Inspection on 19/12/07 for Penn House

This inspection was carried out on 19th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Penn House 02/12/09

Penn House 11/12/08

Penn House 20/12/06

Penn House 11/01/06

Penn House 19/10/05

Penn House 09/11/04

Penn House 01/03/04

Penn House 01/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Penn House The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 ORJ Lead Inspector Mike Murphy Unannounced Inspection 19th December 2007 10:00 th Penn House DS0000023006.V344455.R01.S.doc Version 5.2 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 Penn House DS0000023006.V344455.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 Adults 18-65. 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. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Penn House Address 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) The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 ORJ 01494 601435 kay.bailey@epilepsynse.org.uk martineau@epilepsynse.org.uk The National Society for Epilepsy Mrs Kaye Bailey Care Home 22 Category(ies) of Physical disability (22) registration, with number of places Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Provision of respite care for service users. Date of last inspection 20th December 2006 Brief Description of the Service: The National Society for Epilepsy is an independent registered charity that is administered by a Board of Governors who oversee the management of the Chalfont Centre. The Centre is located on a large site on the edge of the village of Chalfont St Peter. It consists of residential houses, a supported living project, a number of workshops and sites for daytime activities, an assessment unit which is an NHS provision, and additional services including a chapel, a restaurant, central kitchens and laundry, a small shop run by residents, administrative buildings and staff accommodation. Penn House is one of the residential houses and provides 24 hour residential care for up to 22 adults. The home is divided into five ‘flats’ and is located centrally on the site. Attractive, open, grassy areas surround the house. It has no private garden of its own but there is a small area at the front with benches and tubs of flowers. There is access to public transport and this is used by residents living in the home. The fees at the times of this inspection were between £891 - £1311 per week. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector towards the end of December 2007. The inspection included discussion with the registered manager, staff and residents, observation of practice, a visit to the home, consideration of information provided by the manager in advance of the inspection, consideration of CSCI survey forms returned in connection with the inspection, examination of records (including care plans and staff records), and a tour of the home. Overall, it is considered that the home is performing reasonably well. It provides good support to residents, has good systems for safeguarding adults and dealing with complaints, has good procedures for staff recruitment, training and development, and is managed by experienced and qualified managers. At the same time, however, the quality of the environment is variable, there are pressures on staffing (a matter which, to a certain extent, is outside the home’s control), there is scope for greater integration and development in its approach to quality assurance, and weaknesses are noted in the application of its systems for managing residents monies. The home, like other services at the Chalfont Centre, is facing change and uncertainty. This is being discussed with residents, relatives, staff and other stakeholders. At the time of this inspection there were no signs that the situation was having any adverse effect on residents. Care plans are comprehensive and are drawn up with residents. Residents have opportunities to participate in a range of activities, both on and off of the Chalfont Centre. Residents healthcare needs are well met. The organisation’s arrangements for safeguarding vulnerable adults and for dealing with complaints are good. A discrepancy noted while checking resident’s monies highlighted a potential weakness in systems. These were promptly investigated by the registered manager after the inspection visit. This quality of the environment is variable – in particular it is felt that the shower rooms and some WC’s are of a poor standard. This matter has also been commented on in recent Regulation 26 reports carried out by members of the Board of Governors. The home has experienced some pressure on staffing since the last inspection but was covering vacancies through overtime and its own bank staff. Systems for staff recruitment are good and the induction programme includes training on Equality and Diversity. The organisation provides good opportunities for staff training and development. Staff supervision and appraisal is well established in the home. Residents and relatives express a good level of satisfaction with the home. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Ensure that systems for managing residents’ monies in the home are effectively implemented and monitored in order to protect residents from risk. Improve the quality of the environment, in particular shower rooms and WC’s so that all areas of the home provide a safe and comfortable environment for residents. Please contact the provider for advice of actions taken in response to this Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 7 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. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are carefully assessed before admission to ensure the home can meet the person’s needs. EVIDENCE: The home had not received an admission since the last inspection in December 2006. The registered outlined the process for assessing the needs of prospective residents. Referrals are usually made by statutory authorities – local authorities or primary care trusts – and are dealt with in the first instance by the placement officer who is based in the central administration office of the Chalfont Centre. Having been initially checked by the placement officer the records are passed on to the Director of Services who decides which of the Chalfont Centre home’s would be most appropriate given the needs of the prospective residents. The home is notified and arrangements are made for the person to visit the home, view its facilities, and meet staff and people living there. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 10 Where the referral is progressed further information to inform the assessment of needs is acquired by the registered manager. The registered manager has access to relevant information including the most recent assessment carried out by the person’s care manager. At the same time, arrangements are made for further visits of increasing duration – a day, a weekend including an overnight stay - to be made to the home by the prospective residents. If both parties agree a one month trial admission is arranged. A review is held at the end of the one month admission. If all parties wish to progress to a longer term admission then the prospective residents returns home while the care manager arranges funding of the place. The registered manager keeps in contact with the person during this period. Once all formalities have been finalised arrangements are made for longer term admission. With changes currently taking place at the Chalfont Centre referrals are likely from other homes on the site. The process of assessment is similar but the prospective resident has the advantage of being already familiar with the Chalfont Centre. The registered manager has ready access to the person’s care plan and other information. The process is designed to ensure that there is a full assessment of the person’s needs before admission, that the person is comfortable in accepting the offer of a place, and that the home can meet the persons needs. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment of needs and action to meet needs set out in care plans aim to ensure that residents needs are met, that their independence is supported, that risk is minimised, and that care is provided in line with the person’s wishes. EVIDENCE: Care plans are in place and care plans are co-ordinated by residents key workers. The care plans of residents whose care was being case tracked on this inspection were examined. Care plans are considered to be well constructed and comprehensive. Care plans include key information on the person, a ‘pen picture’, a copy of the person’s weekly timetable, a section relating to the person’s current care needs Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 12 regarding epilepsy and on how those needs are to bet, medication compliance, (dealing with) aggression, eating & drinking, physical care (dental, chiropodist or optician), personal care, social skills, communication, general health, friends & family, general health, finances, care at night (in some cases), and current needs. Goals to be aimed for included managing money, taking a holiday, using local amenities, and going to college. Care plans included neuropsychological reports, work experience reports, details of seizures, competency assessment regarding managing money, and moving & handling assessments. It was noted that some care plans included vague terms such as ‘Hard Breathing’ and ‘Hysterical Behaviour’. It would be advisable to use more objective terminology such as a description of the breathing problem or of the behaviour. Care plans included evidence of review and of liaison with local authority care managers. Care staff encourage and support residents to be involved in drawing up and reviewing their care plans. Residents are encouraged to participate in the running of the home through monthly meetings in each flat. The level of participation was reported to vary according to the ability of individual residents and the level of interest in the matters under discussion. Risk assessments are numerous and cover such activities as (among others) smoking, money management, epilepsy, supervision and support required during personal care, and going to local shops. In summarising the care a relative wrote ‘They take care and look after [relationship] very well. This is the best home he has lived in. If I have any problems I ring up and they are dealt with straight away which gives me peace of mind. I am so grateful with all that they do’. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents lead a varied lifestyle according to their individual interests, abilities and wishes. This ensures that residents experience a range of social, leisure and other activities and are involved with the local community. Residents have a varied and nutritious diet. EVIDENCE: A number of activities are available for residents to participate in if they wish. Some residents go to college in High Wycombe and attend sessions in computing, social skills, English and horticulture. Some residents work at Chalfont Assembly and Packing Service (“CAPS”) which is locatedon the site of the Chalfont Centre. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 14 The home is about a mile and a quarter from the village of Chalfont St Peter. Residents make use of local shops and either walk or go by car to the village centre. A number of social and recreational events are regularly held on the Chalfont Centre site. There is a social centre and a recreation hall. Bingo is available in the social centre and badminton and basketball are regularly played in the recreation hall. The registered manager said that residents have gone bowling in Uxbridge and, at the time of this inspection just before Christmas, were planning to go to a pantomime in Rickmansworth. One resident said that he went to the “blind club” in Chalfont St Peter. The daily routine in the home has evolved over time and seems to suit the needs of residents living there around the time of this inspection. Staff support residents in their personal care and at breakfast if required. The majority of residents then go out pursuing planned activities for the morning. Lunch is served around noon and is the main meal of the day. Planned activities are resumed between 1.30 and 3.30 pm. Supper is served at 5.30 pm. People watch TV, read, listen to music, or may go out in the evening. Apart from breakfast (which usually consists of fruit juice, cereals, toast and hot drinks) meals are prepared at a central kitchen and served in the home. Meals are selected from menus in advance. Lunch and supper each consist of main course and dessert. Two residents prepared their own food. Residents are weighed monthly. Residents seemed satisfied with the home. Those spoken to during the inspection visit seemed satisfied with the support provide by staff. One described the home as “All right” and said that staff are available to provide help when needed. One resident said that he finds it easier to get on with some staff more than others. During the course of the inspection visit staff were observed to be responsive and attentive to residents needs. In the CSCI survey carried out in connection with this inspection one resident wrote ‘I like my work, but sometimes I feel down and don’t want to go. Staff encourage me. I chose to learn computing at college. Sometimes I can’t go where I want to go because staff need to organise trips in advance’ and ‘I like living at the Centre, I like activities, trips organised by staff’. Staff support residents in keeping in touch with families and friends as necessary. A relative wrote ‘They are very good. They bring my brother to see our mother who is nearly 90 yrs quite regularly. This helps them both to keep in contact’ and ‘They are very friendly and treat each person as an individual. They have time for the little things that can make a big difference to a person’. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 15 Another relative wrote ‘They are very friendly and treat each person as an individual. They have time for the little things that can make a big difference to a person’. A care manager wrote ‘The establishment is reducing in size and facilities such as the ‘workshop’ may be lost – to the detriment of some residents’. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for supporting residents and liaising with health services in the community are good. Arrangements for the control and administration of medicines are satisfactory. Together, these aim to ensure that residents healthcare needs are met. EVIDENCE: Information on resident’s support needs and on their preferences for care is included in care plans. Personal care is provided in the person’s bedroom or in a bathroom. The residents in this home are generally active but where required the home has a hoist, a chair lift in one bathroom, and a wheelchair. The ground floor accommodation is accessible to a person in a wheelchair. All residents are registered with a local GP practice and have access to specialist medical services – in particular neurologists and a specialist nurse through the Chalfont Centre. Some residents were receiving care from a Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 17 psychiatrist and care plans include evidence of contacts between the home and specialist mental health services. A chiropodist visits the home. The registered manager said that there is a dental surgery on the Chalfont site. Hospital services are provided through Wexham Park or High Wycombe hospitals, specialist neurological services through the National Hospital for Neurology and Neurosurgery at Queens Square in central London. Medicines are prescribed by medical staff – either neurologists or the resident’s GP. A separate medicines administration record (‘MAR’ sheet) is available for each, pink for neurologists and green for GPs. MAR charts contain a photograph of the resident. Medicines are dispensed by the pharmacy which is on site. Receipt and disposal of medicines is recorded. Medicines are stored in two lockable metal cabinets in an office. Medicines requiring cool storage are kept in a lockable container in the fridge in the main kitchen. There is a policy governing the administration of medicines and staff training is provided on site. Staff are required to attend update training every two years. The organisation has a system for reporting errors in administration. The results are periodically reported back to staff and trends monitored. To date the pharmacy has not carried out