Inspection on 29/06/06 for Pentrich Residential Home

This inspection was carried out on 29th June 2006.

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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pentrich Residential Home 11/12/09

Pentrich Residential Home 23/11/09

Pentrich Residential Home 25/09/09

Pentrich Residential Home 29/05/09

Pentrich Residential Home 03/06/08

Pentrich Residential Home 04/12/07

Pentrich Residential Home 13/06/07

Pentrich Residential Home 12/01/06

Pentrich Residential Home 27/01/05

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

CARE HOME ADULTS 18-65 Pentrich Residential Home 13 Vernon Road Bridlington East Yorkshire YO15 2HQ Lead Inspector Mr M. A. Tomlinson Key Inspection 29th June 2006 09:45 Pentrich Residential Home DS0000061162.V296584.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 Pentrich Residential Home DS0000061162.V296584.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. Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pentrich Residential Home Address 13 Vernon Road Bridlington East Yorkshire YO15 2HQ 01262 674010 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) Mr Olu Femiola Mrs Jean Lesley Bailey Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (3) Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 12th January 2006 Brief Description of the Service: Pentrich is registered to provide accommodation and personal care for a maximum of thirteen (13) younger adults (service users) who have a mental health problem. Three (3) of the service users may be over the age of 65. Nursing care is not provided. Should such care be required on a short-term basis then it will be provided by the community health services. Pentrich is a linked double fronted property situated in a residential area of Bridlington and is conveniently located for all of the main community facilities including the public transport network. A parking area is available at the front of the property. There is also unrestricted on-road parking. The property has three floors with the service users’ accommodation located on all floors. The accommodation consists of seven double or shared bedrooms and two single rooms. One room has en-suite facilities. Bathing/toilet facilities are available on each floor of the property. A dining room and two lounges, one designated for the use of service users who smoke, are located on the ground floor. The property does not have passenger lift and is consequently only considered suitable for service users who are fully ambulant. Current fees for the accommodation and personal care of service users ranges from £1127 to £1221 a month. This equates to £263 to £285 a week. This information was included in the Pre-Inspection Questionnaire submitted by the Registered Provider. The service users are charged for ‘additional’ services such as: Hairdressing, chiropody, toiletries, magazines and newspapers, some social activities and transport. Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first site visit made to the home by an inspector of the Commission for Social Care Inspection (C.S.C.I.) during this inspectoral year. This report has been based on information obtained during discussions with the service users, the staff and manager of Pentrich, telephone discussions with two social care professionals (Care Managers) and information contained in the survey forms provided for the service users and others involved with the care of the service users. Reliance was also placed on observation of the staff and service users, an examination of several statutory records and an inspection of the premises. The report also incorporates information received by the CSCI prior to, and subsequent to, the site visit. What the service does well: What has improved since the last inspection? The registered manager has made considerable progress in the personal development of the service users by further involving them in the routines of the home. The majority now take responsibility for the cleanliness of their rooms, with staff support where necessary. Several service users expressed considerable pride in the standard of their rooms. The staff have been encouraged to spend more ‘quality time’ with the service users in order to discuss and resolve any issues or problems that they may have. Several service users said that they were confident that they could talk to the staff about their problems. The manager continues to promote training for the staff and the majority have obtained a National Vocational Qualification. According Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 6 to the staff they have far more involvement in the running of the home and the service users’ care records than they did in the past. What they could do better: The following areas need improving: • The premises. Whilst some improvement had been made to the property since the last inspection, overall it continued to be of a relatively poor standard with discoloured paintwork, worn and stained carpets, and stains and unsightly marks on some of the bedroom walls and ceilings. In some areas there was an unpleasant smell. The manager thought that on the ground floor in particular the main drain was the cause of the smell. The front external aspect of the property was also marked by dampness. To the visitor the physical standard of the property was uninviting. Some of the service users and external social care professionals also commented on the need for redecorating/refurbishing. The overall physical standard of the property must be addressed as soon as possible. Care of the service users. It is acknowledged that the majority of the service users expressed satisfaction with the service provided by the home but there were some aspects that require attention. Among the foremost of these was the apparent staff ‘control’ of the service users. For example, several of the service users had their cigarettes issued by the staff and are given a cigarette at a particular time. Whilst this had been recorded in the form of an ‘agreement’ with the service users concerned it was, nonetheless, rather demeaning and must be regularly reviewed along with the service