Inspection on 28/01/08 for Penn House Residential Care Home

This inspection was carried out on 28th January 2008.

CSCI found this care home to be providing an Adequate service.

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

Penn House Residential Care Home 08/10/09

Penn House Residential Care Home 23/09/09

Penn House Residential Care Home 16/02/09

Penn House Residential Care Home 05/10/06

Penn House Residential Care Home 04/05/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Penn House Residential Care Home 169 Penn Road Wolverhampton WV3 0EQ Lead Inspector Bhag Jassal Key Unannounced Inspection 28th January 2008 09:20 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 Penn House Residential Care Home DS0000066040.V355636.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. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Penn House Residential Care Home Address 169 Penn Road Wolverhampton WV3 0EQ 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) 01902 345470 Mr Vijay Odedra Mr Arjan Bhoja Odedra, Mrs Shanta Arjan Odedra, Jasvinder Takhar, Daljit Takhar Mrs Nina Price Care Home 24 Category(ies) of Dementia (24), Old age, not falling within any registration, with number other category (24) of places Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Older People (OP) 24 Dementia (DE) 24 The maximum number of service users to be accommodated is 24. 2. Date of last inspection 5th October 2006 Brief Description of the Service: Penn House care home provides personal care and accommodation for 24 older people with Dementia. The home is an early Victorian two – storey building that has been adapted internally and suitably extended to meet the needs of older people. There is easy access to local amenities, which includes a park, churches, temples, a library and shops. The home is located approximately 1 mile from the city centre. The accommodation consists of two lounges and one of these is a large L shaped lounge, and a dining room. There is one double bedroom and 22 single bedrooms and seven of these have en-suite facilities. All the bedrooms are fitted with a staff alarm system, fire alarm system, secondary lighting and television aerial points. There are adequate communal bathrooms/showers and WCs on each floor. The home has a vertical lift, in addition to two staircases. There is adequate car parking space at the front of the premises and the garden is at the rear of the premises, which is accessible for people who use the service. Mr Vijay Odedra and Jasvinder Takhar have been operating this service since March 2006 (on behalf of Odedra & Takhar Partnerships Stonebank Investments). The present Acting Care Manager Ms Sherry Lee Boon has been in her post since November 2007. Penn House makes its services known to prospective service users in the Statement of Purpose and the Service Users’ Guide. The inspection Report is mentioned in the statement of purpose and a copy can be obtained from the home upon request. The care charges (fees) are reviewed annually and people who use the service Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 5 are notified one month in advance. The only additional charges to people who use the service are clearly laid out in the contract/terms and conditions of residency. The current fees charged at Penn House as of 1st of April 2007 are: £349.00 to £406.00 All people using the service pay monthly. Up to date information about the fees is obtainable from the manager. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means the people who use the service experience adequate quality outcomes. This report is on a Key Inspection, part of which included an unannounced visit undertaken on 28th January 2008. This unannounced visit started at 09:20 and lasted 10 hours and 55 minutes. The home had 23 places occupied and one bed remain vacant. The judgements made within this report are based upon information supplied by the home, from interviews with the Acting Care Manager, the staff and people who use the service and their relatives. During the course of inspection the assessment information and care plans were inspected for 6 people who use the service. Medication administration was checked. Staff records were seen to check staff rotas, recruitment procedures and training. Various documents were seen in order to check compliance with health and safety legislation. A tour of premises was also undertaken and observation of care practices and interaction between staff and people using the service was also completed. We looked at six files of people who use the service to enable us to monitor progress in meeting previous requirements. Discussions took place with several members of staff and over a dozen of people who use the service and four visiting relatives were spoken to throughout the day of inspection. Acting Care Manager – Ms Sherry Lee Boon was present throughout the inspection process. A partner - Mr Jasvinder Takhar was also present for a very brief period in the morning. On this occasion all the key Standards of the National Minimum Standards were inspected. Regulation 37 Notifications, concerns and complaints against the home, Regulation 26 reports and Annual Quality Assurance Assessment (AQAA) received from the care home were also considered and discussed with the Acting Care Manager. Subsequent to this inspection we sent a letter to the registered provider expressing serious concerns about several issues identified on the day of this inspection and asking them to address those issues as a matter of urgency and priority. A response was received on 13th February 2008, confirming that all of the issues identified had been addressed in order to ensure the safety and well-being of people who use the service. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 7 We wish to thank the Acting Care Manager, Responsible Individual, the staff, people who use the service and their relatives for their assistance and cooperation on the day of inspection. What the service does well: What has improved since the last inspection? The new Acting Care Manager has introduced formal supervision for staff, a new training programme and the key worker system of working. Medication practices have improved and more staff have received training in safe handling of medicines. A number of staff have completed their training in infection control, Dementia care, NVQ Level 2, adult protection and food hygiene, and that will enable them to expand their knowledge and skills and enhance the care they give to the people who use the service. It was noticeable that there have been many improvements made to the environment of the home. A rolling programme of decoration and refurbishment has been implemented, and some of the communal areas and several bedrooms have been redecorated and new floor covering and items of furniture have been provided. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 9 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 Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 10 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 Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 11 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): 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Penn House care home provides good information to prospective people who will be using the service and their families to enable them to make decisions about whether or not they wish to live at the care home. All prospective people who will be using the service receive a needs assessment prior to admission to ensure that their needs will be met. But the current needs assessment format needs updating and amending to ensure that there is a full/comprehensive needs assessment available on all prospective people with Dementia who will be using the service. EVIDENCE: Admissions are not made to the home until an initial assessment has been undertaken. At present the Acting Care Manager visits all people who use the service at their home or hospital prior to admission. There was evidence in the 6 files/care plans of people using the service that were seen which contained Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 12 initial/brief pre-admission assessments carried out by the home, and by other relevant professionals. The Acting Care Manager stated that she will be revising and updating the needs assessment format to ensure that the staff in the home have full/comprehensive information on the needs of people who use the service. She also stated that all the risk assessments will be updated by using the new revised format. The Acting Care Manager also stated that she will revise and update the home’s Statement of Purpose and Service Users’ Guide to reflect the changes in its registration and also recent changes to the Care Homes Regulations 2001 (as amended). Observations and discussions with the people using the service, the Acting Care Manager, and staff on duty indicated that despite the recent changes in staff, the home continues to meet the individual needs of all the older people with dementia accommodated at the home in a satisfactory and sensitive manner. It was noted from the staff training records that several members of staff have received training in Dementia care and others need to undertake this mode of training. The Acting Care Manager stated that all members of staff who as yet have not received training in Dementia care will do so as a matter of priority in order to increase their awareness and knowledge about the care needs of people using the service. The home does not provide a service for those assessed and referred solely for intermediate care, who require help to maximise their independence and return home. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 13 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. Each service user has an individual plan of care but these do not detail how their needs will be met. Health care needs are addressed promptly. Medication is managed safely and people who use the service are protected by the home’s policy and procedures. People who use the service are treated with respect and dignity, and their rights to privacy are understood and upheld. EVIDENCE: All people who use the service undergo an assessment of their needs prior to admission to the care home, either by the care home and other relevant professionals. As it was noted in the previous section that the current needs assessments does not contain full/comprehensive information about people who use the service and thus it also reflected on the quality and details Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 14 contained in the care plans. The Acting Care Manager stated that currently the care plans are produced, which are based on the initial assessment of needs. It was noted that the home operates a key worker system, which helps to ensure that the recommendations arising from the care plans and monthly reviews are implemented. Six care plans/files of people who use the service were examined in detail and it was noted that the short-term and long-term goals, aims and objectives were not clearly identified and appropriate interventions required to put them into action to meet the individual residents’ needs also were not identified. It was also noted that risk assessments in some aspects have not been carried out or not updated. For example, one new service user’s needs assessment was not fully completed and thus the care plan was also incomplete. The care plan review of this service user had not taken place. In addition, 3 other service users’ needs assessments were incomplete and were in need of updating. It was acknowledged by the Acting Care Manager that the recent high turn over of care staff and inadequate staffing levels has contributed to this deficiency in some of the care plans that have not been reviewed and updated for the last few months, and stated that these care plans will be reviewed and updated by the end of February 2008. It was also acknowledged by the Acting Care Manager that insufficient number of staff on duty also could have adverse effect on the quality of person - centred care for individual people who use the service. The Acting