Inspection on 27/06/08 for Penmeneth House

This inspection was carried out on 27th June 2008.

CSCI found this care home to be providing an Adequate 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

Penmeneth House 04/07/07

Penmeneth House 06/07/06

Penmeneth House 20/10/05

Penmeneth House 19/05/05

Penmeneth House 07/10/04

Penmeneth House 15/04/04

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Penmeneth House 16 Penpol Avenue Hayle Cornwall TR27 4NQ Lead Inspector Ian Wright Unannounced Inspection 13:00 1 and 4th July 2008 st 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 Penmeneth House DS0000009128.V364980.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. Penmeneth House DS0000009128.V364980.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Penmeneth House Address 16 Penpol Avenue Hayle Cornwall TR27 4NQ 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) 01736 752359 F/P 01736 752359 Mr Philip John Richards Mrs Felicity Ann Richards NA Care Home 14 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (14) of places Penmeneth House DS0000009128.V364980.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) - maximum 14 places Dementia (Code DE) - maximum 10 places The maximum number of service users who can be accommodated is 14. 4th July 2007 2. Date of last inspection Brief Description of the Service: Penmeneth is situated in Hayle, West Cornwall. The property provides care and support for up to 14 elderly people. The home offers residential care for up to fourteen elderly people, some of whom could have dementia. Accommodation is provided on two floors, the first floor can be accessed by a stair lift. There are three smoke free lounges, and there is a small-seated area adjacent to one of the corridors. There is a small garden to the front of the home and a courtyard at the back with bench seating. There is limited roadside car parking. Wheelchair accessibility is very limited. The registered providers Mr and Mrs Richards- live nearby, and are in control of the day-to-day running of the home. A copy of the inspection report is available from the registered providers, and it is suggested a copy is requested from management or obtained via the CSCI website if required. The range of fees at the time of the inspection is £318£367 per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. Penmeneth House DS0000009128.V364980.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 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection took place over eleven and a half hours in two days. All of the key standards were inspected. The methodology used for this inspection was: • To case track four people who use the service. This included interviewing the people who use the service about their experiences and inspecting their records. • Interviewing five care staff about their experiences working in the home. • Informal discussion with staff and other people who use the service. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred) were used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? Some improvements have been made to the physical environment including improvement to decorations inside the home. Pre admission assessment procedures now appear to be generally satisfactory. The care planning system has improved and is continuing to develop well. Staff induction and training have improved, although there is still some work to be completed in this area. Penmeneth House DS0000009128.V364980.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Penmeneth House DS0000009128.V364980.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 Penmeneth House DS0000009128.V364980.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information provided to people who use the service (e.g. statement of terms and conditions of residency / contract) is satisfactory, and provides people who use the service with suitable information regarding their rights and responsibilities. Pre admission assessment processes appear satisfactory, and appear to show the registered persons check they can meet the needs of people before formal admission is agreed. This should help to ensure people who use the service know their needs will be met when an agreement is made to admit them to the home. EVIDENCE: Most people who use the service have been issued with a statement of terms and conditions of residency / contract. Copies of this documentation are available on the files of people who use the service. The registered persons have an appropriate procedure for assessment. Mrs Richards said she will either go out and visit the person before admission is arranged, or the person will visit the home. Some people have been admitted Penmeneth House DS0000009128.V364980.R01.S.doc Version 5.2 Page 9 after they have either spent time at the home as a day care client or have spent time at the home as a respite (short stay) client. Even in these cases pre admission assessments need to be documented. A pre admission assessment was viewed for several people, and these seemed satisfactory. People who use the service, who the inspector spoke to, could not remember if an assessment was completed or not before they moved to the home. Mr and Mrs Richards said they obtain a copy of an assessment from the Department of Adult Social Care (social services) or the health department, when one has been completed. Penmeneth House DS0000009128.V364980.