Inspection on 06/12/07 for Penfold Lodge

This inspection was carried out on 6th December 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Penfold Lodge 10/07/08

Penfold Lodge 13/12/06

Penfold Lodge 21/09/06

Penfold Lodge 14/03/06

Penfold Lodge 09/02/05

Penfold Lodge 06/01/05

Penfold Lodge 24/08/04

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

CARE HOME ADULTS 18-65 Penfold Lodge 8-10 Penfold Road Clacton on Sea Essex CO15 1JN Lead Inspector Gaynor Elvin Unannounced Inspection 6th December 2007 10:30 Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 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 Penfold Lodge DS0000028590.V356219.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Penfold Lodge Address 8-10 Penfold Road Clacton on Sea Essex CO15 1JN 01255 223311 01255 223311 manager.penfoldlodge@careuk.com 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) Care UK Mental Health Partnership Limited (Arc Healthcare Limited) vacant Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (17) of places Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require care by reason of a mental disorder (not to exceed 17 persons) 13th December 2006 Date of last inspection Brief Description of the Service: Penfold Lodge is a residential care home, registered to provide personal care and accommodation to seventeen persons of either sex, between the ages of 18 - 65 years, who require care by reason of a mental health problem excluding dementia or a learning disability. The home is owned by the national organisation Care UK Mental Health Partnerships and currently does not have a registered manager. Penfold Lodge is located in the seaside town of Clacton on sea and situated in the town centre, close to the sea front. A range of facilities and services such as shopping, education, leisure, public transport and the beach are within walking distance from the home. The care home is an older type property made into five separate units. Each unit has single bedrooms, bathroom, kitchen and dining area. Six of the bedrooms having en-suite facilities. Communal areas consist of a non-smoking main lounge with dining area and a dedicated sitting room for smokers. Although staff do provide support or assistance with personal care where required, the home does not aim to meet the needs of those with a physical disability or illness, and is not equipped to meet such needs. The passenger lift is no longer in use. There are small gardens to the front and rear of the property. The front garden is laid to lawn with flowerbeds and some off-road parking in the driveways. The rear-enclosed garden is paved with shingle, a lawn and paths. The fees range from £350.00 to £512.50 per week. Additional charges are made for personal items, hairdressing, chiropody and some activities. Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over seven hours during a weekday. This report has been written using accumulated evidence gathered prior to and during the inspection. Comment cards from residents and relatives were completed and returned to the Commission and views expressed are included within the contents of this report. Four of the five comment cards received from residents were completed with the help of the support workers. The Annual Quality Assurance Assessment (AQAA), a self-assessment that focuses on how well outcomes are being met for people using the service, was completed by the home and returned to us prior to the visit to the home. Information received in the self-assessment provided us with some detail to assist us in understanding how the registered persons understand the service’s strengths and weaknesses and where they will address these. The inspection process included reviewing the progress of the requirements made at the last inspection on 13th December 2006, and documents required under the Care Home Regulations. Additionally a number of records were looked at relating to the residents, staff recruitment, training, staff rosters and policies and procedures. Time was spent talking to senior carer, support workers and residents. What the service does well: What has improved since the last inspection? Recent refurbishment and re decoration has included re wiring and electrical work, new floor covering in main communal areas and some bedrooms and re decoration in some bedrooms and bathrooms. Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is adequate. Prospective residents’ cannot be assured that all their assessed needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose had not been reviewed. Information relating to management and staff was no longer accurate with regard to management details and staffing structure, training and skill status. The situation we found during the visit to the home did not fully reflect the care provision described in the brochure produced for Penfold Lodge, with regard to trained staff, tailored care packages and structured and individualised activity programmes. The Service User Guide provided the residents with information relevant to living in the home including fire safety and the complaints procedure. Whilst the content is generally sound, consideration should be given to the format in relation to the resident group and literacy abilities. The complaints procedure was in small font. The document did not contain reference to the details of total fees payable in respect of services provided, arrangements and circumstances for the payment of such fees or those responsible for all or part Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 9 of the payment. A separate document was evident in care files, this was generic and only provided information in relation to the sum of fees payable. The people most recently admitted to the home had been supported in their placement by the Community Mental Health team and had visited the home prior to