Inspection on 26/09/07 for Pennefather Court

This inspection was carried out on 26th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pennefather Court 17/09/08

Pennefather Court 12/06/06

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

CARE HOME ADULTS 18-65 Pennefather Court Croft Road Aylesbury Bucks HP21 7RA Lead Inspector Delia Styles Unannounced Inspection 26th September 2007 12:05 Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pennefather Court Address Croft Road Aylesbury Bucks HP21 7RA 01296 484810 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) caroline.rush@sanctuary-housing.co.uk www.sanctuary-care.co.uk Sanctuary Care Ltd Caroline Rush Care Home 14 Category(ies) of Physical disability (14) registration, with number of places Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th June 2006 Brief Description of the Service: Pennefather Court is a care home providing personal care and accommodation for fourteen residents with a physical disability. On the day of the inspection there were thirteen residents living in the home. 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. The current scale of fees is from £732.86 to £1492 per week. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home which took place on 20 September 2007 from 12:10 pm to 16:45 pm. The registered manager, administrator, senior support workers and other care staff assisted the inspector. The inspection was a thorough look at how well the service is doing. The inspector took into account detailed information provided by the service, in the form of the Annual Quality Assurance Assessment (AQAA) that all registered services must complete and send to the Commission, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who live here and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. Comment cards were received from 8 residents and 5 relatives/carers/advocates. The inspector looked at how well the service was meeting the ‘key’ standards - a selection of the national minimum care standards that apply to care homes for Younger Adults and that are considered by the Commission to be the most important indicators of the quality of the service. The inspector also spoke to residents, toured the building and looked at samples of resident’s care records and staff recruitment and training records. Feedback was given to the manager and admistrator at the end of the insepction. The insepctor would like to thank residents and staff for their welcome and assistance during the inspection. What the service does well: People who live here are encouraged and supported to be as independent as possible and to make choices about their lifestyle. Residents’ comments included: ‘I like the home and I am very happy. I would not want to move’; and ‘I am very happy’. Residents are encouraged to give their views about how the home is run. The service helps and supports residents to be involved in interesting and varied activities both in the home and in the community. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The number and skills of staff are not always adequate to provide the continuity of care and support for residents that fit with their lifestyle choices and preferences. The home must provide enough suitably qualified staff to meet residents’ individual assessed needs. Though there has been some improvement in the standard of individual plans of care for residents, further work is need to make sure that the individual plans are drawn up with the involvement of the resident, are written in sufficient detail and are reviewed and updated regularly. Staff should receive accredited training in medication, and in other aspects of care and support so that they can meet the varied and changing care needs of residents. Staff training needs have been identified by the organisation and there are plans in place to provide the relevant training. There is not enough storage space for wheelchairs and equipment, such as hoists and a medicine trolley, in the home. Separate storage space should be found so that residents’ communal space is not taken up with stored items and staff and residents can access equipment and rooms with less difficulty. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. Arrangements are in place to ensure that prospective residents are fully assessed before being admitted to the home to ensure that the home will meet individual’s assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current Statement of Purpose, Service User’s Guide and complaints procedure information are on display in main entrance lobby on the ground floor. The manager confirmed that the revised draft documents are still with the company’s Head office for finalising (Sanctuary Care acquired Pennefather Court in April 2007) There is information about Sanctuary Care and this home on the company website. There have been two new residents since the last inspection. New residents have a period of approximately 2 months as a trail period and assessment time to see if the home is likely to suit them and to meet their care needs. During this introductory period other residents also have an opportunity of getting to know prospective new resident and share their opinions about their compatibility. Five of the 7 residents survey responses indicated that they had been able to make a positive choice about whether or not they came to live at Pennefather Court; one person indicated their decision had been based on wanting to live in the area and the limited choice of other homes that could meet his or her care needs. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. Residents are encouraged to make decisions about their lives and to take risks thus maintaining an independent lifestyle. However, residents’ care records need to be more detailed and reflect any changes in residents’ health and social care needs to ensure continuity of care. Residents should be involved in the development and review of their care plans. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector looked at two residents’ care records. There were no specific care plans as such, but a summary of residents’ usual daily care preferences and pattern of their day was included in the plans seen. There was evidence of monthly reviews of plans, with goal statements to show that residents are involved in choosing social events and activities they want to be involved in and an evaluation comment to show whether the goals agreed have been met. Each resident has at least 4 hours a week of ‘one to one’ time with a staff member, when the resident is free to choose any activity they wish, for example, shopping, theatre or cinema visits or hobbies and pastimes in their Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 11 own rooms. The home plans to work with a ‘creative solutions’ worker who will advise on additional activities to further develop in-house group activities. The manager explained that a new format of care plans is being developed currently and will be more ‘user – friendly’ and will enable residents, together with family, friends and/or an advocate as appropriate, to have a more active involvement drawing up and reviewing their care plans in future. There were no specific written care instructions for care staff in relation to moving and handling, care of catheters, or the first aid actions to be taken by staff in care of residents who may be subject to epileptic seizures. Staff spoken to were able to describe how they managed the individual physical care of residents and had been shown how to use equipment - for example, hoists. It is important that there is sufficient written detail in residents care records for care staff, especially agency or bank staff, to refer to and carry out care in a way that meets residents’ preferences and that protects the safety of residents and staff from injury or cross infection. The care records seen included relevant risk assessments for residents, for example, their security and safety when going out shopping. The home has a system in place for dealing with residents’ money that is held in the home and is separate from the home’s petty cash system. Written records of transactions are maintained and receipts are retained. The company has a system of independent audit in place to ensure that records of any monies or valuables held by the home on behalf of residents where residents are not able to manage their own finances. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,15, 16 and 17. Quality in this outcome area is good. Residents are able to choose their own lifestyle and to be involved in any decision that may affect them, helping them to maintain and develop independence and to be part of the local community. The manager recognises factors that are limiting some aspects of residents’ lifestyle and there is evidence that planning is in place to resource and manage improvements for the benefit of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents’ survey responses showed that 5 out of the 7, who answered questions about being able what they want to do each day, stated ‘yes’ they could do so. One person added that they could do more if voluntary support was available. Relatives’ surveys also indicated that the majority (4 out of 5) feel that the care service supports people to live the life they choose; one person felt that this is ‘usually’ the case. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 13 One resident was out attending college on the day of the inspection. Two residents were busy with cross-stitch embroidery, out in the gardens, and chatting with staff. One person has a word processor and enjoys writing. Residents told the inspector about the literacy classes that they had been involved in, and how they missed these now they had stopped. The manager said she would look into the possibility of follow up links with the tutors who had led the weekly visits in the home that had included art and IT work as well as literacy skills. One resident said it would be good to have computers to practice writing on, because they could then write to friends and relatives. However, the manager said that the current available space and layout of the communal areas is too limited to have computers set up for shared use by residents. The manager said that as the local Day Centre had closed, social services have made additional funds available to pay for extra staff to assist residents to access these group activities. Some residents choose to attend Gateway club, a disco for people with disabilities. Other local clubs and facilities are Jigsaw, Headway, drama, pottery, bowling and swimming. Residents are seen very much as part of the local community. Some have close links with the local church and are invited to services and other church functions. There are some limitations on residents’ independence and choice, for example about bed times and getting in and out of bed, for residents who need 2 staff members assistance. This is because the home currently has only one waking care staff member and one ‘sleep-in’ staff member. The inspector said that there was a proposal to have two waking staff on duty at night starting in the new financial year. (See also Standard 18 ‘Personal support’ and Standard 35 ‘Staffing’) The manager has also identified the needs for more flexibility about the timing of the evening meal that is at 17.30. Work has commenced to replace the kitchen and when completed, will provide heated cabinets to allow for residents to eat up to an hour later, if they choose. Residents had a choice of two hot main meals every day, as well as choices of salad, baked potatoes and a varied breakfast and lunch menu. The cook said she tries to involve residents with the choice of meals and suggestions for menu changes. When the kitchen refurbishment is complete, staff plan to develop ‘café’–style’ menus to give a picture of the food choices on offer. A relative wrote: ‘I understand [from my relative] that the food is good (after a number of years of mediocrity) now that there is a good cook’. Residents spoken with confirmed that they enjoyed the meals. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 14 Staff are expected to knock and wait for a reply before entering residents’ bedrooms. One resident had a printed notice on their door to remind staff to do this. Residents if they wish to are provided with keys for their bedroom doors and the main front door. Staff do not open residents’ letters unless they are asked to do so by those residents that require assistance. Residents’ preferred form of address was documented in the care plans. Some residents choose to spend time alone and enjoy their own company and this is respected by staff. During the inspection visit staff and residents looked relaxed and comfortable in each other’s company. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. Overall, residents’ health needs are monitored and appropriate action and intervention taken. People who use the service have access to health care services both within the home and in the local community. All staff responsible for handling medication must have training and monitoring of their practice to minimise the risk of errors that could have a negative impact on resident’s health and wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents confirmed that personal care was provided sensitively, taking into consideration their wishes and preference on gender care. It was noted that residents were appropriately dressed with attention to detail. Staff spoken to confirmed that those residents whose moving and handling risk assessments required that two members of staff assist with moving and handling techniques was always followed to ensure residents’ safety. The home provides aids and equipment such as ceiling-track hoists with slings and slide sheets to maximise residents’ independence. Staff and other health care professionals such as the district nurse, the general practitioner, and physiotherapist supports residents to maintain their physical Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 16 and health care needs. The district nurse is providing continence aids and equipment to those residents with continence problems. The sample of residents’ care records seen by the inspector did not contain a nutritional needs assessment or evidence of a regular review of their nutritional status and any additional care that may be needed to maintain residents dietary intake and well being. The inspector looked at the home’s medication storage and administration records. The home now uses a large high street chemist chain to supply residents’ prescribed medication using a monitored dosage system (blister packs) for medication. One person has recently been prescribed a strong analgesic that is required to be kept securely as a ‘controlled’ drug. This medication was kept with other medicines in a locked drug trolley. The manager is aware of the special storage requirements for controlled drugs and is advised to use an existing secure storage cupboard. However, the manager should first obtain verification about whether this storage cupboard complies with the current regulations and guidance issued by the Royal Pharmaceutical Society. The manager and senior staff on duty could not recall their last training in safe handling and administration of medicines. The inspector concluded that the requirement made at the last inspection for staff to be regularly assessed to ensure they are competent to administer medications, had not been met, but is now being addressed: the registered manager has informed the commission that training has been arranged in October 2007 for all staff who administer medications in the home. There has been no pharmacist visit the home for over 12 months to monitor the standard of medication storage, administration, record keeping or disposal. A letter from the local Primary Care Trust (PCT) indicated that there would be a visit from a pharmacist and included the audit tool that would be used. The inspector suggested that the audit tool could be used by the staff to check the home’s systems. Overall, the Medication Administration Record (MAR) charts seen were correctly signed by staff to show that residents had received the correct medication at the times prescribed. Some MAR charts were confusing in that they listed ‘p.r.n.’ – as required – medications, and some medications that were no longer needed by the resident. M.A.R charts did not set out the indications for giving ‘p.r.n’ medications or the maximum dose (in the case of analgesics, such as Paracetamol) that could be given in any 24-hour period. The staff said that there had been some difficulty in getting doctors to review and change residents’ prescription orders so that discontinued items are removed from the MAR charts. The manager is currently contacting GPs to request that they do this. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 17 The home’s Annual Quality Assurance Assessment (AQAA) states that, since the last inspection action has been taken action to improve the standard of recording of medication and procedures, but acknowledges there is still a need to improve the information staff receive when they accompany residents to medical appointments in order to ensure that any changes to residents’ health care needs are properly communicated. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate Residents feel safe and confident about how to make a complaint. The home should continue to develop the procedures and printed information available for residents about safeguarding and complaints. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. Information recorded in the home’s AQAA and Sanctuary Care’s ‘Analysis and Evaluation of Complaints’ indicated that the home had not received any complaints or recorded any ‘official’ complaints in 2006. However, the commission had been informed by the home about a resident’s complaint that had been referred to, and investigated by, social services and safeguarding team members and police, with a satisfactory outcome reached. Residents’ survey comments showed that 5 out of 7 were aware of the home’s complaints procedure and confident about how to make a complaint. One person said that they ‘had been told but can’t remember’. Relatives’ survey responses also showed that the majority knew how to make a complaint and were confident that their concerns would be investigated and addressed by the home managers. The home’s AQAA statements show that they intend to improve the information and guidance materials available to assist residents’ understanding of safeguarding issues. The home has also included a question for residents in a questionnaire to make sure they are aware about how to make a complaint and the advocacy support services that will support them in doing so. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 19 Information about the home’s complaints procedure and independent advice services is available for residents and visitors in the reception area of the home. Sanctuary Care has undertaken a Training Needs analysis of the home for 2007/2008 and has prioritised training in safeguarding for staff. Nine staff had received training in 2006/7 and further training is planned for 2007/8. The home has written policies in place to support staff to ‘whistle blow’ about unsafe or abusive practices, and about identifying and reporting any suspected abuse of residents. Staff spoken with confirmed that the induction programme for new care staff meets the Skills for Care induction standards that include adult safeguarding information. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. A programme of refurbishment and renewal of equipment and facilities mean that the environment has significantly improved since the last inspection. Managers have identified barriers to improvement and are have working to address these where possible, so that residents will be provided with comfortable and accessible facilities that meet their individual needs and preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Though ‘purpose-built’ in 1989 the layout and access to the building present some difficulties for access for the people living here; for example, the building is on a slope, internal corridors are narrow and do not allow for people in wheelchairs to pass and there is insufficient storage space for wheelchairs and other equipment. However, since Sanctuary Care took over ownership of the home in 2006, considerable improvements have been made to the environment and are ongoing as part of a five-year improvement plan. Since the last inspection, all the doors and windows have been replaced. A resident confirmed that Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 21 everyone had been consulted about the changes, and the new doors to the patio area at the rear of the home were much easier to use. Paving slabs and the patio area have been re-laid to create an even surface. Other changes that have improved the building for residents have been creating a comfortable lounge area to replace an infrequently used kitchenette. Plans for major work to the main kitchen have been brought forward and are due to start in October 2007. Residents and staff have planned how the meal service and mealtimes will be managed during the 3 weeks when the kitchen is out of use. The refitted kitchen will incorporate an area adapted for residents’ use. Since the last inspection, corridors have been repainted and protective corner plates fixed to avoid damage from equipment and wheelchairs. The bathrooms and shower facilities do not meet the needs of the service users: two baths are not easily accessible as they are fitted against the bathroom walls. The fittings are old and institutional in appearance. Bathrooms are due to be upgraded this year. On the day of the inspection one bathroom was out of use because of a leak. A shower room shows evidence of damp damage to the walls. The manager said that part of the refurbishment plans is to provide a new wet room to replace the shower room. The manager and administrator currently have offices on the first floor. There is no resident accommodation, or access for residents to the first floor (there is no passenger lift). The manager’s office is to be relocated to the ground floor, which will be easily accessible for residents and help the ‘open door’ approach to managers for residents, families and visitors. A small sitting room on the ground floor was infrequently used by residents – the door is not wide enough to allow independent wheelchair access- and is currently used for storing folding wheelchairs when not in use, and hoist equipment. A resident complained that the room door bangs shut when staff go in and out with equipment, which causes annoyance and wakes the individual at night. . The Fire officer must be consulted for advice about an acceptable automatic door closer device that could be fitted to this door to meet the fire safety standards but could hold the door open for ease of access. It is strongly recommended that the home identify alternative storage space for wheelchairs on site, possibly a secure storage shed outside. Residents spoken with were happy with their rooms (though some would like more space) and that they are able to choose their own décor and colour schemes. The home was free from offensive odours in the communal areas. Residents’ survey responses were positive about the standard of cleanliness in the home: Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 22 four out of seven residents stated that the home is ‘always’ fresh and clean and three that this is ‘usually’ the case. The laundry room was clean and tidy and the machines meet the current standards for disinfection. Staff have access to protective clothing such as disposable aprons and single-use gloves to reduce the risk of cross-infection. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. Staffing levels do not consistently enable residents to exercise choice or receive assistance with their care that promotes individual independence and dignity. There must always be sufficient numbers of staff available to support and assist residents. The planned training and development programme for staff should be implemented to ensure that all staff have the skills to fulfil the aims of the organisation and to meet residents’ assessed support and care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and relatives’ survey comments showed that there is room for improvement in the numbers and skills of staff available to support residents. Two relatives wrote that the home could improve by ‘[having] more staff’; ‘having more staff when needed’. The attitude of staff was found to be lacking in one relative’s view - ‘some of the staff are dedicated to the work they do. Others could not care less about the job they do’. Four out of the 7 residents who completed the CSCI’s questionnaire feel that staff ‘always’ treat them well; and 3 out of 7 state that this is ‘usually’ so. Two out of 7 residents stated that carers ‘always’ listen to them and act on what they say; and 5 of 7 that this is ‘usually’ so. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 24 The home employs twenty-five care staff, of whom six have achieved National Vocational Qualification (NVQ) at level 2. The home has not yet achieved the recommended proportion (50 ) of care staff who have an NVQ Level 2 or above. A further 8 care staff are working towards NVQ qualification. Staff questioned by the inspector could not recall having had any training in managing catheter care; the care of people who have or may have, epileptic seizures; or in assisting residents with swallowing difficulties with their meals and drinks. A training and development plan for all staff should be in place to ensure that staff meet the assessed care needs of residents and fulfil the aims of the home. There was some evidence to show that new staff complete an induction programme that meets the Skills for Care standards and that counts towards the NVQ training award. The provider organisation, Sanctuary Care, has undertaken a Training evaluation and identified the training needs for staff in the next 12 months. This includes maintaining and developing the NVQ training programme. Since the closure of a local day care facility that many residents enjoyed attending until it closed last year, the home has negotiated funding to pay for additional staff, so that residents have at least 4 hours of one to one staff time a week and can be supported in recreational and social activities of their choice. The home ensures that there are five staff on duty covering the morning shift. This number is reduced to four staff in the afternoon. One waking carer and a senior support worker sleeping in covers the night shift. The manager said that there are plans to have two waking staff on duty overnight starting in the new financial year in 2008. The inspector noted from the care records of one resident that they needed two people to assist them. Because there is one waking care staff member available at night, this resident’s care and dignity is compromised, because they cannot be assisted to the toilet during the night. There must always be the number of staff with appropriate training and skills to meet the assessed needs of residents; the home’s plan to increase the staffing levels at night must be implemented as soon as possible to achieve this. The manager confirmed that the home has been successful in recruiting more staff recently and is confident that this will improve continuity of care for residents. The home has had to use agency staff on a regular basis, but this has decreased in recent months. Where possible the same agency staff are used to reduce the impact on resident’s usual support and care provision. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 25 The inspector looked at two staff files. These contained the relevant information to show that the home had undertaken the required checks and obtained satisfactory references before starting these individuals to work in the home. The home’s AQAA states that residents are involved in recruitment process of new staff, though this was not evident from the records seen by the inspector on this occasion. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. The management arrangements are good with an established senior management team to provide continuity and leadership. Managers have a good understanding of the areas in which the home needs to improve and plans are in place to resource and manage these improvements. The home regularly monitors and reviews aspects of the care and services through a system of consultations with residents and their relatives and representatives, and staff to ensure that the outcomes are to the benefit of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is experienced in her role. She has recently returned from maternity leave. The manager is assisted in her role by senior care leaders and an administrator. As part of Sanctuary Care organisation, the home has regular Quality assurance audits; two have been carried out in the past 12 months looking at finances and care practices. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 27 There are regular residents meetings – one had been held on the morning of the inspector’s visit – and residents’ views are sought, and influence, any changes and developments proposed for the home. In the home’s AQAA document, the managers acknowledge that more needs to be done to encourage staff to attend the regular staff meetings. Regular senior and full team meetings and formal staff supervision meetings are held to encourage good communication about the aims of the home, development plans and to share best practice and policy guidance. Since the last inspection the home states in the AQAA document that it has improved the way in which it keeps in touch with relatives and friends by starting a quarterly newsletter to keep people informed about events. Relatives’ comment cards indicated that they generally felt that the home communicates well with them about any issues affecting service users. One person felt that contact from the home could be improved: ‘I feel occasionally the main/senior staff could ask me personally if I am happy with the care of my [relative]’. Sanctuary Care’s own analysis of the 8 reported accidents involving residents between April 2006 and 2007 identified the need for ongoing staff training in Health and Safety, First Aid Awareness and annual manual handling updates. Staff training in fire awareness, food hygiene, equality and diversity and infection control are amongst the training sessions planned over the next 12 months. Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 X 3 X X 2 X Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 YA6 Regulation 15(2)(b) Requirement Residents care plans must be 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. All staff responsible for the handling and administration of medication must receive accredited training in accordance with the British Pharmaceutical Guidelines. All staff who administer medication must have their competencies regularly assessed. Ensure that at all times suitably qualified competent and experienced persons are working at the care home in such number as are appropriate for the health and welfare of service users. Consult with the fire officer in relation to fitting suitable automatic door closer devices to room doors. DS0000067529.V343884.R01.S.doc Timescale for action 30/11/07 2. YA20 18(1)(c) 30/11/07 3. YA33 18 (1) (a) 30/11/07 4. YA24 23 (4) 30/11/07 Pennefather Court Version 5.2 Page 30 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 YA19 YA20 Good Practice Recommendations Monitor residents’ nutritional status to identify potential problems and ensure service users receive specialist support and advice a needed. Seek the pharmacist’s advice about the storage arrangements for controlled drugs and ensure these comply with the current regulations and guidance issued by the Royal Pharmaceutical Society. Provide sufficient accessible and separate storage space for wheelchairs and other equipment when not in use. Implement the planned training and development programme for all staff so that they are appropriately trained to meet the assessed individual and joint needs of service users. 3. 4. YA24 YA35 Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 Pennefather Court DS0000067529.V343884.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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