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and personal care standards are generally satisfactory, although some improvement is required to care planning and the management of medication. People who use the service and their representatives said they were happy with the care provided, although the registered providers do need to monitor staff are respectful to people who use the service, and take appropriate action as necessary. EVIDENCE: Care plans for some people who use the service were inspected. The registered providers are currently introducing a new system which is generally comprehensive, and appropriate for people with dementia. There is suitable evidence care plans are regularly reviewed. However some additional information needs to be maintained: 1. A clear record of medical interventions (GP, District Nurses, Dentist, Community Psychiatric Nurse, Chiropodist, Optician etc.) It is currently difficult to trace these interventions; relying on what is recorded in the Penmeneth House DS0000009128.V364980.R01.S.doc Version 5.2 Page 11 daily notes. It is also difficult for staff to assess whether these interventions are at an appropriate frequency. 2. Manual handling assessment- however the separate assessments contained in the ‘old’ care plans is satisfactory, and should be transferred to the new file. 3. All care plans should be dated. The people who use the service, who the inspector spoke to, said they were not aware they had a care plan, and could not remember being involved in the drafting, or review of their care plans. However everyone, who the inspector spoke to, said they thought the care provided was good. If people who use the service are not currently involved in their care planning, the registered persons should consider increasing the participation of people who use the service e.g. via a ‘Keyworking system,’ and / or involving the person’s next of kin. Health care support appears to be satisfactory. People who use the service said they had access to relevant external professionals when necessary. Mrs Richards said no people who use the service currently had pressure sores. Comments from two sources said there could at times be a delay in the registered provider contacting the GP or district nurse if somebody was unwell. Mrs Richards said she would always ensure a GP or district nurse was contacted as soon as possible when necessary. It is essential that staff are empowered to contact medical services when a person using the service requests this, or when staff believe it is necessary. This responsibility should not be limited to management discretion. The inspector spoke to one district nurse who generally had no concerns regarding health care in the home. However she said it had been discussed with the registered provider that appropriate moving and handling techniques must always be used in line with current guidance. The Commission fully endorses this comment. The registered providers need to monitor this. The medication system was inspected. The medication is stored in a locked cupboard. Medication is administered via a monitored dosage system. The requirement issued at the previous inspection on 4th July 2007 has not been complied with, and there remains a number of problems with the operation of the system: 1. Some medication had no labels on the containers; Medication must only be administered to people for whom it is prescribed. 2. There were some dosages of medication which were signed for but did not appear to be administered. 3. Medication for one person was prescribed to be administered at 0800, but is being signed as administered at 1200. The GP’s prescription must be followed. If this is altered by the GP, the instruction must be made clear on the medication sheet, and in the person’s care plan. Penmeneth House DS0000009128.V364980.R01.S.doc Version 5.2 Page 12 4. Some medication was not on the medication sheet. For example, two items were dispensed on 11/4/07 and 3/8/07. If these are no longer required, such items must be returned to the pharmacist. 5. Empty dossetts were in the medication cabinet. Two identified tablets were in one of the dossetts. Medication must never be ‘secondary dispensed’ (i.e. removed from packages, put in a dossett or other container). It must be administered when required and/ or disposed of appropriately if not required. We assessed training received by staff. In regard to medication training, most staff appear to have received training. However the training records of two night staff did not have any evidence of medication training being received. Three of the ‘day’ staff had only received training in 2003 and 2004. Considering the result of the inspection of the system, and the number of renotified statutory requirements regarding the operation of the system, an update of training would be appropriate for staff who have not received training in the last two years. The statutory requirement regarding the operation of the system is again renotified. Previous reports outline deficiencies in the operation of the system. It is essential the registered providers or senior staff thoroughly audit the operation of the system regularly. If the registered providers are renotified again regarding this statutory requirement, the commission may take enforcement action. People who use the service were generally positive about care and support delivered by staff. We also spoke to several relatives of people who use the service and they also were generally positive about care. However, some people raised concerns about the attitudes and approach of a minority of staff. This matter was discussed with the registered provider, who had recently become aware of the concern, and was