Inspection on 08/05/09 for Penlee

This inspection was carried out on 8th May 2009.

CQC found this care home to be providing an Poor service.

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 12/09/08

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 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Penlee 21 Uphill Road North Weston Super Mare North Somerset BS23 4NG Lead Inspector Patricia Hellier Unannounced Inspection 8th& 11th May 2009 08:30 DS0000020337.V375497.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Penlee DS0000020337.V375497.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Penlee DS0000020337.V375497.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 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.V375497.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. 12th September 2008 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.V375497.R01.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 0 star. This means the people who use this service experience poor quality outcomes. This key inspection took place over 11 hours on two days. The Manager, Ms P.Rodman and the Registered Provider Dr. H.Gupta, were present throughout. This key inspection had been undertaken earlier than planned due to a number of concerns we had received from healthcare professionals regarding the safety and well being of residents in the home, as well as complaints from two relatives. The findings of the inspection supported the concerns. Before the inspection we reviewed all regulatory activity undertaken since the last inspection, and all information we have received in that period. This informed our focus on the key standards. The accumulated evidence for this report comes from the above and also fieldwork that included discussions with eleven residents, four relatives, and six staff. Practices were observed and documents relating to care, recruitment and health and safety were reviewed. Three relatives spoken with were satisfied in the main with the overall care their relatives receive at the home. One relative is unhappy about the care 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 us the home is good and the staff kind. Comments received were “it is very homely and comfortable”; “my care needs are 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. Outcomes for some residents are positive, but not for all. For example three residents spoken with said, “The home is nice, the staff are kind and caring, and the food is good.” A good rapport between staff and residents was observed. The home has a warm and pleasant environment with a good standard of fixtures and fittings. Penlee DS0000020337.V375497.R01.S.doc Version 5.2 Page 6 Meals are varied, well balanced and nicely presented offering choice and variety. Residents feel that if they had something to complain about they would speak to a member of staff and their complaint would be heard and acted upon. A relaxed and friendly atmosphere is felt in this home, which is kept clean and tidy. Relatives told us they are always made to feel welcome. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Penlee DS0000020337.V375497.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Penlee DS0000020337.V375497.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home’s assessment process, while person centred in the main, does not show clearly how the home is able to meet residents’ needs. EVIDENCE: Care needs assessment on admission to the home is undertaken and is person centred in part, however information 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. In one record the information was incomplete and did not specify the outcome of the medical condition for the individual and thus the need to be met. The admission assessment form did not state where the assessment took place and if the home can meet the needs of the individual. No documentation was Penlee DS0000020337.V375497.R01.S.doc Version 5.2 Page 9 available to evidence that the home had considered they could meet the individuals needs. Risk assessments undertaken as part of the admission assessment process were incomplete and did not state actions to minimise the risk for the guidance of staff and the benefit of the individual. Personal preferences had been recorded. For residents with some cognitive impairment there was no personal history to assist staff to make meaningful contact with residents. The manager does not write to new residents, or their relatives to confirm the home can meet their individual needs and provide confirmation of any discussions. People said they had been offered the opportunity to visit the home before moving in on a permanent basis. The manager told us people are welcome to stay in the home on a trial period, to ensure they settle into the home and are happy with the service provided. Penlee DS0000020337.V375497.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans do not always give clear, information to enable staff to meet residents’ health and social care needs. Personal and environmental risks are not always well managed. The system in place for the management of medicines is satisfactory and provides all the safeguards necessary for the protection of residents. People are treated with dignity and respect. EVIDENCE: Individual records are kept for each of the residents, and are person centred in the main but do not always include a social history. Of the three records inspected one did not reflect the current state of the resident and carers were not following the plan. One care plan while containing risk assessments did not have actions stated to minimise the risk. For example in the pressure sore risk assessment there was no clear guidance about regular changes of position, or evidence this is Penlee DS0000020337.V375497.R01.S.doc Version 5.2 Page 11 undertaken for the well being of the individual. In discussion with two staff we were told no records are kept we just know. Pressure risk assessment had been recorded using an identified tool, and this had been used to inform the care plan of pressure area care actions needed, but not evaluated. The appropriate use of pressure relieving equipment was seen in the home. In one record there was reference to a pressure sore