Inspection on 04/04/07 for Penlee

This inspection was carried out on 4th April 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Penlee 08/05/09

Penlee 12/09/08

Penlee 04/10/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Penlee 21 Uphill Road North Weston Super Mare North Somerset BS23 4NG Lead Inspector Patricia Hellier Unannounced Inspection 4th April 2007 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.V334588.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Penlee DS0000020337.V334588.R01.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 0117 9400657 Dr Harmandar Singh Gupta Mrs Diljeet Kaur Gupta Mrs Demelza Beryl Louise James Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Penlee DS0000020337.V334588.R01.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. 14th September 2006 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 £523.57 - £560 per week with additional charges being made for hairdressing, chiropody, newspapers, escorts, toiletries and some transport. This information was provided in April 2007. Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place with two inspectors over 8 hours with the manager present throughout. The provider was present for the latter part of the day. As part of this inspection concerns raised to the Commission by visiting Health Care Professionals, regarding Manual Handling practices were particularly assessed and the concerns supported. The Commission had also received information regarding an allegation of poor practice from a member of care staff to a resident. This was not supported. Before the inspection the information about the home was received from the pre inspection questionnaire. It was not possible to send comment cards to residents, relatives and Health Care Professionals that visit the home, as the information was not available to CSCI prior to the inspection. The last inspection report was reviewed together with all correspondence, and complaints since the last inspection. The accumulated evidence for this report comes from the above and also fieldwork that included the following: discussions with 10 residents, 2 relatives and 5 staff, observation of practices, tour of the premises, review of documents relating to care, recruitment, health and safety; review of policies; inspection of medication records and storage. Relatives spoken with were satisfied with the overall care their relatives receive at the home. All knew how to make a complaint and felt that it would be listened to and resolved as far as the home is able. All residents and staff spoken with told the inspector that the home was good and the staff very kind. Comments received were “it is very homely and comfortable”; “my care needs are well met”. What the service does well: This is a family run home with a friendly atmosphere. Residents’ relatives and staff all appreciate the day-to-day input of Dr. and Mrs Gupta. The staff ensure the well-being and comfort of the residents’ and treat them with great respect and kindness. For example 9 residents spoken with said, “the staff are kind and caring.” Meals are varied, well balanced and nicely presented offering choice and variety. Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 6 Residents feel that if they had something to complain about they would speak to a member of staff. All residents spoken with said they had nothing to complain about. A relaxed and friendly atmosphere is felt in this home, which is kept clean and tidy. What has improved since the last inspection? What they could do better: Assessments of needs are not person centred and thus do not ensure that all prospective residents’ needs are identified and met in the way that is best for them. Assessments should be reviewed and amended to provide a person centred approach. Care plans are not a working tool or person centred, thus they do not inform staff of the care needs and preferences of individual residents. Care plans should be reviewed to enable them to become a working document to inform person centred care. Activities are limited and do not always provide a variety of stimulus for residents. A review of activities in consultation with residents would provide a more appropriate programme. Staff do not have good knowledge and practice for moving and handling residents. Training and clear leadership in the use of good handling practices is needed for the benefits of residents’ comfort and safety. The systems for the protection of residents from potential cross infection are poor, and need to be reviewed for residents’ safety. Staff do not always have the knowledge and training required to provide informed and safe care to residents. Provision of, and attendance at, training in both mandatory and specialist areas is needed. Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 7 The management of the home needs to provide clear leadership and direction to staff to ensure systems and practice provide a knowledgeable team and safe environment for the care of residents. 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.V334588.R01.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.V334588.R01.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 1,2,3,4,5 The Statement of Purpose and Residents’ guide is comprehensive and provides prospective residents with information to make an informed choice. The home’s assessment process is not person centred and does not show clearly how the home 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. One relative said, “the information was good and told us all we wanted to know”. Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 10 Resident files inspected showed that all privately funded residents receive a contract of Conditions of Admission and Terms of Business, and those who are publicly funded receive a copy of the Terms and Conditions document which forms a contract of agreement. In these documents the breakdown of fees, and who is responsible for their payment is clearly stated. Care needs assessment on admission to the home is undertaken but is not person centred and is not always clearly recorded. Of the three care records inspected assessment documentation did not always reflect the full needs of residents and how they were to be met. Personal preferences had not been recorded. For residents with some cognitive impairment there was no personal history to assist staff to make meaningful contact with residents. One recently admitted resident when spoken to said ‘I am well looked after; they know what I need”. Care practices observed showed that staff were aware of the residents needs as stated in their assessments. Penlee DS0000020337.V334588.R01.