Inspection on 06/11/07 for Pennine Centre

This inspection was carried out on 6th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pennine Centre 07/01/10

Pennine Centre 27/01/09

Pennine Centre 14/11/06

Pennine Centre 08/02/06

Pennine Centre 05/10/05

Pennine Centre 03/12/04

Pennine Centre 30/06/04

Pennine Centre 27/02/04

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

CARE HOME ADULTS 18-65 Pennine Centre Pennine Way North Bransholme Kingston upon Hull East Yorkshire HU7 5EH Lead Inspector Angela Sizer Unannounced Inspection 6th November 2007 09:30 Pennine Centre DS0000034637.V353779.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 Pennine Centre DS0000034637.V353779.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. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pennine Centre Address Pennine Way North Bransholme Kingston upon Hull East Yorkshire HU7 5EH 01482 839311 01482 839021 pat.walker@hullcc.gov.uk 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) Kingston upon Hull City Council Mrs Patricia Mary Walker Care Home 12 Category(ies) of Physical disability (12), Physical disability over registration, with number 65 years of age (1) of places Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That the intended work as stated in the action plan in regard to the premises is carried out. To provide personal care and accommodation for three service users with physical disability who have reached 65 years of age. 14th November 2006 Date of last inspection Brief Description of the Service: The Pennine Centre is a modern purpose built building situated on a large housing estate on the outskirts of the city of Hull. It is operated by Kingston upon Hull City Council, social services department. There is an adjacent day centre. The Pennine centre has been over the past two years subject to major refurbishment. The home is now registered for up to 12 younger adults with a physical disability on a respite/short term basis and one named resident who has reached 65 years of age. The statement of purpose and service user guide has been amended and clearly states how the needs of the residents’ will be met. The home is secure and has it’s own well tended grounds. Public transport is accessible adjacent to the home. Although local facilities are limited, a large retail centre can be reached by a short journey. The home has a ground and first floor with a passenger lift connecting the two. There is ample communal space for the service users to access including three lounges, a visitor’s room and a large dining area. The home intends to use 8 of the bedrooms for respite care, 1 for long term residents and 1 as a step down bed with funding from the Health Authority, in addition on the first floor there are two rehabilitation bedrooms. All new residents are given a service user guide explaining what the home will provide. The weekly fees range between £25.60 and £77.42 this information was provided during the inspection visit. Additional charges are made for toiletries, newspapers, activities and transport. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection and took place over one day and took a total of 6.5 hours. Prior to the visit surveys were posted out to people living in the home, their representatives and social and healthcare professionals; 7 residents surveys were returned, 5 of the relatives surveys were returned, none of the staff members, 3 of the health and social care professionals and 2 care manager surveys were returned. The Annual Quality Assurance Assessment was completed and returned to the CSCI (Commission for Social Care Inspection). The previous requirements were discussed with a senior care officer as the manager was on annual leave when the inspection took place. A discussion occurred regarding how the residents are supported to follow their religion of choice and practise their faith and how the home meets diverse needs of individuals. Several of the residents were spoken to throughout the day regarding the care they receive and what it is like to live in the home, some of their comments have been included in this report. Four residents’ care records were tracked during the site visit and two staff personnel files were looked at. Three of the staff were spoken to find out what it was like working in the home and what training, management and support was offered to them. A tour of the premises was undertaken and a number of records were looked at to ensure that the correct maintenance has been undertaken. As part of the inspection process an Expert by Experience assisted with the inspection, part of their role was to look at the environment and give feedback in relation to the accessibility for someone who has a physical disability. Some comments and observation will be included within this section of the report. The senior care officer was given feedback during and at the end of the visit. The inspector would like to thank the people living in the home and staff for welcoming her into the home and contributing to the content of this report. What the service does well: Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 6 On the whole people using the service are assessed by the home prior to being offered a place and moving in, therefore prospective residents know that the home will meet their needs prior to admission. Each person is issued with a statement of terms and conditions that describes the facilities offered, this ensures that people know what they will receive as part of the fee and what will not be included. Two staff members were spoken to during the visit and they could clearly describe what the needs of individuals were and what the care plan stated. One staff member stated, “it’s brilliant, residents are encouraged to maintain their independence”, “it’s a lovely atmosphere and whatever the needs are these are usually met”. People who live in the home are encouraged to maintain outside links with their family and friends and the routines in the home are flexible, therefore they have their rights respected and independence promoted. The menu and food offered is of a good quality, therefore people receive a varied and healthy diet. During the visit some of the people living in the home were either spoken to about what it was like for them living in the home, some of the comments included; “I am still happy here”, “we like watching the