Inspection on 17/09/08 for Pennefather Court

This inspection was carried out on 17th September 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pennefather Court 26/09/07

Pennefather Court 12/06/06

Extracts from inspection reports are licensed from CQC, this page was updated on 01/12/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Pennefather Court Croft Road Aylesbury Bucks HP21 7RA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Chris Sidwell     Date: 1 7 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Pennefather Court Croft Road Aylesbury Bucks HP21 7RA 01296484810 Telephone number: Fax number: Email address: Provider web address: caroline.rush@sanctuary-housing.co.uk Name of registered provider(s): Name of registered manager (if applicable): Sanctuary Care Ltd The registered provider is responsible for running the service Name of registered manager (if applicable) Caroline Rush Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: Date of last inspection Brief description of the care home Pennefather Court is a care home providing personal care and accommodation for fourteen residents with a physical disability. Sanctuary Care owns the home. The home is located in Aylesbury in a quiet cul-de-sac close to shops, pubs the post office and other amenities. Public transport is easily accessible. The home was opened in 1989 and consists of a two-storey building. The ground level accommodates residents and all bedrooms are single occupancy. Two of the bedrooms have en suite facilities. There is a patio area, which is easily accessible by residents. 14 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The service was last inspected on the 26th September 2007. This inspection was conducted over the course of three days and included an unannounced visit to the home. The key standards for adult services were covered. Information received about the home since the last inspection was taken into account in the planning of the visit. Prior to the visit, the manager completed an annual quality assurance self-assessment and questionnaires were distributed to residents, visiting health and social care professionals and staff. Residents were spoken to on the days of the unannounced visit. Discussions took place with the manager, care and ancillary staff. Care practice was observed. A tour of the building and examination of some of the required records was also undertaken. The homes approach to equality and Care Homes for Adults (18-65 years) Page 5 of 27 diversity was considered throughout. What the care home does well: What has improved since the last inspection? The home has been redecorated and new kitchens and bathrooms have been installed. Access to the garden for people with disabilities has been improved. Residents have been consulted on the choice of décor. The staffing levels have improved and the home is just completing a reprofiling programme which will mean that additional staff are on duty to go out with residents who wish to join in local activities but are unable to go on their own. The training Care Homes for Adults (18-65 years) Page 7 of 27 records have been updated and it was evident that there is a training programme in place. Sanctuary Care has introduced a new quality assurance programme which is being introduced in the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs and wishes are identified and agreed with them before they move to the home on a permanent basis. Evidence: There is a comprehensive assessment process in place to ensure that residents have the information they need and the opportunity to decide whether they would like to move to the home. They are visited by the manager or her deputy and an assessment is carried out. The documentation used identifies prospective residents care needs and their cultural and faith wishes. They are then invited to stay at the home for a period of six to eight weeks for further assessment and for them to decide whether they wish to move to the home on a permanent basis. At the end of this time a meeting is held with the prospective resident, family and care manager and a decision is made. One resident was spoken to who said he decided to stay because he liked the home and the independence he had. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive support to help them maintain and achieve their goals safely. Their written support plans and risk assessments should be updated regularly to reflect residents changing needs and aspirations. Evidence: The care of three residents was followed through. All had care plans although the level of detail and the frequency with which they were updated varied. The detail in two was limited and they had not been updated regularly, one was reviewed in January 2008 and the other in February 2008. Although the documents relating to the monthly reviews contain a section to record residents views, these had not been completed. The third care plan seen was much more detailed. The resident had complex healthcare, social and psychological needs. These had been recognised and support plans were in place. The manager said that this had been necessary not only to meet the service users needs but also to ensure that care and the approach of the staff was consistent. Risk assessments were in place. At the last inspection, the manager said Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: that new care plans were being introduced. The organisation has developed a new care plan although the manager said that she did not feel it was entirely suited to recording and meeting the needs of younger people. Whilst there is an example of one resident having a good support plan, these are not in place for all residents and plans are not updated on a regular basis. Staff support residents to be independent and to make decisions about thier lives, in conjunction with their families and care manager. Residents said that staff respect their individuality. A number of residents manage their own financial affairs. The home can offer safe keeping facilities for small amounts of money for residents. Where this is undertaken records are kept and receipts given. The amounts held are regularly audited by an external auditor. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are actively supported to live an independent lifestyle and to remain in contact with their families and friends. The standard of food in the home is good and mealtimes are a sociable occasion. Evidence: Service users are supported to live an independent life and to pursue their hobbies. They said in the questionnaires that they were able to choose how they spend their day. On the day of the unannounced visit to the home a number of service users were out and those in the home were enjoying their hobbies. They are part of the local community and some are members of the local church. Two residents said that they were a member of the local arts centre and attended classes there on a regular basis. The care staff rota is being reorganised to allow for a carer to be on duty specifically to accompany those service users who need support to go out on a regular basis. Both Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: the carers and the service users were looking forward to this. Families are encouraged to visit at any time and most play an active part in service users lives. The atmosphere in the home was relaxed and friendly. Staff were courteous and relaxed towards service users and engaged with them. Some service users have keys to their rooms. Service users have free access to all parts of the home. There are a number of sitting areas and a separate television room. The chef provides a varied menu and service users have a choice of main course. Service users choose a light lunch, which may be sandwiches, salad or a snack on toast. The main meal is in the evening and was seen to be a sociable occasion. The chef said that she tried to encourage healthy eating and offered healthy options although these were not always chosen. The kitchen has been refurbished since the last inspection and there is a small kitchenette area where service users or carers can make snacks or drinks during the day. Service users said they enjoyed the meals, that they were varied and that they were able to influence the menu. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported in their personal care and are supported to ensure that that their healthcare needs are met. The medication arrangements in the home should be reviewed as a matter of urgency to ensure that residents are not at risk from medication errors. Evidence: Residents are supported to maintain their personal care and their privacy is protected. They choose and wear their own clothes, which are in good repair. There was evidence in the files that their health is monitored and that they are registered with their own General Practitioner, who they visit on their own if they wish. There was evidence that residents who have complex healthcare needs see a number of specialist primary and secondary healthcare professionals. A number of requirements were made about the management of medication at the last inspection which have been partially met. There are medication policies and procedures in place. Staff who admnister medication have had training to support them in this task. Staff said that medication was not administered covertly. The Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: medication administration records were checked. There were gaps in the recording of when medication was given with no explanation. The staff said that this sometimes happened when medication was delivered at the weekend and was incomplete. The medication administration records (MARS) also had dosage and frequency mistakes on them. The home must work closely, as a matter of urgency, with the general practitioner and the dispensing chemist to ensure that these errors are corrected. It is recommended that a copy of the repeat prescriptions are kept in the home and that the MARS sheets are checked against these when they are delivered. The home has a controlled drugs cupboard but no controlled drugs register. The controlled drug cupboard held a small pack of controlled drugs which had not been checked in. The administration of controlled drugs was recorded on a separate sheet of paper and kept with the medication administration charts. This is not good practice and is not in line with the latest guidance from the Royal Pharmaceutical Society or recent legislation. The home must have a controlled drugs register in which the receipt, administration and disposal of controlled drugs is recorded. Further guidance is available on our website www.csci.org.uk and from the Royal Pharmaceutical Society www.rpsgb.org.uk Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents concerns are addressed and there are safguarding policies and procedures in place to protect them from harm. Evidence: The home has complaints policies and procedures in place. These are made available to residents and those who returned the surveys said that they knew how to raise a concern. The home said that they had received two complaints in the last year, which had been investigate and action taken to address the concerns. There are safeguarding and whistle blowing policies and procedures in place. Staff have in house training in safeguarding. The manager said that she would be attending the Buckinghamshire County Council train the trainer course to lead the training in the home. The Commission for Social Care Inspection has not received any concerns or been notified of any safeguarding issues relating to the home. Care Homes for Adults (18-65 years) Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and provides an accessable, comfortable and clean environment for residents. They are able personalise their rooms to preserve their individuality and to ensure that they feel at home. Evidence: The home