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 7,8,9,10,11 Care plans do not always give clear, person centred information to enable staff to meet residents’ health and social care needs. Personal and environmental risks are not well managed. The system in place for the management of medicines has improved but does not provide all the safeguards necessary for the protection of residents. Kind and caring staff does not always maintain respect and dignity EVIDENCE: Individual records are kept for each of the residents, but are not person centred and do not always include a social history. Of the five records inspected three did not reflect the current state of the resident and carers were not following the plan. Two care plans did not show clearly the actions to meet the residents identified needs. From discussion with residents and observation two further care plans did not show all identified needs and how these should be met. From Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 12 inspection of the care plans and discussion with staff it was evident that staff are not provided with clear guidance, and understanding of resident’s needs and how they are to be met. For one resident who exhibits extreme behaviour there were no clear guidelines as to how to assist this resident in their need. In discussion with staff it was clear that they do not see the care plans as working documents to enable them to provide good person centred care. Care routines are conveyed by word of mouth. None of the care plans showed resident or relative involvement. This practice needs to be implemented. Residents spoken with said, “the home is nice and the staff are good”. All care plans contained Manual Handling risk assessments but these were not always correct. One care plan spoke of needing to use the hoist for moving the resident while the review made no mention of this and by implication the person could move without aid. Four instances of poor practice were witnessed during the inspection. One was when two members of staff were observed using an under arm lift for transferring a resident from a wheelchair to an armchair. Another was again using the under arm lift and not being fully aware of the resident’s paralysed foot and the position into which it was being put during the transfer from the chair. The use of underarm lifts had also been highlighted in the staff communication book as causing discomfort to the residents. This poor practice also potentially put staff at risk as well as residents. Staff were also observed using a handling belt incorrectly demonstrating poor training and understanding of the principles of safe moving and handling. Another instance was in one residents room where the over the knee table had an empty glass on it and the jug of juice was across the other side of the room. The resident had a mobility problem identified, and thus was unable to access the juice. Documentation is undertaken for the management of personal and environmental risks but actions to minimise these risk are not always recorded, or acted upon. A nutritional risk assessment for one resident identified a problem with food and fluid intake but there was no evidence of high protein drinks. The monitoring charts are not being completed by competent persons, and are not used by any of the registered nurses to identify, and evaluate, care needs. Care practices observed showed caring interactions from staff. Choices and preferences were not observed being discussed or offered and had not always been recorded in the care plans. Inspectors observed that all residents in the lounge and conservatory were provided with blackcurrant drink and no alternative was offered. Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 13 Risk assessments for falls, pressure sores and nutrition were seen but did not contain actions to meet identified risk. In one care record the actions stated were incompatible with the level of risk identified. Outcomes of the interventions to minimise risk had not been measured – this was recommended. Pressure risk assessment had been recorded using an identified tool, but these had not been used to inform the care plan of pressure area care actions needed, or evaluated. The appropriate use of pressure relieving equipment was seen in the home. Daily records were up to date and written in a respectful manner. Not all information recorded in the daily records e.g. that which showed a new need for a resident, is transferred to care plans. Thus not all care need are fully recorded on care plans and actions to meet those needs for the benefit of the resident. All residents were neatly dressed, and attention had been paid to hair and nail care. Detailed conversations with ten of the residents confirmed a satisfactory standard of nursing and personal care. Two residents said, “ it’s homely” another resident said, “people are very kind, we are well looked after”. Two of the resident’s spoken with expressed concerns about the length of time it takes for call bells to be answered and the distress it appears to cause to other residents. Call bells were answered promptly during the inspection. The management of medicines has improved since the last inspection but remains poor with unsafe practice in relation to medication dosages and the use of self-medication for some residents. The residents that were selfmedicating had not been risk assessed as to their competency to undertake this. It was not clear to the inspector how monitoring of medication given in this way is undertaken. The morning medication routine observed was safe and complied with the guidance. Codes are used to denote the non-administration of medication, but the reason for this non-administration is not recorded. Variable dose medications do not have the dose recorded and this does not allow for the