big TV”, “the staff are wonderful and friendly”. From observation staff were seen to interact with residents in a caring and empowering way, it would appear that staff have developed very good relationships with the people living in the home. Overall people who use the service are well protected from possible harm or abuse, as the home only employs staff when the appropriate vetting has taken place prior to them starting work. The financial records held for people living in the home are accurate and up to date. A vulnerable adults procedure is in place, staff have undertaken the POVA training and demonstrated sound knowledge of the procedure. Six surveys were returned from people using the service and all of which stated that the home is always clean and tidy. Four surveys were received from relatives and some comments included; “the home is well-maintained and clean, I cannot fault it in any way and the staff are always there to help”. Two people living in the home were spoken to during the site visit about the environment and some of the comments were; “it is always clean, the staff work very hard”, “the home never smells”. The home operates a robust recruitment procedure that ensures the residents receive support from properly vetted staff. Staff receive supervision and support on a regular basis, therefore people receive support from a staff group that is supported and monitored. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 7 On the whole the health and safety of the people using the service is maintained and promoted. What has improved since the last inspection? What they could do better: Staff have either not undertaken or updated their knowledge in relation to dealing with difficult to manage behaviour and understanding what it is like to have a physical disability, therefore the home does not always meet or fully understand the more diverse needs of some people using the service. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 8 Choice is promoted, but people using the service are not always able to make all decisions about everyday life. During the visit some of the people using the service confirmed that sometimes they couldn’t bath when they choose to and have to wait for staff because they are seeing to someone else. Some comments included; “usually I can have a bath or get up straight away, but probably about 4 or 5 times I have had to wait because there aren’t enough staff on duty”, “sometimes I have had to wait for about 30 minutes before staff can help me, I know they are busy, but I find this frustrating”. The environment is comfortable, homely and meets the general needs of its residents, but there are several areas that require improvement to ensure that people who have limited mobility can access all parts of the building. As stated in the previous inspection report, whist the staffing level is appropriate for the majority of the time; sometimes it is insufficient. From speaking to residents and relatives and from surveys received it was confirmed that sometimes people have been kept waiting for long periods for personal care tasks to be carried out. The home’s quality assurance programme currently does not seek the views of all stakeholders, nor is an annual report produced, therefore the system is not as effective as it could be and although people using the service have their views listened to, other people such as relatives and other professionals are not asked their opinions. 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. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 9 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 Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. On the whole people using the service are assessed by the home prior to being offered a place and moving in, therefore prospective residents know that the home will meet their needs prior to admission. Staff have either not undertaken or updated their knowledge in relation to dealing with difficult to manage behaviour and understanding what it is like to have a physical disability, therefore the home does not always meet or fully understand the more diverse needs of some people using the service. Each person is issued with a statement of terms and conditions that describes the facilities offered, this ensures that people know what they will receive as part of the fee and what will not be included. EVIDENCE: During the inspection visit four files of the people using the service were looked at and this included two recent admissions and this was their first at the Pennine Resource Centre. This was to find out if their needs had been Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 11 properly assessed, there was evidence in place to confirm that prospective residents are usually visited and an assessment undertaken that would show whether the home can meet that person’s needs. On three of the files there was an assessment both from the Social Services Department and one that the home had developed, these clearly define what support is required. One person had been admitted in an emergency and came without a full assessment of need and with minimal paperwork; this was confirmed by speaking to the staff. Some comments included; “we recently had to take a person without the community care assessment and although they had said this person had diverse needs and difficult to manage behaviour, it was not clear about the level of support that was required. Some of the carers are finding it really difficult to cope”. Another staff member said, “the carers have to attend to the person in twos because of the difficulties, I feel that I have not had the training to deal with such specialised areas”. Following the inspection visit the manager was spoken to on the telephone as she was on annual leave when the inspection visit took place. She confirmed that a pre-admission visit had taken place to the hospital and information was given to the person about the Pennine Resource Centre, she said, “the person decided that she did not want to come and stay at Pennine. About a week later we received a call stating that the person was leaving hospital and could we take them as this was an emergency, we did receive the old community care assessment and I spoke to the care management team to gain further up to date information prior to the admission taking place”. “An updated community care assessment