on one leg and a care plan providing guidance to staff. We discovered there was a very nasty sore on the other leg of which staff and management were unaware. Two members of staff told us care can be a bit lacks-a-daisical at times. Two care records stated a need to review the individuals weight for nutritional purposes; however no weight had been recorded on admission or since. In discussion with staff we were told that residents are weighed by a particular member of staff but the records had not been completed. One relative spoken with told us they thought their relative had lost weight since admission but there were no records, however their relative appeared to have lost bulk on their arms and legs. Another relative also told us they were concerned about their relatives weight and nutritional input, but no weight had been recorded. One care record had an entry in the daily notes referring to a swollen foot and toes going blue but there was no further mention of this or any actions taken for another week. Thus the individual was left in discomfort for sometime and needs not met. The next entry was following the GPs visit. 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”. In discussion with two members staff it was clear that they were not aware of key medical details, contained in the care plans of two residents that are intrinsic to understanding how to meet their needs appropriately. We were told this information had not been communicated to them and they had not asked as they had not fully read the care plan. All care plans contained Manual Handling risk assessments but these were not always correct. One care plan spoke of needing to use the stand aid for moving the resident while care records indicated staff sometimes move the resident with two care staff only. In discussion with staff we were told that this is the case, and it is dependant on the individuals well being on the day. In the care records there is clear information from the physiotherapist that the stand aid should be used at all times. Records of GP visits and daily records show that this individual has suffered recent injuries with no clear explanation for these. Penlee DS0000020337.V375497.R01.S.doc Version 5.2 Page 12 During the two days of inspection we saw only one instance of poor manual handling practice. However we were told by two relatives they have seen staff using handling belts sometimes, and at other times using under arm lifts, which is poor practice and can be detrimental to the individual. In discussion with staff they agreed that this is their practice and could not see the impact such poor practice could have on residents. . Documentation is undertaken for the management of personal and environmental risks but actions to minimise these risk are not always recorded, or acted upon. . Care practices observed showed caring interactions from staff. One example of good practice seen was when a resident was not happy with her meal and she was offered an alternative. This arrived quickly and although she commented that it seemed a lot she ate it all with obvious enjoyment. Choices and preferences were observed being discussed and offered and had been recorded in the care plans. We observed that all residents in the lounge and conservatory were provided with a choice of drinks. 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 three of the residents confirmed a satisfactory standard of nursing and personal care. Two residents said, it’s homely” another resident said, “people are kind, we are 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 and the requirement has been fully met. Thus the systems in place provides for the safe management of medicines for the protection of residents. 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 said “they are very kind, I am well looked after”. Staff were observed entering residents rooms without knocking. We observed an incident of poor practice where a resident was being assisted with their meal and their head was bobbing back and forth. This was discussed with the member of staff and a support provided. Penlee DS0000020337.V375497.R01.S.doc Version 5.2 Page 13 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. Penlee DS0000020337.V375497.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 us “there is nothing to do. We make our own entertainment and the man comes for a sing a long sometimes. As mentioned in the previous section care records do not always show all personal preferences and routines recorded. During the inspection we saw a resident in their room dressed and ready to go to the conservatory, but when their relative arrived an hour later they were told the individual was not ready and they would go and fetch them. The relative was upset as they come at a Penlee DS0000020337.V375497.R01.S.doc Version 5.2 Page 15 regular time every day and this often happens. This does not take account of personal routines for the benefit of residents. During the inspection a number of residents were seen just sitting in the conservatory. On one of the inspection days the gentleman who provides a sing along session was observed entertaining residents in the conservatory. No other activities were observed to be offered to residents, and staff did not seem able to sit and talk with them very often. Resident’s social and recreational needs are not being met. In discussion with the manager we were told that there is no activities organiser and the music man comes three times a week. The manager acknowledged that this is a gap in provision. At the last inspection we reported 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 organiser. This has not happened and residents are lacking in social interactions and activities. Several visitors were seen coming and going during the inspection. Relatives spoken with said they could come any time and felt “their relatives were looked after by friendly staff”. Two relatives spoken with were concerned about the ability of the staff to appropriately look after their relative and described poor care practices they had seen. 