Inspection on 09/11/07 for Pendennis Residential Home

This inspection was carried out on 9th November 2007.

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

The inspector 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

Pendennis Residential Home 18/02/08

Pendennis Residential Home 15/05/06

Pendennis Residential Home 13/01/06

Pendennis Residential Home 07/09/05

Pendennis Residential Home 16/03/05

Pendennis Residential Home 25/01/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Pendennis Residential Home 64 Dartmouth Road Paignton Devon TQ4 5AW Lead Inspector Judy Cooper Unannounced Inspection 9th November 2007 10:10 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pendennis Residential Home Address 64 Dartmouth Road Paignton Devon TQ4 5AW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 551351 01803 555100 hilda86@msn.com Pendennis Ltd Mrs Hilda Teale Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (22), of places Physical disability over 65 years of age (22) Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15/05/06 (Key inspection) 05/01/07 (Random inspection) Brief Description of the Service: Pendennis is an extended three storey detached property, situated in a residential area of Paignton. The home is near all local facilities and within a short walk from the sea front. Bedrooms are located on all three floors and a mezzanine level between the first and second floors. The home is situated in its own grounds to which service users have ramped access. Within the home, all but two of the bedrooms have en suite bathroom facilities. One of the large rooms within the home is currently being used as double room by a married couple. The home has a passenger lift, stair lifts to the mezzanine level and a variety of aids and adaptations for physically disabled people. Since the last inspection the bed places at the home have increased by two to now provide 22 places. Care at the home is for people, who are over 65 and who may or may not have a physical disability or suffer with dementia. The current range of fees is from £301 to £450. The owners will make the report available within the home’s statement of purpose and on request. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place on Friday 9th November between 10.15.m. and 6.30 p.m. Opportunity was taken to observe the general overall care given to the people who live at the home. The care provided for five of these people was also inspected in specific detail, from the time they were admitted to the home, which involved checking that all elements of their identified care needs were being met appropriately. A tour the premises, discussions with the senior staff member - who was in charge of the home on the day of the inspection, (as both the home’s registered manager and the owners were on annual leave), as well as discussions with other staff, some people living at the home, three visitors to the home, a visiting district nurse and a visiting psychiatrist, also formed part of this inspection. Staff generally were also observed, in the course of undertaking their daily duties. The owners, who co-incidentally returned from their annual leave on the day of this unannounced inspection, were also able to be present for the last two hours of the inspection. Other information about the home, including the receipt of three completed questionnaires from relatives and one from a staff member, provided additional information as to how the home performs. All of this collated information has been used in the writing of this report. All required core standards were inspected during the course of this inspection as well as some others which related to the inspection. What the service does well: The people who live at the home benefit from a “community spirit” within the home and are encouraged and enabled to socialise with each other as desired. The result of this is that people can benefit from companionship with each other as desired but can choose to “keep themselves to themselves” if they so wish. A loyal group of core care staff interact well with the people, and have a respectful and caring attitude towards providing care to them. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 6 Relatives and friends visiting the home receive a warm welcome and those who fed back or who were spoken with stated that they always feel comfortable visiting at any time; in fact one visitor stated they have called in after 10 p.m. on occasions and reported that they were made welcome at this time as well. People benefit from a good, wholesome and varied diet, where their dietary needs are known and appropriately provided for by an experienced and trained cook. There are pleasant, light and airy communal areas, which the people enjoy. What has improved since the last inspection? What they could do better: The home’s statement of purpose and home’s service user guide both need to be made available to any new person (and/or their family/advocate) who is considering staying at the home the home, either permanently or for a shorter time. This will ensure that people who live at the home and or their carers will be aware, prior to their admission, exactly what facilities and services the home can be expected to provide. Relatives or carers should also be made aware of the home’s policies and procedures regarding such things as naming clothes on admission so that a new person is not disadvantaged. Some items of a newly admitted person’s laundry went missing because the management had not informed the relative that clothes should be marked on admission. A member of the management staff, should, wherever possible undertake a pre assessment visit to a prospective person considering moving into or staying at the home, and ensure that they record and share the needs of the prospective person to be admitted with the staff at the home. This information should then be used to compile a detailed care plan for use after admission. This is so that all involved in the care of any prospective person are aware of their needs prior to and after admission and can prepare for their admission appropriately and deliver the appropriate care from the moment of their admission. The management must also forward a confirmation letter to each prospective person and/or their family/advocate, following their pre assessment, stating that the home will be able to provide the appropriate care for their current health and welfare needs. This is so that each prospective person and/or their family/advocate can be sure that the home knows and then agrees to meet their needs. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 7 The care plans for each person, detailing the care to be given, must contain up to date information about each person, including a personal profile, fully completed risk assessments and in depth information in relation to their personal and social needs. The care plans must be complied, as far as possible with the person themselves and or/their family/advocate and should be undertaken in a more person centred manner to ensure, wherever possible, the people who live at the home and their families/advocates are fully involved in choices made regarding the care that is to be provided to them. This is to ensure that any care provided has been agreed with the person and that the person is happy with the both care to be provided and with the manner it is to be delivered in. The system used for care planning must be easily available and be easily understood by all staff. Information regarding care needs and how to meet them must also be kept together in one place to make for easy access. All care plans must be reviewed with the person and/or their advocate monthly for the same reasons. Risk assessments, contained within care plans, must be further enlarged to ensure that all details appertaining to any risk to a person is regularly reviewed and updated as the person’s needs change. This is so that staff are providing the care that is needed and appropriate. Also weight charts contained within the care plans need to be completed to provide effective and useful information that can be used to maintain the welfare of the person. Daily records should be detailed and completed in a professional manner. Any form of restraint used i.e. the use of a cot side must always be regularly risk assessed by the home’s management staff, with advice sought from outside professionals, as well as agreement obtained from the person themselves and/or their family/advocate as to the use of such restraint. These details must be kept in the individual person’s file at all times. This is to ensure that any form of restraint used is always in the best interests of the individual person and fully meets their individual needs, whilst at the same time respecting their right to freedom and choice. Any person who is either room bound or bed bound should have the availability of their call bell at all times. This is to ensure that they can summon help as needed. The security of the medicine cupboard should be reviewed. In particular the medicine cupboard key should be kept with the senior person on duty at all times and additionally any controlled drugs, held in the home, should be kept within a fixed, locked, separate container within the home’s general medicine cupboard. The taking of medicines should be supervised, where necessary, to ensure that the people are enabled to take their prescribed medications. These measures will help ensure that the people, who live at the home, remain protected regarding their administration of medication. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 8 The home’s activity programme should be reviewed to ensure that all peoples’ needs are being met. A record should be kept of what activity has been provided on what day and who participated, so that the management of the home can easily keep a record or activity is enjoyed and proves popular and, if necessary, adjust the activity programme to ensure that all people who live at the home that want to join in can. Additional activities and the staff required to provide the activities must be made available so that the people benefit from a varied programme that creates interest. Meal time choices should be made easily available so that the people can know and then choose what they wish to have at meal times. Several comments were received during the inspection, which indicated that the people do not know that there is a choice available. To ensure the people remain protected the management should ensure that all interested parties are aware of how to complain as information received during the inspection indicated that people who live at the home were not sure how to contact the Commission for Social Care Inspection if they needed to. The flooring in the first floor communal toilet floor should be repaired to ensure that any risk of cross infection is minimised. The home’s heating to individual bedrooms and landing areas should remain constant. Where there are any failures resulting in the management having to provide a portable heating device a risk assessment must be put in place regarding the use of the portable appliance and immediate action taken to rectify the problem. This is to ensure that all the people remain comfortable and safe within the home. The home’s management must review staffing levels to ensure that there is sufficient staff on duty at all times to fully meet the peoples’ needs. During the inspection there were several comments made stating that people felt that the current staffing levels are too low, at times, to allow staff to be able to fully meet the needs of all of the people who currently live at the home. The role of the second “on-call” member of night staff must also be reviewed and action taken to ensure that they always are available to fulfil the requirements to provide a second cover as required. This will ensure that the people who live at the home remained cared for by the correct number of staff at night time. All training provided to staff must be recorded so that the management are aware of what additional training staff need to receive to allow them to have required skills to deliver care appropriately. This refers specifically to the induction training when staff commence working at the home and moving and handling training. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 9 The management must undertake the home’s recruitment programme in a robust manner to ensure suitable people are employed to work at the home. This must include obtaining two written references. The management must provide regular supervision to all staff and keep written records of the same. This is to ensure that all staff have the opportunity to have individual time with the management of the home and to allow the staff member the opportunity to discuss any issues regarding their role and also for the management of the home to be able monitor the progress of each staff member over a period of time and offer support/training as required. The management must undertake a formal quality audit of the service, which must include seeking the views of the people who live at the home, their relatives/advocates and any other interested parties that may have contact with the home. The management must then act on the information received by producing annual development plan for the home taking into account this feedback. This is to ensure the home is always run in the best interests of the people who live there. All record keeping should be maintained in accordance with Data protection Act 1998 requirements in ensuring peoples’ right to confidentiality is maintained. In particular an individual record should be maintained, regarding any fall a person may have, rather than recording this information collectively so that other details would also available. The management of the home must be more responsive to the needs of the both the people who live at the home at the home and their relatives/carers. This is so that people who live at the home and their carers can feel confident that the home is being managed effectively. The person deemed to be “in charge” of the home in any absence of the registered manager should have access to necessary documentation and records to allow the home to be run effectively. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is poor People considering whether to come and live or stay at the home do not always have access to up to date information about the home, which would not allow them to make an informed choice about whether the home can offer the necessary services they may need. Pre-assessments have not been undertaken prior to people having a short stay, which meant these peoples needs are not be fully known by staff prior to admission. This places them at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides care for up to twenty-one permanent people and also provides a regular respite bed, which is utilised a lot and provides a valuable resource for local people who need residential care for a short period only. There was a copy of the home’s service user guide and statement of purpose available within the home’s hallway, however some relatives spoken to had not been shown this document and were unaware of what it contained. Therefore these people and/or their carers/advocates would not have this information easily to hand prior to a stay at the home. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 12 Since the last inspection the home has admitted several new people due to natural circumstances. Five such peoples admissions were looked at in detail. In respect of the people who had come to live permanently at the home there some pre-admission details, however these varied in both the detail and amount of information recorded, so it would not always easy for staff to know the full needs of all new people and indeed staff confirmed this during the inspection, stating that on occasions they were given little information to allow them to be sure they were providing the correct care. Two people were having short stays in the home. One was leaving after having had a week at the home and one had just arrived. There were no pre assessments for either of these people and neither were there any care plans. Therefore the staff had had to provide care for the one short stay who was leaving following a stay of a week at the home without staff having any real knowledge of the person and a in respect of the admission who arrived during the inspection there were again absolutely no details whatsoever of what care was to be provided. This meant that that the management had arranged for and accepted at least two new people without being aware of their needs and how the staff were to meet them. Therefore the two people were potentially at risk as staff had no knowledge of their needs. Also because there has been several new people admitted in the past year, not having full and easily accessible pre assessment details has meant that staff have not always known immediately what care a new person may need and due to staff being very busy it had taken them longer to get to know this information from the people themselves once in the home, or from other staff providing care. Staff agreed that they did not always feel that they had enough information available to know what the person’s needs would be from the beginning of their stay. This means that the people may not get the needed care from the beginning of their stay. There was no form of written communication, on any of the five peoples files, to show that the management of the home had confirmed with the prospective person/and/or their family/advocate that the person’s health and welfare needs could be met prior to admission. Therefore the prospective person and/or their family/advocate would not be sure that the home knew and had then agreed to meet their needs. The home does not provide intermediate care although it does offer a regular respite facility. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,and 10 Quality in this outcome area is poor. The lack of information contained with a person’s care plan can potentially put the person at risk. The homes’ medication system needs to be refined to ensure that people are protected regarding the both the administration and security of medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although there has been some attempt by the management to reformulate the care plans they still do not contain enough information to ensure that each person needs are known and recorded so that appropriate care can be provided. There was no evidence to show that care plans had been drawn up with the involvement of the person and/or their family/advocate although it was evident that some people would be very able to be involved in this and others had regular visiting family members who had not been asked to be involved in this aspect. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 14 Care plan reviews were spasmodic and what has been undertaken had not been done with any involvement from the person and/or their family/advocate. For example, one persons pre assessment indicated that the person was mobile with the help of a walking aid and a staff member. However staff reported back that this person now finds it very difficult to be mobile at night. There was no recording of this new need and so all staff may not be necessarily aware of this change of need unless their colleagues informed them as the information could not be accessed in any other way. One relative also stated: “ Home used to meet X’s needs until about six months ago, when X became more frail and is now almost totally blind. The amount of care has not been increased to the slightly higher level that she now needs. This further demonstrates that the care planning process operating within the home is not always addressing peoples’ increased needs. A person’s pre-assessment did not contain necessary information regarding the persons medication and the possible side effects of the medication. This information was only obtained by speaking with the person’s next of kin who happened to be visiting during the inspection. The information given was very relevant to the care required and should have been recorded. If the next