks at any time. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 16 and 18. There is a complaints procedure. The Registered Provider knows how to properly deal with complaints. People are safeguarded from being bullied or taken advantage of. Evidence: We asked several people about making complaints. They say and show by their relaxed manner they would feel quite okay about raising a complaint should they need to. There is a written complaints procedure. This explains how to go about making a complaint or raising a less formal concern about something. In our questionnaire for people who live in the Service we ask, do you know how to make a complaint? Six people say that yes they do and one person says no. This last person then adds, I dont have anything to make a complaint about so far! The Registered Providers questionnaire asks, how satisfied are you with the availability of managers to discuss any problems when you need to? One person says hes always available. Another says, Im very happy with everything Ive discussed. The Registered Provider says that he hasnt received a formal complaint since our last inspection. We also dont have any complaints about Pembroke Lodge that are outstanding. Care Homes for Older People Page 20 of 35 Evidence: The Registered Provider says that a record will be kept of any complaint that may be received in the future. This will give a clear account of what was the matter, what was done to look into it and what has been done to put anything right that needs to be. Its very important that people are confident that they are safe. For example they need to know that theyre not going to be bullied or pushed around in some way. The Assessment commits the Registered Provider to guarding against this. We asked some care workers about this matter. They know what to look out for. None of them have any concerns about how things are going. The Registered Provider has a written policy and procedure about this matter. The people who live in the Service say and show us that they feel safe in Pembroke Lodge. In our questionnaire we ask them, do you know who to speak to if you are not happy? Six people reply always and one person says that they sometimes do. The last person then says, I dont know anyone special to ask, they are all very nice. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 19, 22, 25 and 26. The accommodation is comfortable and pleasant. Some of the toilets and a bathroom need attention. There is a modern fire safety system. The kitchen is well equipped. There is a suitable laundry. Evidence: On the outside, the building is well maintained. There is a large, level and well kept garden at the back. On the inside, the accommodation is well decorated and furnished. Overall, the place has a homely, lived-in feeling to it. The Registered Providers questionnaire asks, how satisfied with the general cleanliness and tidiness of the building and grounds? Two people say that its very good and one person says that its good. The bathrooms are neat and clean. However, in general they do look rather bare. They could be made more welcoming with things like pictures and plants. Since our last inspection various improvements have been made to the accommodation. These include air conditioning being put in the sun room. Another thing has been new tables and chairs being provided in the dining room. The Assessment says that bedrooms will continue to be redecorated as and when they become vacant. Care Homes for Older People Page 22 of 35 Evidence: The bathroom on the first floor is quite small, as is the toilet next to it. Unlike all of the other areas these rooms are not in a good condition. The flooring is worn and all in all they look a bit tatty. The Registered Provider says that these rooms are rarely used. He plans to remodel both of them. This is so that they will become private bathrooms for the two bedrooms that are next door to them. The Registered Provider hopes to do this work within the next six months or so. The Registered Provider also wants to make some alterations to two of the ground floor toilets. This is because the walls that form the cubicles dont go right up to the ceiling. He says that they now need to be fully enclosed. This is so that people can use the toilets without being overheard. He hopes to have the work done within about a year. The building is fitted with an automatic fire detection system. This provides a high level of fire safety protection. The fire brigade people looked at the system in December 2008. They recommended that three relatively minor improvements be made. The Registered Provider has made arrangements for all of them to be finished by the end of June this year. The Registered Provider has a system of doing regular fire safety risk assessments. This is where he goes around the place to check out that everything is still working in the right way. We looked at the records of the most recent one. It says that things are still okay. Its a good idea for the assessment to be sent to the fire brigade people. This is so that they can have a look at it to check that its detailed enough. The Registered Provider is going to do this once he has finished the work we have mentioned above. The local Department of Environmental Health called to look at the kitchen in 2008. A number of improvements were recommended. For example, it was recommended that the thermometers that are used to measure how cold the fridges and freezers are should be replaced with more accurate ones. The Registered Provider says that all of the recommendations have been done. We looked in the kitchen. Its well equipped, clean and well organised. Sensible things are done to ensure good food hygiene. For example, once food is opened it is covered. Then a date is written