was received one week after the person was admitted, a review was held on 13.11.07 due to the ongoing difficulties that the home has had in providing support for this person, a decision was made by the person to leave Pennine on 17.11.07 and the care support package is now in place”. During discussion with some of the staff team about meeting diverse needs it was clear that they had a good awareness of the different needs individuals may have and how these could be met. They gave examples about religion, culture and special dietary needs of residents. It was confirmed from speaking to several of the people who use the service that their religious, cultural and dietary needs were all being fully met. From looking at training records it was clear that some staff have received more specialised training in areas such as Parkinson’s, Huntington’s, Epilepsy, Motor Neurone, Diabetes and Cerebral Palsy, but this was not in the past two years. Two staff have undertaken training in connection with difficult to manage behaviour and this was in 2005. It is recommended that all staff have the opportunity to update their knowledge and skills in relation to more specialised areas as this would give the staff team confidence, skills and understanding that would ultimately enhance the stay of people using the service. People living in the home are issued with a contract or statement of terms and conditions; this clearly states the room to be occupied, facilities, fees and Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 12 notice to be given. Therefore people are fully informed of the fees charged, what support and services are included in the fee and what is outside of that fee. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 13 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 & 9 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service do have a care plan and risk assessment and these describe what the needs are, therefore residents’ needs are met in full and risk is managed in a way that would ensure the residents are safe. Choice is promoted, but people using the service are not always able to make all decisions about everyday life. EVIDENCE: Prior to the inspection visit the Annual Quality Assurance Assessment was received stating that care plans and risk assessments have been updated giving clearer direction to staff, risk identified and more in-depth. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 14 During the inspection visit it was confirmed by speaking to people using the service, staff and from looking at files that the care planning and risk assessment process has been improved. People are clear about what is in their care plan and how staff will assist them if this is necessary. The care plans are clear and informative and look at the long-term aims/objectives for the person. One detailed nutritional needs and the reluctance to eat meals, also describes diabetic needs and what was required as part of that person’s diet, assistance with personal care, moving and assisting and difficult to manage behaviour, symptoms and triggers of behaviour were recorded. All of the care plans looked at were up to date and had been reviewed on a regular basis, the staff showed a good awareness of what was contained in the plan and how they should assist, all in all the home has a very good care planning system in place that ensures that individuals have their needs fully recorded and monitored. Since the previous inspection visit the risk assessment management system has been updated and individual risk assessments now cover a variety of areas including feeding residents through a gastric tube, mobility, self-harm behaviour or difficult to manage behaviour, epilepsy. The care plans and risk assessments include specific direction informing the reader about who does what and when. The moving and handling of residents has been risk assessed and these are clear, detailed and describes how staff should assist the person to move. One good example was for a blind resident and the staff are directed to introduce themselves upon and talk to the person as personal care tasks are being attended to. Two staff members were spoken to during the visit and they could clearly describe what the needs of individuals were and what the care plan stated. One staff member stated, “it’s brilliant, residents are encouraged to maintain their independence”, “it’s a lovely atmosphere and whatever the needs are these are usually met”. Another staff member said of the care offered, “choice is promoted, we always ask preferences on a daily basis, the communication levels with the residents is excellent”. 6 surveys were returned from people using the service and 5 confirmed that they are able to make everyday decisions; one person stated that sometimes they are able to make decisions for themselves. During the inspection visit three residents were spoken to about making choices and again they both confirmed that overall they are able to do what they choose to do and when they prefer, apart from not being able to take a bath or shower at a time convenient to them or as regular as they would have liked. Other comments were very positive about how the staff interact and treat them, some of these were; “the staff are wonderful”, “always treated with respect and courteously”. Staff were observed during the visit to undertake their duties in a professional and caring way, empathy and understanding was shown towards the people living in the home. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 15 There is a kitchen for people using the service and although this does promote independence and assists with daily living skills being developed or maintained, it is difficult for a wheelchair user to access and this was confirmed by the Expert by Experience who visited the home with the inspector. Comments included; “The kitchen was lovely but was of a standard height so not promoting independence to wheelchair users. Sockets were impossible to access from a wheelchair due to the height of the units. The table was not accessible to wheelchair users due to space, the kitchen was quite small”. The environmental issues will be addressed in the section relating to this later in the report. Overall the home enables them to take make choices and participate in the day to day running of the home and also that they are consulted about everyday issues such as the menu and the new smoking guidelines. But from speaking to some of the people using the service, relatives and staff it would appear that there remains some restriction in relation to choosing when to bathe. From speaking to the manager it was clear that she thought all of these issues had been previously dealt with, but she did state that, “I will discuss this with the staff team and customers and look at ways of how we can continue to improve this area, since the last inspection we have changed the rota to ensure that it is more flexible and we have more staff on duty at particular times when we know it will be busy”. During the visit some of the people using the service confirmed that sometimes they couldn’t bath when they choose to and have to wait for staff because they are seeing to someone else. Some comments included; “usually I can have a bath or get up straight away, but probably about 4 or 5 times I have had to wait because there aren’t enough staff on duty”, “sometimes I have had to wait for about 30 minutes before staff can help me, I know they are busy, but I find this frustrating”. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 16 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 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are enabled to take part in appropriate activities and education. People who live in the home are encouraged to maintain outside links with their family and friends and the routines in the home are flexible, therefore they have their rights respected and independence promoted. The menu and food offered is of a good quality, therefore people receive a varied and healthy diet. EVIDENCE: Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 17 During the visit some of the people living in the home were either spoken to about what it was like for them living in the home, some of the comments included; “I am still happy here”, “we like watching the big TV”, “the staff are wonderful and friendly”. From observation staff were seen to interact with residents in a caring and empowering way, it would appear that staff have developed very good relationships with the people living in the home. People living in the home are encouraged to attend education, community centres and local events, written evidence of this was present in residents’ files, but this was also confirmed when speaking to the residents themselves. From speaking to several people who live in the home it was also confirmed that regular activities take place within the home and there is usually something occurring on a daily basis, “we played pool this morning and have been playing cards too”. The home had written evidence to confirm that other outings occur, but these are not always on a regular basis. One survey received from a relative stated that more regular activities would be beneficial. As mentioned earlier in the report choice is sometimes compromised, people who using the service confirmed that they are not always able to get up when they want to. Some comments included; “sometime I have had to wait for about 30 minutes because there are not enough staff on”, “the staff are wonderful and do their best, but sometimes there are not enough staff on duty to have a bath when I would like to”. Surveys received from relatives and people using the service also confirmed this. The home continues to offer a varied menu and from speaking to several of the people who live in the home it was evident that the cook or staff consult them on a daily basis in order to discuss the options for lunch and tea, this is also displayed in large print on a wipe board in the dining room. Some comments made by people included; “the food is lovely”, “the food is good and we get a good choice”, “we have meetings and tell the cooks what we like”. One person did comment that sometimes the lighter option offered at tea time did not always feel enough. From looking at written records and from speaking to the senior carer on duty it was confirmed that this has been addressed and as part of that persons care plan, the staff always ask at supper time (8pm) if anything else is required. The main meal of the day is served at lunchtime with a lighter option for tea. The menu continues to be healthy and nutritious and the home has received the Heartbeat Award for the fifth time. From speaking to several of the people living in the home it was evident that mealtimes are a social event, some comments included; “the food is lovely”, “there is always a good choice available”. 6 surveys were returned from people using the service confirming that staff support residents in maintaining family links, friendships and relationships Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 18 inside and outside of the home. From speaking to some people living in the home it was clear that relationships and friendships are fully supported. The senior carer spoken to stated that the local community is accepting of the home and residents and include them in community events. Several people attend the day centre situated adjacent to the home and also attend other community events or activities that they would normally do. Some comments included; “I go to the day centre every week and when I come in here for respite I can still go as usual”. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service receive a good level of personal and healthcare support that ensures their needs are met. The medication procedure is adhered to and staff have been appropriately trained, therefore people using the service receive their medication in a safe way. EVIDENCE: Prior to the visit-taking place an Annual Quality Assurance Assessment was received and had been completed by the registered manager. This stated that all of the health care needs of residents had been maintained since the last inspection visit. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 20 During this visit four of the files for people who live in the home were looked at, written evidence was in place confirming what health care checks have been undertaken with the residents and these included optical, dental, chiropody, psychiatrist and other health care and social care professional involvement. From speaking to the residents it was apparent that they have access to all of the healthcare services they need. Some comments from people living in the home and from surveys received from relatives and other professionals included, “they keep my daughter informed and give her all the help she needs. She is very happy there”, “my relative is well cared for. The staff will go out of their way to make her comfortable”, “I am very happy with what I have seen. They give everybody the same attention and care”, “the staff are polite, friendly, caring and chatty, totally committed to their work, we have no problems, they do very well”, “the staff are always there to help”, “always friendly and caring, my daughter is always happy to be there, which tells it all”. Staff spoken to could describe the needs of the residents who they were key worker to and what support was required from them, it was obvious that the staff had developed a good understanding of what the residents needs were and on the whole residents were treated with respect and their dignity maintained at all times. During the visit it was confirmed by speaking to several people living in the home that staff were always polite and courteous, calling the person by the name they prefer and knocking before entering their bedroom. From speaking to the people who live in the home and staff it was clear that people receive personal care in a way that maintains their dignity and privacy. From looking at the residents’ files it was confirmed that independence is supported and residents have some control over their lives; times for getting up and going to bed vary. As detailed earlier, residents are not always supported to bath at times of their choice and therefore independence is restricted. During the visit the medication procedure was looked at and the records were in good order, there were no gaps in recording. Only staff who have undertaken training in relation to medication administer the medication, written records were seen to evidence that this is the case. The home has a returns procedure, which detailed the name of the person the medication was for, the drugs returned, prescribed drug and amount. The medication is stored in a locked medication room and within that room there are several locked cabinets and these are secured to the walls, there is also a medication trolley. There is a fridge that is used to store medication only, records were seen confirming that the temperature was taken on a daily basis. It was observed that medication in bottles or packaging that once opened have the date recorded. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 21 The current Medication Administration Records were looked at. There is a photograph of each person living in the home and this is attached to sheet. The home has a controlled drugs register and a facility to store the medication, there are two staff signatures for each entry and the record is also maintained on the Medication Administration Record. Any medication carried forward from the previous month is now detailed on the back of the Medication Administration Record, ensuring that there is a clear audit trail in place. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 22 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 & 23 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use the service are informed about the complaints procedure and are able to express their concerns in an open culture. Overall people who use the service are well protected from possible harm or abuse, as the home only employs staff when the appropriate vetting has taken place prior to them starting work. The financial records held for people living in the home are accurate and up to date. A vulnerable adults procedure is in place, staff have undertaken the POVA training and demonstrated sound knowledge of the procedure. EVIDENCE: The home has a complaints procedure and it was clear from speaking to people living in the home and from surveys received that they were aware of the procedure and knew how to make a complaint if necessary. One person said, “I recently complained about being hungry after tea, the manager has looked into this and the staff always ask me if I want supper before I go to bed”. All five of the questionnaires received back stated that they knew whom to approach to raise concerns and complaints. Since the last inspection there have been three complaints made and from looking at the written evidence it Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 23 was clear that these have been dealt with appropriately. A written outcome letter has also been forwarded to the complainant. The home has a multi-agency policy and procedure for the prevention of abuse, staff demonstrated a good understanding of this and training is mandatory. From speaking to two staff members during the visit it was clear that they had a good understanding of the procedure and where aware of what their responsibilities were. Since the last inspection there hasn’t been any safeguarding referrals made to the local care management team. The home has a policy and procedure for dealing with residents’ monies and financial affairs. Records for maintaining the personal finances of residents are kept. The financial records for two people who live in the home were looked at and found to be up to date and accurate. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 24 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): 24,26,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is comfortable, homely and meets the general needs of its residents, but there are several areas that require improvement to ensure that people who have limited mobility can access all parts of the building. The home is clean, fresh smelling and hygienic. EVIDENCE: A tour of the building was undertaken and overall the standard of accommodation, equipment and furnishings as stated in the last inspection, is of a very good standard. Following the completion of the building works Hull City Council’s building control and the Fire Department have made final visits Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 25 to ensure the health and safety of the building. The problem with the automatic doors in the dining room has been corrected; confirmation was received from the Fire Department stating that the home has taken appropriate action. As part of the inspection process an Expert by Experience assisted with the inspection, part of their role was to look at the environment and give feedback in relation to the accessibility