Inspection on 20/06/06 for Penmount Grange

This inspection was carried out on 20th June 2006.

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

Other inspections for this house

Penmount Grange 24/07/07

Penmount Grange 31/01/06

Penmount Grange 03/05/05

Penmount Grange 21/12/04

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 Penmount Grange Lanivet Bodmin Cornwall PL30 5JE Lead Inspector Philippa Cutting Key Unannounced Inspection 20th June 2006 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 Penmount Grange DS0000061897.V298579.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. Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Penmount Grange Address Lanivet Bodmin Cornwall PL30 5JE 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) 01208 831220 Mr Leander Joseph Difford Mrs Pauline Janet Difford Vacant Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One named person with a learning disability (LD) under the agreed age range. Because of limitations to communal spatial requirements resident service users and day care must not exceed 24 together at any given time. 31st January 2006 Date of last inspection Brief Description of the Service: Penmount Grange is situated on a hill, overlooking the A30 approximately half a mile from the village of Lanivet near Bodmin. It is a family run care home registered to provide accommodation and personal care for up to twenty-one older people. The home consists of the main house and two added extensions. Building work is presently taking place to improve the accommodation. Bedroom accommodation is provided for service users on the ground and first floors. En suite facilities have been, or are being added, to service users’ rooms. There are assisted bathrooms provided for service users with additional toilets near communal areas. The home offers a respite bed facility when there is space if not all rooms are occupied. A number of clients attend the home for day care. There are two lounges (the smaller of the two being a `quiet area) a dining room and a new conservatory. The detached house stands in its own grounds with seating areas provided. Limited car parking is available in the grounds of the home. Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over two days and lasted in total for 14.5 hours. Time was spent looking at records for service users and staff, an inspection of the premises and in discussion with service users, staff and management representatives. A random inspection had been made previously on 04.05.2006 after a community nurse had raised concerns. These were addressed with the registered provider following that visit. The previous registered manager resigned three months ago. The acting manager was undertaking a review of records, starting with service users. She and the registered provider were aware that other records needed attention. They were planning to do this on a phased basis. The registered provider is in the throes of refurbishing the home and upgrading the facilities. Service users said they were happy and found the staff helpful. Some respite care is offered – a service user said this was her first experience and she had been pleased with the care provided. What the service does well: What has improved since the last inspection? What they could do better: Records are poor although the home realises this and is taking steps to address this, having now revised those belonging to service users. Policies and procedures need revising. The inspector felt this was well overdue as the home changed ownership nearly two years ago but the policies still bear the Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 6 name of the previous owners. In discussion the registered provider undertook to have this completed within three months of this inspection. When new areas for service users are created, the registered provider needs to take more account of keeping the Commission informed of the work and that the safety checks etc have been carried out satisfactorily. 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. Penmount Grange DS0000061897.V298579.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 Penmount Grange DS0000061897.V298579.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Whilst people living in the home were satisfied with their care and had made a positive choice to move to Penmount Grange, the home needs to be able demonstrate more diligence in assessing service users’ needs prior to offering care. The registered provider did insist that he was aware of the home’s responsibilities in this respect and would not take anyone for whom the home was not registered. Full use of the home’s pre-assessment documentation would support this assertion. EVIDENCE: The registered manager has left and concerns had been raised, prior to this inspection that the home had admitted two people outside their registered category. This was resolved and a new pre assessment documentation has been introduced for use with prospective service users. The acting manager has started using this with new service users. It will be used for all new service users and will supplement information received from the local authority where they are funding people. Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 9 The registered provider said that all service users, or more frequently families on their behalf, are supplied with a copy of the home’s statement of purpose. It was noted that this need some revision. All service users, including those funded by a local authority should have a contract from the home that details the terms and conditions of residency at Penmount Grange. This is not currently the case. Advice is sought from other agencies when specialised care is needed for service users. The home offers a limited day care service and the registered provider has a domiciliary care service so people thinking of seeking admission may often had contact with the home or some of the staff beforehand. Penmount Grange DS0000061897.V298579.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 The practical side of caring for service users is good and the response from service users and relatives indicated that they were pleased with their care. The records that support the care have improved with the review of all care plans. This needs to be maintained with further attention paid to ensuring that night records are as full and informative as the day ones, thus giving a complete picture of a person’s care. Care plan aims need to be definite measurable goals not euphemistic aims. EVIDENCE: The acting manager has just completed a review of all the service users’ care needs and implemented a new system as the previous one was felt to be insufficient and had lapsed with regard to reviews etc. The majority have not been signed by the service user or a relative to demonstrate their agreement with the care plans. This should be sought. Care plans need more details where there are particular problems (e.g. sensory deficits, mobility problems etc.) indicating a need for fuller planning. Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 11 The daily recording is good and gave details of any events that occurred during the day. It was noted to be full where a person had been unwell or needing extra attention. The night records were discussed. On the first day of the inspection, these were seen to be very basic and gave little information such as ‘all fine’, ‘no problems’, ‘all asleep’. Indeed when the night staff were asked to record in more detail what had happened during their duty, the difference was informative. It indicated, for example, that Mrs X had needed to use the commode four times during the night and Mrs Y three times. This information is important, as broken sleep at night may be a pointer as to why someone does not respond as staff would hope, by day. It would also help substantiate or not a service user’s claim that he/she had had a very poor night. The inspector agreed that the information does not need to be recorded twice, but it does need to be recorded properly and cross-referenced where necessary. There were also past entries that indicated that some service users can be disruptive at night and the way in which this should be handled needs discussion and agreement. Turning off a person’s bell is not an acceptable response. Entries for a service user who was terminally ill provided details of the care given and of problems that staff had encountered. This was well recorded. There was a discussion about how best to keep all notes so that carers had easy access to the care plans and the daily recording. There was evidence that other professions and services ancillary to medicine were sought when needed with records of medical visits etc kept. A senior carer, who is supported by a colleague if she is away, deals with medication. The home uses a monitored dose system which is audited six monthly by the home’s supplying pharmacist. Medication is stored on locked trolleys that are placed one on the ground floor and one on the first floor. The carer in charge said that the majority of people had their medication in the morning and some in the evening. At present there was little required at midday so the trolley arrangement facilitated the medication round and saved the carer having to carry stocks around the home. There are arrangements to store controlled (CD) medication in locked cupboards where it is are needed and a CD book is available. No CDs are currently in use. Medication administration record sheets were seen to be completed correctly. Two medication issues were discussed relating to people who self medicate. The senior carer agreed that some amendments would be helpful. Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 12 Generally the privacy & dignity of service users appeared to be observed. One issue was discussed and an alternative arrangement was put in place quickly. The home cares for service users unto their lives’ end when ever possible, with support from the community nurse & doctors. Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Penmount Grange provides an environment where service users are encouraged to exercise choice and independence. The importance of social stimulation and selected activities is recognised with some provision being made to provide this. The management team need to be alert to the importance of having completed risk assessments where this is indicated. Service users commented that their meals were good; the visual impact of soft diets could be improved. EVIDENCE: The acting manager said that since she had been in the home she had made a positive effort to encourage people to come downstairs with some considerable success. The home’s new conservatory had helped this as it provided a light, bright area for people to sit. However those who prefer to remain in their room do so and this choice is respected. Activities are arranged periodically for service users; armchair activities took place during the first day of the inspection. In addition there are a number of people who attend for day care. They bring interest to the home with conversation and gossip about the local community. Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 14 The service users with whom the inspector spoke said the food was good and that they enjoyed their meals. The lunchtime meal is a set one but reflects any personal likes or dislikes. The cook, who was a relief person, said that for those who needed their food liquidised she tend to make it into a soupy consistency. Thought could be given to presenting the different components of the meal so that they kept their individual colour and flavour. The home does not seek to look after service users’ money but has identified a need to provide safekeeping for cash and does therefore hold and account for monies left for people by the families. Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The evidence of an active complaints policy and procedure was not seen in the home. Whilst it is available in the service users guide the registered provider must consider whether or not service users will recall this should they wish to raise a concern or make a complaint. EVIDENCE: A concern raised by a community nurse has been addressed. The home has a complaints book but there have been no entries for three years. The inspector was told that the complaints procedure forms part of the statement of purpose & service users guide. It was suggested that it should be displayed on the notice board where people could read it easily if necessary. POVA Training for staff on the prevention of abuse for vulnerable adults needs to be implemented and documented for all staff. Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Improvements are in hand and at the time of this inspection, disruption was being kept to a minimum. Rooms were seen to be clean and tidy but the floor coverings in communal area are dirty and worn. These are due to be changed once building is completed. EVIDENCE: The registered provider is in the throes of upgrading the accommodation in the home so that all rooms will have en suite facilities or if not, a dedicated toilet adjacent to the room. A conservatory has also been added since the last inspection to create more communal space which, it was identified, was lacking if the home is to use all the bedrooms and care for day care service users. Four new rooms have also been created. At the time of the inspection the Commission had not received written notification of clearances from the Building Control Department and Fire Officer to say that these areas are satisfactory and suitable for use. This Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 17 is now required urgently as the registered provider could otherwise be at risk of using unregistered rooms. The registered provider said that he has further plans to create a new kitchen and improve the circulatory space by the entrance of the home as well as making a staff room and office. The inspector recommended that he forward a copy of these plans to the Commission for information. Rooms, especially the newer ones, were seen to be nicely presented with good quality furniture and furnishings. People indicated that they were satisfied with their accommodation, which had been