on it to make sure that things arent allowed to hang around too long. The temperatures of the fridges and the freezers are checked and recorded to make sure that they are cold enough. We saw that new thermometers are now in place to take the necessary readings. The temperature of certain hot foods is checked to make sure that things have fully cooked through. We spoke with the person doing the cooking on the day of our visit. She knows the importance of good hygiene. We saw her washing her hands before Care Homes for Older People Page 23 of 35 Evidence: touching food. She also knows about how important it is to keep uncooked meats separate from other foods. People who need it are helped to get about. One of the baths is fitted with a special hoist. This means that there is a seat that goes up and down. You can sit on it outside the bath, then it can be raised to go over the side of the bath before its lowered once youre over the bath. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. There are frames near to the toilets. People find these very helpful when they are getting down and getting back up again. There are other less obvious things to help people get about. For example, there are special belts that can be used to give people that extra bit of help they might need when getting up from a chair. Also, there are special sheets that can be used to help people change position in bed. When someone moves into the Service, the Registered Provider and the Senior Care Worker make a note of what assistance they need to get about. They look at things such as the help someone needs in the bedroom and in the bathroom. We asked care workers about this. They know what theyre doing. We saw one person being helped to sit in their armchair in the lounge. They were helped in a way that is right for them. After they were seated, the care worker concerned arranged the persons cushions. This was done so that they were comfortable and in the right position to have their breakfast. We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. When we arrived in the Service the central heating was on and it was on when we left. The accommodation was pleasantly warm, even though it was a very cold day outside. One person told us that they like to have their bedroom on the warm side. We visited them there later on in the day. Their room was very warm indeed. The radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. The hot water taps that are used by the people who live in the Service are temperature controlled. This means that they wont get hot enough to scald someone. We tested a few taps and the temperature seems alright to us. The laundry has a washing machine. This has an extra cycle for items that need an especially hot wash. There is a large dryer. We looked in the laundry. Its neat and clean. There are new regulations about water purity. These say that things like washing machines and dish washers have to be fitted with special valves. This is so that used water cant leak back into the main cold water supply. The Registered Provider isnt sure that the Service meets these regulations. He is going to check this out with the local water supply company. This will be done by 1 April 2009. Care Homes for Older People Page 24 of 35 Evidence: The Senior Care Worker says that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. This is very important because its a really basic thing to wear only your own clothes. We asked people about this. They say that they do nearly always get their own clothes back from the laundry. When we were in the laundry, we checked some of the garments that were hanging up there to air. All of them were marked either with a name or with a room number. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 27, 28, 29 and 30. There are enough care workers around. Care workers know what theyre doing. Some parts of the training arrangements can be strengthened. Security checks are completed on new members of staff. Evidence: There are normally four care workers on duty from early in the morning until around tea time. Then the number reduces to three. There is a waking staff presence in the Service at night. At the moment, there is no cook. This means that one of the care workers is having to spend quite a lot of time in the kitchen. During the week, there is a housekeeper who does most of the cleaning. There is no laundry person and so care workers have to fit this in to their other work. We looked at the written roster in detail for a period of two recent days. We wanted to see how many care workers were actually on duty. The count is largely as described above. In our questionnaire we ask members of staff, are there enough staff to meet the individual needs of all the people who use the Service? Two people say always and the remainder say that there usually are. These latter people dont say any more about their answers. One of the former group says, there is a good sense of teamwork Care Homes for Older People Page 26 of 35 Evidence: at Pembroke Lodge which means that no one is made to hurry, but everything gets done. The Registered Providers questionnaire also asks about this. It says, how satisfied are you with staff availability, do they come to help you for example when you ring for help? One person says, Im very pleased, they come to help me when I need help. Another person says, Oh yes, they always help me. We looked in some detail at how things are at night. We wanted to know that if people ask for assistance they get it without having to wait too long. None of the people we asked about this mention night time as being a concern for them. One person summarises the general view when they say, I dont need much help at night but I know that other people have said that if they ring the