Inspection on 24/07/07 for Penmount Grange

This inspection was carried out on 24th July 2007.

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

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

Other inspections for this house

Penmount Grange 20/06/06

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 Elaine Bruce Key Unannounced Inspection 24th July 2007 08:20 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.V346769.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.V346769.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 Mr Stephen John Difford Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Penmount Grange DS0000061897.V346769.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 providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category - (Code OP) The maximum number of service users who can be accommodated is 27. 20th June 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.V346769.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key unannounced inspection at Penmount Grange took place over 6 hours on the 24th July 2007. The registered manager was on duty on the day of the inspection as was one of the assistant managers. Time was spent looking at care plans, staffing records, policies and procedures, meals in the home, medication, an inspection of the premises and discussions with the people in the home and the staff on duty. During the course of the inspection 10 people were spoken to and 4 of those people were case tracked. All of the people in the home expressed positive comments on the standard of care they are receiving in the home for example: “the night staff are lovely, I do not sleep well and they bring me a cup of tea which is very kind”. During the week a number of clients attend Penmount Grange for day care and on the day of the inspection three clients were at the home for this service. They were observed to add stimulation and conversation to the longer stay people in the home and therefore the service appears to be working well. One client stated that “he enjoyed the company when he came to Penmount Grange for the day”. The home does not offer a respite care service now as they have full occupancy on their beds at the home. The registered manager is supported in his duties by the registered providers who are very involved in the running of the home and are all family members. The weekly range of fees for care at the home is from £300.58 to £420. What the service does well: The registered manager presents as very committed to delivering a good service at the home. The environment is constantly being upgraded and where this has been done and is being done standards are high. New bedrooms in the home are spacious and very comfortable with en suite facilities. Older bedrooms in the home are being upgraded as are the communal facilities. A Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 6 new kitchen is presently being built and the old kitchen will be used to provide a staff room. What has improved since the last inspection? What they could do better: The inspection report of the 20th June 2006 identified that staff required adult protection training. It is recognised that senior staff members (and one junior staff member) have undertaken this training but more work needs to be done in this area to ensure the safety and well being of the people in the home at all times. The statutory requirement to address this is again included in this inspection report with the date for compliance extended again. The inspection report of the 20th June 2006 identified that no quality audit/monitoring had taken place. This was included in the inspection report as a statutory requirement. Again, this inspection has found that no progress has been made in this area and the statutory requirement is again included in this inspection report with a new timescale for compliance. Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 7 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. Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures are in place prior to admission to ensure that the people being admitted (and their relatives) can be confident that their needs will be met. EVIDENCE: The home has in place a statement of purpose/service users guide document that has recently been updated. Included in this document is information on the admission procedure for the home. People are encouraged (with their relatives/representative) to visit the home on two occasions prior to admission to enjoy a meal with the other people at the home and to meet the staff. The documentation also clearly states “appointments are not necessary, you’ll see things as they are every day”. Some further small amendments required to Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 10 the statement of purpose/service user guide were discussed at the time of the inspection. The home offers a day care service to a number of clients and on the day of the inspection three people were attending the home for the day. One day care person was spoken to he said “I enjoy the company when I come here”. The home have until recently offered a respite service but are now stopping this as they have a waiting list for long stay beds at the home. There is a continuity of care for the people that have been able to attend the home prior to admission for day care and respite care. Prior to admission to the home all the people are assessed by the registered manager to ensure that their care needs are met. In his absence one of the assistant managers would undertake this task. Documentation is in place to evidence this and assessments of care needs are in place where funding is taking place from other areas. It is recommended that this document is at all times signed by the person undertaking the assessment. Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people at Penmount Grange can be confident that they will be treated with respect and that their personal and health care needs will be met. EVIDENCE: Each person at the home has a care plan in place with care needs identified and how these care needs can be met. Improvements to the care plans are noted since the last inspection. Monthly reviews are up to date and health care information is included in care planning. Risk assessments are included in the care plans. The daily records are generally good but in two examples could have been improved in regard to nutrition. Information which had been identified in the care plan as a problem was not then recorded as to what action had been taken to address the problem. Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 12 Documentation is in place to evidence that people are weighed regularly and the nutritional needs of each person at the home are screened. This information is though kept separately to the care plans and it was suggested that all this information should be kept together. Health care records include information when people have been attended to by the community nursing service. The home uses the monitored dosage system for medication. The medication is stored in a locked trolley. There are arrangements in place to store controlled medication in a locked facility and a controlled record register is available. Medication administration records were found to be completed appropriately on the day of the inspection. Some of the people at the home take responsibility for their own medication and secure storage facilities are provided for them to manage this safely. All staff who administer medication have received training. Generally the privacy and dignity of the people in the home appeared to be observed. The home cares for people unto their lives’ end when ever possible, with support from the community nursing service and general practitioners. Penmount Grange DS0000061897.V346769.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The routines at Penmount Grange are relaxed, relatives and friends can be confident that they are welcomed into the home. The dietary needs of the people in the home are well catered for with a balanced and varied selection of food that meets peoples’ tastes and choices. EVIDENCE: Activities are arranged periodically for the people at Penmount Grange. The day care clients who attend the home contribute positively to the daily life in the home to include conversations and discussions about the community. The daily records evidence when the people in the home have received a visitor and visitors are welcomed into the home. They are asked to sign into the home on arrival in the visitors’ book. On the day of the inspection the hairdresser attended the home and a piano was played in the afternoon for the people in the home to enjoy. Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 14 People spoken to during the course of the day indicated that the meals at the home were good. The inspector joined two people at lunch time in the dining room for the main meal of the day. This was braised steak with croquette potatoes and vegetables followed by bread and butter pudding. It was noted that although a pleasant occasion the staff brought the desserts to the table before people had finished their main course which gives the impression that the meal is being rushed. One person in the home said “It is okay here, the staff are okay and the food is okay”. Another person said “the meals have improved, the new cook is good and the staff are kind”. More documentation is required to evidence that a full choice of meals is being provided to each person at the home. At this time there is only the tea time meals that evidence this. The menu rotates over a four week period and is mainly traditional. The manager is looking forward to the new kitchen being up and running which he says will be above legislation requirements. The home employs three part time cooks. Penmount Grange DS0000061897.V346769.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people at Penmount Grange can be confident that any concerns or complaints that they have will be treated seriously. To ensure the safety and well being of the people in the home at all times more staff require adult protection training. EVIDENCE: The home has in place a complaints policy and procedure which is clearly displayed in the entrance of the home. This documentation is also provided to the people in the home in the statement of purpose/service user guide. The home have not received any recent complaints. The CSCI had been involved in a complaint which has now been closed. Three senior staff members and one junior carer have recently attended adult protection training run by Cornwall County Council. There are plans for this training to be cascaded to all staff and this must take place as a priority. Staff cover basic adult protection through their induction training which is based upon the Skills for Care documentation. Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 16 As discussed at the time of the inspection further work needs to be done with the adult protection policy and procedure to ensure that it clearly states who to contact when an alert is raised. Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 17 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. On going improvements to the environment at Penmount Grange are still taking place. When these are completed the home will provide a well maintained environment that has generous communal space and spacious, comfortable bedrooms. EVIDENCE: The home is now registered to provide accommodation for 27 people and the home is presently running at full occupancy. Considerable improvements are noted to the premises since the key inspection of the 20th June 2006. This includes new furniture and carpets to bedrooms as well as communal space. A new pleasant conservatory is regularly used and there are plans to landscape Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 18 the gardens which will provide a nice outlook from the conservatory. The area for car parking outside the home has also been improved. On the day of the inspection a maintenance person was watering all the baskets and plants in containers. In addition this staff member is responsible for the cleaning duties in the home. When he is off duty care staff help with the cleaning duties. Work has commenced on the plans to move and upgrade the kitchen in the home which will then result in the old kitchen being turned into a staff room. Older furniture in the home is gradually being replaced and new carpets being laid. The current laundry is small but handles all the laundry for the home. When all the work is completed on the premises the environment will be of a good standard. Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people at Penmount Grange are cared for by capable and caring staff in sufficient numbers to meet the needs of those currently living in the home. Safe recruitment practices protect the people in the home. EVIDENCE: The staffing team at Penmount Grange are generally a stable team with a number of staff being long standing. The staffing rota indicated on the day of the inspection that there were five carers on duty in the morning. In the afternoon this reduces to four and then to three between 1800 to 2000. There are two waking night staff members employed. One person in the home said “the night staff are lovely, I do not sleep well and they bring me a cup of tea which is very kind”. Staff training is taking place and has recently included training on the Mental Capacity Act. The statutory training for staff was generally was found to be up to date with some small gaps on moving and handling and fire drill which the registered manager is fully aware of and has immediate plans to address. Out of 15 care staff employed, 10 of these have an NVQ qualification. It is Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 20 noted that progress has been made in the presentation of the staff files. Staff training for infection control is good. Staffing recruitment procedures for new staff were found to be satisfactory a good practice recommendation is made to update two criminal records bureau checks. 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 people with nursing needs. Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 21 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): 31,33,35,37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people at Penmount Grange are living in a safe environment with a newly registered capable manager and supportive management system. It is now appropriate for the manager to improve outcomes to the people in the home by meeting requirements of legislation. EVIDENCE: The home has recently registered a manger who is the son of the registered providers. It is positive that this registration has taken place as the home has been without a registered manager for over a year. The home’s business plan was spoken about during the course of the inspection with the home having a clear plan on their future directions. Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 22 The manager presented as enthusiastic and capable on the day of the inspection with a view to the future of the home, he is aiming to provide a good quality of care. He is supported in his duties by two assistant managers and all three members of this team share on call responsibilities when they are not working. Both the assistant managers are undertaking studies to obtain a management qualification. The registered providers are very involved in the running of the home. No quality assurance/monitoring system audit has taken place at the home. This was also identified in the inspection report of the 20th June 2006. The home does not look after any peoples’ money as such but does have money kept in safe keeping for some people. This is accounted for and any receipts kept. Again, as identified in the inspection report of the 20th June 2006 current policies and procedures should be reviewed and where necessary updated. The registered manager takes responsibility for meeting health and safety requirements of legislation. He discussed his registered managers award training where this was part of what he had to do. Maintenance records for equipment in the home was all up to date and the majority of staff have received infection control training. Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 23 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 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 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 1 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 1 3 3 x 2 3 Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 24 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 OP18 Regulation 18(1)(c) Requirement The registered provider must arrange for staff to receive training on whistle blowing and the protection of vulnerable adults. (original timescale for compliance 25/09/06, second timescale for compliance 31/03/07) Timescale for action 31/10/07 2. OP33 24 3. OP37 The registered provider must introduce a system to monitor the quality of services provided by the home. (original timescale for compliance 25/09/06) 17(2)Sche The registered provider must dule 4 ensure that all policies and procedures are updated and personalised for Penmount Grange. (original timescale for compliance 25/09/06, second timescale 31003/07) 31/10/07 31/10/07 Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 25 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. 3. Refer to Standard OP3 OP7 OP15 Good Practice Recommendations To ensure at all times the pre admission assessment document is signed. To ensure that the daily records reference the problems identified in care planning. To give consideration to storing all health care information in care planning. To ensure that all records of meals are in place as required by legislation. Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. Extracts may not be used or reproduced without the express permission of CSCI Penmount Grange DS0000061897.V346769.R01.S.doc Version 5.2 Page 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!