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. As mentioned in the previous section of this report we observed good practice in relation to a main meal choice and alternative. Feedback from relatives, staff and residents told us that the evening and weekend food could be improved. In discussion with the cook we ascertained that a variety of nutritional foodstuffs is available for staff to offer residents. We discussed with the manager and her deputy if the comments related to the presentation of the food to residents as we had observed a resident who needs assistance with eating, being given a large thick sandwich to eat. The resident was obviously finding this difficult and staff appeared unaware. 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. 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.V375497.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are confident that they are listened to and their requests acted upon. Residents are potentially at risk from staff who have not received training in adult protection procedures and are unaware of how to safeguard their rights and liberty. 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. 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. 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 Penlee DS0000020337.V375497.R01.S.doc Version 5.2 Page 17 through a best interests meeting as recommend under the Mental Capacity Act 2005. This is required to protect residents from potentially abusive practices. When we asked the manager about this and if any residents were subject to a Depravation of Liberty safeguarding process she said I have never heard of it. At the last inspection we reported 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. This has not been acted upon and continues to put residents at potential risk of abuse. Where people are assessed as lacking capacity to give consent; consent should be obtained either through an IMCA or via a multidisciplinary approach (best interest meeting), and not just from a relative. 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. Five staff when interviewed had knowledge of what abuse is and stated understanding their role in reporting it to the management. A recent incident was not reported by the staff and did not come to light for several days. However some senior were not fully conversant with how incidents of abuse should be handled. The management have now taken appropriate steps to safeguard residents’. The staff were aware of the Whistle blowing policy but some were not sure if they would feel confident to use it. Two members of staff told us staff do their best but some will only do the minimum. When asked if they had seen any signs of abuse or neglect in the home we were told possibly but not on purpose. Three residents said ‘the staff are kind and caring, I can’t fault them’. One resident told us the staff can get cross at times. Penlee DS0000020337.V375497.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of 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. 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 home was clean and free from offensive odours throughout. The laundry facilities were organised to minimise potential cross infection. Penlee DS0000020337.V375497.R01.S.doc Version 5.2 Page 19 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.V375497.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of 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 robust 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”. Three residents told us “sometimes when the staff are busy you have to wait for them to answer the call bell”. One relative was concerned that there is no means of calling for help for residents sat in the conservatory. In discussion with the manager and provider we were told this is the central area of the home and there is always someone about. 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, Penlee DS0000020337.V375497.R01.S.doc Version 5.2 Page 21 however it was noted that new staff had been included in the numbers rather than as supernumerary, to ensure they received adequate supervision to ascertain competence for the safety and well being of the residents. A good team of ancillary staff supports them. In discussion with residents they told us “the staff are very good and come when they can.” In discussion with the manager she informed us she felt that staffing levels were adequate to meet the needs of residents. Three staff when interviewed told us that the do not always feel there are enough staff to meet the needs of residents. Two staff were unaware of how often residents have baths. When asked if anyone had been given a bath during the day of inspection we were told they did not know, perhaps one. One member of staff told us they were not confident to use the baths and did not do baths. 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 told us language difficulties can be a problem and lead to different understandings and practice. 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 both 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 were no references, and in the other record there was no information regarding gaps in employment and notes exploring the reason for leaving last post. This information should be documented and evidence obtained to ensure the required checks are completed for the protection of residents. All staff said they tried to work as a team but it is not always the case, as some do the minimal and others do it properly. They also told us we do our best. Comments from residents, and observations of practice during the inspection, verified this. Evidence was seen of staff induction in the file of one of the new members of staff, thus ensuring they have the skills and knowledge to care for residents appropriately. When interviewed we were told that the induction “was ok and I worked with a senior for a few days”. Another comment was I thought it was quite thorough. One personnel file contained evidence of induction training and completion, but the other did not. Penlee DS0000020337.V375497.R01.S.doc Version 5.2 Page 22 Training for staff in mandatory areas has not been provided since the last inspection, and staff indicated that clear leadership is not given to ensure all staff understand the need to attend training, and gain the knowledge and skills to appropriately meet residents needs. On the day of inspection some staff were observed attending a Safeguarding Adults training session. 