bell staff come right away. People arent left waiting around for someone to come to their bedroom. We also looked in some detail at the records of the help one person receives at night. We chose this person because they need quite a lot of help to use the toilet. The records show that this help is being given in a timely and reliable manner. Its very important that only honest and trustworthy people are employed as care workers. With this in mind, the Registered Provider completes a number of security checks on new care workers. These include things such as confirming their identity, taking up references and doing a police check. We looked at the records for two care workers who have been appointed since our last inspection. The necessary checks are all in place. New care workers have introductory training before they work on their own. We asked one care worker about their introductory training. They say that it was very useful. They say that they were introduced to the people who live in the Service and that they were told about each persons needs for support. Also, they were told about important things. For example, they were introduced to the individual plans of support. In their own words they say, I was told about the alarms and about the call bells before I stated to work on my own. I was shown the exit routes and the (fire) meeting point in the back garden. I was told to keep the heavy doors shut because fire cant get through them so much. I also met all of the residents and got to know their ways and what help they need. The introduction was very good and it wasnt rushed at all. In our questionnaire for staff we ask, did your induction cover everything you needed to know to do the job when you started? Seven people said that it met their needs very well and one person says that it partly did. One of the former people adds, I was given help and guidance by other staff at all times. This initial training is just to get them started. Theres a lot to learn after that. The Registered Provider says that all care workers are expected to do regular training in important subjects. For example, in how to safely support people move about, in food Care Homes for Older People Page 27 of 35 Evidence: hygiene and in basic first aid. Most of this training is done in-house. It involves the Training Coordinator coming in to meet with a number of care workers to do a particular subject. However, some of the training that has recently been done has been by distance learning. This latter training has involved care workers completing courses in supporting people who have problems with their understanding and in infection control. We looked at the records of the courses that two care workers have done. Theyve done quite a bit of training. There are one of two gaps where the odd course seems to have been missed. Were not quite clear about how or when these oversights are going to be put right. We think that it would be a good idea for the Registered Provider and the Training Coordinator to review who has done what training. This is so that any gaps can be sorted out. They say that they will now do this using a new national model. This is all about how to assess what skills and knowledge care workers already have. When its used in the right way, it gives a really good idea of what additional training each care worker might need. This is quite a big exercise to do and so it will take some time. They hope to have it completed by the end of the year. Nearly all of the care workers have either completed a National Vocational Qualification in health and personal care or they are on with doing it. This qualification is a very good idea. This is because it helps care workers to deliver high quality residential care services. In our questionnaire for staff we ask, are you being given training which is relevant to your role and which keeps you up to date with new ways of working? Everyone says that yes they are. We spoke with three care workers to find out what they know about particular bits of the support they will need to give people. They know a lot about how each of the people who live in the Service like to be supported. For example, they know about helping older people to take care of their skin. They also know about how people sometimes express themselves in an indirect way by what they do rather than by what they say. Care Homes for Older People Page 28 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 31, 33, 35, 36 and 38. Things are well managed. People are asked what they think of the Service. People are helped to buy what they want. There are sensible health and safety things Evidence: The Registered Provider is in day to day charge of the Service. He has both of the formal qualifications that are required for people who manage residential care services. These qualifications are important. This is because they are designed to help managers ensure that high quality support is reliably provided. The Registered Provider is quite organised and he knows whats going on in the Service. The Registered Provider says that its really important to have good team work in the Service. He says that this is supported in several ways. There are handover meetings at the beginning and end of each shift. These are held so that care workers can be Care Homes for Older People Page 29 of 35 Evidence: kept up to date with developments. There are team meetings every month or so. We looked at the records of the last one of these. We wanted to see what sorts of things are being discussed. Theyre practical and relevant. For example, the members of staff talked about how important it is to whistle-blow if they are concerned about someones wellbeing. They also reviewed various bits of the fire safety procedure. We asked two care