Care Manager stated that since the resignation of the last Registered Manager - Mrs Nina Price on 19th October 2007, the care home had been without a Registered Manager for few weeks and thus the needs assessments, risk assessments and care plans recordings have not been kept up to date and now she will be addressing these deficiencies. The Registered Providers need to ensure that the needs assessments, risk assessments and care plan formats are appropriately revised and updated and then all the records are completed and kept up to date at all times to ensure the care and well-being of all the people using the service. The Acting Care Manager also must explore ways in which to involve the people using the service and their relatives in care plans reviewing processes. Where this is not possible due to the nature of the mental health problems/dementia needs experienced by some of the people who use the service this should be clearly documented in the care plans. Daily care records were also seen and entries made by care staff could not always be crossreferenced to the uncompleted care plans. The daily care (day and night) recording formats were also examined and it was noted that the quality and detail of care recording needs improvement. It was observed during the day of inspection that staff were not following appropriate procedures/techniques in their moving and handling of people who Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 15 use the service. This matter was drawn to the attention of the Acting Care Manager. The Acting Care Manager stated that she will ensure the staff are aware of the importance of including all the information regarding people who use the service and their well being, and all the entries made by the staff are always to be cross-referenced to their care plans. The Acting Care Manager also stated that the revised and updated formats of care plans and daily care recordings will be implemented immediately; and the staff will be closely supervised and supported to make further improvements in daily care recordings as a matter of priority. The home maintains records of all health checks carried out by doctors, opticians, district nurses and chiropodists. People who use the service are assessed by the senior staff to determine whether or not they are at risk of developing any pressure sores. District Nurses visit the home regularly and support staff with the provision of pressure relieving equipment as necessary. The Acting Care Manager confirmed that at present there is no service user in the home with pressure sores. The home also completes a dietary needs assessment that details each person’s abilities at meal times and lists their likes and dislikes and the type of help needed. All people using the service are to be weighed monthly, which will help staff to monitor their health well being and physical conditions. People who have specific conditions such as diabetes, mental health needs and epilepsy generally had management plans in place to ensure that staff were aware of their individual needs. All of the people using the service have some form of dementia and occasionally they display some behaviour that challenges staff and /or other people who use the service. This means that staff may find these situations difficult to handle and meet the needs of people who use the service without specific guidance and training. This was discussed with the Acting Care Manager during the inspection and she is to discuss this matter with the Registered Providers and then take appropriate action to provide staff with guidance on managing such likely behaviours and to organise appropriate training on these issues for staff. Medication Practices within the home have improved since the last inspection. The medication cupboard was found to be clean and tidy. Medicines were stored appropriately. Evidence gathered from staff records and from discussions with the Acting Care Manager showed that several members of care staff have received training in safe handling of medication. Now this training will ensure that the staff are aware of the processes involved in administering medicines and enable them to do it safely. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 16 Medication rounds were observed during the inspection. Senior staff were seen to administer and record when medicines have been given. The Acting Care Manager stated that all senior carers, who are responsible for the handling and administration of medication have completed their training in safe handling of medication. Records seen included medication received, administered and leaving the care home. It was noted that the mobile medication trolley was securely stored after use in the dining room and medicines are kept under lock and key in a medication cupboard. It was noted on the day of inspection that no personal interventions were undertaken in communal areas. In addition, consultations with health and social care professionals were carried out within the bedrooms of people using the service. Visitors were able to meet people using the service in their bedrooms and lounges. It was also observed that the people using the service were being treated with respect and staff were working both professionally and sensitively in meeting individual needs. Staff were working hard to try and maintain the dignity of people using the service, which can be difficult at times due to the type of illness and conditions they have. Relatives have commented that they are pleased with the care their relatives received, but sometimes there are difficult situations the staff having to deal with. Additional care staff could help the residents. The Acting Care Manager stated that she will discuss with the Registered Providers this situation and the particular needs of people using the service and the need to provide additional staff to provide care for people who use the service. We spoke at some length with several people using the service, who were able to have meaningful conversation; they stated they were happy with the care provided and staff were very helpful and caring. Three people using the service stated that “the carers are always there to help, and we are very pleased with them”. However, during the discussions with people using the service they also said that “on many occasions the carers are pushed for time when they have to cover sickness and other duties when there were fewer carers on duty, and this was true in the morning, afternoon and weekends”. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 17 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 home does not provide a structured programme of social and leisure activities and outings, which are designed to meet the needs, preferences and capabilities of people using the service with dementia. People who use the service are positively helped to exercise control over their lives as far as it is practicable and safe to do so. The dietary needs of people who use the service are well catered for with a balanced and varied selection of foods, and ample quantities to meet the tastes and individual requirements of people using the service. EVIDENCE: It was noted that the home does not provide a structured programme of social and leisure activities inside and outside of the home in accordance with people who use the service with dementia care needs, their preferences and capabilities. There is inadequate system of maintaining records of activities in the home. The Acting Care Manager said that at present there is no one clearly identified to lead on co-ordinating the activities programme, and there was no evidence of any co-ordination. The Acting Care Manager needs to Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 18 ensure that the carers (key workers) should identify the interests that the people using the service wish to pursue and also always to be mindful of their capabilities and choice to participate in any proposed activity. At present the care plans do not clearly identify in detail the social and leisure needs of the people who use the service. It was also noted that there was very little in the way of entertainment and activities within the home and no outings and trips have been arranged during the recent months. The external entertainers are invited occasionally to deliver entertainment in the home for people who use the service. But not specific activities for people with dementia care needs and their abilities. The Acting Care Manager stated that she will ensure that the social and leisure activities needs are clearly identified in their care plans, and any activities enjoyed by the people using the service will be appropriately and consistently recorded, evaluated and incorporated into their individual care plans. Activities seen during the afternoon on the day of inspection included listening to music and game of cards. Several people who use the service were engaged in conversation with each other whilst the others were watching television. It was noted that the garden areas were in need of tidying up, but the people using the service could not make use of it, given that it was winter season. Several people who use the service spoken to stated that they are in regular contact with their family members and friends, and spoke about their visitors’ interest and some involvement in their care matters. The visitors’ book kept in the home showed a considerable activity. Family and friends are encouraged to visit and the home has an open visiting policy. There was a steady flow of visitors during the day of inspection. Two visitors commented that “its good to see the residents taking part in doing some activities, and its good for them, but more staff would be helpful”. Relatives of two people who use the service stated that they visit the home at various times of the day as they wish. Two relatives who spoke to us said they are given warm and friendly welcome by the staff whenever they visit. Some people who use the service also keep some contacts with the local community – for example, local shops. The Acting Care Manager stated that the people who use the service are positively assisted and helped to exercise choice and control over their lives as far as practicable and safe to do so, and subject to risk assessments. A close liaison is maintained with the relatives and representatives where the people who use the service are not able to make decisions. People who use the service and their relatives are informed about the availability of the local Advocacy Service based at the local Age Concern office. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 19 Several people who use the service told us “the food is very nice and tasty”. The consensus of people who use the service was the range, quality and choice of food provided was good and the home caters for those people who use the service who have individual preferences and medical needs. The Acting Care Manager stated that the current four weekly menus has been changed recently in consultation with the people who use the service and also taking into account their health needs. The cook has completed her basic food hygiene training. The Registered Providers also needs to take appropriate action to address the issues noted below: The First-Aid box needs checking and to be stocked with the required items; and there were several weeks gaps in the records maintained of daily food eaten by people using the service and which needs to be kept up to date. The cooking oil in the deep fryer was in need of changing immediately. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 20 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. Concerns and complaints are dealt with promptly and professionally. People who use the service are protected from abuse by the home’s policies and procedures. Formal training is required for all staff to ensure that people who use the service are protected from forms of harm and abuse. EVIDENCE: The home has a good Complaints Procedure, which is referred to for information in the Service Users’ Guide. There is a satisfactory system of recording concerns and complaints. Since the last inspection two complaints have been made against the home concerning the care of people who use the service and staffing issues. Both complaints were still being investigated by the Registered Providers and the local Social Services Department. Two relatives of people who use the service when asked were certain of how to formally make a complaint but said they would quite happily talk to one of the staff in charge or the manager. The home had to report one vulnerable adult protection issue, which was still being investigated through the local multi- agency vulnerable adults protection procedures. The home have policies and procedures in place regarding the prevention of abuse, which needed updating in line with the recently revised Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 21 and updated Wolverhampton’s multi-agency vulnerable adults protection procedures. The home has a whistle – blowing policy in place. The Acting Care Manager stated that adult protection issues are discussed during staff induction training and supervision meetings. However, formal training in adult protection issues has not been provided to all members of staff. The Acting Care Manager stated that there are five members of staff who as yet have not received this mode of training will do so as a matter of priority. The home also needs to obtain a copy of Wolverhampton’s inter-agencies’ safeguarding adults from abuse policy and procedures. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 22 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. The home is well maintained but needs some improvements to fittings and safety matters. The home is clean and hygienic. EVIDENCE: A tour of the premises highlighted a number of issues that must be addressed to the internal environment. The Acting Care Manager stated that there is a planned programme for maintenance with timescales for specific jobs, including redecoration of bedrooms, and communal areas, and renewal of old furniture, fittings and floor covering. The two relatives commented about the décor within the home and stated that some areas would benefit from renewal. The hot water supply in several bedrooms was not sufficiently working and needs to be rectified promptly in order to ensure the people using the service enjoy a regular supply of hot water without the risk of scalding or not having the supply of sufficiently hot water at all. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 23 There is no garden furniture, which could be used by people using the service and their relatives. On the day of inspection, it was seen that the gardens needed to be tidied up and to make them more inviting for people using the service and their families to use. The Acting Care Manager stated that these both issues will be addressed promptly. The main lounge carpet is in need of professional cleaning or replacement. The Acting Care Manager stated that this is being done as part of the rolling programme of redecoration and refurbishment. The several bedrooms with new furniture need to have suitable lockable facility for the use of the people using the service. The window restrictors in bedrooms 10 and 15 on the first floor were broken and not in working order. The Acting Care Manager stated that these both restrictors will be replaced immediately and henceforth all window restrictors will be checked on more regular basis for the risk and safety of people who use the service. The self-closure mechanisms fitted on several bedroom doors should be checked regularly to ensure that they close properly to their rebate in the event of fire to ensure safety of people using the service. The door to bedroom 5 on the ground floor was not closing properly to its rebate and thus posing a high risk in case of fire and in need of urgent repair/replacement. Suitable furniture and fittings, including lockable personal lockers needs to be provided for staff use and the staff WC on the ground floor was without disposable paper towel and soap dispenser facilities. The bathroom on the first floor is in need of refurbishment or the Registered Providers may wish to consider converting it into a shower with new WC for the use of people using the service as recommended in the last inspection report dated 5th October 2006. Broken mirror in bedroom 7 needs to be replaced. Broken overhead lights in bedrooms 1, 3 and 6 needs repairing/replacing appropriately. There were several bedrooms and three corridors areas where fused light bulbs need replacing in order to ensure safety for people who use the service. Broken lock need replacing on the linen cupboard in the bathroom on the first floor and the extractor in the WC on this floor was not in working order and need repairing appropriately. The windows in bedrooms 12, 13, 14 and 15 that have broken seals to the double glazing and are steamed up are repaired or replaced appropriately. The Registered Providers need to take appropriate action to address the above issues to ensure comfortable and safe environment for the people who use the service. It was noted that a number of bedrooms have been redecorated, new furniture items and new floor covering also have been provided. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 24 The AQAA received from the care home states that “the home has been extended from 17 to 24 beds; the front drive is now larger and the gardens at the rear of the home are being made more safe and friendly for service users and ramps have also been put in by the main entrance doors for wheelchair access”. The home was found to be clean, tidy and free from any unpleasant odour. The Acting Care Manager stated that the floor covering in the bedrooms are being replaced as rolling programme. The home has good policies and procedures regarding infection control. It was also noted from the staff training records that a majority of staff have received training in infection control and those who as yet have not received this mode of training must do so as a matter of priority. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 25 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 numbers of staff on duty on day shifts needs to be revised and improved sufficiently to meet the needs of people with dementia. The recruitment procedures have improved but require fine-tuning to fully protect people using the service. The home continues to support staff to complete training, but not all staff are yet adequately trained to do their jobs. EVIDENCE: There is a minimum of one senior carer and two carers on duty throughout the day and three carers on wakeful duty at night. However, information provided by the home and the available staff rotas on the day of inspection indicated that this level of staffing is not always adequate to meet the needs of 23 people with dementia using the service. The home employs a cook to cover 6 days a week and a domestic assistant for 6 days a week; there is no cook cover for the evening teatimes throughout the week. Therefore, one of the three staff on duty in the afternoon is expected to provide a meal at teatime throughout the week with additional cooking and cleaning duties at the weekends. The home also does not employ a laundry assistant and the care staff are also expected to provide cover for the laundry throughout the week. In addition, one of the three staff on duty during the day is expected to undertake social and leisure activities for the 23 people who use the service. These additional duties mean that there are effectively only two staff available Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 26 on the floor to provide care and supervision to 23 three people with dementia care needs, located in two lounges/sitting areas, with some service users who may wish to stay in their bedrooms on two different floors. During our meetings with the staff, they stated that they feel under pressure and “pushed” for time in the mornings and afternoons and more particularly during the weekends. It was noted that as the numbers of people who use the service increases and their dependency levels rises the staff were struggling to provide quality time and a good standard of care. In such circumstances the staff have very little time to provide or to organise structured social and leisure activities including outdoor outings/trips. Staff were spoken to and all stated that despite the changes in staff recently they felt they were for the better and they were beginning to work as a team. There is good balance within the staff team, which includes experienced, mature and younger staff, who are embarking on a new career. The staff team also have a good ethnic and gender mix. The relatives spoken with also made observations about the staff team “they all are working hard in the present circumstances to provide good care and attention to our relatives here”. People who use the service were full of praise for care staff stating “they are caring and kind and do anything for us”. It was also noted that the home is now registered for 24 people who use the service with dementia care needs. The references to staff deficiencies also have been highlighted in earlier sections of this report i.e. - Health and Personal Care, and Daily Life and Social Activities. The Acting Care Manager’s hours are in addition to the staffing hours referred to above to allow her time to manage the care home. In order to provide a good standard of care and up keep of the home, the Registered Providers need to review the staffing levels and then need to take appropriate action to provide adequate numbers of care and ancillary staff on duty at all times. It was noted from the staff training records and discussions with staff and Acting Care Manager that there are over 50 members of staff, who have completed their NVQ Level 2 training and four carers are currently undertaking their NVQ Level 2 training. The Acting Care Manager stated that the remaining staff will undergo this mode of training shortly. It was also noted that a number of staff have undertaken their mandatory training in safe working practice topics. It was noted also that not all members of staff have received training in safe working practice topics and some members of staff need to update their training in this area. The Acting Care Manager stated that they will be put forward to undertake this mode of training shortly. Staff will also be nominated to receive training in adult protection and safeguarding issues, Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 27 equality and diversity, Mental Capacity Act 2005, challenging behaviours and Dementia care. The staff records showed that new staff only received the basic in-house induction training. The Acting Care Manager stated that all new members of staff will receive their induction training in accordance with the Skills for Care standards/requirements. We held meetings with staff on duty and they confirmed that they are being supported by the home for any training needs that they have. However, the Acting Care Manager stated that she will compile a staff training list/matrix which will provide detailed information on staff training programme. Since the last key inspection, the home has not operated an acceptable recruitment procedure. On inspecting 6 staff files, it was noted that not all staff recruited recently have been POVA and CRB checked. Two written references were also not have been obtained in all cases. The staff records seen showed that four carers recruited recently have been employed without CRB and POVA checks. There was no evidence available in the home to show that the CRBs for new members of staff have been applied for. However, the Acting Care Manager acknowledged that there were some gaps in the above areas, which will be rectified immediately. The job application forms were fully completed and contain full employment history. The Acting Care Manager stated that any gaps in employment are also explored/discussed with the job applicants during the interviews. There was evidence on files that staff receive statements of the terms and conditions of employment. There is now a staff training and development programme in place, which is being implemented. The Acting Care Manager stated that she will ensure that the home continues to refine and follow the staff recruitment processes/procedures in order to ensure that the people who use the service are safe and protected from any harm and abuse. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 28 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, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. At present the home is without a Registered Manager. The Acting Care Manager is not registered with the Commission for Social Care Inspection and has limited management experience but is making a positive contribution to the development and improvement of the service. Financial interests of people who use the service are safeguarded. The home promotes the health, safety and welfare of people using the service, but needs some further improvements. EVIDENCE: The home has been without a Registered Manager since 19th October 2007. However, the Registered Providers has appointed an Acting Care Manager - Ms Sherry Lee Boon in November 2007. Ms Boon is to undertake her NVQ Level 4 Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 29 in care subsequent to her current RMA training, which has started on 28th January 2008. Ms Boon has worked as a carer at Penn House since 2004 and she was promoted to a senior carer in 2005. She has already completed her NVQ Level 2 and 3 qualifications. Ms Boon also needs to update her mandatory safe working practice topics training, for example first aid and so on. The AQAA received from Penn House showed that Management and Administration section of AQAA was not completed. This matter was discussed with the Acting Care Manager and she stated that she only had been in her current post since November 2007 and thus she was not able to complete this part of the AQAA. There are clear lines of responsibility and accountability within the home and the Acting Care Manager is well supported by the Registered Providers. The home has a formal staff supervision system in place and now this is being implemented. It was seen from the staff supervision records that some members of staff have not received their regular supervision from the previous Registered Manager and there were some gaps in this area. However, the Acting Care Manager stated that she will be organising supervision dates with those members of staff who as yet have not received their formal supervision since the previous Registered Manager resigned on 19th October 2007. Observations made and discussions with people who use the service and their relatives and staff have indicated that the new Acting Care Manager is very approachable and she operates an “open” door policy. People who use the service, who could express themselves stated that they are happy to approach the Manager and staff with any problems they might have and were confident that they would respond to them appropriately. Equality and diversity for service users were seen to be promoted throughout the home within the assessments, care plans and activities. Equality for staff is promoted through the opportunities for training at all levels. It was noted that the home has a Quality Assurance monitoring system in place. However, the questionnaires and analysis report on the feedback on the quality of services provided by the home were not available for inspection at the home for the year 2007. The Acting Care Manager confirmed that she has distributed recently the questionnaires to people using the service, their relatives. Ms Boon stated that she will complete the report on the outcome of the feedback by the end of March 2008 and the report will be made available in the home and a copy to the CSCI. However, the home also needs to obtain feedback from other stakeholders and visitors to the home and analyse their responses as well. In addition, the Acting Care Manager should consider developing systems for determining the Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 30 views of people using the service with Dementia/mental health needs/problems, who are unable to verbalise their needs. The Registered Providers also need to undertake their monthly visits to Penn House care home under Regulation 26 of the Care Homes Regulations 2001 (as amended), and ensure the reports of these visits are made available in the home and also for CSCI inspections. Financial records and administrative procedures relating to the handling of monies of four people who use the service were inspected and were found to be well ordered and maintained. However, the Acting Care Manager stated that she will ensure that all the receipts of incoming and outgoing expenditure will be kept together and appropriately numbered. All the money belonging to people who use the service will be kept in a safe and under lock and key. The home has good health and safety policy and procedures, and staff were aware of their responsibilities regarding these issues and a number of staff have received training in these issues. All safety systems and equipment are regularly checked and well maintained and records of all tests/checks are kept up to date. However, it was noted from the test records of the Fire Alarm System that this system had not been tested and appropriately recorded since 14th January 2008. The Acting Care Manager stated that this system will be tested immediately. It was also noted that regular Fire Drills and Fire Prevention training for staff have not been undertaken, which needs to be provided as a matter of priority. The Fire Risk Assessment also needs updating. The tests on hoists in the bathrooms, and mobile hoists in the home, passenger lift and wheelchairs are undertaken on a regular basis to ensure the safety of people using the services in the home. The records showed that the gas boiler was checked/serviced by a CORGI qualified engineer on 20th January 2007 and it should have been checked /serviced again on due date of 20th January 2008. The Acting Care Manager stated that she will follow up this immediately and make contact with the contractors to undertake this work urgently. The staff training records indicated that there were some gaps in mandatory training for staff that includes fire safety, moving and handling, first-aid, health and safety, a fully qualified first–aider to be on duty to cover all shifts, infection control, COSHH and food hygiene. The Acting Care Manager stated that the Registered Providers are aware of this deficiency and they are taking appropriate steps to rectify this unsatisfactory situation shortly. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 31 Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 33 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. Standard OP7 Regulation 15 (2)(b) Requirement The service user plans must be kept under review to ensure that any changes of need are identified and addressed. People who use the service must be provided with a range of social and leisure activities both indoor and outdoor of the home. Timescale for action 15/04/08 2. OP12 16 (2) (m) (n) 15/04/08 3. OP18 13 (6) All staff must receive adult 15/04/08 protection training to ensure that people who use the service are not at risk of harm or abuse. The home’s adults protection procedures must be revised and updated in line with the Wolverhampton’s multi-agency adults protection procedures. Appropriate action must be taken to ensure that essential maintenance and repairs, such as those identified in this report are dealt with promptly. This is to ensure that people live in a comfortable and safe home. Care and ancillary staff must be DS0000066040.V355636.R01.S.doc 4. OP19 23 & 16 15/04/08 5. OP27 18 15/04/08 Page 34 Penn House Residential Care Home Version 5.2 provided in sufficient in numbers to ensure that the care needs of people who use the service, particularly those with Dementia, are appropriately met. 6. OP29 19 Two written references and one 15/04/08 of these from the last employer, CRB and POVA checks must be obtained on all new staff prior to their commencement of employment in order to ensure safety and protection of people who use the service. All new staff must receive their 15/04/08 induction training in accordance with the Skills for Care standards and requirements to ensure the safety and protection of people who use the service. The Registered Providers 30/04/08 must put forward a suitable care manager for registration with the Commission for Social Care Inspection as a matter of priority as the home has been without a Registered Manager since 19th October 2007. Feedback must be sought from stakeholders and visitors to home on the quality of services and facilities provided to people using the service, as part of the home’s Quality Assurance monitoring systems. The Registered Providers must undertake their monthly visit to the care home and provide copies these monthly visits to the care home as required under Regulation 26. 30/04/08 7. OP30 18 8. OP31 8 (1) (a) 9. OP33 24 & 26 10. OP38 23 (2) (j) Action must be taken to ensure a 15/04/08 consistent supply of hot water at a safe temperature. This is to ensure that people using the DS0000066040.V355636.R01.S.doc Version 5.2 Page 35 Penn House Residential Care Home service enjoy a regular supply of hot water without the risk of scalding. 11. OP38 18 All staff who as yet have not received mandatory training in respect of • Fire Safety • Health and Safety • First Aid • Food Hygiene • Infection Control must do so in order to ensure the safety and protection of people using the service. 30/04/08 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 OP19 OP1 Good Practice Recommendations The Registered Providers should consider converting the first floor bathroom into a shower room with a new WC for the use of people accommodated on this floor. Appropriate action should be taken to revise and update the home’s Statement of Purpose and the Service Users’ Guide to reflect the home’s current registration and also in line with the recent changes to the Care Homes Regulations 2001 (as amended). Appropriate action should be taken to revise and update the home’s current needs assessment format in order to ensure that detailed and comprehensive information is obtained at the point of initial needs assessment process. It is recommended that the all care plans of people using the service contain clear and detailed goals, aims and objectives recorded, and detail and quality of daily care should be further improved in order to ensure that staff are aware of the importance of recording all information regarding the well being of people using the service, and all the entries made by staff are always cross-referenced DS0000066040.V355636.R01.S.doc Version 5.2 Page 36 3. OP3 4. OP7 Penn House Residential Care Home 5. OP30 6. OP12 7. 8. OP36 OP33 to care plans. The Acting Care Manager should develop guidelines for staff to follow when service users display aggressive/challenging behaviours in order to safeguard and protect both staff and people who use the service. It is recommended that all staff receive training in the protection of people who use the service from abuse, Dementia care, equality and diversity, Mental Capacity Act 2005, aggressive/challenging behaviours and mental health needs, in order to safeguard, and fully meet the needs of, people using the service. It is recommended that a suitable member of staff is nominated to act as an activities co-ordinator in the home. The activities should be varied in range and appropriate, and in accordance with the service users’ choice, preference and capabilities. Records of all activities enjoyed by the people who use the service should be incorporated into the individual service user plans. It is recommended that all staff receive six formal supervision meetings annually and appropriate records should be maintained of such meetings. It is recommended that the Acting Care Manager should develop systems for determining the views of people using the service who are unable to verbalise their needs. Penn House Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Residential Care Home DS0000066040.V355636.R01.S.doc Version 5.2 Page 38 - 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!