due to investigate the matter the day after the inspection. Appropriate action has since been taken. Some people said occasionally laundry is not returned, so management need to monitor this, and ensure there are appropriate systems in place to ensure items are returned to the right person. The district nurse also said some staff were at times not always as respectful as they should be to people who are in the late eighties and beyond. The matter was raised with the registered provider. We did ask the provider to investigate a similar matter after the last key inspection in July 2007. It is essential staff attitudes are monitored, professional relationships are nurtured and maintained, and good role modelling takes place. Appropriate action must take place by the registered provider if further concerns are raised. These are also reportable to CSCI, under regulation 37 of the Care Homes Regulations 2001. However, the inspector observed people who use the service receiving Penmeneth House DS0000009128.V364980.R01.S.doc Version 5.2 Page 13 appropriate levels of support, and people who use the service on this occasion expressed no other concerns to us. Penmeneth House DS0000009128.V364980.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate arrangements are in place so people who use the service can enjoy a lifestyle that meets their needs. Food provided is to a good standard so people enjoy a choice of good quality meals that meet nutritional needs. EVIDENCE: People who use the service said they could get up and go to bed when they wished. However breakfast is at a set time, and this should be reviewed as people may wish to have breakfast at a different time if they choose to get up earlier or later. Staff support was observed as being relaxed and unhurried. Most of the people who use the service all spent their day in the lounge. This is apparently their choice and people can spend time in their bedrooms if they wish. Two people attended a day centre on the day of the inspection. There are some activities available. Some organised activities are offered. For example an accordion player visits the home every two to three weeks. There is a regular church service. People who use the service also go out in the home’s car sometimes. The registered provider’s have said they have tried to set up further activities, but people who use the service are reluctant to pursue these. Penmeneth House DS0000009128.V364980.R01.S.doc Version 5.2 Page 15 The registered provider has purchased a training package from the Alzheimer’s Society, which contains various activities. Particularly as there are large periods of time when nothing is currently scheduled, it would be good if the registered provider utilised this information so more opportunities for stimulation and recreation were available. The inspector shared a meal with people who use the service, on the day of the inspection. Food served was of good quality, and there is some choice of food provided at lunchtime. A choice of evening tea is provided. Suitable records are kept of meals provided. Staff support at meal times appears to be to a good standard. Penmeneth House DS0000009128.V364980.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is suitable information how to make a complaint. The adult safeguarding procedure needs expansion. Improvement of this procedure should help in assisting people who use the service, to have more assurance that appropriate procedures will be followed if there are any allegations of poor practice or abuse. EVIDENCE: The registered persons have a suitable complaints procedure. Information how to make a complaint is included in the service user guide. Since the last inspection, the Commission for Social Care Inspection has not received any complaints regarding this service. Some people who we spoke to raised some concerns particularly about the attitudes of two members of staff. When we raised this matter, the registered provider said they were in the process of investigating the matter. Following the inspection, the matter appears to have been appropriately investigated in liaison with the Department of Adult Social Care (Cornwall Social Services). We are currently awaiting a report from the registered provider and have asked this to be copied to the Department of Adult Social Care. The adult safeguarding (protection) policy needs some development. The policy needs to state the correct procedure if there was an allegation of abuse e.g. the matter should be reported to the Cornwall County Council Department of Adult Social Care, who act as the co ordinating agency, if there are any Penmeneth House DS0000009128.V364980.R01.S.doc Version 5.2 Page 17 adult safeguarding (protection) issues. The matter should not be investigated by the registered persons unless they are delegated to do so. The registered provider confirmed there had been no allegations of abuse since the last inspection. Some staff have undertaken training regarding the awareness of abuse. It is important other staff attend this training, and the providers also attend it if they have not already done so. Some initial training should occur on staff induction. For example staff could watch the Cornwall County Council ‘No Secrets’ video, which is available, free of charge to care homes. The registered provider said no referrals of ex staff had been made to the Criminal Records Bureau for inclusion onto the Protection of Vulnerable Adults list (i.e. as people unfit to work with the vulnerable). Penmeneth House DS0000009128.V364980.