Inspection on 12/09/08 for Penlee

This inspection was carried out on 12th September 2008.

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

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

Other inspections for this house

Penlee 08/05/09

Penlee 04/10/07

Penlee 04/04/07

Penlee 14/09/06

Penlee 26/09/05

Penlee 25/04/05

Penlee 11/10/04

Penlee 14/05/04

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 27/02/2009.

CARE HOMES FOR OLDER PEOPLE Penlee 21 Uphill Road North Weston Super Mare North Somerset BS23 4NG Lead Inspector Patricia Hellier Unannounced Inspection 12th September 2008 09:30 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 Penlee DS0000020337.V370766.R03.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. Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Penlee Address 21 Uphill Road North Weston Super Mare North Somerset BS23 4NG 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) 01934 632552 01934 412711 penlee@freeuk.com Dr Harmandar Singh Gupta Mrs Diljeet Kaur Gupta Manager post vacant Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. May accommodate up to 29 persons requiring nursing care Staffing Notice dated 23/04/02 applies. Manager must be a RN on part 1 or 12 of the NMC Register The provision of one interim care bed for service users 50 years and over. 4th October 2007 Date of last inspection Brief Description of the Service: Penlee is a Victorian building renovated in 1992 situated along from the main sea front and overlooking the Weston Golf Club. It provides nursing care for up to 29 older people. The building and décor is of a good standard providing a comfortable and homely environment. Accommodation is provided over three floors with a passenger lift giving easy access to all floors. There are twenty-three single rooms, and three that may be shared. Eighteen of these have en-suite facilities and all have a call bell system. Communal space is provided in a lounge and dining room in the main building, and a conservatory. This looks out onto an enclosed garden with a feature fountain. Provision is made within the home for some activities and outings, which also enable close links with the local community to be maintained. All local facilities are within easy walking distance but some are closed in winter. The enclosed garden allows for good weather activities outside. Garden furniture is provided. Dr and Mrs Gupta have owned Penlee for many years. They are very involved in the day-to-day running of the home. They make information available through a brochure about the home that incorporates key information from the Statement of Purpose and Service User Guide. CSCI reports are displayed in the entrance to the home and available for all to read. The fess range from £545 - £650 per week with additional charges being made for hairdressing, chiropody, newspapers, escorts, toiletries and some transport. This information was provided in September 2008. Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection took place over 11 hours on two days. The Registered Manager, Ms P.Rodman and the Registered Provider Dr. H.Gupta, were present throughout. Before the inspection the information about the home was received from the file held in the office and surveys received from three people who use the service. The last two inspection reports were reviewed as a Random inspection had been undertaken in July 2008 to review the running of the home since the departure of the previous manager, and in response to a complaint received about poor care practices and staff shouting at residents. The outcome the inspection was that some concerns were upheld and that the new manager was addressing these issues. The Annual Quality Assurance Assessment (AQAA) form, from the provider was also reviewed. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We (The Commission) also reviewed all correspondence and regulatory activity since the last Key inspection. The accumulated evidence for this report comes from the above and also fieldwork that included discussions with eleven residents, two relatives, and six staff. Practices were observed and documents relating to care, recruitment and health and safety were reviewed. Of the ten resident surveys sent three were returned. The replies indicated that responsive staff meet their care needs, and they are provided with all that they need. Comments from residents were “the staff are very kind and helpful”; “they make you feel welcomed and part of the family.” “I like living here”. A concern was raised about having to wait for a couple of days for replacement medications. On inspection of the medicines management practices were not clear and occasionally this may be the case. None of the surveys sent to staff or Health Care Professionals were returned. The home has recently received a compliance visit from North Somerset Council contracts department. The feedback from this indicated that “the new manger has already has made changes in respect of CSCI requirements and recommendations”. “Penlee presented as a care home that has a positive, homely and well run feel.” Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 6 All residents and relatives spoken with told us that the home was good and the staff very kind. Comments received were “staff are exceptionally kind”. “ Nice home and the food is good”. What the service does well: What has improved since the last inspection? Since the last inspection a number of specific nursing profile beds with integrated bed rails have been purchased for the safety and comfort of the residents. Staffing levels have been kept under review and adjusted according to the dependency of the residents, to ensure there are enough staff to meet the needs of the residents. Provision is made for snacks to be available at all times should the residents’ wish and staff are aware of this to ensure that no resident goes for long periods without food or is hungry. Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 7 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. Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 8 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 Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 9 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): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User Guide is comprehensive and provides prospective residents with information to make an informed choice. The home’s assessment process is satisfactory and ensures that it is able to meet residents’ needs. Prospective residents and relatives are encouraged to visit the home to assess suitability. EVIDENCE: Residents are provided with a comprehensive Service User Guide containing the Statement of Purpose and all the information required to ensure they or their relatives have access to the relevant information at all times. Two recently admitted residents, who had come to the home as emergency admissions, had not been provided with this document but told us “they told me about the home and daily routine”. Provision of this document to all residents on admission would ensure they, and their relatives, have access to reference the information provided verbally, and to clarify any points of confusion. Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 10 The Statement of Purpose includes information regarding equality and diversity issues and the homes philosophy of care that includes meeting cultural and diversity needs. Three resident files inspected showed that all privately funded residents receive a contract of Conditions of Admission and Terms of Business. Recently admitted residents who are publicly funded had not received a copy of the Terms and Conditions document which forms a contract of agreement. The new manager was unaware of these documents and stated she would “rectify that immediately”. The contract documents supply residents with clear information about the breakdown of fees, outlining the contributions to be made and by whom, to make up the weekly chargeable amount. The registered manager carries out a needs based pre-admission assessment on all prospective residents. Admissions to the home take place once the registered manager is confident the residents care needs can be met. The registered manager does not always write to new residents, or their relatives, to confirm the home can meet their individual needs and provide confirmation of discussions. For emergency admissions the manager always obtains a Social Services assessment and care plan to ensure the home can meet the prospective resident’s needs. Three residents assessment documentation were read to find out how well the needs are assessed. The assessments were informative, and showed the residents had been consulted about their range of physical needs, mental care needs and dietary choices and preferences. Preferred names had also been recorded, demonstrating person centred care. One assessment record had gaps in contact information. The risk assessment documentation in all records was incomplete and did not provide clear information and actions as to how the risks were to be minimised for the benefit and safety of the residents. The assessments seen while person centred did not evidence the outcome of the assessment. It is recommended that this information be completed. In discussion with the manager, staff and residents it was evident that good practice outcomes are achieved in the admission process, however gaps in documented information do not always support this, to enable consistent and knowledgeable care provision. Care practices observed showed that staff were fully aware of the residents’ needs as stated in their assessments. Residents were able to recall having been visited by the manager prior to admission, and also being invited to visit the home. Thus enabling the prospective residents to meet other residents, see the facilities offered and look around the accommodation available. One recently admitted resident told us ‘I am well looked after; they know what I need”. Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 11 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): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from care plans that are mainly well formulated and give clear information to enable staff to meet residents’ health and social care needs. Personal and environmental risks are not always well managed. Residents’ cannot be sure that the management of medicines is safe and protects their health and well being. Respect and dignity are well maintained by kind and caring staff. EVIDENCE: The residents and visitors with whom we spoke said that they were very satisfied with the standards of care and felt the staff were good. One relative told us that the staff are “always understanding about the residents needs and wishes. Individual records are kept for each of the residents and include details of personal preferences and interests, reflecting a person centred approach. Three care plans were inspected and all reflected current identified health and social care needs. In one of the care plans a recent care need had not been Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 12 recorded or any actions to meet that need identified. There had been no follow up of the need in the daily records for five days which was not in the best interests of the resident. In discussion with staff they were unaware of the need. For identified needs clear actions to meet these were recorded and regular evaluation noted to ensure provision of appropriate care for residents. In all three records inspected risk assessments had been completed but despite the assessment indicating a high risk there were no recorded actions to meet those needs. E.g. a nutritional risk assessment indicated cause for concern, however there had been no record of the resident’s weight on admission and no planned review during their stay. The care plan did state to give “dietary supplements as required”; but there were no clear indications as to when this might be. Risk assessments for pressure relief had been completed but no clear actions noted on the care plan. Residents at risk of developing pressure sores were observed to be nursed on pressure relieving mattresses, and staff told us they regularly assisted the residents to change their position. A chart to record the position changes, and fluid and dietary intake was available but it had been sparsely completed for recent days and did not evidence the staffs’ comments. At the time of the inspection one resident had a pressure