users’ Care Manager to ensure that it does not become an institutional practice. In a similar vein, it was noted that the main entrance doors were kept locked for the safety of those service users who are considered unsafe in traffic or required staff supervision when out of the home. This action, however, has a negative effect on the more able and independent service users who had to ask staff to be let in and out of the home. This again is somewhat demeaning and detracts from the home’s aim of promoting independence. There was also some indication in the surveys received from service users that the attitude of some of the staff was controlling and that this had a negative effect on at least one service user. Urgent attention must also be given to the needs of a service user who had mobility problems and required the assistance of staff to access their bedroom on the first floor of the property. Visits by the Registered Provider. Assurance was given by the registered manager that the registered provider made regular visits to the home. He did not, however, make a written report of his visit for the benefit of the manager. The manager had written the report of the visit on his behalf. DS0000061162.V296584.R01.S.doc Version 5.2 Page 7 • • Pentrich Residential Home • Quality Assurance. The registered provider had not implemented a quality assurance monitoring system and although there were elements of quality assurance in use they were not sufficient to enable a considered decision to be made as to whether the home was achieving its stated aims. Staffing level. Whilst the home meets the minimum recommended staffing level it was considered inadequate to fully meet the assessed needs of the service users especially as two service users required ‘close supervision’ and another was relatively physically dependent. It was evident that the level of staffing dictated the frequency and content of the social activities particularly for the more dependent service users. For example, on the day of the inspection the less able service users were taken out as a group by a member of staff and consequently they all had to do the same activity when out of the home. The apparent problem with the staffing level was further exacerbated by the fact that the staff were expected, albeit willingly, to assist with the redecorating of the property. Such activities could detract from their main caring and support role. It was also noted that the registered manager was occasionally included as part of the care staff team and did a considerable number of ‘sleep-in’ duties. This again, it could be argued, could detract from her main managerial duties. • The Registered Provider has been requested to provide the Commission for Social Care Inspection with an ‘improvement plan’ to address the above issues. 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. Pentrich Residential Home DS0000061162.V296584.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 Pentrich Residential Home DS0000061162.V296584.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service”. Adequate levels of assessment are undertaken on prospective service users to enable the registered manager to make a considered assessment as to the appropriateness of the proposed placement. EVIDENCE: No new service users had been admitted into the home for over twelve months. Three service users’ care records were examined. These contained written evidence that the service users had been provided with an assessment at the point of, or prior to, admission. The assessments undertaken by staff of Pentrich were in addition to assessments provided by a placing authority. The assessments identified the primary needs of the service users. The combination of these two assessments provided the registered manager with adequate information on which to make a considered decision regarding a proposed placement. A Social Services Care Coordinator confirmed that the registered manager closely liaised with them particularly during the admission process of a service user. The registered manager stated that they would occasionally challenge an external assessment of a service user and provided an example where they had refused a proposed placement on the grounds that it was inappropriate and the home could not meet the needs of the prospective service user. One service user stated, “ I had an interview to help me decide if Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 10 the home was suitable for me and that I liked the home”. Several of the service users were the subjects of ongoing assessments to ensure that their placement continued to remain appropriate. This particularly applied to one service user who had on occasions displayed inappropriate behaviour including physical aggression towards staff. Another had an eating disorder and consequently required close supervision by staff. One service user had poor mobility and required the use of a wheelchair particularly when out of the home. This service user had their room on the first floor of the property and could only access it with the assistance of the staff. According to the staff, plans have been put in place to eventually provide this service user with a ground floor room. A risk assessment on this service user was in place. Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service”. The service users’ care plans provided the staff with sufficient information in order to meet their needs. The somewhat controlling environment could undermine the service users’ abilities to make considered choices. EVIDENCE: All of the service users had been provided with a care plan that was in addition to any care plans provided by a placing authority. Three care plans were examined. The care plans were reasonably comprehensive and were generally written in a ‘narrative’ format. They identified the needs and abilities of the service users along with any personal idiosyncrasies. The service users’ ‘key worker’ had direct input into the care plans and there was also evidence of the service users involvement in so far as they had, where possible, signed their care plan in agreement. According to the staff, prior to the registration of the current provider, they did not have access to any records except the daily records. A Care Manager confirmed this. It was apparent that the care plans had been regularly reviewed. A Social Services Care Coordinator who had Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 12 several clients accommodated in the care home confirmed this. Where a service user’s rights could be possibly infringed by, for example, staff control of their personal money or cigarettes, then it was done with the written agreement of the service user concerned. These ‘agreements’ were included with the service users care records and, according to the manager, were regularly reviewed (See Lifestyle). The service users presented as having a range of ability levels from one service user who was relatively independent and had a part-time job at the local super-market to a service user who, due to their behavioural problems, required considerable input from the staff. Several of the service users were able to go out unsupervised. This was observed and confirmed by these service users. Other service users due, for example, to their poor mobility or lack of understanding of the dangers of traffic, required staff supervision when out of the home. It was evident during the visit that the service users were encouraged by staff to make decisions for themselves. For example they generally chose what clothes they wished to wear and what they wanted to do with their time. However one service user commented “ I would like more choices of things to do each day. I get told what I can and can’t do each day” and “ Some members of staff let me do things such as watch T.V. in different rooms whilst others don’t let me”. These comments were discussed with the registered manager. The manager had endeavoured to get the service users more involved in the daily routines of the home as part of their life skills training. Several service users confirmed that they cleaned and tidied their bedrooms and assisted in the kitchen. It was noted that the staff did not ‘fuss’ over the service users but allowed them to act reasonably independently within the home even where their actions may have included an element of risk. Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service”. Staff ‘control’ of service users could undermine promotion of the service users’ independence and infringe their human rights. EVIDENCE: According to the staff the opportunity for service users to achieve their potential and develop their skills was limited due to the lack local resources. Evidence was provided, however, that since the last inspection the registered manager and the staff had endeavoured to provide the service users with opportunities to develop as individuals. This, as previously mentioned in this report, included the involvement of the service users in the domestic routines of the home and also attendance at local educational classes. The more able service users confirmed this. The implementation of this process had been difficult, according to the staff, with reluctance on the part of some of the service users and consequently considerable encouragement had been required. Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 14 It was evident that, when possible, the service users made maximum use of the community facilities. They confirmed that, weather permitting; they went out at least twice a day. For reasons of safety the staff occasionally took out a group of service users. Consequently this group did activities together. Some service users followed a similar routine each day. For example, one went and sat in a local pub. They stated that “it was to get away from all this” but they wouldn’t expand on this comment. A number of service users had recently gone ‘on holiday’ for a few days at a local holiday camp accompanied by several staff. According to the staff this was the first holiday that many of the service users had experienced. Those service users who went said that they enjoyed it. Other service users had made a decision not to go and had stayed at Pentrich. Only a few of the service users had regular contact with members of their family. As previously mentioned in the report several of the service users had their cigarettes controlled by the staff. The rationale for this, according to the staff, being that they would smoke all of their cigarettes in a short period of time and not be able to afford anymore. This restriction was contained in a written agreement, signed by the service users concerned, and kept with the respective care record. The downside to this was that the service users had to ask or rely on the staff to give them a cigarette at a designated time which appeared to the observer to be a less than adult approach and undermined the service users’ dignity. Other areas of ‘control’ were, with the exception of the two most able service users, with regard to the service users’ personal money and the locking of the main entrance doors. In the latter case it was observed that more able service users who were able to go out unsupervised had to ask the staff to be let out and in of the home. The home had a dedicated cook who had been employed at the home for a considerable number of years. The cook demonstrated a good understanding of the service users’ preferences with regard to food and provided examples where these had been incorporated into the planned menu. There was also evidence that meals were discussed during the service users’ meetings. The manager provided copies of the menus with the pre-inspection questionnaire. The menus indicated that whilst the meals were fairly traditional, they were varied and provided a reasonable nutritional balance. The more able service users expressed their satisfaction with the meals and stated that would occasionally have something to eat whilst out of the home. On the day of the inspection several of the service users were going out as a group and said that they were going to buy an ice cream. The manager said that the service users have a ‘treat evening’ when they would be given chocolate or other sweets as a treat. It was observed that the service users had their meals together in the dining room, which presented as a congenial setting with conversations being natural and spontaneous. As previously mentioned in the report the service users were encouraged to assist with clearing the tables and washing up. Pentrich Residential Home DS0000061162.V296584.