their decision to live there. Information in the AQAA informed the Commission that admission and assessment procedures had been reviewed and improved. Records for most recent admissions were found to be variable in the quality of their completion and content. The format of the pre admission assessment forms was divided into headed sections to prompt the assessor in relevant areas such as cognition; recreation, social functioning, behaviours, risk factors and self care skills. The actual level of information completed in these documents varied and some replicated information provided by the placement team. This impacted on how successfully a person centred plan could be developed to deliver quality care to meet the resident’s needs, abilities and preferences. The staff and management team has recently been inconsistent and the use of agency staff has been high. One healthcare professional had raised concerns about the lack of a clear management structure within the home and that there had been no preparation for a potential new resident visit to the home and that during the visit staff seemed unhelpful. The deputy manager and the senior carer are the only members of the staff team to have achieved a National Vocational Qualification at level 2 in care. The remainder of the staff team are working towards it. Some staff have attended a short course in mental health awareness. Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is adequate. People who use this service do not receive care and support that is planned, recorded and tailored to meet their individual needs and provided in a consistent and effective way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We inspected a sample of four care plans. At the last inspection the previous manager had reviewed and begun to develop the care planning process. It was disappointing to note that this work had not moved forward with more detailed recording and meaningful reviews. Steps had been taken to obtain historical information about the individuals living in the home, this was noted to relate mostly to the persons’ family tree and past working life. Further work in this area is needed to gain more information about the person to be utilised within the care plans and help staff Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 11 understand some of their anxieties that may link with past experiences and mental health problems. Care plans were more task orientated and lacked a person centred approach and did not reflect a full appreciation of the diversity of residents. For examples: ‘to clean flat – to become independent’ and ‘to participate in activities – to become more sociable’ and ‘to prompt with personal hygiene – to become more independent’. The care plans lacked detail in, and in some cases omitted, the actions required of staff in providing appropriate support to achieve outcomes for example ‘needs prompting’. A review for one plan simply stated ‘ to continue to give reminders’. More detail specific to the individual in the action required would direct staff in how to support the resident consistently to a level that would maintain dignity, optimal independence, achieve satisfactory outcomes and minimise any associated risks. Where related risks were identified such as verbal aggression; self-harm and refusal to take medication, again, there was insufficient detail to enable staff to have a consistent planned approach. Management strategies were blank and we were advised that this was because the staff did not know how to complete the forms. The mental health related needs for one person included impaired reasoning, impaired judgement, impulsive behaviours, history of self-harm and mood swings. These needs were not taken account of in the care planning process and the care records did not demonstrate care and support planning arrangements or review to evaluate the effectiveness of the care being provided. The inspector was informed that the service had given this person notice of termination of placement, as the home was unable to manage the individuals’ behaviour and was unable to meet their needs. Entries in daily records were brief and some simply stated ‘care plan achieved’. More detail with regard to benefits or outcomes achieved, or not, would provide a clear basis upon which to review support and care practices. Residents are encouraged to maintain the cleanliness of their rooms and participate in a rota for household duties in their flat. The standard of cleanliness varied throughout the flats. The floor of one bedroom had a heavy layer of accumulated dust and dirt. We were advised that the carpet was new. Staff spoken with stated that the residents were encouraged and prompted to participate in their household chores but ultimately their choice of lifestyle was respected. Careful consideration needs to be given to the reasons or effects of mental health on individual behaviour, particularly with regard to safety, personal Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 12 hygiene and daily living and social skills to ascertain whether this is simply choice or an affect of illness. Recorded structured management strategies would guide staff in providing mutually accepted solutions in supporting residents to make real and informed choices that are socially valued. Residents’ personal money is kept secure in individual named tins in the office; the person in charge holds a key to the tins and the resident holds the other. Records are kept for checking finances daily at staff handover. Transaction records identify income and expenditure and the resident and a staff member sign off each transaction. We checked a sample of balances and found that one balance was short by £5.00. It transpired that this amount was taken out the day before by the deputy manager and put into an envelope and stored in the staff room in case the resident required it the next day. This action was taken because there was no senior member of staff on the next day and support workers did not have access to the office or the resident’s money. This is not good practice and appropriate management arrangements should be considered to enable residents to have appropriate security and access to their money at all times. Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 and 17. Quality in this outcome area is adequate. People using the service can expect to live in an unrestricted environment within independent units. However the extent to which people are offered opportunities for personal development and supported to take part in valued and fulfilling activities varies according to level of need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a relaxed atmosphere observed in the home. It was clear that some resident’s were used to coming and going freely, in particular one person said that they went out more since coming to live at Penfold Lodge. Routines for getting up and going to bed varied according to the preferences of the individuals and people were observed to get up at different times throughout the morning. Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 14 As part of the inspection visit the inspector was shown around the home including the bedrooms belonging to people who lived there. None of the rooms were entered without first knocking and gaining the person’s permission. Staff were respectful to peoples’ privacy and ensured this was protected when showing a visitor around the home. Some residents kept their room locked and held their own key. The people living at the home said they generally found staff to be helpful in the way that supported them. The home has the facilities to enable independent living however this is not used to its full potential. Each unit has a kitchen and residents were provided with basic provisions from the home’s stock to prepare snacks, such as value brand tins of tuna, spaghetti, hotdogs and meatballs and bread. This system still encouraged an element of dependency although we were advised that residents went out daily to purchase their milk. Opportunities and support in menu planning, budgeting, shopping, food preparation and basic cooking skills would further benefit the residents in developing and maintaining daily living skills. Care plans did not include long-term goals or aspirations and did not provide any information on how the individual spent each day. An activity of daily living needs assessment for one person stated that the individual has difficulty to engage interest in anything and spends free time doing nothing. A mental health review undertaken with social worker identified that another person enjoyed walking, used to attend a local bike club and complained of lack of sufficient activity. This lack of future planning does not promote well being, self-esteem or quality of life. On the day of the inspection the majority of the residents attended a Christmas dinner at a local restaurant, with staff. On their return residents said that they had enjoyed the afternoon and had a good dinner. We were advised that residents participate in menu planning although this was not evident on the day of the inspection when the remaining residents were told what was being prepared for dinner. Staff prepare the meals. Food stocks in the main kitchen were plentiful and comprised mainly of frozen foods such as various fish portions, steak and kidney puddings, pies, sausages, chicken fillets, chips, limited frozen vegetables such as broccoli and mixed vegetables. Other stocks included instant noodles, various cereals, tins of fruit cocktail, jars of sauces such as sweet and sour, bolognaise and lasagne. People living at the home had a diverse range of nutritional needs relating to physical and/or mental health needs requiring a more health focused well balanced diet. We were informed that fresh fruit was delivered twice a week and was freely available to the residents, bananas; pears, mandarins and apples were evident. A drinking water cooler had recently been installed for residents. Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. Aspects of people’s physical and mental health were addressed proactively but people did not receive care and support in a planned and recorded way to effectively meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From observation and discussion with staff it was clear that they generally understood the individuals’ needs and provided a level of care that the residents appreciated. There was no recording in the care plans of those individuals regarding any strategies for managing issues relating to their physical and emotional health needs or the level and type of support each individual required or received. Brief entries in care plans for actions to be taken included ‘attend weight watchers’ and ‘see dietician’ and ‘needs support to record results of blood sugar monitoring and gain knowledge in diabetes, to eat regularly’. Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 16 Staff felt that communication was good at the home and that resident’s physical and mental health was not overlooked; despite them not being written into a care plan. However it is good practice for all actions and interventions to be recorded in this way as it ensures all staff are informed and appropriate care is provided in a consistent and planned way. Residents said that staff help them with their health care needs and that they attended regular reviews with the mental health team. Overall the home is better at recording hospital and health specialist appointments and referrals to health specialists in order to meet identified physical and mental health needs of residents. However care plans were not revised or in some cases generated to reflect any changes or monitoring in the care to be provided. A psychiatrist was visiting a resident during the inspection and they were given privacy for the consultation. Staff would benefit from training in understanding and managing diabetes as three residents had type 2 diabetes and were controlled by medication and diet and diet only, and one resident had type one diabetes and was insulin dependant. Diabetes is a diet related chronic disease and if appropriate diet is not understood or planned for this will lead to complications and associated health risks. There was no evidence of specialist monitoring such as NHS Dietician, Optometry or NHS chiropody in line with the National Service Framework (DOH 2002) for Diabetes, or links with organisations such as Diabetes UK, which may potentially place the resident at risk. Nutritional needs were not fully assessed using a risk assessment; and weight monitoring was also noted to be inconsistent and not always recorded on admission. This does not ensure that well-being and changing needs are being closely monitored in this area, particularly important for people with physical and mental health related needs. Observation of the lunchtime medication dispensing demonstrated a robust system with two staff overseeing the process. The routine in some aspect was a little institutional with people coming to collect their medication from the dining room, staff were asked to call others and medication was only taken to those residents who failed to come from their rooms. Only one resident self medicated and at the time of the inspection was on leave from the home and staying with family. Information provided in the AQAA indicated that promoting and assessing people’s self-medicating abilities was an area for improvement. The home had a dedicated sitting room for use by people who smoke. This room could not be fully closed off to non-smokers as it provided access to other parts of the home including the staff room, a toilet and one of the group flats. An open window was the only form of ventilation and will not comply with new legislation that comes into effect in July 2008. Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. People who use this service can expect their concerns to be listened to and acted upon but limited staff training may put residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of residents commented that they were aware of the homes complaints policy and knew who to go to if they had any concerns about the service. One resident commented that they were not aware of how to make a complaint but knew who to go to in the event of any concerns; another resident commented that they were not aware of the complaints procedure and did not know who to go to. We noted that the residents’ copy of the complaints procedure was kept in the residents file, in the locked staff office. Although residents had access to their files on request they would benefit more if these documents were in their possession for easy access and reference. The document was noted to be in small font. Consideration should be given to alternative formats suitable for those residents with limited literacy skills. The complaint policy needs to be reviewed and updated to include details of the local authority, the appropriate statutory body for people to direct any serious concerns. We were advised that staff had undertaken training in safeguarding vulnerable adults although not all records seen supported this, those staff spoken with Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 18 were clear about their responsibilities under the safeguarding vulnerable adult policy. In the last year the home had made a safeguarding referral and the organisation undertook an internal investigation. Records of the outcome and the agreed action to be taken were evident, although it was not clear if the action was fully implemented or monitored. The Commission was not informed of the outcome. The Commission was informed of a recent incident but it was not clear as to whether the home had appropriately reported the allegation to the local authority. The current local authority guidance to reporting such matters, produced by Essex Vulnerable Adult Protection Committee (EVAPC) and appropriate reporting forms were not available in the home. Staff would benefit from a more structured and formal training accessed from the local authority that would inform them of the correct processes. Staff records did not show that staff had received appropriate training in respect of understanding and managing mental health related needs such as challenging behaviour including physical or verbal aggression. The lack of training in these areas could limit their understanding in respect of protecting people, whose behaviour could be challenging or threatening. Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26 and 30 Quality in this outcome area is adequate. People do not benefit from an environment that is clean or maintained in such a way that suits their lifestyle and promotes their safety and wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises indicated limited improvement in the general state of the premises. Recent refurbishment and re decoration has included re wiring and electrical work, new floor covering in main communal areas and some bedrooms and re decoration in some bedrooms and bathrooms. The staff were unsure of any future plans to continue the refurbishment programme and other areas remained in urgent need of attention. The condition of the carpets in some areas reflects poorly on the home. A healthcare professional raised concern with regard to the poor standard of the Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 20 environment. These improvements are much needed and would improve outcomes for residents. Bathrooms were bare and clinical, and had an odour similar to that from