workers about team working in general. One says, we all work together as a team here. Theres no us and them with (the Senior Care Worker) you can talk to her and she really cares about you. This is a really happy place to work and that makes a big difference. The residents pick up on it too. The other says, you feel really supported here and we have the handovers when we talk about how things are going and what needs to be done for each person. In our questionnaire for staff we ask, do the ways you pass information about people who use the Service between staff (including the manager) work well? Seven people say always and one person says sometimes. The Registered Provider is in the process of introducing a new system that will see each care worker meeting with someone senior on a regular basis. This is a good idea because it will give them a chance to take time out and to have a chat about how their work is going. Its really important that the people who live in the Service have a direct say on how things are going. After all, theyre the experts. because they live there. There are house meetings every month or so. The Registered Provider says that most people do go along and that they can talk about anything they want to. We looked at the record of the most recent meeting. They show that people feel quite free to raise anything that might be on their mind. For example, one person asked for the mirror in their bedroom to be lowered a little. Another person wanted to have the heating turned up in their bedroom at night. We then asked the people concerned if their requests had been attended to since the meeting. Both say that they have. Earlier in this Report we have told you about the questionnaires that the Registered Provider sends out each year to the people who live in Pembroke Lodge. A version of these questionnaires is also sent out to relatives and to other people such as doctors. The Registered Provider says that he looks carefully at the results so that he can attend to any improvement that might be suggested. We think that all of this is really useful. However, the system can be developed further. At the moment, there are no questionnaires for members of staff. This is a shame because members of staff know in detail how things work in the Service. Theyre bound to have lots of helpful suggestions about how things might be improved. The Registered Provider says that next year staff will be included in the questionnaire exercise. Also, he says that next year the people who live in the Service and their relatives will be given a more detailed account of what will be done to introduce any improvements they may have suggested. Care Homes for Older People Page 30 of 35 Evidence: The Registered Provider helps some of the people to pay for everyday things. For example, if they if they want to see the visiting hairdresser, or if they want to have a newspaper delivered. The Registered Provider adds up what he has been spent and then sends a bill about once a quarter to the relatives. Each person and their relatives have agreed to this in advance. We looked at the records for one person. We wanted to see if the amounts claimed to have been spent are reasonable. They are. We also wanted to see if the purchases are supported by a receipt to prove that the money in question has been spent. Again, we found things to be in order and above board. Regular checks are completed to ensure that the Services fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells. More detailed checks are completed every now and then by an engineer. There are annual fire drills. The last one took place in September 2008. The Registered Provider is now going to have a drill once every six months. This is a good idea. This is because drills are a really useful way to make sure that everyone knows what to do under emergency conditions. In addition to this, all members of staff are expected to attend a fire safety course once each year. This training is more detailed than the things that are done in a fire drill. Again, the Registered Provider is now going to strengthen the present arrangement. In future every member of staff will be asked to show that they understand key parts of the fire safety procedure at least once every six months. The Registered Provider says that everyone will have been included in this new system by 1 April 2009. There are up to date reports from engineers about the gas appliances, the electrical wiring installation and the lift. They say that everything is in good working order. We looked at the record of accidents that have occurred in the Service since the last inspection. There hasnt been that many. Most have been minor bumps and bruises. The Registered Provider keeps an eye on who has had an accident and what has happened. This is done so that he can do something if there is a particular problem that is causing the accidents. We dont think that theres anything obvious that needs to be sorted out at the moment. The Registered Provider says that he regularly checks the building to make sure that there isnt anything that might result in someone having accident. Hes looking for things like frayed carpets that might cause someone to trip over, or something sharp that can catch you when you walk by. He says that he hasnt found anything that needs attention. We kept our eyes open when we were walking around. We didnt see anything either. Care Homes for Older People Page 31 of 35 Care Homes for Older People Page 32 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 35 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, Care Homes 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 Older People Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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