has been refurbised in the last year and the communal areas redecorated. Residents rooms are homely and they are encouraged to bring their personal posessions. The kitchen has been refurbished and an area has been set aside where residents can make their own drinks and snacks when they wish. There is good access throughout the home for people with disabilities. The bathrooms have been redecorated and two have been turned into wet rooms to give residents a choice or bath or shower and to enable easier access. The gardens have been tidied and, at the residents suggestion, raised beds have been built. There are infection control policies and procedures in place. There were no offensive odours in the home, which was clean and tidy on the day of the inspection. The laundry is separate from the kitchen and has washing machines with appropriate wash programmes to deal with soiled laundry. Protective disposable aprons and gloves are available for staff. Care Homes for Adults (18-65 years) Page 18 of 27 Care Homes for Adults (18-65 years) Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff who have the knowledge and skills to meet residents needs. The recruitment process is thorough protecting residents from unsuitable carers. Evidence: The staffing levels have been increased since the last inspection. The allocation patterns have been reviewed and the home is about to start a new pattern which will allow them to allocate one person each day to support individuals and groups who wish to go out and cannot go out without support. The night staffing levels have been increased and there are now two waking members of night staff which means that residents can go to bed at whatever time they wish and there will always be two people to help them. There is a training programme in place and records were seen to confirm this. The manager said that she had been successful in appointing additional staff on permanent contracts which gives better continuity of care for residents. Sixtyeight per cent of staff hold the National Vocational Qualifications in Care at Level 2. The recruitment files of three members of staff were selected at random and checked. All had the required documentation to show that checks as to their suitability had been undertaken before they started work. Criminal Records Bureau disclosures and two references had been sought. Interview records were kept. The organisation has an Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: equal opportunities system in place to monitor the application process. The atmosphere in the home was relaxed and calm. One residents said I am happy here. Care Homes for Adults (18-65 years) Page 21 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in the interests of residents. The quality assurance system in the home should be applied systematically to ensure potential problems with care planning and medication are recognised and addressed, to protect and support residents. Evidence: The home has an experienced, qualified manager who also manages the adjoining supported housing. Sanctuary Care has a quality assurance system which comprises a self audit monthly and verification audit. A health and safety audit and financial audit has been undertaken recently. The home needs to continue to develop their audit skills and ensure that care planing and medication audits are included in the programme and rigorously applied. An operational manager visits the home on a regular basis and reports of her visits are kept in the home. Residents views are sought on a day to day basis and through residents and family meetings. There is a comments box in the main entrance and a newsletter is published. The residents said that their views are listened to. Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: There are health and safety policies and procedures in place. Training records show that staff had had training in safe working practices although this may not be up to date. The manager has plans to address this. Risk assessments are in place although these need updating for some resident activities. Care Homes for Adults (18-65 years) Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 6 15(2)(b) Residents care plans must be 30/11/2007 sufficiently detailed to describe the assessed and changing needs and personal goals of the individual and should be drawn up with them and any family, friends and/or advocate as appropriate. Care Homes for Adults (18-65 years) Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Care plans must be kept up to date and reviewed regularly. In order that they reflect residents current needs and aspirations 28/11/2008 2 9 12 Residents risk assessments must be updated regularly. To promote and support their independence whilst helping them to manage any risk that that might entail. 28/11/2008 3 20 13 The home must work closely 14/11/2008 with the doctor and the dispensing chemist to ensure that the Medication Adminitration Records, which come from the chemist with medication are accurate. To protect residents from medication errors. Care Homes for Adults (18-65 years) Page 25 of 27 4 20 13 The receipt and administration of controlled drugs should be recorded in a controlled drug register. To protect residents from medication errors and to comply with best practice and legislation. 14/11/2008 5 20 13 The home must ensure that accurate records of medication received and administered to residents are kept. To ensure residents receive their medication in a consistent and timely way 14/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 20 The home should ask their pharmacy supplier to undertake regular audits of the homes medication managements arrangements. The quality monitoring systems should be applied systematically to ensure that deficiencies in care planning and medication management are identified and addressed. 2 39 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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