resident to fully benefit from the medication prescribed. The recording of doses is recommended. The homely remedies policy was seen and these remedies that had been administered were seen on the individual Medication Administration Record Sheets. The Homely Remedies policy is clear, was reviewed this year and is signed by the local GP’s to demonstrate their agreement with it. Hand transcribed prescriptions were seen on the Medication Administration Records and these had not been signed by two members of staff when written thus not providing the recommended safeguard for residents. The medications Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 14 fridge was locked and temperatures recorded satisfactory, thus providing for the safe storage of medicines. All residents spoken with felt that kind and caring staff respected their dignity and privacy. One resident stating “they always knock on the door”, and another saying “they are very kind, I am well looked after”. Staff were observed entering resident rooms without knocking. Concerns raised about residents were other residents clothes, were verified by written comments seen from staff to one another. The home has Equality and Diversity policy that recognises the cultural and social needs and differences that are present in society. The staff team is international and has experience of equality and diversity issues. Both management and staff demonstrated clear knowledge and desire to meet cultural and diversity needs of residents as and when they should arise. Care plans inspected did not contain plans of care for residents nearing death. This does not fully enable them to manage resident’s death in a sensitive and respectful way, acknowledging their wishes. The development of end of life care plans is recommended to ensure residents wishes and needs are met. Penlee DS0000020337.V334588.R01.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 12,13,14,15 Social activities are limited but routines are flexible. Local links are maintained through visits from organisations within the town and personal visitors Friendly staff always welcomes 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 just sit here and look out all day”. Another resident told the inspector “there is nothing to do. We make our own entertainment one sings and another shouts, while I just sit and dream”. As mentioned in the previous section care records do not always show personal preferences and routines recorded. During the inspection a number of residents were seen just sitting in the conservatory. No activities were observed to be offered to residents, and staff did not seem able to sit and talk with them. Resident’s social and recreational needs are not being met. Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 16 Several visitors were seen coming and going during the inspection. Relatives spoken with said they could come any time and felt “their relatives were well looked after by friendly staff”. 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 recent inspection from the Environmental Health Officer (Food) commented on the “continuing good standards at the premises”. They re-issued the Somerset Food Hygiene Award to the home. A number of staff have not received training in Food Hygiene and handling to ensure safe practice. All staff who handle food require this. Penlee DS0000020337.V334588.R01.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 16,18 Residents are confident that they are listened to and their requests acted upon. Residents are potentially at risk from staff who are not fully aware of the North Somerset “No Secrets” policy and the use of equipment that can potentially restrain them against their will. EVIDENCE: The home has a comprehensive complaints procedure and all residents receive a copy on admission. . Residents spoken with were aware of the procedure for making a complaint, and felt they would be able to tell staff or the owners if they had a complaint. The home has had 2 complaints since the last inspection and one allegation of abusive behaviour from a member of staff to a resident. The allegation was not substantiated however the member of staff no longer works at the home. One complaint related to lost clothes in the homes laundry system and while the resident was satisfied with the outcome, no documented action was taken to prevent a reoccurrence. The second complaint related to poor care practices and has not been fully resolved yet. A record of complaints is held but this is not analysed for trends to inform care practices. Bed rails and recliner chairs were observed in use for residents, however consent for the use of these had not been obtained from the resident or their Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 18 relative in the care files inspected. This is required to protect residents from potentially abusive practices. The home has a copy of the North Somerset ‘No Secrets’ guide and an abbreviated local policy /procedure for the home specifically for responding to allegations of abuse. In the handling of the recent allegation it was demonstrated that the management are not familiar with the policy and thus it was not followed. Four staff when interviewed had knowledge of what abuse is but were not fully conversant with how incidents of abuse should be handled. The staff were not aware of the Whistle blowing policy. Neither that policy, nor the home’s specific Adult Protection policy, contained the required information regarding contact details of the local police and CSCI office. Four residents said ‘the staff are very kind and caring, I can’t fault them’. Penlee DS0000020337.V334588.R01.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 19,20,21,22,24,25,26 Residents are provided with homely and comfortable surroundings. Outdoor space is attractive and accessible for residents to enjoy. The home has suitable equipment to maximise resident independence. Robust infection control practices are not followed which potentially place residents at risk from cross infection. EVIDENCE: The property is well maintained, with homely and comfortable communal spaces. The living accommodation décor is looking tired but homely. Residents’ rooms are personalised and comfortable. On a tour of the premises the inspectors noted that bath water temperatures are kept well below the suggest temperature of 43°C and hot water outlets felt tepid to the touch. The lack of secure storage for mobility equipment does not ensure a safe internal environment. Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 20 Another potential hazard was also seen with wheelchairs being stored outside the first floor sluice and another hazard was noted on the top floor landing with the storage of the hoist obstructing the way to the stairs. All clinical waste bins observed were rusted and had flaking paintwork. The ground floor bathroom has been upgraded since the last inspection with a walk in bath to assist staff in bathing frail residents. The home has grab rails situated at relevant points and a shaft lift that is easily used to assist resident mobility and aid independence within the home. The home was clean and free from offensive odours throughout. The regular use of air sprays that can be overpowering, does this. The laundry facilities were well organised and a door guard has been fitted to the laundry door since the last inspection. Staff interviewed demonstrated good understanding of Infection Control procedures and practices and the use of personal protective equipment (PPE). While PPE is provided and used, robust infection control practices are not followed. There was no liquid soap available for use in the sluice areas, bathrooms had tablets of soap sitting in pools of water and a hoist sling was seen to be stained with red and brown stains. The sluice vents were observed to be very dirty and not working. Penlee DS0000020337.V334588.R01.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 27,29,30 The home’s staffing levels are sufficient to manage the care needs of residents. Robust recruitment procedures are in place for the protection of residents. Staff do not receive adequate training to enable them to provide safe and knowledgeable care to residents. EVIDENCE: Staff were not rushing in their duties but appeared task centred rather than person centred, and were not observed spending time talking with residents at any point in the inspection day. Residents reported “staff never rush us through personal care tasks but always go at our pace”. Three residents told the inspectors “sometimes when the staff are busy you have to wait for them to answer the call bell”. Copies of two weeks staffing rosters were supplied to the inspector. Staffing levels rostered are satisfactory during the day. Nighttime staffing levels should be kept under review to ensure adequate staff are available to meet residents needs. A sufficient team of ancillary workers supports care and nursing staff to ensure the smooth running of the service. The home has a Key Worker system in place for all residents. Residents and staff were aware of the role and said, “it worked well”. Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 22 A number of staff from overseas are employed and the provider promotes a multicultural staff team approach within the care team. Recruitment procedures have improved since the last inspection and are robust, with all four files inspected containing the required documentation. All staff interviewed stated they had contracts of employment and job descriptions. Newly appointed staff told the inspectors that they had not received a thorough induction to ensure they had the knowledge and skills to care for the residents, and maintain a safe environment for them. Personnel files did not contain evidence of induction training and completion. Training for staff in mandatory areas is arranged, but clear leadership is not given to ensure all staff understand the need to attend the training, and gain the knowledge and skills provided. Specialist training is not provided and the use of the Interprofessional team is not accessed to assist staff to meet the specialist needs of some residents. Interviews with staff verified that mandatory training is provided but not always attended by staff. Staff told the inspectors that specialist training has not been provided e.g. Parkinson’s disease or managing challenging behaviour. Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 31,32,33,35,36,38 The management provide a happy and relaxed atmosphere to the home. The underpinning management structures of the home are lacking in some areas to ensure the smooth running and safety of the home. Residents’ views are sought and acted on, but a formalised system is not in place. The management of resident’s monies are handled safely by the home Health and safety issues are not regularly monitored in the home and a safe environment not always maintained. EVIDENCE: Dr and Mrs Gupta have a number of year’s experience of caring for the elderly and running Penlee, and the registered manager has her Registered Manager’s Award. Dr and Mrs Gupta are around daily in the home and support the Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 24 manager in running the home. However the management team do not give clear leadership and guidance to the staff to ensure that they are knowledgeable and competent to meet residents’ needs. Residents feel the manager is approachable, available and seeks to ensure all their needs are met. Many residents’ said they liked seeing Dr and Mrs Gupta on a daily basis and that their involvement in the home was helpful. Staff felt that their efforts are valued but they are not encouraged to develop their skills. The home does not have a formal quality assurance system. Samples of resident satisfaction surveys from earlier in the year were seen and these showed that residents are happy living at the home and feel their needs are met in a pleasant environment. However there was no evidence to indicate how their suggestions were to be incorporated into an improvement plan, thus providing an effective framework to ensure that monitoring and reviewing of the various aspects of quality assurance, are undertaken and acted upon. Since the last inspection a system of Quality Assurance has been adopted but it does not include current issues such as, mental capacity assessment, end of life plans or palliative care audits. There are problems with its implementation too, e.g. the