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service”. The service users are provided with good standards of support from health and social care professionals thereby ensuring that their physical and emotional health needs are met. EVIDENCE: The service users generally expressed satisfaction with the support that the staff provided. Written and verbal comments from the service users were varied and included, “It’s ok here – I’ve been here seventeen years. The staff are brilliant. I can only go out with the staff”, “I’m happy here. I can come and go as I like but I let them (staff) know. I go to the shops every day”, “I get out to get away from all this. I like to spend time in the pub”; “I would like choices of things to do each day. I get told what I can and can’t do each day”, “Some members of staff let me do things whilst others don’t let me”, “Some members of staff are easier to talk to about problems than the boss”, and “Sometimes the manager is abrupt and shouts and makes me feel low about myself. Other members of staff are excellent”. As previously mentioned in the report, it was observed that whilst the more able service users could go out unsupervised they had to get a member of staff to let them out and in again. Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 16 It was also evident that some service users were given a cigarette at certain times by staff or had to ask to be given one. It was also observed that the staff on duty at the time of the inspection provided the service users with appropriate support and spoke to them in an adult and respectful manner. Through discussions with the staff and service users and an examination of the care records, it was evident that the service users had good levels of external support from health and social care professionals. Care Managers who had made placements at the home also confirmed this. There was evidence of specialist input from a Community Psychiatric Nurse (C.P.N.) and Dietician. It was apparent that the manager and staff closely monitored the health of the service users and had taken appropriate action as necessary. As an integral part of this process the service users had been regularly weighed. The recent sudden weight loss of a service user, for example, served as the trigger for their admission into hospital. The home continued to use a monitored dosage system for the administration of the service users’ medication. The medication was appropriately secured and the administration records were complete and up to date. The medication was stored in a neat and methodical manner. It had been regularly ‘rotated’ to ensure that it was administered in date order. The majority of the staff had been provided with appropriate training to enable them to undertake the administration procedure. It was also regularly monitored by the local pharmacy. From the description of the procedure provided by the staff it was evident that it was appropriate and reduced the possibility of error. No controlled drugs were in use at the time of the inspection. One service user had been provided with the responsibility to self-administer their inhaler. Another service user had an injection administered by the C.P.N. Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service”. The Adult Protection procedure does not ensure that appropriate action will be taken where allegations of abuse are made thereby potentially putting the service users at risk. EVIDENCE: There was an appropriate complaints procedure in place. The more able service users indicated either during discussions with them or in the survey card that they were confident that they could make a complaint if necessary. It was evident from the records that even the most minor issues raised by the service users were taken seriously by the staff. As all of the service users had regular contact with external health and social care professionals they had the opportunity to raise concerns and complaints with them. The manager had recently revised the Adult Protection procedure. The procedure did not fully comply with the agreed protocol insofar as it indicated that in the first instance, following an allegation of abuse, the manager or her representative would investigate the allegation internally. It also included elements of the complaints procedure. The staff records indicated that the staff had received training on adult protection. They demonstrated a reasonable understanding of the types and indications of abuse. At least one service user had behavioural problems including physical aggression. Whilst the manager stated that restraint was never used it was, however, conceivable that physical restraint may be necessary particularly as the staff stated that there had been occasions when a service user had hit them. The staff had not Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 18 received training in the use of restraint. The manager had previously questioned the appropriateness of the placement of this service user and was keeping the situation under review. In order to minimise the chances of the service users being financially abused, the registered provider had applied to have the local social services department act as a ‘corporate financial appointee’. The home’s manager continued to deal with the service users’ personal allowance and had maintained records and kept receipts of all transactions made on their behalf. Two service users had been assessed as being capable to managing their own money. Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28, 29 and 30. “Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service”. The premises require considerable refurbishment and redecoration in order to bring it up to the required standard and therefore make it appropriate for the use of the service users. EVIDENCE: An inspection was carried of the premises including the service users’ bedrooms. Some improvements had been made including the fitting of new carpets in the smokers’ lounge. There was also some evidence that staff, on a self-help basis, had endeavoured to undertake some internal redecorating. This was, however, in addition to their primary care tasks. Much of the paintwork on the stairway and corridors was discoloured through age and cigarette smoke. The paintwork in the main lounge was faded. Some of the carpets were ‘rucked’, stained and generally ‘tired’ looking. The floorboards on the upper floor were uneven. In the entrance to the main lounge, ‘duck tape’ had been used to prevent the edges of the carpet from causing a tripping hazard. Several of the bedrooms, particularly those on the top floor, had stained ceilings and some had bare patches on the walls. The majority of the Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 20 bedrooms were being shared. The bedroom doors had inappropriate locks fitted although according to the manager the service users did not use them. Some bedrooms were not furnished to the recommended standard by not, for example, having a bedside light. One bedroom and a toilet on the ground floor had an unpleasant smell. The home did not have a passenger lift and consequently it was not considered suitable for service users who have mobility problems. As previously stated in the report, however, one service user who had poor mobility was accommodated on the first floor and consequently required the assistance of staff to get to her room. The kitchen and the staff sleeping-in room had received some upgrading. The rendering at the front of the building was stained by dampness. The entrance gates were badly rusted and there was some rubble next to the wall. One visitor said, “The staff are very good and very caring. The only problem is the building – it smells. It needs decorating throughout”. A Care Manager commented, “ The home is run down. It needs a lot of money spent on it as it gives a poor impression”. The views of service users included, “A bit of decorating would be nice” and “It needs some decorating doing all over the house”. On the day of the inspection the home was reasonably clean. As previously mentioned the service users, assisted by the staff, are encouraged to keep their bedrooms clean and tidy. One service user expressed considerable pride in their room. The home had a dedicated cleaner who was primarily responsible for the cleanliness of the communal areas and the bathrooms/toilets. Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service”. There is doubt that the level of the day staffing enables the staff to fully meet the need of the service users on all occasions. EVIDENCE: Since the previous inspection the deputy manager had left the home. The Registered Manager said that the Registered Provider was intending to obtain a replacement deputy manager for the home over the next week or two. In general the day staffing consisted of two support workers plus the manager and, for a proportion of the day, a domestic and a cook. From discussions with the manager and the staff it was evident that at times they were ‘stretched’ due to the diverse and, on occasions, demanding needs of the service users. It was evident from discussions with the staff that activities in the home were, to an extent, dictated by the availability of the staff and the needs of the service users. This would be particularly evident at weekends when only two staff were on duty during the day. It was noted from the staff roster that the manager worked as part of the staff team and also provided sleeping-in cover at night. She confirmed that she spends ‘most of her time in the home’. According to the staff rota the night staffing level consisted of one person awake and one on-call in the building. The on-call person slept in a dedicated room on the Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 22 ground floor and could be contacted by the waking member of staff by the use of a pager. The staff records confirmed that the staff had been provided with training in mandatory subjects such as moving and handling, fire, first aid and food hygiene procedures. The staff confirmed this training. They said that the manager was very supportive and endeavoured to provide them with as much training as possible. The majority of the staff had achieved a National Vocational Qualification. The staff spoken to confirmed that they had regular supervision by the manager. The staff records evidenced this. Three staff records were examined. They contained documented evidence that prospective employees had undergone a satisfactory recruitment and selection process. The manager did not have access to the Internet or email facility and consequently was unable to use the POVA First process or access information provided by the Commission for Social Care Inspection. It was evident from discussions with staff that they had a good understanding of the needs of the service users in particular those service users for whom they were the key worker. They related well to the service users and, on the day of the visit, conversations with them were natural and respectful. The staff said that they felt far more involved in the running of the home than they had in the past. Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service”. The staff are provided with good support from the registered manager that enabled them to take a more active part in the running of the home and the provision of care. The lack of a Quality Assurance process limited the manager’s ability to assess whether the home is achieving its stated aims and identify where improvements are necessary. EVIDENCE: The manager was in the process of taking the Registered Manager’s Award. On the completion of this she is intending to take a National Vocational Qualification at level 4 in care. It was evident that following the previous inspection the manager had endeavoured to improve the quality of life for the service users. This had included encouraging them to assist with the daily domestic routines in the Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 24 home, increased involvement in their reviews and care planning and an improved programme of activities. The manager stated that introducing change was difficult as some service users were resistant to it and found it unsettling. The manager continued to encourage the service users to attend regular meetings so that they could discuss any issues or problems openly. The registered manager confirmed that the registered provider made regular visits to the home but did not provide a written report of the visit for the manager. The manager had written a report of the visit on behalf of the registered provider. There was not a formal Quality Assurance monitoring process in place although evidence of elements of quality assurance was available. These included questionnaires for service users and their relatives, minutes of staff meetings and regular review of the home’s policies, procedures and records. These were not, however, linked and did not form part of a systematic cycle of planning, action and review. It was not, therefore, possible to fully assess whether the home was fully achieving its stated aims and objectives or what action was being taken to do so. The manager was unclear as to the purpose of a Quality Assurance process and thought that it only applied to the personal development of each service user. The manager had made a considerable effort to make the records more meaningful and accessible. It was apparent from an inspection of the home’s records and the premises along with discussions with the staff and service users that the manager had taken appropriate action to ensure a safe environment. This included staff training in health and safety related subjects. Of some concern, however, was the fact that one service user required the assistance of two staff to access their bedroom on the first floor. The accident and fire records were examined. The manager confirmed that the home had complied with the recommendations made by the Fire Department except for the provision of ‘double door protection’ on the fire evacuation route as it was deemed impracticable. This had not been put in writing to the Fire Department. Fire risk assessments had been undertaken. Fire drills that included the service users had been regularly carried out. The temperature of the hot water available to the service users was, according to the manager, regularly checked but not recorded. Two outlets were checked on the day of the inspection and were found to be within the recommended safety limit. Confirmation was provided that the electrical and gas systems had been serviced although an electrical servicing certificate had yet to be received from the contractor. Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 25 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 3 23 2 ENVIRONMENT Standard No Score 24 1 25 2 26 2 27 X 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 3 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 3 3 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 X 1 X X 2 X Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA16 Regulation 12(1)(4) Requirement Timescale for action 2. YA23 13(6) 3. YA24 23 (2) Staff control of service users and the restriction of service users’ rights must be kept under review 01/08/06 to ensure that they do not undermine the service users’ dignity or become institutional practices. (This refers to service users leaving and entering the building, control of their cigarettes and personal money and the use of ‘treats’.) The service users must also be provided with equal opportunities regardless of disability. Care must be taken, for example, to ensure that an ‘institutional’ approach is not taken when involving service users in external activities (e.g. acting as a group). The Adult Protection procedure must comply with the agreed protocol to ensure that all allegations of abuse are 01/09/06 promptly reported to the appropriate agency. A restraint policy is to be implemented and staff provided with training on the subject. A programme of refurbishment 01/08/06 DS0000061162.V296584.R01.S.doc Version 5.2 Page 27 Pentrich Residential Home (b)(d). and redecoration of the premises, along with timescales, is to be provided for the Commission for Social Care Inspection. (Previous requirement timescale of 01/03/06 not met). A Quality Assurance Monitoring system is to be developed by which all aspects of the service provided can be assessed and reviewed on a regular basis. This will consequently enable the Registered Persons to verify that the aims of the home are being achieved. The registered provider must undertake an unannounced visit of the home at least every month. A written report of this visit must be provided for the registered manager and, if requested, the Commission for Social Care Inspection. (Previous requirement – timescale of 01/03/06 not met). 4. YA39 24 01/11/06 5. YA41 26 01/08/06 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 YA7 YA11 Good Practice Recommendations The service users’ right to make decisions and choices for themselves should be regularly reviewed. Consideration should be given to reducing the number of shared bedrooms by, for example, making them single DS0000061162.V296584.R01.S.doc Version 5.2 Page 28 Pentrich Residential Home 2. YA33 3. YA37 4. YA42 5. accommodation when vacated by one of the present occupants. The day staffing hours should be reviewed to ensure that the needs of all of the service users can be met on all occasions. The registered manager should achieve a National Vocational Qualification at level 4 in both management and care. Confirmation should be sought in writing from the Fire Safety Officer that they fully accept that the recommendation for double fire doors on the evacuation route is not feasible. Risk assessments for the service users access to unrestricted hot water should be implemented. Consideration should also be given to providing the service user who has mobility problems with a room on the ground floor. Pentrich Residential Home DS0000061162.V296584.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 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. 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