CARE HOMES FOR OLDER PEOPLE
Penlee 21 Uphill Road North Weston Super Mare North Somerset BS23 4NG Lead Inspector
Alison Murray Unannounced 25 April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Penlee Address 21 Uphill Road North Weston Super Mare North Somerset BS23 4NG 01934 632552 01179 400657 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dr Harmandar Singh Gupta Mrs Demelza James (awaiting registration) Care home with nursing 29 Category(ies) of Old Age - (29) registration, with number of places Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. May Accommodate up to 29 persons requiring nursing care 2. Staffing Notice dated 23 april 2002 applies 3. Manager must be RN on part 1 or 12 of the NMC Register Date of last inspection 11 October 2004 Brief Description of the Service: Penlee provides nursing care for up to 29 older people. The home is situated on the main road along from the sea front in Weston Super Mare. Accommodation is provided over three floors in an attractive old house. There are twenty three single rooms, and three which may be shared; Eighteen of these have en-suite facilities. Communal space is provided in a lounge and dining room in the main building, and a recently built conservatory. This looks out onto an enclosed garden with a feature fountain. A passenger lift offers easy access to all areas of the home. Dr and Mrs Gupta have owned Penlee for many years. They are very involved in the day-to-day running of the home. Demelza James has recently been appointed home manager. Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. During this unannounced inspection, over 6 hours were spent in the home. Although four sets of care records were reviewed, the day-to-day care and experience of the residents was the main focus of the inspection. Many of the residents were not able to express an opinion, so time was spent sitting and chatting with them. During this time, it was possible to observe their body language, and the way staff and residents responded to each other. During the inspection, one relative, and four staff members were consulted. Time was also spent with Mrs James and Dr and Mrs Gupta. What the service does well: What has improved since the last inspection?
Since the last inspection, Mrs James has been appointed home manager. Dr and Mrs Gupta are confident in Mrs James’ abilities, and feel that they work well together. Staff said that they value Mrs James’ support and leadership. Residents and relatives said that they found her to be open and approachable.
Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 6 The staff recruitment procedures have improved significantly. The staff records seen during the inspection contained all the required information, and showed a robust recruitment procedure. Newly appointed staff are given a thorough introduction to the home, and are well supported through their induction period. Mrs James has introduced a ‘no smoking policy’. As staff are no longer smoking in the staff room, the atmosphere in the dining room is much improved. 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.
Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4 and 5. As Penlee does not provide intermediate care, standard 6 does not apply. Residents’ needs are thoroughly assessed before admission to the home. Family members are given the opportunity to meet staff and get to know the home before they decide to place their relative at Penlee. EVIDENCE: Mrs James said that she visits prospective residents, either at home, or in hospital to carry out an assessment of their needs. Records for two recently admitted residents showed that this is a comprehensive assessment. In both cases, a care management plan had been obtained from the placing social worker. Conversations with staff and observation during the inspection confirmed that care provided is in line with the written plan. A new resident was due to be admitted the following day. Staff had already introduced her family to residents in the nearby rooms, ‘so that they all know each other’. During the inspection the family called into Penlee, to get the room ready for their relative. Whilst they were visiting, they called in to see her new neighbour. Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 9 The statement of purpose and service user guide have not changed since the last inspection. They must be updated to include Mrs James’ details, as well as the new address for the CSCI team. Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 The health and personal care needs of residents are well met. There is a friendly, informal atmosphere in the home, a good rapport between residents and staff. Care documentation places insufficient emphasis on individual risk assessment. Medicine recording and administration systems are poor, and place residents at risk. EVIDENCE: Standardised ‘core’ care plans were provided for the majority of identified needs. Staff had added guidance regarding individual needs, but care records reflected a very ‘medical’ view of the resident. They had not been reviewed every month, and it was difficult to work out when amendments had been made. Residents and their families gave no indication that they were aware of the contents of the care plan. A number of bedrooms had ‘safety gates’ fitted to the door. Staff felt that these were a sensible risk management strategy for specific residents. These gates are a form of restraint. Their use must be risk assessed and agreed with residents or their representatives. This must be documented in the care records.
Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 11 The residents appeared very frail, and few were able to initiate a conversation. They looked relaxed in the home, and were happy to chat to the inspector. All were neatly dressed, and attention had been paid to their hair and nail care. One resident has significant health and nutritional needs. She said that staff monitor her condition closely, and offer very good advice. Another lady has recently moved to Penlee. Although this lady has limited speech, it was clear that she and the staff have worked out a highly effective system of communication. Staff were helping her to organise appointments with various health professionals. Since she arrived in the home, Mrs James has forged good links with the local GP surgery and district nurses. With their assistance, she is currently reviewing all the wound care documentation. Most of the medicine administration records (MAR sheets) were clearly printed by the community pharmacist. Staff in the home had handwritten some amendments. These were not signed or dated. In one case, correction fluid had been used. One of these amendments implied that staff routinely conceal a resident’s liquid medication in her drinks. Although the progress notes indicated that the next of kin had been consulted about this practice, there was no risk assessment in place. It was not clear if staff had consulted the pharmacist to check that the medication could be administered in this way. When the MAR sheets were inspected at 11:30am, staff had already signed to confirm that medicines due at 13:00 and 17:00 had been administered. Although this was not the case, it is very poor practice. A random audit trail revealed that a ‘prescription only’ medicine for one resident was being given to another. Staff had altered the name of the resident on the pharmacy label supplied with the tablets. The MAR sheet for the second resident indicated that she was actually prescribed a lower dose than the first resident. Staff said that they had not noticed this. Because of gaps in the signage of the MAR sheets, it was not possible to determine how many incorrect doses had been given. Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 15 Activities provided tend to target the less able residents. Some residents are able to choose how to organise their day; others feel that staff make this choice for them. Residents’ family and friends are made welcome. Residents are encouraged to continue to attend local churches and clubs. The standard of food provided in the home is consistently good. EVIDENCE: A singer and keyboard player visits the home several mornings a week to play for the residents. During the inspection, he played to a group of about 10 residents in the conservatory. It was clear that these residents were highly dependent. They were obviously enjoying the music, joining in with the singing and playing percussion instruments. The activities record showed that the same group of residents attended these sessions each time. A significant number of the more articulate residents said that they preferred to stay in their room, rather than join in organised activities. They said that they spent their time reading and watching TV. Residents’ interests and hobbies were not formally documented in the care records. One resident expressed concern that he was ‘made to get up too early in the morning’. He said that the night staff got him up and dressed at about 6:30am. He then spent the rest of the day in an armchair in his room. He felt
Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 13 this made his day too long. With his permission, these concerns were shared with Mrs James. She agreed to speak to the night staff to ensure that residents were able to choose when to get up and go to bed. Two other residents said that they also got up early in the morning. They were very clear that this was their choice. A visiting relative said that he was always made welcome in the home. He visits every day and said that he is always offered a meal or hot drink. There was a steady stream of visitors during the inspection. Residents said that they were encouraged to go out on trips with family and friends. Several have continued to attend local churches and clubs. All residents praised the quality of the food provided at Penlee. The lunch served during the inspection looked and smelt appetising. Residents were able to choose where to take their meal. Tables and trays were laid with attractive linen and crockery. Staff offered residents verbal prompts, and assistance where necessary. The mealtime looked relaxed and unhurried. One resident did not eat much lunch. Staff were observed to offer her a food supplement drink after the meal. Residents were offered drinks at regular intervals during the day. One resident said that Mrs Gupta always offered him a can of beer with his lunch. He said he really appreciated this. Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The complaint procedure in the home is satisfactory. Staff demonstrate a good awareness of adult protection issues. EVIDENCE: Residents and staff said that they would be able to raise any concerns with Dr and Mrs Gupta. No complaints have been received since the last inspection. Staff consulted during the inspection demonstrated a good awareness of adult protection procedures. Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 24, and 26 Penlee offers comfortable and homely accommodation, but a strong smell of urine does not create a pleasant atmosphere to live in. EVIDENCE: When the inspection started at 10:45am, there was a strong smell of urine on the ground floor. There was one cleaner on duty, and the smell lessened towards lunchtime, as she completed her work. Penlee is a converted older property, with a purpose built extension. Storage space is limited, with spare furniture, wheelchairs and equipment kept in the corridor to the extension. The communal lounges are pleasantly decorated. The atmosphere in the dining room has improved since Mrs James made the home a ‘smoke free zone’. There are two assisted bathrooms. Both of these would benefit from refurbishment. Bedrooms were well personalised, with pictures, photographs and small items of furniture. Several have been redecorated since the last inspection. Dr Gupta
Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 16 has provided small fridges for residents to keep drinks chilled. Rooms at the front of the home enjoy a view over the links. One lady commented that she loved to sit and watch the birds in the trees outside her window. Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The numbers of staff on duty are sufficient to meet the needs of the current residents. Recruitment procedures are robust. Staff receive a thorough induction to the home, and are encouraged to enrol on further training. EVIDENCE: Conversations with staff and a regular visitor indicated that staffing levels were appropriate to the needs of residents. Staff said that they were kept busy, but still had time to chat with the residents. The visitor said that he did not have a problem finding staff to speak to. Call bells were answered promptly during the inspection. Some care staff have been recruited from overseas. They have integrated well with the existing staff, and were seen to communicate effectively with the residents. Staff records demonstrated a thorough recruitment procedure. A recently appointed care assistant said that she had been allocated a mentor, and given a good induction to the home. She said that Mrs James had encouraged her to start an NVQ course. She was due to enrol on this the following day. Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 and 38 This is a family run home. Residents and staff appreciate the active involvement of the owners. Shortfalls in health and safety provision could be improved by a regular risk assessment of the home. EVIDENCE: Dr and Mrs Gupta are actively involved in the day-to-day running of the home. Residents were keen to say how much they appreciated their daily visits. There was a strong sense of ‘family’. Mrs James said that she found their input invaluable, as it enabled her to concentrate on the residents and staff. Automatic door closures are fitted to doors in the communal areas of the home. The door to the ground floor annexe was propped open with a medicine trolley. Dr Gupta agreed to order an automatic closure for this door. One of the residents uses oxygen intermittently. This is stored in his room, but there was no hazard warning sign on his bedroom door.
Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 19 Staff had placed a carpet off cut under one of the chairs in the lounge. The edges of this were uneven, and posed a trip hazard. Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 4
COMPLAINTS AND PROTECTION 3 3 2 3 3 3 3 2 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 x x x x x 2 Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 21 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 OP1 Regulation 6 Requirement The statement of purpose and service user guide must be updated to include Mrs James details, as well as the new address for the CSCI team. Care plans must be reviewed and updated at least once a month. The invlovement of residents or their representatives in the care planning process must be documented The use of safety gates must be risk assessed and agreed with residents or their representatives This must be documented in the care records. Staff must sign and date handwritten amendments to the medicine administration records. Correction fluid must not be used. There must be a clear audit trail of medicines received into the home, and administered to residents. Staff must not conceal medication in residents food or drink, unless this has been fully discussed and risk assessed with relevent health professionals and the service user or their Timescale for action 25/06/05 2. OP7 15 25/05/05 3. OP7 13 25/05/05 4. OP9 13 25/04/05 5. OP9 12, 13 25/04/05 Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 22 representative. Any decisions made must be documented in the care records. 6. OP9 13 Staff must check the medicine administration record before they give a prescribed medicine to a resident. They must ensure that the correct strength of medicine is administered. They must not sign the record until the medicine has been administered. Medicines prescribed and dispensed for one resident must not be given to another. Residents must be able to choose when to get up, and when to go to bed. Staff must ensure that the home is kept free from unpleasant odours. Fire doors must not be wedged open. Hazard warning signs must be provided to identify rooms in which oxygen is stored. Trip hazards must be identified, and action taken to minimise the risk they pose. 25/04/05 7. 8. 9. 10. 11. 12. OP9 OP12 OP26 OP38 OP38 OP38 13 12 16 23 13 13 25/04/05 25/04/05 25/04/05 25/04/05 25/05/05 25/04/05 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 OP12 OP21 Good Practice Recommendations Activities provided in the home should be reviewed to ensure that they meet the needs and expectations of residents. The communal bathrooms should be redecorated. Penlee D53-D02 S20337 Penlee V222253 25.04.05 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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