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the building and furnishings are generally pleasant, improvement is still required to the number of bathroom facilities available. The provision of satisfactory bathroom facilities will ensure people who use the service have a suitable facility on the first floor of the home, and nearer to most people’s bedrooms. EVIDENCE: The building was inspected. The building appears to be well maintained, clean, pleasantly decorated and homely. There is a small but pleasant garden, which people who live in the home can use. Mr and Mrs Richards ensure the building and decorations are maintained to a high standard. Recently the downstairs bathroom has been redecorated and new floor tiles have been fitted. All communal rooms are homely and comfortable. There are three lounges, and a quiet alcove area in one of the corridors. People who live in the home have their meals in the lounge / dining area at the rear of the home. Penmeneth House DS0000009128.V364980.R01.S.doc Version 5.2 Page 19 Bedrooms are pleasantly furnished, well decorated, individualised and comfortable. A stair lift is provided to assist people to go upstairs. There is a ‘Parker’ bath facility on the ground floor, which offers a good facility particularly for those who are frail or have a mobility problem. However the upstairs bathroom has been converted to a sleep in bedroom for staff. The registered provider said this was done, as the bathing facility was not used. However this has resulted in there not being a bathroom on the first floor of the home. Staff and the registered providers do not feel this is a problem as people who live in the home tend to bathe in the evening before going to bed, rather than being put to the inconvenience of having to go downstairs first thing in the morning. However, there needs to be a facility on the first floor, for example if a service user is incontinent, the current facilities could result in inconvenience and difficulty. There also needs to be an upstairs bathroom as this is more convenient for most people living in the home, and will enable people who live in the home to have a choice when and where to bathe. After further discussion the registered provider has agreed to install a shower in the room which is currently used by some staff to sleep in. This is satisfactory as long as this is clearly space which people who use the service feel comfortable entering and using without asking staff to enter the room. The facility must also be suitable for the needs of the people who use the service. The fitting of the facility must not a tokenistic gesture primarily for staff use. Previous reports have detailed non-compliance regarding this matter. We are subsequently renotifying the statutory requirement for the third time. We are only doing this as the provider has agreed to take appropriate action. However, if there is continued non-compliance regarding this matter, the commission will consider taking enforcement action. We are requesting the registered provider confirms in writing once the statutory requirement has been complied with. Suitable kitchen and laundry facilities are provided. Cleaning staff are employed, and the home was clean and hygienic at the time of inspection. Penmeneth House DS0000009128.V364980.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels currently appear satisfactory. Recruitment checks and staff training need some improvement. This should help to ensure people who use the service are supported by staff that are appropriately vetted and trained to work with elderly people with dementia requiring personal care. EVIDENCE: On the day of the inspection staffing levels appeared to be satisfactory: • Two staff were on duty from 0800 to 1500 • One member of staff was on duty from 08:30 to 11:00 • Two members of staff were on duty from 1500 to 2200 • One person ‘sleeps in’ from 2200 to 0800, and one person is on a ‘waking night’ duty for this period. The registered providers work in the home each week day. Both are actively involved in the day to day care of people who use the service. Personnel and training records of twelve care staff were assessed. Staff turnover is low. Some of the staff have worked at the home for over ten years. Pre employment checks on newer staff need improvement: • The registered providers’ staff application form needs to be expanded. Currently only information regarding the person’s last two employers is given. The application form needs to list all previous employment, so the DS0000009128.V364980.R01.S.doc Version 5.2 Page 21 Penmeneth House • • • registered providers can, for example, check the appropriate referees are being approached, and secondly any gaps in the person’s employment history can be investigated. Information regarding the person’s physical and mental fitness to work with vulnerable people needs to be recorded. Two referees were obtained for most people recently employed, although these had not been obtained for one person who had been employed in June 2008. Verbal references should be taken up and recorded before someone starts working, and these should be confirmed in writing. It is not satisfactory for a person to commence employment, unless the registered persons can be sure the new employee is suitable to work in an environment with vulnerable people. A Protection of Vulnerable Adults (POVA) check, (This is a check performed by the Criminal Records Bureau which checks the person is not on a list which states they are not fit to work with vulnerable people), was not performed on one