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 has not been provided. Staff told us that specialist training has not been provided e.g. wound management. A training plan was not available. At the last inspection the manager 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. This has not been done. Residents tell us that they feel “the staff are kind and do what they can to help them. Penlee DS0000020337.V375497.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home lacks robust management systems to check the quality of services and facilities provided, resulting in practices that do not always promote and safeguard the health, safety and welfare of residents. EVIDENCE: Dr and Mrs Gupta have a number of year’s experience of caring for the elderly and running Penlee. The manger has been in post for a year but has not yet applied to be registered with the Commission, so we are not able to comment on her suitability to manage the home. Dr and Mrs Gupta are around daily in the home and support the manager in running the home. However the management team do not give clear Penlee DS0000020337.V375497.R01.S.doc Version 5.2 Page 24 leadership and guidance to the staff to ensure that they are knowledgeable and competent to meet residents’ needs. A number of issues raised in this report reflect poor management structures and lack of clear leadership and guidance. Four members of staff told us the home lacks leadership. The manager has good knowledge but not always the skills to apply it. The manager does what she can but is sometimes weak with staff and needs to be stronger and more disciplined. The manager is approachable. Staff felt that their efforts are valued but they are not encouraged to develop their skills. Three residents spoken with told us the manager is kind and approachable. Two relatives spoken with told us they are not confident in her ability to ensure my relative gets the right care. But my relative seems content enough here so am not wishing to move them. Policies, and practice guidance, are provided in the home although they are not always dated and signed for accountability purposes. These provide staff with 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 home have not developed the process since the last inspection when we made the good practice recommendation 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. 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. Personal records in the home are 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 to ensure good and safe care provision and the protection of residents. 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. However since the inspection documentation to verify this has been sent to us. Some fire doors throughout the home have electronic release systems should the fire alarm sound to protect residents. Three fire doors were seen not shutting flush to frame to protect residents. One bedroom door at the top of Penlee DS0000020337.V375497.R01.S.doc Version 5.2 Page 25 the building was wedged open thus not affording the resident protection in case of a fire. Penlee DS0000020337.V375497.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 X X 1 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 X X 3 2 1 1 Penlee DS0000020337.V375497.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 Requirement The registered person must ensure that all pre admission assessments should be fully completed, and confirmation in writing made that the home is suitable to meet the needs of the residents. Timescale for action 30/06/09 2. OP7 15 The registered person must 30/06/09 ensure that all care plans contain sufficient and accurate information to ensure residents needs can be met in an appropriate manner for their health and well being. 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. Previous timescale of 16/10/08 not met. 30/06/09 3 OP8 13.4(c) 4. OP8 13.5 The registered person shall make 30/06/09 suitable arrangements to provide a safe system for moving and DS0000020337.V375497.R01.S.doc Version 5.2 Page 28 Penlee handling residents. This refers to the lack of training and poor practices in the home The registered person must having regard to the needs and wishes of residents provide recreational activities and facilitate them to engage in social activities The registered person must ensure that residents are protected from harm or abuse or being placed at risk of harm or abuse. This relates to lack of staff training and awareness of how to protect residents. 7. OP29 19.1 Schedule 2 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 Previous timescale of 30/09/08 not met 30/06/09 5. OP12 16.2 30/07/09 6. OP18 13 30/06/09 8. OP30 18.1(c) Specialist training provision must 31/07/09 be provided to ensure care needs can be met in accordance with best practice guidance Previous timescale of 30/12/08 not met 9. OP30 18.1(c) 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 and to enable them to adequately meet residents’ needs. Previous timescale of DS0000020337.V375497.R01.S.doc 31/07/09 Penlee Version 5.2 Page 29 30/11/08 not met 10. OP31 8&9 The registered provider must appoint a person to manage the home and ensure they are registered with the commission for the safety and protection of residents. 31/08/09 11. OP37 17 This relates to the lack of action from the provider and manager to initiate the registration process. An immediate requirement was issued The registered person must 30/06/09 ensure that all records kept in the home are accurate and kept up to date for the safety and well being of residents. The registered person must ensure that all fire doors shut properly and provide the necessary protection for residents in the event of a fire. 30/06/09 12. OP38 23 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. DS0000020337.V375497.R01.S.doc Version 5.2 Page 30 Penlee 3. 4. OP12 OP33 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. 5. OP36 6. OP37 Penlee DS0000020337.V375497.R01.S.doc Version 5.2 Page 31 Care Quality Commission South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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