drains. Staff also commented that they had noted this smell but did not know where it was coming from. This needs to be addressed in the maintenance programme. Some rooms were personalised with individual’s own belongings although one resident confirmed that they were not offered the opportunity to participate in any decisions or choice regarding the décor and colour scheme of their room. Other rooms had limited furniture and facilities that suited lifestyles, for example, due to the lack of furniture a lamp and television was kept on the floor on the floor; there were an inadequate amount of wall electrical plug sockets for increased use of personal electrical appliances for today’s lifestyle, inadequate storage facilities and seating in bedrooms. The residents are expected to take responsibility for the cleaning of their room and the units they lived in. The standard of cleaning varied in different areas of the home indicating that some people required more support than others. Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is poor. People who use this service are not supported by a stable and effective staff team that is well trained and supported in their role. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of staff records was viewed to ascertain compliance with regulatory requirements. Information relating to recruitment, job induction, training and supervision were requested. No records were available relating to the recent recruitment of a staff member who had commenced employment at Penfold Lodge approximately three weeks prior to the inspection. Without this information the service cannot determine that the applicants they propose to employ are suitable candidates to care for vulnerable adults. Records relating to a staff member who commenced employment approximately two months prior to the inspection visit contained the required recruitment documentation. The records did not provide documentary evidence of the new staff member undertaking an induction or that appropriate supervisory arrangements were in place. There was also no evidence to Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 22 indicate that this person had received any structured support or formal supervision. This was particularly concerning as this person had not worked in care before or with people with a mental health problem. Despite the lack of structured induction assessment and formal supervision this staff member received a basic attendance only training in administration of medication from a local pharmacist and records indicated that competency in medication administration was assessed as safe by the temporary manager on 30/10/07, approximately 2 weeks following commencement of job. The declaration of competency did not indicate the content of the assessment or how competency was assessed. An action plan, received from the home in March 2007, advised us that staff had completed a three-day mental health induction course and understanding diagnosis. The plan did not state who or how many staff attended. There was no evidence on the site visit to support this information. However it was noted on the AQAA, completed by the manager in July 2007, that six members of staff have left employment in the last 12 months. The AQAA also informed us that the staffs lack of understanding; education and motivation were seen as barriers to improving the service. It also stated that the manager (at that time) had tried to reduce the impact of barriers by staff training in an effort to stop institutional practice, which included completing induction and training updates and that all staff had started to work towards a National Vocational Qualification. The deputy manager and the senior of care were currently the only members of the staff team who have successfully achieved an NVQ level 2 in care. We were advised that all but one of the staff team had commenced NVQ. Staff files did not demonstrate a commitment to continued and focused training in core areas such as infection control, fire safety, health and safety, food hygiene and first aid or areas pertinent to the residents’ assessed mental health related needs. Staff confirmed that they had limited opportunities offered for training. Some core training has been provided for some staff through short course attendance only. We noted that those certificates confirming attendance for safeguarding vulnerable adults, teamwork, caring for adults with a mental health problem and first aid were all dated the same day. Training and development plans for staff individually or as a group were not available. Training would be more beneficial to residents and staff if it was provided within a planned programme in response to identified needs of the residents and the staff skills mix. Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 23 Staff files or supervisory notes do not provide documentary evidence of assessed staff competence in areas of training received by ‘attendance only’ from external training companies. Staff supervision was not recorded regularly and there were no records to identify when dates were programmed for supervision with their line manager. The opportunity for staff to have protected one to one time in which they receive feedback on their performance and have the opportunity to raise any issues of concern to them is an important part of ensuring quality care. Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42. Quality in this outcome area is poor. The home is not effectively and efficiently managed and improvements identified at previous inspection have not been sustained. A lack of commitment to continuous improvement in quality services, support, accommodation and facilities and health and safety, does not assure the safety and quality of life of people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A high staff turnover and the resignation of the registered manager have had an impact on the quality of service delivery and outcomes for people who live there. Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 25 One relative commented ‘‘I am concerned about the frequent change of staff and management. My son is affected by changes…. this affects his mood swings. There have been many changes during his stay at Penfold Lodge’’ The deputy manager was recruited just over 6 months ago and has had to take over the daily running of Penfold Lodge. He is not experienced or qualified to manage a home and receives minimal support from a manager based at another establishment, provided by the company, more than 50 miles away. On the day of the inspection the deputy manager was on a course during the morning and attended the residents Christmas lunch during the afternoon. The senior carer who came in on her day off assisted the inspection visit. Initially on the inspectors arrival there was no senior member of staff on duty and the support staff did not have access to the office. Staff indicated that there were generally times when there was not a senior member of staff on duty. Staff annual appraisals had recently been undertaken and we noted that some staff had remarked on the current staff dynamics and low morale, this was confirmed during discussion with staff. We were informed that the last staff meeting took place in February 2007. There were no records available to demonstrate that resident meetings had taken place although we were advised the last one took place some time in June/July. The knowledge of the senior was limited in relation to the records and documentation required to effectively and efficiently run the care home and experienced difficulty in locating documentation requested. There was no evidence available in the home to demonstrate that a system for evaluating the quality of the services provided at the care home was in operation. The staff were unaware of any quality assessment and monitoring systems in place, indicating that if a system had been developed they were not included in this process. During the tour of the building we noted a serious issue in relation to the overloading of electrical plug sockets posing a risk to the health and safety of the people who live and work at the home. An 8 socket extension lead was plugged into the main wall socket; 6 appliances and 2 other extension leads were plugged in to the extension lead, 4 appliances were plugged into one and one electrical appliance and two battery chargers plugged into the other. In total 11 electrical appliances, two extension leads and two battery chargers were plugged into one wall socket. The plugs were immediately removed. Residents used part of the landing of one of the units as a lounge area. A lamp, a CD layer, a TV and a DVD player were plugged into an extension lead. There was only one electrical wall socket on the landing and the cables Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 26 trailed across the floor of the passageway. Due to the potential safety hazards the extension lead was immediately removed. Another room was filled with an accumulation of boxes and bags filled with objects; old electrical goods and food collected as a consequence of the residents’ mental health problems and were a potential fire hazard. These health and safety issues should not have necessitated the attention of the inspector to prompt this action and did not demonstrate that checks in relation to fire safety and health and safety were carried out regularly and routinely. Attention should be given to ensure facilities are adequate for the residents needs. A large 20 litre container of hard surface cleaner and 3.5 litre container of washing up liquid was stored on the floor of the laundry room to which residents had access. Appropriate storage is required to protect residents particularly those with a history of self-harming. Risk assessments relating to safe working practice, the environment and fire safety were not in place and therefore did not ensure that any actions and management strategies were being taken to reduce or prevent any identified risk. Consideration should be given to developing an internal audit system to ensure that all aspects of the service are maintained and developed, for example, environmental audits and recording system audits etc. A representative of the company, on behalf of the responsible person, undertakes monitoring visits monthly. A report of the findings is made, a copy of which is sent to the Commission. The most recent report highlighted that fire action notices were required, fire exit signage was not obvious in the dark and exposed wires were observed hanging outside of a bedroom. Prompt action had not been taken to address these issues. Following this inspection, these issues were brought to the attention of the Tendring District Council Environmental Health Department. The Annual Quality Assurance Assessment (AQAA) requested by the Commission informs the inspection process and provides us with information about the service. The content of the AQAA did not give an accurate picture of the current situation in the home and did not tell us that the management is fully aware of the services weaknesses and the steps that are required to develop the quality of service provision such as quality assessment and promoting health and safety. Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 2 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 2 26 2 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 X 15 2 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 1 1 X X 1 X Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 6 Requirement The Statement of Purpose and Service User Guide should be kept under review and updated accordingly to provide current and prospective residents with up to date and accurate information. Timescale for action 01/04/08 2. YA5 5 Residents’ contract/statement of 01/04/08 (1)(ba)(bb) terms and conditions must (bc)(bd) inform them of the arrangements and circumstances of fees payable, what they refer to and who is responsible for the full/ partial payment. 