of kin had been involved originally in the care planning process they would have had the opportunity to inform the home of the side effects of the medication from the beginning. During the inspection it was noted that the same person had two marks just above their wrist, which they stated they had received when being handled by staff. There was no record at all of the person having acquired any marks when they were clearly obvious or how these marks had come to be received or whether the person had been admitted with them already. This meant that it was not possible for the inspector to verify how and when these marks may have been sustained. Discussion took place with the staff on duty and the person’s records were looked out where it was noted that the person had sustained a fall a little while ago at the home. Therefore it was quite feasible that the marks had been sustained following a staff member lifting the person up, and from records seen it would appear that only one staff member helped lift the person back onto their bed. Correct moving and handling measures, including using two staff members, must always be an option to ensure that the person is protected from unnecessary trauma. The person’s next of kin also confirmed that the person concerned had always bruised easily and was on medication that could also increase the risk of bruising. This was not recorded in the person’s care plan. The person’s care manager was also alerted to the situation and followed up the noted marks at a review which took place three days after the inspection. There were also daily records available for all the people and in some instances these were in depth and thorough allowing carers to have easy access to what care had been provided each day/night. However for some others there was less information recorded. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 15 One record was noted as not being helpful or respectful as it stated: “X said she couldn’t walk, didn’t know if X was being lazy or had a cold coming”. The next day the person was diagnosed with having a chest and urine infection, which indicated the person was obviously unwell the previous day but a carer had considered the person may be being “lazy”. This sort of entry may lead other staff to make the wrong assumptions and so not provide the necessary care. During the inspection it was noted that one person, who was in bed, did not have their call bell to hand as it had been left sited away from the bed even though it had a long lead that allowed for it to be placed on the persons bed and therefore be within easy reach should the person require assistance. Without the call bell being made available the person would not have been able to summon help. The District Nurse services have provided two hospital beds for use within the home. These beds were noted as having cot sides in place, which are used, however there were no records in place to inform carers why the sides are to be used and how. The decision to use cot sides must always be discussed with the person involved, if possible, and/or their family/advocate as well as relevant professionals involved to ensure that this form of protection is considered to be in the best interests of the person concerned. The home’s systems for the administration of medicines were examined. A monitored dosage system is used and records relating to this system were accurate and up to date with people who live at the home’s photographs also in place on each record to add a further element of protection when the staff administer medication. Medication training is provided by the local supplying pharmacy and only trained staff administer medication. There was also a list of homely remedies approved for use in the home. Medicines are held in locked cupboard and further storage is available for controlled drugs within this cupboard, however this is not permanently secured. Additionally it was noted that the key to the medication cupboard was kept in a communal area with staff accessing it and they needed. This could mean that someone who was not authorised to do so could also easily access the key. Both these practices are therefore compromising the security of the medications held in the home. There was also feedback received from a relative, which stated that there had been a period of time when a person had not been supervised in the taking of their medication. As the person has poor eyesight they had not always been aware that they had not taken their medication and were throwing it away with their napkin into the bin near them. Therefore the person could have been at risk by not having their prescribed medication. Observation of staffs’ interactions with the people evidenced that the staff treated people with respect and dignity and tried to ensure that their individual choices and needs were upheld at all times. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 16 During the inspection a district nurse was spoken with who felt that the care provided was satisfactory and that any instructions she gave were followed. A visiting psychiatrist also fed back that although he had not had a great deal of contact with the home he did not have any the specific concerns regarding the home. People spoken to also felt that the staff provided good care. A comment received stated: “Always has a caring atmosphere. Meets individual requirements or needs, welcomes visitors”. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,and 15. Quality in this outcome area is adequate. People who live at the home are mostly confident that they will be generally well supported to pursue their chosen lifestyles. The home’s activity programme does not currently meet everyone’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live at the home, who were able to, were noted as pursuing their own interests, (e.g. reading, watching television). A bright communal lounge area is available for those who wish to sit and socialise. Those who wish to remain private are able to do so and individual rooms contained personal possessions. Feedback from relatives confirmed that there are flexible and open visiting arrangements in place and during the inspection several visitors came and went quite freely. They confirmed that they were always made welcome. Staff were noted as trying to met all the peoples’ needs effectively and were sensitive to their individual needs. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 18 A staff feedback comment stated that:“The care home will not stand for any racial or any other discrimination. This further evidences that staff are aware that all the peoples’ needs must be considered and all must be treated with equal respect. The activities programme was limited. Although there is a regular external entertainer who visits on Monday afternoon there are few other regular activities planned and provided. This is mostly because staff, who normally run the activities in the afternoons, are too busy providing for the required care needs of the people to provide additional social activities. Therefore people are left to amuse themselves and it was noted during this inspection that for some people this meant just sitting in the lounge and not undertaking any specific activity. There were no up-to-date records available to show what activities had been provided in the recent past or whether people had enjoyed them and had been able to participate in them. This means that the management is unable to monitor whether or not all the people choose or are able to participate in activities when they are able to be provided. People were generally satisfied with the meals provided by the home, however although the cook and the staff stated that there was always a choice available at mealtimes, most people spoken to were not aware of this and neither were their relatives. The menu board, which is displayed in the dining room, also had no alternative written down. Therefore although the cook and the staff are willing to provide a choice, people feel they can only have the meal that is stated. Menus were inspected and appeared to provide a variety of nutritious and well-planned meals. The cook working on the day the inspection confirmed that the components of liquidized meals were liquidized and arranged separately when such measures were needed. Meals are mostly taken in the home’s dining room but people can have them in their own room if they wish to. There are two cooks who work opposite each other and they provide the main meal of the day, which is lunch. Care staff prepare and provide the breakfast and supper for the people. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The quality in this outcome area is adequate. Arrangements for protecting the people and responding to their concerns are such that they should be protected at all times. However not everyone was aware of how to make a complaint to the Commission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection key inspection carried out in May last year, the Commission has received two complaints. These have centred on different care issues which people have had concerns about. One complaint resulted in a random inspection, which was undertaken in January this year whilst the provider investigated the second complaint. The random inspection did not conclude that there were any shortfalls in the care provided. Fuller details of this inspection can be obtained upon request from the Commission. The internal investigation undertaken by the owners highlighted some areas (such as staff communication) that could be improved upon. This evidences that the owners take complaints seriously and will use the information received to better the service. Therefore the people at the home can be confident that any concerns or complaints they may have will be taken seriously. Staff spoken to were clear about how they would deal with any allegation of abuse. However during conversations with people at the home and their relatives it was concluded that they did not know how to make contact with the Commission for the Social Care Inspection if they felt the need to. This may be because not everyone had received the home’s Statement of Purpose or Service User Guide. Although a complaints procedure is displayed Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 20 within the home it could easily be missed if people were not aware of its location. The owners do not deal with the peoples’ money other than to hold small amounts if requested/required. Full details were seen of monies held and of records of any expenditure. This ensures that the peoples’ monies are protected. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The quality in this outcome area is adequate. Pendennis is mostly comfortable, clean, well maintained and provides a safe standard of accommodation. Isolated odours, associated with incontinence in some bedrooms, are compromising these peoples enjoyment of their room. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The tour of the home confirmed that the owners mostly continue to maintain high environmental standards throughout the home by means of good maintenance and upgrading as required. A comment received from a relative stated: “the cleanliness of the home is always spotless” Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 22 Furnishings and décor both in communal areas and in the individual rooms were comfortable, homely and well-maintained. All areas were warm with plenty of access to natural light and were being well used. Individual rooms contained personal possessions such as photographs and pictures. However it was noted that there was an odour associated with incontinence in three peoples’ bedrooms. Also a relative of a person at the home fed back to the Commission that the radiator in her relative’s room and in the hallway directly outside had recently been switched off or was not working. This had resulted in a portable fan heater being used in the person’s bedroom, which had not been the most comfortable option for the person as it had made the room very stuffy. The relative stated that although the manager had told her that the radiator did not work when she tried to operate it herself she found it did work properly. (In the event of a portable heater being used a risk assessment must be carried out to ensure that the use of the appliance does not compromise the health and safety of the person occupying the room and should only be used as an emergency measure). During the inspection of the premises it was also noted that the floor covering in the communal first-floor toilet was lifting away from the skirting board. This could cause a risk of cross infection. The home’s infection control measures were noted as being adequate with anti-bacterial gel having been placed throughout the home including central areas such as the entrance hall. Staff receive regular fire training and the management maintain the home’s fire log book and undertake the home’s fire risk assessment, both of which were seen. The laundry facilities are situated in an outbuilding, and at the last inspection were noted as having cleanable walls and an impermeable floor with hand washing facilities available to staff in the laundry. One person fed back that some items of their relative’s clothing had gone missing when they were first laundered by the home. This was because they had not been told, on admission, that all clothing needed to be marked. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The quality in this outcome area is poor. Staff at the home are not always employed in adequate numbers to meet the peoples’ care needs. Staff training is not providing new staff with the required skills to be able to fully understand the requirements and expectations of their role. The home’s recruitment programme does not always fully protect the people. EVIDENCE: The staffing levels at the home were noted as not being adequate for the needs and numbers of the people accommodated. For example on the morning of the inspection there were only three care staff on duty, with the designated senior care staff member also providing management cover in the absence of the registered manager and owners. There were 21 people in the home, some with a high degree of need. The inspection commenced at 10.15 a.m. and it was noted that there was still people sitting at the breakfast table at this time. It was also noted that one person, sitting in a wheelchair in the lounge, was unable to be helped into an easy chair when they asked to because there were no staff available to do this. It was also noted that one person wanted to go and lie on their bed, however again the person had to wait as they were not enough staff to be able to do this when the person asked. Another example of when the home could be considered to be short staffed was at breakfast time when there would have been only three members of staff on duty to both care for the people as well as provide breakfast. It would be the same at tea time teas as the two cooks only prepare and serve the daily lunch. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 24 The staff spoken to confirmed that they felt pressurized and unable to provide the one-to-one care that they sometimes felt was necessary due to pressure of providing the general care to ensure the basic care needs and safety of the 21 people at the home was maintained. Further discussion with staff highlighted that there was some confusion at night time as to who provided the on-call cover. It was understood that the manager, who lives in a separate but adjacent bungalow within the home’s grounds, was expected to provide on call cover and her bungalow has an on call bell so that staff can summon help from the main home. However staff reported that recently she has not always responded to their calls for assistance and so consequently the waking night staff has had to wake another member of staff, who lives in at the home but works on the day shift and is not rostered to be on call at night, to get the assistance she needs to provide the care required. A relative’s feedback also stated that the home could improve by: “Having a greater ratio of staff to residents so that more individual care and attention can be given. Quite often when I visit on an afternoon at weekends there appears only to be two staff on duty”. However comments received also indicated that people were happy with staff members who did provide the care, for example comments received stated such things as: “All staff appear genuine caring people. Always a welcome and nothing too much trouble”. The staff work well together as a team. From my point of view premises and the staff are excellent. Although the designated senior care staff member on duty on the day of the inspection was rostered to provide the management cover for the home she was also needed to provide care due to the low staffing numbers. This meant she was not always freely able to fully undertake what are considered management tasks such as being able to talk to a visiting district nurse, a visiting psychiatrist, several relatives, discharging a short stay person back home, admitting a new short stay person into the home or being available to deal with the questions that arose during this inspection in a relaxed manner as she was also very aware of the need to ensure the care of the people was maintained. It is to her credit that she put the peoples’ needs first, but having been designated to be in charge, sufficient time should have been allocated to allow her to undertake any necessary management tasks associated with being in charge of a residential premise. Staff stated that several of them had already completed or were going to complete nationally recognised training in care. Out of the current staff group of nine, five have already achieved a recognised qualification in care. This ensures that an appropriately trained and aware staff group cares for the people at the home. The staff confirmed that they had also received statutory training including fire training, vulnerable adults training and some had received and others were in the process of receiving moving and handling Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 25 training from the manager. When questioned staff confirmed that the manager’s training, in respect of moving and handling, had consisted of giving them some paperwork to complete whilst she had shown them how to use lifting equipment such as the hoist and handling belt. As the manager was unavailable to speak with, it is not clear how effective she felt her training had been. However evidence was gathered, which confirmed that inappropriate moving and handling techniques has been used recently in respect of two people who live at the home. One was in respect of the person whose care has been previously discussed under the section: “Health and Personal Care”. The relative of the second person stated that there has been an incident a few weeks ago when the person had had a fall and a member of staff: “had pulled her back onto her chair” The relative also stated that the same member of staff had subsequently not reported the incident or informed others of what action they had taken. Some new staff have been employed at the home since the last inspection and their recruitment records were checked. They were mostly in order, however in one instance there was only one reference on file. The owners are in the process of recruiting some more staff and have already employed an overseas member of staff, through an agency, who has now integrated well into the staff team. The owners are due to employ a further staff member from overseas, within a short time, when all their visa requirements have been met. There was very limited information regarding the induction training that any new member of staff had been through. This made it impossible to verify whether the new members of staff had received the necessary training to allow them to be able to carry out their care duties in an appropriate manner. Comments received from both the people who live at home and their relatives evidenced that people feel the staff themselves are caring, kind, professional and that they try their best to meet the peoples’ needs. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 (some parts of standard 37 was inspected bit it was not inspected fully): Quality in this outcome area is poor. The service is not benefiting from a strong and consistent management approach and peoples quality of life is poorer for this. The home is not currently operating in the best interests of the people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last full inspection undertaken in May last year the owners have appointed a registered manager. Although the manager is suitably qualified having undertaken the NVQ4 in care and the registered managers award, the evidence gathered during this inspection would indicate that the manager is Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 27 not fulfilling the tasks that are required of a manager to the required standard to ensure that the home runs in the best interest of the people who live there. Although the registered manager was due to provide supervision for staff none has been formally provided and there are no records to support supervision of any kind. Therefore the staff have not had the ability to meet with manager on a one-to-one basis to discuss any concerns, training needs or ways that they can personally develop within their career. Several staff members collectively spoke about the fact that they felt that the communication between the manager and themselves was not always as good as it could be. By not providing supervision this is not helping these communications. Other evidence which indicates that the registered manger is not fulfilling the requirements of her role include: Inadequate pre-assessments prior to a persons admission, inadequate care planning and risk assessing of individual peoples’ needs, lack of communication between staff and manager, lack of ensuring that all recruitment records, as required, are received on behalf of each newly employed member of staff and a lack of ensuring that a quality assurance system operates within the home. On the day the inspection, as previously mentioned, a designated senior member of staff had been left in charge of the home for the week preceding the inspection and was in charge on the day of inspection. However she did not have access to required records, including the necessary forms needed to notify the Commission of two deaths that had taken place during the week. Neither did she have access to any staff records or any other formal documentation including the manager’s appointments diary. This was because these were locked in the homes office and she was not provided with the key. Therefore there was an expectation that she could manage the home without access to necessary documentation, which could have put people at risk. An example of this was the admission of a short stay person, whose admission was only known about when the person’s relative telephoned the home the day before the admission. The senior care staff member had no knowledge of this admission and could not check the homes appointment diary, which was in the locked office. Access to the office for the inspection of other records was only made available because the owners returned back from their holiday and immediately made their way to the home to rectify the situation. The registered manager has not commenced any form of quality auditing of the service, including seeking the views of the people who live at the home, their relatives/advocates or any other interested parties that may have contact with the home, as to how they feel the home is performing. Therefore an annual development plan has not been compiled which would take into account either good or negative feedback, which would then allow the service to further develop. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 28 This evidences that the home is not always run in the best interests of the people who live at the home. Comments were also received that indicated people generally thought that the service was not running to the high standard it had done before, for example: “Home used to meet X’s needs six months ago” “ In recent months the standard has declined” When speaking to the manager a few weeks ago she admitted that X needs more care but no one has suggested she is reassessed or moved, the manager just did not seem to care. The home’s pre-inspection documentation stated that all required policies and procedures are available and that all health and safety requirements are met and maintained appropriately by the management. It was noted that in one instance, where hot water regulation has not been provided due to the person’s personal choice, a risk assessment was in place in respect of this person having access to water hotter than the recommended safe temperature of 43°C. The owners have continued to visit the home on a monthly basis and have forwarded a record of all their visits to the Commission. There have been several incidences, within the last year, which the home has been has required to notify the Commission of and this has been done in a timely manner which has ensured that the Commission is aware of incidences that effect the people at the home. Records inspected were mostly in order, however the home keeps a book detailing any falls (in addition to their accident reporting). The details are held collectively, which means that should anyone want to read the information held about them they would also be able to read details regarding others as these details either follow on or are recorded before their own, on the same page. This is compromising peoples’ rights to confidentiality. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 x 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 x x x x x x 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 3 1 2 3 Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No (non issued) 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 OP1 Standard Regulation 4 (2) 5 (2) Requirement The management of the home must ensure that the home’s service user’s guide and the home’s statement is made available to any prospective new person and or their family/advocate who might be considering living/staying home. This is so that any prospective person considering coming to live or stay at the home can be aware of the services and facilities available at the home. It will also allow people who decide to come to live at the home to be informed as to what expectations the home has for a new person on admission. This relates specifically to a person knowing that their laundry must be marked, prior to admission, to prevent it getting lost. 2 OP3 Pendennis Residential Home Timescale for action 09/12/07 14(1)(a) The management of the home 09/12/07 and (2)(a) must ensure that any new persons’ needs are fully assessed DS0000062705.V351359.R01.S.doc Version 5.2 Page 31 by the management, prior to admission, and any changes following admission fully recorded and appropriately provided for. This will ensure that the person and/or their family/advocate can be assured that the staff are able to fully meet these needs. 