person who has recently commenced employment. It is an offence to employ somebody who is on the POVA list. Although this check was performed on some staff, there is no record it was performed on others. We have notified the registered providers on two previous occasions regarding non-compliance regarding these matters. We are renotifying the registered provider for the third time regarding this matter. Failure to comply in future with regulations regarding these matters could result in the commission taking enforcement action. Records regarding staff training for the sample group were assessed. By law all staff must have: • Regular fire training in accordance with the requirements of the fire authority. • There must always be at least one first aider on duty (at appointed person level). • All staff must have manual handling training. • All staff must have basic training in infection control. • If staff handle food they must receive training regarding food hygiene. • All new staff must have an induction and there should be a record of this. As people with dementia are also accommodated in this service, it is important staff have some basic training regarding awareness of conditions associated with this diagnosis. There has been some development with the training received by staff since the last inspection: • All staff have received fire training from Mr Richards who is trained as a fire warden. • There were satisfactory first aiders on duty on the day of the inspection. Penmeneth House DS0000009128.V364980.R01.S.doc Version 5.2 Page 22 • • • • • Most staff had received training in manual handling- apart from two staff recently employed. Only two staff have received training in infection control. Most staff had received training in food handling- apart from two staff recently employed. There are partial records competed that staff recently employed have received a structured induction. This needs completion. Five staff have record that they have received training regarding dementia awareness. Training needs regarding awareness of abuse, and the handling of medication are detailed elsewhere in the report. The registered persons have a suitable approach to enabling staff to have the opportunity to obtain a national vocational qualification (NVQ) in care. Currently the registered provider said 50 have at least an NVQ level 2. It is essential a copy of the person’s certificate is kept on file to validate they have obtained this qualification. Penmeneth House DS0000009128.V364980.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): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered persons have made some improvement to this service over the past year. However we are concerned about the renotifications of some statutory requirements outlined in the report. There is some work to do to ensure the quality assurance process satisfactorily monitors and ensures compliance regarding some key areas of the service (e.g. medication and staff training). These measures will ensure people who use the service can be assured they live in a service which is safe and has a sustained record of improvement. EVIDENCE: The registered provider is Mr and Mrs Richards. They appear to care for the group of people living in the home, and work hard to deliver the service to the resident group. We do have some concerns regarding some of the renotifications of previous statutory requirements. Suitable management systems need to be put in place to address some issues raised earlier in the Penmeneth House DS0000009128.V364980.R01.S.doc Version 5.2 Page 24 report. Despite some of the strengths of the service, we cannot tolerate continued non-compliance in the areas renotified, and will seriously consider taking enforcement action if appropriate action is now not taken. The registered persons have developed a quality assurance policy. The home’s approach is briefly outlined in the home’s Statement of Purpose and Service User Guide. The physical standards of the home are generally good and furnishings are maintained to a high standard. The registered providers said they are due to survey people who use the service, and their representatives, again shortly. Other systems need to be considered for example to improve the operation of the medication system, and to ensure staff recruitment and training meets the national minimum standards. Some monies are looked after on behalf of people who use the service. Records maintained are kept to a good standard. The registered provider acts as an agent for one person’s financial benefits. Such arrangements should be avoided where possible, although the registered provider said he only carries out the responsibility, as there is nobody else to act on the person’s behalf. Records are maintained to a good standard. It is advisable the company accountant checks and audits records at least annually. Other monies of people using the service are either maintained via individual solicitors or people’s relatives via Power of Attorney arrangements. Otherwise people who use the service are responsible for their finances, and fees are paid via bank transfer. Suitable insurance for the building and people using it appears to be in place. The registered persons have a satisfactory health and safety policy. The home has a fire risk assessment. Health and safety risk assessments are satisfactory. Although appropriate action appears to be taken regarding the control of legionella; this risk and subsequent control measures need to be documented as part of the home’s health and safety risk