medication audit scored as complete, was not, as the inspector found aspects of poor practice in the medication area that had not been identified with this audit. The management of resident monies by the home were inspected. A satisfactory system of recording was seen and all entries and monies inspected tallied. Each member of staff has an element of their practice directly supervised by the manager, her deputy or one of the senior care staff. The system for this is not fully formalised and happens on an ‘ad hoc’ basis, which does not ensure standards of practice are understood and maintained. One member of staff said, “the supervision system did not work”. No supervision records were seen in the four staff files inspected. Staff interviewed verified that supervision takes place “as and when”, “if there is something to discuss”. A formalised system of supervision needs to be implemented to monitor practice. The home records and stored securely and used in accordance with the Data protection Act 1998. A number of records e.g. the care plans, staff files are not accurately maintained and up to date. This is recommended. None of the records inspected showed evidence of regular safety and fire checks being carried out. Staff spoken to confirmed they have received fire instruction and drills had taken place, with the last documented fire drill being in January 2007. A number of health and safety hazards were identified during a tour of the building with loose and ill fitting bed rails seen, a damaged commode arm rest, Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 25 no sign on the boiler cupboard door, and the air vents in the two sluices very dirty and not working. A corridor area was also being used as storage area for wheelchairs and frames etc. this was not guarded and thus provided a health and safety risk to residents. It also poses a risk should there be a fire. Another aspect of poor practice posing a health and safety risk was seen on the top floor where the hoist was stored at the entrance to the stairs. Some fire doors throughout the home have electronic release systems should the fire alarm sound to protect residents. Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 26 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 1 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 1 2 3 3 3 3 3 3 1 STAFFING Standard No Score 27 2 28 X 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X 3 2 2 1 Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 27 YES 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 OP3 Regulation 14.1 (a) Requirement An assessment of all care needs should be person centred and provide a clear overall picture of the care a prospective resident needs to ensure that that home can meet the prospective residents needs Prepare a written plan of care with all identified needs recorded and actions as to how these needs are to be met for the health and welfare of the resident. Previous timescale of 20/11/06 not met. Timescale for action 30/05/07 2. OP7 15.1 10/05/07 3 OP8 13.5 4 OP9 13.2 To provide a safe system for 10/05/07 moving and handling residents through staff training and adherence to the Moving and Handling policy For the safe handling of 10/05/07 medicines to clearly identify a resident’s ability, through risk assessment, to self medicate and make clear records. To ensure a clear and legible DS0000020337.V334588.R01.S.doc 5 Penlee OP9 13.2 10/05/07 Version 5.2 Page 28 6 OP12 16.2 (m) 7 8 OP15 OP18 18.1(c) 13.6 prescription is available for the administration of medication stating dosage and time. Arrangements should be made to 30/05/07 enable residents to engage in social local and community activities Provide training for all staff that 30/05/07 handle food in safe food hygiene. To ensure that any equipment 10/05/07 used for the protection and safety of residents has been consented to by the resident’s, their relative or the multidisciplinary team. The home is kept clean and free from potential hazards of cross infection and potential Health and safety hazards. The registered person to make suitable arrangements to prevent infection and the spread of infection at the home. To implement a formal quality assurance system to ensure reviewing and improving the care of the home take place regularly, for the benefit of residents. Previous timescale of 20/01/07 not met All bed rails are fitted correctly to ensure the safety of residents Damaged equipment is removed from use until mended to safeguard residents from harm. 10/05/07 9 OP19 13.4 10 OP26 13.3 10/05/07 11 OP33 24 30/05/07 12 13 OP38 OP38 13.4 13.4 10/05/07 10/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Penlee Refer to Good Practice Recommendations DS0000020337.V334588.R01.S.doc Version 5.2 Page 29 1 2 3 4 5 6 7 8 9 10 Standard OP7 OP9 OP9 OP11 OP16 OP18 OP27 OP30 OP32 OP36 The involvement of residents or their relative in the development and review of plans of care. To record the reason for non-administration of medication when this occurs. All hand transcribed entries on the MAR sheets to have two signatures. The development of End of Life care plans to manage residents’ death and dying in a sensitive and respectful manner. Complaints records are analysed periodically to observe for trends. The homes Adult protection and whistle blowing policies are reviewed and the contact detail of the local CSCI and police included. Staffing levels are kept under review especially for night duty to ensure residents’ needs can be met. To ensure staff are provided with and undertake mandatory and relevant training to ensure they have the skills and knowledge to perform the care for residents. The management team develops its knowledge skills and practices to provide clear leadership, direction and guidance to staff in all areas of the care home The implementations of a formalised and regular supervision system to ensure staff have the skills and knowledge to meet the needs of residents. All written records are maintained up to date with full relevant information. 11 OP37 Penlee DS0000020337.V334588.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Registration Team Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. 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