personalised to a greater or lesser degree according to preference. Bathrooms were clean and there were enough with bath aids or hoists to assist people who required this level of help. Some comments were offered to the registered provider and acting manager regarding service users who have visual impairments or mobility problems. The carpets in the communal rooms were dirty and worn in places but the registered provider said new carpet was already available and would be put down as soon as the building works had been completed in a few months time. The inspector suggested that a notice was displayed advising people of the changes that were anticipated as an awareness of the plans and time scale can prevent disquiet or complaints. In the mean time staff must be vigilant so that any tears or worn places in floor coverings do not become trip hazards. The current laundry is small but handles all the laundry for the home. Service users said their clothes were returned promptly when sent for washing. Staff are aware of the need for discretion in some cases when persuasion is needed to encourage people to change their outfits. Externally improvements are also in hand to create a larger patio at the rear for the use of service users. Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 A regular team of staff has been established but records relating them were not up to date. The registered provider & acting manager had planned to review these next. Staff with whom the inspector spoke were aware of the varying needs of the service users. EVIDENCE: The manager said that there had been several staff changes since the last manager left but felt the home had now settled to a regular team although two extra people were being sought. She was aware that the staff records were in disarray with insufficient details and training programmes lapsed. This was evident on inspection and there was no record of current supervision. She said this was the next task to be tackled and updated. The registered provider said that another person was joining the management team for the business shortly. Updating records, policies and procedures and all other documentation would be one of his responsibilities. The home has a copy of the new induction programme ‘skills for life’ and was planning to introduce this as a precursor to National Vocational Qualifications training for staff. Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 19 As the home was aware of its deficiencies regarding staff recruitment and support, this was not inspected at length on this occasion but will be the focus of the next visit. It was noted that senior staff wear navy uniforms that are the same colour as those worn by Sisters in hospitals or community nurses. The home needs to be careful that this does not give the impression that they are able to care for service users with nursing needs. Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,35,36,37 The care of service users has been paramount in recent weeks. This has been maintained but the state of the records indicated that an overhaul of the administration and management system is indicated. The inspector felt that dedicated time was need to achieve this and indeed the registered provider said that another family member would be joining him to undertake this role. EVIDENCE: The future management of the home was discussed. The registered provider was advised that the present acting manager would have to make an application to the Commission to become the registered manager rather than transfer from her previous post within the same organisation. The inspector recommended that a decision regarding this be made as soon as possible. The acting manager has put considerable effort in the space of eight weeks into updating service users’ records and initiating some changes in care practice within the home. Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 21 To date the home has not introduced a quality assurance and monitoring system. The home does not look after service users’ money as such but does have money kept in safe keeping for some service users, which is accounted for and receipts kept for any purchases. The records required by statute were inspected and included the accident book, fire records and the registration certificate and insurance. The registration certificate will need to be updated as soon as the Commission receives the clearances on the new accommodation. The home’s policies and procedures need to be updated. This is now well overdue from when the current registered providers took over the ownership and management of Penmount Grange. Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 22 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 2 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 3 3 1 2 X Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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. 2. Standard OP37 OP2 Regulation 18(1) 5 Requirement The registered provider must appoint a registered manager The registered provider must ensure that each service user is provided with a contract of care that details the terms and conditions of their placement. The registered provider must arrange for staff to receive training on ‘whistle blowing’ and the protection of vulnerable adults. The registered provider must provide the Commission for Social Care Inspection with copies of written confirmation of clearances from the statutory bodies for any structural work undertaken in the home before those premises are used. The registered provider must ensure that the recruitment process for staff is robust and conforms to all aspects of standard 29. The registered provider must introduce a system to monitor the quality of services provided DS0000061897.V298579.R01.S.doc Timescale for action 25/07/06 25/09/06 3. OP18 18(1)(c) 25/09/06 4. OP19 23(4)(5) 25/07/06 5. OP29 19 Schedule 2 24 25/09/06 6. OP31 25/09/06 Penmount Grange Version 5.2 Page 24 7. OP36 18(2) by the home The registered provider must ensure that all staff receive regular recorded supervision at least six times a year. The registered provider must ensure that all policies and procedures are updated and personalised for Penmount Grange. 25/09/06 8. OP37 17(2) Schedule 4 25/09/06 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 The registered provider should ensure that the home’s pre admission assessment document is always used when assessing a prospective service user. Information from other sources may be used to supplement the document but should not supersede it. The registered provider should seek to have care plans signed by either the service user or a relative to demonstrate their concurrence with the plan of care. The presentation of liquidised or soften diets should be reviewed so that the vegetables and meat etc retain their visual appeal. A copy of the home’s complaints procedure should be clearly displayed in an easy to read place. 2. 3. 4. OP7 OP15 P16 Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Penmount Grange DS0000061897.V298579.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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