assessment. There are suitable records regarding the testing of fire equipment. The chair lift and assisted bath are appropriately serviced. The electrical hardwire circuit of the home was tested and deemed satisfactory. Portable electrical appliances were tested in July 2007, and the registered provider confirmed they are due to be serviced again shortly. The boiler has been serviced in the last year. A Radon test has been performed on the property. This is very good, essential in Cornwall and its importance is often overlooked. Some improvement regarding health and safety training is required-as outlined in the previous section of the report. Penmeneth House DS0000009128.V364980.R01.S.doc Version 5.2 Page 25 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 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 1 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Penmeneth House DS0000009128.V364980.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15. Requirement Care plans need to contain comprehensive information. Where possible the person using the service should be involved in the writing and review of care plans. Care plans need to contain the following additional information: 1. A clear record of medical interventions. 2. Manual handling assessment. 3. The date when the care plan was written. This will ensure there is satisfactory information for care staff to provide appropriate care for each individual who uses the service. The medication system must be operated and managed to a satisfactory standard (For example in line with the Care Homes Regulations 2001 and Royal Pharmaceutical Society Guidelines). The issues outlined in the report must be satisfactorily addressed. People who use the service can then be DS0000009128.V364980.R01.S.doc Timescale for action 01/09/08 2. OP9 13(2) 01/09/08 Penmeneth House Version 5.2 Page 27 3. OP9 13(2), 18 4. OP18 10(1), 12(1)13, 18 5. OP18 10(1)12(1 )13 6. OP21 OP19 23(2)(j) assured their medication is managed to a satisfactory standard. (Previous timescale of 01/08/07 not met. Third Notification. Staff who administer any medication must receive appropriate training. It is advisable that any staff who have not received training regarding the handling of medication in the last two years receive an update. This will ensure people who use the service know that staff handling their medication are appropriately trained to do so. The registered providers and all staff members need to attend training regarding the awareness of abuse, and adult safeguarding procedures. This will help to ensure people who work in the home are fully aware of local protocols, and help to ensure people who use the service are protected from abuse. The adult safeguarding (protection) policy must be updated to reflect guidance issued by the Department of Health ‘No Secrets’ guidance, and local authority guidance. This will help to ensure any safeguarding issues are appropriately reported and coordinated by the local authority. There must be a suitable bathing facility on the first floor of the home. This will ensure there are a satisfactory number of bathing facilities situated near to people’s personal accommodation. Previous timescale of 01/01/08 not met 3rd DS0000009128.V364980.R01.S.doc 01/02/09 01/02/09 01/10/08 01/12/08 Penmeneth House Version 5.2 Page 28 Notification Please confirm to the commission what action has been taken, within the timescale set. 19(1)Sche Suitable pre employment checks dule 2 must be performed on all staff employed to work in a care home (For example a POVA First check, a CRB check at enhanced level, two references, a full employment history, proof of identity and a statement by the person as to their mental and physical health.) These measures will ensure there are appropriate vetting procedures performed on staff working in the home. Subsequently people who use the service can be more assured that people employed are suitable to work with vulnerable people. Previous timescale of 01/08/07 not met 3rd Notification Ensure staff have appropriate training according to legal requirements and the needs of people who use the service. For example: • Manual handling, food handling, dementia awareness for those staff who have not received this training. • Infection control training for the majority of staff. The registered providers need to ensure there is an ongoing programme of training for all staff in line with legal requirements and the needs of the people who use the service. This will help to ensure that people who use the service DS0000009128.V364980.R01.S.doc 7. OP29 01/08/08 8. OP29 OP38 12, 13, 18. 19 01/01/09 Penmeneth House Version 5.2 Page 29 9. OP31 OP33 7, 9, 12, 13, 24 receive appropriate support from staff trained to meet legal requirements and their individual needs. Further develop the quality 01/10/08 assurance system to monitor regulatory standards in the home. Measures taken should be included in the quality assurance policy. This will help improve service quality and help minimise risks to staff and people who use the service. 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 OP10 OP14 Good Practice Recommendations The registered provider needs to monitor that staff attitudes are always professional, and people who use the service are always treated with respect and dignity. Look into further opportunities for further stimulation and recreation for people who use the service. Penmeneth House DS0000009128.V364980.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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