for someone who has a physical disability. Some comments and observation will be included within this section of the report. Since the last inspection the requirements in relation to Room 12 did not have a lock on the door has been met. Handrails have been put in place in the shower area for Rooms 7, 9 & 11. An Occupation Therapist has assessed the building in October 2007 to ensure that there are suitable aids and adaptations in place. The manager said, “the occupational therapist came in October 2007, but we haven’t received the report as yet”. There is a ceiling-tracking hoist fitted in most of the bedrooms and bathrooms. The home was clean and hygienic and there no malodour was detected. Disinfectant gel is situated in various places around the home and from speaking to staff it was confirmed that they had received training in relation to infection control. Six surveys were returned from people using the service and all of which stated that the home is always clean and tidy. Four surveys were received from relatives and some comments included; “the home is well-maintained and clean, I cannot fault it in any way and the staff are always there to help”. Two people living in the home were spoken to during the site visit about the environment and some of the comments were; “it is always clean, the staff work very hard”, “the home never smells”. The Expert by Experience commented; “I inspected the building which I found to be on the whole, clean, homely, well decorated and mainly accessible to all, however, there were areas that could be improved”. These are as follows; The lift controls were not easily identifiable and there was nothing in Braille making them assessable to anyone with a visual disability. The Service Users notice board in the dining room was too high for clients to be able to access from a wheelchair. The handle on the outside of the toilet (room 13) was very small and fiddly making it very hard for anyone with limited control of his or her hands. There was no bar on the inside or outside of the toilet door to assist with the easy opening/closing for wheelchair users. The spare toilet roll was kept on the Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 26 windowsill and was too high for someone to reach safely from a wheelchair. The room was very clean and in an excellent state of repair with adequate handrails. The toilet (room 14) with adjoining shower room. The toilet room was lovely and spacious in an excellently decorated and very clean. There was a mobile hoist in the corner. Again the door handle on the outside of the door was very small and there was no grab rail on the inside or outside of the door making opening/closing the door difficult for wheelchair users or those with limited mobility. The toilet chain was very high and quite away back making it nigh on impossible to be reached by anyone with limited mobility. Going through to the adjoining shower room, which again was generally clean and very well decorated with lots of homely finishing touches. However, one of the doors on the wheel in shower cubicle was broken and could not be easily opened on your own, so did not promote independence. The shower chair had dirty tape hanging from the right arm; otherwise it was in a good state of repair. The drain in the centre of the cubicle floor had had the cover removed; this was left lying on the cubicle floor which posed as a real tripping hazard. Before the site visit was completed the inspector requested that the cover be put back in place, a senior care office attended to this and the shower was made safe. Toilet (room 16) was again very clean and well decorated. There are two toilets in this room and a fitted overhead hoist. There was no grab rail on the inside of the door to assist with opening/closing it. The chain was very high and set back on the centre toilet, making using it nigh on impossible for those with limited mobility and I felt that there should be more rails around the toilet nearest the wall. The non-smoking sun lounge was a lovely and sunny room. The furniture has been well appointed though I’m not sure where clients in wheelchairs could sit without feeling isolated and excluded. Might want to consider a hoist to assist clients to use the wicker furniture. There was a good selection on dvds, cd’s, puzzles etc. the room had a hifi, television with a dvd player for clients use. There was a suggestion box on top the television that was out of reach to wheelchair users and there was no paper or pens near by. A round table was placed near to the doors leading to a sun garden, which could cause access to/from this garden if clients were sat at the table. The doors leading to the garden were very heavy making the garden hard to access by those with limited mobility. The kitchen (room 22) was lovely but was of a standard height so not promoting independence to wheelchair users. Sockets were difficult to impossible to access from a wheelchair due to the height of the units. The table was not accessible to wheelchair users due to space, the kitchen was quite small. A dinning chair was propping the door open which didn’t help with access to the table. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 27 The main lounge was stunning, really well decorated with a lovely home from home feel. There was a huge television with sky. Two book cases with a good selection of books available and two really comfy sofas. However, I was not sure where a wheelchair user could sit without feeling excluded from the room or be blocking some ones vision. There was no hoist to assist clients to make use of the sofas. The lounge (room 24) was again well laid out with comfy seating and a television with free view and a video player. There was a good selection of videos available. However, I was not sure where a wheelchair user could sit without feeling excluded from the room or be blocking some ones vision. There was no hoist to assist clients to make use of the sofas Doors to smoking room are very heavy. The toilet (room 25) is adequate, but again no grab rail on the inside of the door to assist with opening/closing. There was a big handle on the outside but not sure how accessible it is as it’s quite high. The kitchen (room 26) is a lovely big kitchen, but again the units were standard height though the sink has been lowered and is accessible from a wheelchair. Sockets were