15 The team must undertake further work to ensure that all residents’ health, personal and social care needs are set out in a detailed individualised plan of care. This is so that people can be sure that their needs and changing needs are appropriately and consistently met, and emotional and mental health related needs are responded to. DS0000028590.V356219.R01.S.doc 3. YA6 01/04/08 Penfold Lodge Version 5.2 Page 29 This is a repeat requirement not met within previous timescales. 4. YA6 14(2) Residents’ needs must be kept under review and reassessed and changing needs identified must be planned for within an individual, detailed plan of care and support. The staff team must develop an understanding of the careful balance that needs to be maintained between the individual rights of the people living in the home and their responsibility to protect people from harm and meet their assessed mental health related needs. Staff must be guided in providing appropriate information; assistance and communication support to people living in the home to enable them to make an informed decision about their life, ensuring their dignity and respect is promoted and maintained. 01/04/08 5. YA7 YA11 12(2) 01/04/08 6. YA9 13(4)(b)(c) Risk assessments must be developed to include management strategies linked to care planning arrangements to guide staff in identifying and managing risk factored behaviours with agreed diversion and coping strategies, reduce identified or potential risk and promote residents safety, independence and well being. This is a repeat requirement. 01/04/08 Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 30 7. YA24 23 (2) All parts of the home must be 01/04/08 kept in a reasonable state of decoration to improve outcomes for residents. Facilities must be provided that meet the needs of the residents. This is a repeat requirement. All parts of the home must be kept clean to promote the health, safety and wellbeing of the people ho live there. Staff must have adequate training to ensure they have current knowledge and skills they need to support and protect people living at the home. This is a repeat requirement. A full employment history must be sought and gaps in employment explored as part of the application process for potential new staff to ensure they are suitable candidates. This is a repeat requirement 01/02/08 8. YA30 23 (2) 9. YA32 18 01/04/08 10. YA34 19 01/02/08 11. YA35 18 (1)(2) Staff that are new to the home 01/02/08 need essential training in the form of induction and core training; and supervised support to ensure their practice is safe and appropriate. Staff must be appropriately supervised so that they have the necessary support to develop their practice in the best interests of the people they deliver care and support to. A system for monitoring and evaluating the quality of care provision in the home must be implemented and maintained to DS0000028590.V356219.R01.S.doc 12. YA36 18 (2) 01/02/08 13. YA39 24 (1) (2) 01/04/08 Penfold Lodge Version 5.2 Page 31 improve outcomes for residents. 14. YA42 13 (4)(c) All parts of the home to which residents have access must be risk assessed and strategies in place to eliminate or reduce actual or potential hazards identified to ensure residents safety and wellbeing, particularly with regard to the hot water system, harmful substances, overloading of electrical plug sockets and trip hazards. This is a repeat requirement The home requires a manager to provide organisation and direction in the home to improve outcomes for the people who live there. 01/04/08 15. YA37 8 01/04/08 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. 2. Refer to Standard YA7 YA7 YA11 Good Practice Recommendations The home needs to consider how to provide appropriate protection and security for the safekeeping of resident’s money and enable them to have access to it at all times. With more appropriate support people could exercise more choice and control in some areas of their lives and be stimulated and occupied in ways that enhance their wellbeing. People should be more involved in deciding what they wish to eat and have a menu they can refer to. Residents should be supported within a risk management framework to manage their medication where possible to promote or retain their independence. Nutritional records should be held for residents to enable an assessment of whether residents dietary intake is satisfactory and that there are specialist diets provided and choices available. DS0000028590.V356219.R01.S.doc Version 5.2 Page 32 3. 4. 5. YA17 YA20 YA20 YA19 Penfold Lodge 6. YA22 The complaint policy needs to be reviewed and updated to include details of the local authority, the appropriate statutory body for people to direct any serious concerns. Some people would benefit if this document is produced in alternative formats to suit their needs. Residents should be provided with furnishings appropriate to their needs. There should be a training plan for staff. This is to identify the skills that staff have and to highlight training gaps and when update is required. NVQ training should continue to be encouraged amongst staff in order to meet the recommended level of qualified staff. The home needs to consider how they can comply with legislation related to smoking facilities in a residential care home that come into effect in July 2008 and meet people’s needs. 7. 8. 9. 10. YA25 YA35 YA35 YA42 Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Penfold Lodge DS0000028590.V356219.R01.S.doc Version 5.2 Page 34 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!