checks on medicines in home but the registered manager said that it will now be doing so. This is a welcome development. Many residents were managing their own medication in line with the organisation procedure. Residents transfer medicines from their main supply to a dosset container. Staff provide support as required. Examination of MAR sheets of residents whose care was being case tracked on the day of the inspection visit showed no obvious errors or gaps in recording. Two residents had died since the last inspection. Their deaths were thought to be related to their epilepsy – an occurrence known as sudden unexpected death in epilepsy or SUDEP. The distress which such an event causes to families, residents and staff and the need for support was discussed with the registered manager during the inspection visit. The organisation has a policy on ‘Dying, Death and Bereavement’. This includes guidance to staff on the action to be taken in the event of sudden death. It acknowledges that there will be a need for support and may be a need for counselling. It states ‘The NSE Counselling service will be involved where requested’. It also includes reference to ‘Delayed Grief’. The organisation’s policy on resuscitation of a person experiencing respiratory or cardiac arrest has been drawn up by the Senior Resuscitation Officer of University College London Hospitals NHS Trust (of which the National Hospital forms part). Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s policies and procedures for investigating complaints and safeguarding vulnerable adults aim to protect residents from abuse and to ensure that complaints are properly investigated. Weaknesses in the monitoring of residents financial transactions could place residents at risk. EVIDENCE: The home is required to conform to the policy of the National Society for Epilepsy (NSE) governing the management of complaints. The policy is detailed and includes definitions of ‘Compliments’, ‘Comments’, ‘Concerns’ and ‘Complaints’. An easy read version of the process was on the notice board of the flats. It is noted that the document includes reference to the former CSCI office in Aylesbury. This should be amended and the revised document should include the new telephone number for CSCI – that of the Customer Call Centre (0845 0150120) and the address of the South East Regional Contact Team in Maidstone. One complaint had been received since the last inspection. CSCI has not received any complaints about this service since the last inspection. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 19 The registered manager said that the home is in occasional contact with advocacy services provided by ‘People’s Voices’ and ‘Age Concern’ and that it soon expects to have contact with an IMCA (an Independent Mental Capacity Advocate - a new type of statutory advocacy introduced by the Mental. Capacity Act 2005). The home is subject to the safeguarding adults policy of the NSE, a copy of which is available in the office. A copy of the Buckinghamshire Joint Agency policy was not readily accessible at the time of the inspection visit. A copy should be obtained from the relevant office. The organisation has designated a senior manager to have lead responsibility on this matter and the registered manager said that the post holder was available to provide advice and guidance if required. Staff interviewed during the course of the inspection visit were aware of the procedure to follow where abuse is suspected. Staff receive training on dealing with aggression during induction, within their first year, and thereafter every three years. A policy is in place governing the management of resident’s monies. An account is opened in the finance department. The department is open on weekday mornings to deal with transactions. Small amounts of cash are held in individual wallets secure storage in the home. All transactions are recorded. The wallets of two residents were examined in the presence of the senior care worker in charge towards the end of the inspection. In one case the amount of cash did not correspond with the balance in the records. A handwritten note stated that another resident owed the resident concerned a sum of money. It looked as if money had been ‘borrowed’ from the resident’s wallet for another resident. It was unclear whether the resident concerned had given his permission for the transaction. The record had not been maintained. The person in charge said the practice was not acceptable and that the matter would be addressed the next day. The registered manager subsequently wrote to us. The manager said that she had looked into the matter and had taken action to ensure that it will “…NOT occur again”. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. With the exception of some shower rooms the home provides an accessible, pleasant and generally well-maintained environment which provides those living there with a comfortable and safe place to live. EVIDENCE: The home is a detached house situated in the grounds of the Chalfont Centre about one and a quarter miles from the centre of Chalfont St Peter. The front exterior of the building presented a pleasing impression having been decorated for Christmas. Car parking is freely available in the grounds of the Centre. Buses connect Chalfont St Peter with other centres of population in the area. Nearest rail stations are Gerrards Cross, about two and half miles away, and Chalfont and Latimer, about four and a half miles away. The house has been divided into five flats, each of between three and six bedrooms. There are four flats on the ground floor and one on the first floor. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 21 Each flat comprises single bedrooms, kitchenette, lounge, shower, WC and storage area. The home does not have a lift. The ground floor is accessible to a wheelchair user. The home has a bathroom with chairlift for residents who require support. The quality of the accommodation is uneven. Bedrooms vary in size but all of those seen during the course of this inspection visit were well furnished and provided a comfortable environment for residents. Decorators were in the course of painting and varnishing some areas of the ground floor. The registered manager said that boilers are to be replaced in order to improve the efficiency of the heating and hot water. There is a spacious and well equipped kitchen from which meals are served. The dining room is sufficient in size for the current number of residents. The use of living areas appeared to vary. Those close to areas of activity were understandably more popular with residents on the day of inspection. The laundry is considered acceptable. The registered manager reports that she wishes to develop an improved system for some aspects of the laundry. The shower rooms were considered to be particularly unwelcoming: cold, dusty, poorly equipped, and in need of refurbishment. In information supplied to CSCI in advance of the inspection in the ‘AQAA’ (Annual Quality Assurance Assessment) the registered manager wrote that one improvement she would wish to see over the next 12 months is ‘To regularly have the shower rooms deep cleaned to prevent infection, this is done now but not regularly’. It is felt that these areas will require rather more attention than that. Some of the shower rooms are considered to provide a barely acceptable standard of accommodation. It is anticipated that the home will close in the autumn of 2011 – almost four years from the date of this inspection in December 2007. This raises the question of the level of investment required to upgrade this aspect of the home’s accommodation in order to provide a safe, warm, comfortable, and pleasant environment for residents, against the background of its closure in less than four years time. It is noted that many of the Regulation 26 reports carried out by members of the Board of Governors in 2006 include comments on the state of décor in the home. The objectives for the home, outlined in its statement of purpose, and which are ‘…to be achieved by 30 March 2008’ do not include a plan for maintaining the quality of the environment. On the day of inspection most areas of the home were clean, tidy and in good order. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels, procedures for the recruitment of new staff, and for staff training, development and support are good. These aim to ensure that there are sufficient numbers of appropriately trained and supervised staff to meet the needs of residents. EVIDENCE: The current staffing resource provides for four staff in the morning, four in the afternoon and three staff at night. These figures do not include the manager. The team structure is comprised of the registered manager, the deputy manager, two team leaders, and support workers. Staff seen during the course of the inspection visit appeared to have the qualities required for their work and to have a positive and supportive relationship with residents. The home has experienced pressures on staffing since the last inspection and at the time of this inspection visit it had six vacancies (out of 16 posts). Vacancies were being covered through overtime and bank staff. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 23 The recruitment of new staff is a combination of word of mouth, advertising on the NSE website, and of overseas staff through a recruitment agency. The home is supported in recruiting staff by the human resources department which is located on the Chalfont Centre site. Interview panels include the manager, deputy manager and team leaders depending upon the grade of staff being appointed. The files of three staff appointed since the last inspection were examined in the human resources department in the presence of a member of the administrative staff. The files were in very good order and included all the information required under Schedule 2 (of Regulations 7, 9 and 19). Over 50 of staff are qualified to NVQ 2 or NVQ 3. The NSE offers a corporate induction programme and an ongoing and comprehensive staff training programme throughout the year. A copy of the induction programme for January 2008 and of the training programme from November 2007 to December 2008 was provided for the inspection. The latter included separate details of mandatory training – comprising 11 subjects – planned over this period. The induction programme includes induction to the organisation, induction to the home, and completion of the ‘Skills for Care’ Book during the first three to four months of employment. It is noted that the induction programme includes training in equality and diversity. Resident respondents to the CSCI survey carried out in connection with this inspection were generally positive in their views of staff. One wrote ‘They’re friendly, look after me, listen to me, understand me’. A relative respondent wrote ‘They are very friendly and treat each person as an individual’. One to one staff supervision takes place monthly during the six-month probation period after appointment. On successful completion of probation, all care staff receive supervision every six weeks. All staff are required to have an annual appraisal. Staff seen seemed satisfied in their work. Staff confirmed that they had received a structured induction programme and that the home provided opportunities for training and development. They confirmed that regular staff supervision took place and expressed positive views of managers – described as ‘open minded’, ‘experienced’, ‘organised’ and ‘reliable’. Staff meetings are held every six weeks. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This is generally a well managed home which is providing positive care outcomes for residents. Weaknesses in monitoring the arrangements for dealing with residents’ monies could pose a risk to residents. EVIDENCE: The registered manager has been in post for seven years and is appropriately qualified and experienced for her position. The manager has acquired the Registered Managers Award (RMA) and Advanced Management in Care. She is also an NVQ assessor. Over the past year the manager said that she had Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 25 attended training in the Mental Capacity Act 2005 and update training on the administration of medicines. A number of activities may be considered to form part of the home’s approach to quality assurance. However, at the time of this inspection, these were at different levels of development and further work is planned for some activities. A health & safety audit is periodically carried out by a senior manager – the most recent audit had been conducted three months prior to this inspection. The manager said that care plans are audited monthly. A report on the results is not made. This audit could be improved through the use of an audit tool based on explicit standards, a report of the audit, and discussion with staff. A seizure audit is carried out monthly under the direction of the specialist epilepsy nurse. The pharmacy carries out an audit on medication errors and reports on the results. The pharmacy intends to carry out checks on the home’s arrangements for the control and administration of medicines but has not yet started. The manager carries out checks on medicines periodically. Regulation 26 visits are carries out by members of the Board of Governors. The notes of visits made in July, August, September and October 2007 were examined during the inspection visit. It is noted that some of the reports include critical comments on the state of some aspects of the home environment. The manager holds meetings with the residents in each flat. The manager said that a questionnaire was sent to relatives in January 2007 but the response (in terms of numbers) was low. As indicated elsewhere in this report relative respondents to the CSCI survey carried out for this inspection expressed a high level of satisfaction with the home. Records examined were generally in good order but at least one of the records relating to the cash held on behalf of residents had not been accurately maintained. The home, like many others on the Chalfont Centre site, is facing a period of change and uncertainty. This is being discussed with residents, relatives, staff and other stakeholders. It is anticipated that Penn will close in the autumn of 2011 A copy of the service objectives for the next twelve months or so was provided for this inspection. These include (among others): promoting resident empowerment, improving the quality of assessment and care planning, improve awareness of diversity issues, ensure staff receive relevant training, develop day services, develop quality assurance, and develop a ‘move-on’ culture. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 26 Arrangements for the maintenance of health and safety appear satisfactory. There is a health and safety policy in place and one of the team leaders takes a lead role for health and safety matters. Systems are in place for recording and reporting accidents and incidents. Reports are checked by senior managers. Fire safety precautions appear satisfactory. A fire risk assessment was carried out in November 2007. A fire drill took place in April 2007. Contracts are in place for the maintenance of fire safety equipment. The manager reports that over the summer there have been many false alarms, many being due to flies getting into the smoke sensors. Staff check the operation of fire points weekly. Contracts are in place for the maintenance of electrical and gas systems and appliances. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 4 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 2 X 2 3 x Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 28 No 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 YA23 Regulation 16(2)(l) Requirement The registered manager must ensure that effective systems are in place for the safe keeping of resident’s monies. Timescale for action 29/02/08 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 YA24 YA39 Good Practice Recommendations The registered manager should ensure that the home provides a safe, comfortable and well maintained environment for residents. The registered manager should further develop the home’s approach to quality assurance building on the systems which it has already established. Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Penn House DS0000023006.V344455.R01.S.doc Version 5.2 Page 30 - 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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