difficult to impossible to access from a wheelchair due to the height of the units. The table was accessible to wheelchair users on one side. Three mattresses were stored in plastic covers leaning against one of the walls and slightly over hanging the wall infringing on access space. The Expert by Experience chatted to one of the clients and observed that the room was pleasant with a real home from home feel. The ensuite shower room was in a good state of decoration with an electric sink that could be raised or lowered making the room accessible to all. She also commented, “I did feel that there maybe a need for more shelving or something as the clients fruit bowl had been place on the floor so that their dinner could be placed on the table. The client didn’t mind this but I felt it inappropriate to place food stuff on the floor”. There was no grab rail on the inside or outside of the room door to assist with opening/closing, the same on the shower room door. There is a safe for clients to use; however, the turn dial would be difficult for some clients to operate. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 28 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): 32,33,34,35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff receive essential training that ensures the health and safety of the people using the service is maintained, but not all of them have received specialised training in relation to different needs resulting in a person having a physical disability and this would promote a better understanding of the person’s disability and inclusion. Staffing levels are insufficient at times and therefore people living in the home may not receive the support they need. The home operates a robust recruitment procedure that ensures the residents receive support from properly vetted staff. Staff receive supervision and support on a regular basis, therefore people receive support from a staff group that is supported and monitored. EVIDENCE: Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 29 During the inspection visit two staff members were spoken to about their roles and responsibilities. From speaking to the staff members it was clear that they had a good understanding of the residents’ needs and could express what care was offered and the way in which the care tasks were undertaken, ensuring the privacy, dignity and independence of the residents. It was clear that the ethos of the home is to offer a very high standard of care in a sensitive and has adapted a person centred approach. Some comments from staff included; “although I have undertaken all of the mandatory training courses, I would like to learn about the different needs such as Huntington’s, Parkinson’s and Motor Neurone disease, this would give me more confidence and understanding”, “the care is brilliant, residents are encouraged to maintain their independence and the home has a lovely atmosphere”. Although some staff have undertaken more specific training in areas such as Diabetes, Epilepsy, Parkinson’s and Huntington’s disease, it would be beneficial for the whole staff group to undertake some basic training in relation to a person having a physical disability and what that feels like for them. The Expert by Experience confirmed that this would be a positive and pro-active move for the home and would demonstrate that they were aware of the multiple difficulties someone with a physical disability may endure and ultimately equip the staff group to deal with varying physical disabilities and the psychological effect that this may have. From speaking to the people who use the service and surveys received from them and relatives it was clear that overall the staff team carry out their duties in a professional and polite way. Some comments included; “they are excellent they keep my daughter informed and give her all the help she needs. She is very happy there”, “my daughter is well cared for. The staff will go out of their way to make her comfortable”, “I am very happy with what I have seen. They give everybody the same attention and care”. More than 66 of staff have now achieved NVQ level 2 or above. As stated in the previous inspection report, whist the staffing level is appropriate for the majority of the time; sometimes it is insufficient. From speaking to residents and relatives and from surveys received it was confirmed that sometimes people have been kept waiting for long periods for personal care tasks to be carried out, some comments included; “I had to wait for about half an hour for staff to come and help me get up, I have complained about this”, “I would like my husband to be able to get up for his lunch”. Staff comments included; “the majority of the time the staffing levels are adequate, but sometimes we do not have enough staff to see to more than one person at the same time”. Surveys received also stated that staffing levels are low when the home has higher level need residents who require two or more staff to assist with personal care. The service provider needs to critically examine the staffing level to ensure that all the needs of residents can be met. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 30 During the inspection visit four staff personnel flies were looked at and this confirmed that the home undertakes appropriate checks including Criminal Records Bureau disclosure and two references prior to staff commencing work. From looking at written records it was confirmed that staff receive supervision and this is on a regular basis. Staff confirmed that the manager and shift leaders are approachable and offer informal support on a daily basis. One staff member said, “I get supervision at least once a month, sometimes more if I feel that I need it”, “the manager is very supportive and the seniors give us support too”. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 31 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 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a well run home and an open door policy ensures that people using the service are able to speak to the manager on a regular basis. The home’s quality assurance programme currently does not seek the views of all stakeholders, therefore the system is not as effective as it could be and although people using the service have their views listened to, other people such as relatives and other professionals are not asked their opinions. The health and safety of the people using the service is maintained and promoted. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 32 EVIDENCE: From speaking to some of the residents, a relative and from surveys received it was confirmed that the management of the home is approachable and efficient in dealing with any problems or complaints. Three staff members were spoken to about the general running of the home and they stated, “the manager is quite relaxed in style, but is always approachable”, “the manager is lovely, really supportive”. The home has developed a quality assurance system, this incorporates regular liaison with the people who use the service, but since the last inspection no other stakeholders have been contacted for their views, this includes family/friends and other professionals. The home produces an annual report highlighting both positive and corrective action, a copy of which has been forwarded to the CSCI. A newsletter has been produced informing the residents of events, activities, stories and staff news, it is well presented, colourful and interesting to read. All complaints and compliments are recorded. Since the last inspection the Building Regulation and Fire Department have both approved the building work that has been undertaken. Documentation in relation to the maintenance of the building was in place to evidence that regular checks have been carried out. These included gas, electrical wiring certificate, the water system is also checked for Legionella. The hoists and lifts were all up to date and evidence was seen confirming this. All of the mandatory training is offered to the staff including moving and handling, fire safety, first aid, health and safety, the protection of vulnerable adults and infection control. Evidence was seen on the staff files to confirm this and from speaking to the staff members it was clear that they undertook appropriate training and was fully supported to do so. Therefore the residents receive support from a well-trained and experienced staff group. A discussion with a senior care officer took place with regard to the diverse needs of residents and how the home are able to meet those needs. Currently none of the residents have a different ethnic background or culture. She did state that the cooks have looked at alternative menus in the event of the person from a different culture being admitted. Also that equality and diversity training is mandatory and therefore all staff have been trained appropriately and should be aware of differing needs the residents’ may have. The home offers support to a varied age group (18-66) and has appropriate aids and adaptations that would maintain independence. Some staff have also undertaken training in relation to Huntington’s and Parkinson’s disease, Diabetes and Epilepsy. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 33 As mentioned in the staffing section of the report the staffing levels are insufficient at times and therefore people living in the home may not receive the support they need. The management needs to review the staffing levels and manage this more effectively; to ensure that all of the people who use the service are supported by sufficient numbers of staff and choice is promoted. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 34 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 2 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 2 30 4 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 x 3 X 2 X X 3 X Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 35 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA3 Regulation 18 Requirement Timescale for action 06/03/08 2 YA7 12 Staff have either not undertaken or updated their knowledge in relation to dealing with difficult to manage behaviour and understanding what it is like to have a physical disability, therefore the home does not always meet or fully understand the more diverse needs of some people using the service. People using the service are not 06/03/08 able to make decisions about everyday life in particular when they choose to have a bath or shower. (Previous timescale not met - 21/03/07) See standard 7. (Previous timescale not met 21/03/07) 06/03/08 3 YA18 12 4 YA24 23 There are several areas in 06/10/08 relation to the environment that require improvement these include; The lift controls need to be clearly identifiable, Notice board in the dining room DS0000034637.V353779.R01.S.doc Version 5.2 Page 36 Pennine Centre 5 YA29 requires lowering to ensure that this is accessible from a wheelchair, Some of the toilet and bedroom doors had no grab rail or bar on the inside or outside to assist with the easy opening/closing for wheelchair users, Toilet 14 one of the doors on the wheel in shower cubicle requires repairing, The two kitchens that are used by residents for rehabilitation are of a standard build and have not been adapted for people who use a wheelchair, these require further improvement as this would ensure that people who have limited mobility can access all parts of the building and maintain their independence and daily living skills. 12,13,16,23 Once the refurbishment is 06/03/08 completed, an occupational therapist or similar will need to assess the building. (Previous timescale not met – 21/03/07) 6 7 YA32 YA33 18 17,19 See standard 3. The registered person must critically examine the staffing rota and ensure that the staffing levels are appropriate at all times in such numbers as are appropriate for the health and welfare of the residents. (Previous timescale not met – 21/03/07) 06/03/08 06/03/08 8 YA39 17,24 The quality assurance system 06/03/08 must be further developed and incorporate the views of all stakeholders including other professionals, staff and relative. DS0000034637.V353779.R01.S.doc Version 5.2 Page 37 Pennine Centre This would ensure that all the views of people involved with home are sought. (Previous timescale not met – 21/03/07) 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 Refer to Standard YA18 Good Practice Recommendations People who are wheelchair users should be given the option of sitting on the sofas in the communal areas. Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Pennine Centre DS0000034637.V353779.R01.S.doc Version 5.2 Page 39 - 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. 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