3 OP3 14 1 (d) The management of the home must confirm in writing to a prospective person and/or their family/advocate, prior to admission, that the home will be able to meet the person’s assessed health and welfare needs. 09/12/07 4 OP7 15(1) and (2)(b) This will ensure that the person and/or their family/advocate can be assured that the home both know and agree to meet the identified needs. The management of the home 09/12/07 must ensure that all people using the service have an up to date, detailed care plan, which, wherever possible, has been drawn up with the people themselves and or/their family/advocate. The care plans must contain details of peoples’ physical needs and routine monitoring such as weight checks. The care plans must also be such that they are easy to understand and access by the staff providing the care for the people. All care plans must be reviewed monthly with the person and/or their representative. This will ensure that the people Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 32 5 OP7 13(4)(c) receive mutually agreed continuing support that meets their needs. The management of the home must ensure that unnecessary risks to the health or safety of the people who live at the home are identified and so far as possible eliminated. This refers specifically to reviewing and updating individual risk assessments specifically in the respect of a loss of mobility as well assessing the risk of using of any type of portable appliance. 09/12/07 6 OP8 13 (7) The use of restraint measures such as cot sides must be risk assessed by the management of the home and advise sought as to the extent and use of such restraint from other relevant professionals. The use of such measures must always be discussed with the person it affects and /or their family/advocate. This will ensure that the peoples’ health care needs are being met. 09/12/07 7 OP27 18 (a) 8 OP28 18 (c) (1) The registered owners must review the staffing levels at the home to ensure that there are sufficient staff on duty at all times and increase these levels accordingly. This also refers to ensuring that there is the required rotered number of staff on duty at night. This will ensure that the people who live at the home can be provided with the level of care they need. The management must ensure that the staff working at the DS0000062705.V351359.R01.S.doc 09/12/07 09/01/08 Pendennis Residential Home Version 5.2 Page 33 9 OP29 19 (4) (b) 10 OP31 12 (1) (a) (b) 5 (a) 11 OP33 18 (2) home receive appropriate training for the work they do. This refers specifically to ensuring the staff receive an appropriate induction training programme and to moving and handling training. This will ensure that the people who live at the home are cared for by an aware and understanding staff group and as such receive the correct care. The registered owners must ensure that there is a robust recruitment programme operating within the home, which includes the receipt of two written references. This is so that the people who live at the home living at the home will be cared for by suitable staff and will remain protected. The registered owners must ensure that that the home is operated, in their absence, by the registered manager in such a manner as to ensure the health and welfare of the people who live at the home. The registered mananger must also maintian good personal and professional relationships with the people who live at the home and others involved in their care. This will ensure that the people who live at the home feel confident that the management of the home will be able to deal with any arising issues and so feel confident with the management of the home. The management must introduce a structured system to monitor the quality of the service provided. This should include the views of service users and other DS0000062705.V351359.R01.S.doc 09/12/07 09/12/07 09/03/08 Pendennis Residential Home Version 5.2 Page 34 stakeholders. This report must be made available to the Commission. This will ensure that all involved in the receipt of care are able to have a say into how that care is delivered. 12 OP36 18 (2) The management must provide 09/02/08 regular supervision to all staff and keep records of the same. This will ensure that all staff have the opportunity to have individual time with the management of the home and to allow the staff member to discuss any issues of their role that they may wish to have extra support with and also for the management of the home to monitor the progress of each staff member and to offer support/training as required. This will ensure that staff are enabled to feel confident in their role. 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 OP7 Good Practice Recommendations Daily records, used to inform the care planning process should be detailed, noting the care provided and any change to the person’s needs. This information should then be recorded in a professional manner. Any person who is either room bound or bed bound should have the availability of their call bell at all times. The security of the medicine cupboard and the storage of DS0000062705.V351359.R01.S.doc Version 5.2 Page 35 2 3 OP8 OP10 Pendennis Residential Home 4 5 6 7 8 9 10 OP12 OP15 OP16 OP19 OP19 OP31 OP37 any controlled medications should be reviewed. The administration of medication should be reviewed to ensure that staff are aware of the importance of monitoring whether the people need support to take their medication. The management should review the home’s activity programme, update the activities as required and keep records of all activities made available to the people. Meal time choices should be made known to all the people who live at the home. The management should ensure that all interested parties are aware of how to contact the Commission for Social Care Inspection if they needed to. The flooring in the first floor communal toilet floor should be repaired. The home’s heating to individual bedrooms and landing areas should remain constant. The person deemed to be “in charge” of the home in any absence of the registered manager should have access to necessary documentation and records. All record keeping should be maintained in accordance with Data protection Act 19988 requirements. Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pendennis Residential Home DS0000062705.V351359.R01.S.doc Version 5.2 Page 37 - 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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