sore, and records inspected showed appropriate treatment and evidence it is healing. Pressure relieving equipment was seen in use in a number of areas in the home. Communication systems between staff regarding residents care needs was observed to have gaps in the recording, and verbal handover of changes to care needs. Residents would therefore benefit from clearly completed care plans and better communication systems to ensure staff have the information, knowledge and skills to meet care needs in a way that respects the individual’s choice and fulfils their duty of care. (See staffing section of this report for comment about training). Staff when interviewed were clearly able to describe the needs of the residents being case tracked and demonstrated a person centred approach to care. This is good practice. Health care professionals such as GP’s visit the home as required, to carry out health care checks and offer advice to staff. Evidence was seen of residents being taken to other appointments as needed. Resident’s comments supported this. Care practices observed showed caring interactions and good communication skills and interactions from staff. Choices and preferences were observed being discussed and offered. Detailed conversations with eight of the residents confirmed a satisfactory standard of personal care. Two residents said, “it’s homely” another resident said, “people are very kind, we are well looked after” and a third said “they are very respectful and helpful”. Another resident told us “I would recommend the home to anyone”. Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 13 Medication storage, receipt and disposal are not well managed for the safety of residents. A full audit trail of medicines entering and leaving the home is not possible giving rise to concern that medication is not always managed in the best interests of, or for the safety of, residents. Facilities for the storage of medicines were seen to be secure. The Medication Administration Record (MAR) sheets had been well completed with only a few gaps. The staff who administer medication have received appropriate accredited training, to ensure they have the skills and knowledge for the safety of residents. However they have not been competency assessed for sometime. A list of specimen signatures was recorded in the medicine administration record for accountability purposes. Hand written prescriptions had been signed for accountability purposes, and good practice guidelines of two signatures implemented. One resident self medicates, keeping the medication in their room, which can also be locked. All rooms are provided with a lockable space however unsecured medicines were seen in the resident’s rooms. This potentially poses a risk to other residents in the home who may gain access to them. A risk assessment for self medication had been completed for one resident who had signed it in agreement with the assessment. However the staff indicated they therefore had no further responsibility for this person’s medication and had not recorded the amount of medication received into the home. There was no policy guidance as to how staff were monitoring compliance with the prescriptions for the safety and well being of the resident. On checking the audit trail of a number of medicines we found that the numbers recorded, the numbers signed as having been administered and the number of tablets remaining did not tally, indicating that residents had potentially not been given the medication as prescribed Records were incomplete and did not clearly show the use or disposal of medicines thus a number of tablets showed as missing, or in excess. This potentially puts residents at risk of harm from mismanagement of medicines, and is poor practice. A comment received from the surveys returned and also raised during the inspection was “we sometimes have to wait a couple of days for replacement medication”. In discussion with the manager and staff they were not aware of this, however given the above it was not possible to evidence or refute this comment. An immediate requirement was issued to ensure the safe keeping and administration of medicines in the home for the benefit of residents. The manger took action between day one and day two of the inspection and spoke with staff. She had developed a policy guidance document and competency assessment form for use with all staff, to ensure understanding and Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 14 appropriate administration of medicines. She told us she plans to implant this as soon as possible. The home uses Homely Remedies and has a policy and agreement with the local doctors as to what medication may be given without consultation, and for how long. Staff when spoken with had clear understanding of the potential harm that could befall residents, should inappropriate homely remedies be used for too long. The interactions of the care staff observed, demonstrated respect for individuals and their right to privacy. Residents spoken to say, “the staff are very thoughtful and kind and treat you very well”. All residents spoken with felt that kind and caring staff respected their dignity and privacy. The home has an Equality and Diversity policy that recognises the cultural and social needs and differences that are present in society. Both management and staff demonstrated clear knowledge and desire to meet cultural and diversity needs as and when they should arise. Staff interviewed said, “We are all one happy family here”. Clear information about race, age, gender and religion is given in the Statement of Purpose and staff have the knowledge and confidence to discuss diversity issues with residents and their relatives. Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 15 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from routines, and menus, that are flexible to meet their needs. A variety of activities is offered, and residents’ right to choice and control over their lives is well respected, and encouraged. Friendly staff always welcome relatives and visitors. EVIDENCE: Many residents commented on the atmosphere of the home. One person described it as nicely informal, and residents’ felt that their visitors are also helped to feel relaxed and at home. When asked about activities and their daily routine two residents said, “we have singing sometimes”. While another said “I like my own company and have the television”. The activities organiser left recently and the programme of activities has lapsed. The home currently employs a musical entertainer three mornings a week for a sing a long, which residents were seen enjoying during the inspection. The manager informed us that a new system is being introduced from next week, as they have appointed one of the care staff as activities Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 16 organiser. Residents were seen happily engaged in activities of their choice, reading the paper, watching television or enjoying the garden. A large white board was displayed in the conservatory giving residents information of meals, staff names who were working that day, and for how long they would be there. The general atmosphere in the home was good, with a lot of activity, staff and regular contact of owners with residents. Relatives were seen popping in during the course of the inspection and being welcomed by staff. One relative said, “I feel quite happy coming here and the staff are very good to me”. Comments made by relatives indicated that they were made welcome; “there is always a warm welcome when I visit”. A friendly banter was evident between staff and residents throughout the inspection. All the residents said that the ‘food is good’. Menus showed a varied, balanced and nutritious diet. The meal on the day of inspection reflected this. The dining room is homely and tables well presented. A choice of meal is offered and likes and dislikes catered for. Staff and residents are aware that snacks are available form the kitchen at any time. In addition to the usual cups of tea and coffee, a choice of cold drinks was regularly offered throughout the day. All residents were seen to have juice in their rooms and jugs of varied juice, with glasses, were available for residents to help themselves to in the main lounge. Staff were seen offering drinks throughout the day to residents in the conservatory. The home has recently undergone an inspection from Environmental Health (Food) who approved their provision and practice by awarding the home a five staff rating. This is to be commended. Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 17 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ are protected from abuse, and they can be confident that complaints are taken seriously and acted upon. EVIDENCE: The home has a comprehensive complaints procedure and all residents receive a copy on admission. There has been one complaint since the last inspection. This was appropriately investigated and handled, to provide the best outcome for the residents. Residents stated that if they were not happy about anything they would speak to the manager. Residents said that the manager and staff are “very approachable” and they would always raise any niggles or concerns with them. Staff and residents spoken to, say the manager is very approachable and understanding. One resident said ‘I’ve nothing to complain about, it’s just like home – we are one family”. A system for keeping clear records of complaints received, with actions taken, and outcomes is available to demonstrate the homes wish for satisfactory outcomes. The home has a copy of the ‘No Secrets’ in North Somerset guide and a comprehensive local policy and procedure for responding to allegations of abuse for the protection of residents. Staff interviewed were conversant with the home’s Safeguarding policy and demonstrated good knowledge of the adult Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 18 protection procedure that should be followed, if abuse is suspected for the protection of residents. The home also has a Whislteblowing policy and staff are aware of this and their duty of care in relation to whistle blowing for the safety of the residents. Care plans inspected showed that consent for the use of bedrails had been obtained from some residents or their relatives thus safeguarding choice. There was no evidence that residents sat in recliner chairs, which they could not operate, had been consulted or their liberties considered under the Mental Capacity Act 2005. It is recommended that policy guidance is sought and implemented to safeguard residents. Staff have received formal training regarding Safeguarding Adults and how to whistle blow should the need arise. Staff when interviewed were aware of the policy, had an understanding of what constitutes abuse and how best to respond to any allegations or incidents, should they occur for the protection of residents. All residents said, “The staff are very kind and take time”. “I can’t fault them”. Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 19 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): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with homely, safe and comfortable surroundings. Outdoor space is attractive and accessible for residents to enjoy. The home has suitable equipment to maximise resident independence. Satisfactory Infection Control practices are followed. EVIDENCE: The home is nicely decorated and well maintained with a welcoming atmosphere, and made comfortable with homely communal spaces. All rooms are provided with vanity units or en suite facilities. Residents’ rooms are personalised and comfortable. The décor, fixtures and fittings are in good order. The lounges are furnished with a variety of suitable and comfortable chairs to suit residents’ needs. The home has a well maintained garden for residents to enjoy. Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 20 The provider spoke of the employment of a handyman since the last inspection and the ongoing plans for maintenance and refurbishment of the building. A plan to evidence this was not seen, however improvements in the décor since the last inspection were noted. There are plenty of toilets within easy access of all communal rooms, for the comfort of residents. The home has grab rails situated at relevant points and a shaft lift to all floors that is easily used to assist resident mobility, and aid independence within the home. The home has sufficient bathroom facilities with aids for the benefit of residents. Equipment was clean and well maintained to ensure protection for residents from cross infection. Hot water outlets are thermostatically controlled and temperatures measured were within the guidelines of 43ºC for the safety of residents. Thermometers were present for staff to check the water temperature before baths for the safety and protection of residents. The home was clean and free from offensive odours throughout. The laundry facilities were organised to minimise potential cross infection. However with the limited space available during the inspection dirty laundry was seen to be overflowing the containers onto the floor, and creating potential for cross infection. Staff interviewed and observed demonstrated good understanding of Infection Control procedures and practices and maintained a clean and hygienic environment. Dispenser soap and paper towels have been provided in communal areas, thus providing good facilities for ensuring that staff can maintain good hand washing practices, between caring for residents. Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 21 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from staffing levels that are adequate to meet their needs. Residents are not always protected by recruitment practices. Residents do not always benefit from staff that are trained and competent to do their jobs. EVIDENCE: Staff went about their duties in an unhurried manner and were observed spending time talking with residents. Residents reported, “staff make time for a chat when they can.” Staff approached residents with directness, openness and consideration. Each of the residents with whom we spoke said, “the staff are very good”. One resident said, “they are lovely people here”. The staffing rotas for the two weeks prior to the inspection were reviewed. Staffing levels appear to provide sufficient care staff to meet residents’ needs. A good team of ancillary staff supports them. In discussion with residents they told us “the staff are very good and always there when you need them.” Other comments received were “you only have to ring the bell and they come”. In discussion with the manager she informed us that staffing levels had been increased recently to meet the increased number, and needs, of residents. Staff when interviewed confirmed this with two telling us “now we have Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 22 increased the number of residents, the manger has reintroduced the extra staff in the morning and at teatime”. Staff interviewed said that they were kept busy, but still had time to chat with the residents. Person centred interactions were observed with staff taking care to ensure the residents needs and wishes had been met, before moving on to their next activity. Call bells were answered promptly during the inspection. A few of the staff team employed at the home are from overseas. Residents and staff said, “they fit into the team well”. One comment received in the survey responses told us “new staff from overseas can be a bit unsettling as it takes time to understand them”. The home currently has 60 of staff with a National Vocational Qualification (NVQ). This should ensure that staff have the skills and knowledge to care for the residents in a safe and competent manner. Some care practices observed did not reflect this e.g. mouth care. Recruitment procedures do not ensure all the necessary safeguards are in place prior to employment of staff, potentially putting residents’ at risk. Two recruitment files were inspected. In all files a Criminal Record Bureau (CRB) or PoVA first check had been received prior to the commencement of work to ensure the protection of residents. In one of the files there was no documentation to verify identity or a recent photograph; and gaps in employment had not been explored. This information should be documented and evidence obtained to ensure the required checks are completed for the protection of residents. There was no evidence of safeguarding checks for the volunteer who provides the music sessions. In discussion with the manager she told us that this had been overlooked and she would obtain the necessary checks to safeguard the residents. She agreed that in the meantime unchecked staff in the home would be supervised at all times for the protection of residents. All staff said they worked well, as a team and sought to provide a happy atmosphere. Comments from residents, and observations of practice during the inspection, verified this. Evidence was seen of staff induction in the file of one new member of staff to ensure they have the skills and knowledge to care for residents appropriately. When interviewed we were told that the induction “was helpful and covered all the things I needed to know”. The home has not provided in house mandatory training in the last year. The manger told us that she is aware of this gap in skills provision for staff, and is currently seeking to arrange training for all staff in mandatory areas. Staff have been provided with some specialist training in stroke management and nutrition in the last year. However the knowledge and understanding of this Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 23 was not evidenced in records kept and practices observed. A training plan was not available and the manger told us she would be developing one, to ensure all staff received the necessary training to provide them with the skills and knowledge to fully meet residents’ needs. Residents tell us that they feel “the staff have a good understanding of their needs and how to meet them. Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 24 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): 31,32,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides clear leadership and guidance to staff to ensure residents receive consistent care in a safe environment. Quality assurance processes in the home are formal demonstrating that the home consults with residents, families and visiting professionals. Resident’s can be confident that monies held for them by the home are well managed. Health and safety issues are monitored in the home to ensure that issues are identified and addressed where they arise. EVIDENCE: Since the last inspection there has been a change of manager. The new manager has been in post for three months. She is well qualified having been a registered manager of two previous homes. Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 25 She gives clear leadership, guidance and direction to staff, and residents feel she is approachable and seeks to ensure all their needs are met. As the manager is new in post it was not possible to assess the full impact of any changes implemented as yet. Staff told us that “the home is now being knocked into shape” and “recent changes have been smoothly implemented, and have been for the good of the residents”. Dr and Mrs Gupta have a number of year’s experience of caring for the elderly and running Penlee. They are around daily in the home and support the manager in running the home. All staff and residents spoke of their “care and kindness” and told us “they have the residents’ best interests at heart”. Residents told us that the new manager is “approachable and seems to be tightening things up”. Two residents told us that she is “professional and kind and seems to know what she is doing”. All six staff interviewed stated that they felt well supported by an approachable manager. Policies, and practice guidance, are provided in the home although they are not always dated and signed for accountability purposes. These ensure staff are provided staff current good practice advice for the benefits of residents. . Staff are aware of the policy folder and can access it as needed. A formal quality assurance tool was available for inspection in order to demonstrate that the home consults with residents and relatives. The feedback from the questionnaires and compliments seen, told us the home cares for people well. E.g. “thank you for looking after me so well”. “Thank you for all your kindness to Dad”. A summary report of the analysis, to complete the Quality Assurance process, had not been undertaken to show how the home are incorporating, and responding to, resident’s comments in the running and management of the home. There are currently no channels for feedback to residents and relatives in response to their comments. The management of resident’s monies held by the home were inspected. A satisfactory system of recording was seen and all entries and monies inspected tallied and included two signatures for all entries to ensure residents’ monies are protected. Supervision for staff has not been provided regularly over the last year. The manager has implemented a new system in which supervision is cascaded down through the organisational structure, thus ensuring no one person is overburdened. Records inspected showed that issues relating to resident care, personal and professional development had been discussed and actions planned to address issues raised. Staff interviewed said they had received supervision once or twice this year. Records inspected indicated regular safety and fire checks are carried out. Staff spoken to confirmed that fire instruction and drills had taken place. Not Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 26 all staff have received fire training within the prerequisite timescales. must be provided for the safety of residents. This The home stores records securely and uses them in accordance with the Data Protection Act 1998. Information in some care records inspected was incomplete. Records should be accurately maintained to ensure clear information for the provision of knowledgeable and consistent care to residents. Records indicating regular maintenance to gas and water systems were seen, together with servicing records for all equipment. Recommendations raised by these professionals are responded to in a timely manner. Penlee DS0000020337.V370766.R03.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 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 2 3 Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 28 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13.4(c) Requirement The registered person must ensure that all identified risks to residents’ health have clearly described actions as to how these risks are to minimised for the safety and well being of the residents. The registered person must ensure the safe handling and administration of medicines for the benefit and well being of residents. An immediate requirement was issued The registered person must ensure that all required information and checks are undertaken prior to a person commencing employment at the home for the protection of residents The registered person must ensure that all staff employed in the home have received all required mandatory training, for the work they are to perform DS0000020337.V370766.R03.S.doc Timescale for action 16/10/08 2. OP9 13.2 16/09/08 3. OP29 19.1 Schedule 2 30/09/08 4. OP30 18.1(c) 30/11/08 Penlee Version 5.2 Page 29 and to enable them to adequately meet residents’ needs. 5. OP30 18.1(c) Specialist training provision must 31/12/08 be provided to ensure care needs can be met in accordance with best practice guidance 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 OP3 Good Practice Recommendations To document the outcome of the assessment process as to how the home can /cannot meet their needs. To provide written confirmation of decision for clarity for prospective residents and their families. 2. OP7 To improve communication systems, both written and verbal to ensure that all changes in care needs are known to staff and continuity of care provision is maintained for the well being of residents. Records of activities provided, including one to one sessions, to evidence good practice. To complete the Quality Assurance processes by completing an analysis of responses received and write a report demonstrating how feedback has informed the running and development of the home. To ensure regular supervision that includes discussions linked to the aims and objectives of the home to ensure knowledgeable and competent staff. To ensure that all written records are maintained up to date with full relevant information for the benefit of residents’ care. 3. 4. OP12 OP33 5. OP36 6. OP37 Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Penlee DS0000020337.V370766.R03.S.doc Version 5.2 Page 31 - 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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