Inspection on 03/06/08 for Pentrich Residential Home

This inspection was carried out on 3rd June 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 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 04/12/07

Pentrich Residential Home 13/06/07

Pentrich Residential Home 29/06/06

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 28/09/2008.

CARE HOME ADULTS 18-65 Pentrich Residential Home 13 Vernon Road Bridlington East Yorkshire YO15 2HQ Lead Inspector Anne Prankitt Key Unannounced Inspection 3rd June 2008 09:30 Pentrich Residential Home DS0000061162.V365932.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.V365932.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.V365932.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 Post Vacant 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.V365932.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th December 2007 Brief Description of the Service: Pentrich is registered to provide accommodation and personal care for a maximum of thirteen adults who have a mental health problem. 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 restricted on-road parking. The property has three floors with accommodation located on two floors. The accommodation consists of five shared bedrooms and three 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 people who smoke, are located on the ground floor. The property does not have a passenger lift so is only suitable for people who are fully ambulant. On 3 June 2008 the manager said that the weekly fees are £272.80. People pay extra for chiropody, hairdressing and toiletries. Information about the home is available in the Statement of Purpose if people want to see it, as is the most recent inspection report. Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The key inspection included a review of the following information to provide evidence for this report: • • Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told how the registered person and manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Comment cards from ten people living at Pentrich, and three family members. A visit to the home by one inspector, lasting for seven hours. • • During the visit to the home, six people who live there, two staff and the manager were spoken with. Three people’s care plans were looked at, as well as two staff files, some policies and procedures, and some records about health and safety in the home. Care practices were observed, where appropriate. Some time was also spent watching the general activity to get an idea about what it is like to live at Pentrich. The new manager and his assistant were available throughout the day, and regular discussion took place with them during the course of the visit. They were provided with feedback at the end. What the service does well: Staff know people well. They know what their needs are, and in what situations people may find themselves at risk. Because of this, the information they write and discuss about people is good, because it is very individual and personal to that person. People said ‘I am very happy’, ‘The girls who work here are quite good to everyone’ and ‘I am very happy here. I get on well with all staff’. A relative said that the home ‘Takes good care of residents’. Another said ‘I think Pentrich is to a very high standard and very kind to all the residents.’ People are treated as individuals, and their care and support is planned to reflect this. This helps people to maintain their individuality and independence. They said ‘Really we’re a happy band of people’, ‘I’m quite content. I like helping the staff’, ‘We’re fine here. We help each other out’, and ‘I’m quite happy’. Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 6 People are supported to get healthcare when they need it. A family member said when their relative was unwell the staff were ‘brilliant’, taking the person to and from appointments. Staff said they would take complaints, or concerns about people’s welfare, seriously. They said they would let someone know about any concerns so they could be dealt with. A relative said ‘The staff are always helpful and if any problems I can approach them’. Opportunities for people to maintain links with the community in employment, leisure, and social activities are not overlooked. This helps to make people’s life more fulfilled. Where limitations are placed on people’s freedom because of risk to their welfare, staff try to look at other ways to make their life more fulfilled. What has improved since the last inspection? What they could do better: Risks to people, and any restrictions in their lives, could be regularly reviewed with them, and the outcome recorded. This would give people confidence that their rights and choices will not be overlooked. To reduce the risk from error, an agreement could be reached with visiting health professionals that they will record at the home when they have given someone medication which is stored there for them. Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 7 The option of screening could be available to people who share their bedroom, so that they have more privacy if they wish it. People need to know that the routine is now more flexible and that they can access all areas of the home, and request drinks and snacks, at any time, unless there is good reason to the contrary which has been assessed, explained and recorded in their care plan. The manager should think of ways in which staffing can be organised so that opportunities for people to attend social events away from the home, including evening events, become more of a regular possibility. A relative reflected this when they said ‘I think it’s ok as it is but maybe a bit more time and staff to take the clients out more’. People like the food, but their request for more fresh fruit and vegetables should be taken into account. The smoking room could provide adequate heating so that it is a comfortable place to sit at all times of year for those people who choose to use it. In addition to the above, now that the manager is in post, he needs to organise what he has responsibility for, then prioritise how he will manage his workload. This way, slippages in timescales are less likely to happen. He needs to make sure that he gets things done first which, if left, would impact on people’s health and safety. For instance, staff need regular staff training which they are required to have by law, and the requirements of other regulators, for instance the fire authority, need to be considered. He also needs to get the views of people with an interest in the home, so that it improves and develops in line with their feedback. This will help to make sure that Pentrich is run in the best interests of the people who live there. 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. Pentrich Residential Home DS0000061162.V365932.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.V365932.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 People who use the service experience adequate outcomes in this area. People admitted in the future should benefit from the better admission procedures that are now in place. But the Statement of Purpose does not give people a true account about what the service does and does not provide. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Some improvements have been made to the Statement of Purpose, but more are needed to give people a better idea about what Pentrich provides. For example, it states that there is a call bell system throughout the home when, in fact, there isn’t. Five of the bedrooms are shared, and privacy screens are not available. People also need to know this sort of information, because this arrangement may not be acceptable to them. And details about the manager are incorrect. Despite these shortfalls, eight out of ten people said that they got enough information about the home before they moved in. The latest admission took place last year, and was made in an emergency. There appeared to be some delay between the admission being made, and the person’s care plan being drawn up. However, the new manager demonstrated that he would take the right steps before any future admission took place. This included getting information from the person themselves, and professionals involved in their care. This will help to make sure that the home can meet their needs, and will help staff draw up a good quality care plan with the person when the person moves in. Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 10 The manager thought he may wait until after people have moved in to give them their service users’ guide. It would be better for people to have this information beforehand so that they can read about the home at their leisure, before deciding whether it is the right place for them. Pentrich Residential Home DS0000061162.V365932.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People who use the service experience good outcomes in this area. Staff understand the importance of consulting people about decisions which affect their lives. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People’s comments included ‘I am very happy’, ‘The girls who work here are quite good to everyone’ and ‘I am very happy here. I get on well with all staff’. A relative said that the home ‘Takes good care of residents’. Another said ‘I think Pentrich is to a very high standard and very kind to all the residents.’ People knew that they had a key worker. They said that they discussed their care plan with them regularly. Staff demonstrated that they understood people’s needs well, and that giving them choice was important. Staff had taken time to express people’s strengths, and where they needed support, when writing the care plans. This made the plans very individual. Areas of risk were documented, and the reasons why limitations were placed upon people’s freedom were explained. One person said that they would like to go out on their own more, but people do sign to say that they agree with decisions made where restrictions are in place to protect them. When the care plan is reviewed Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 12 each month, staff need to record that they have reviewed these limitations and risks to individuals. This will show that they have been discussed, agreed, and remain applicable, and will help to show that people remain involved in decisions about their care. A detailed review of long and short term goals takes place six monthly, along with reviews from the placing authority. Following a care management review, a care manager had recorded positively about how the person’s mental health had stabilised since living at Pentrich. The manager knows that there are advocacy services in the area. One such service has provided financial advice to one person about their benefits. It would be good practice to provide information to everyone living at the home about these services, so that they can ask for independent advice should they ever need it. Some people choose to manage their own finances, whilst others have help from the staff who keep money on their behalf. Staff keep records of the incomings and outgoings of individual’s monies. There has been a recent burglary, and people’s money was stolen. The manager said that they have held a meeting to inform people about this. The registered provider is claiming against his insurance, and will be reimbursing people. Pentrich Residential Home DS0000061162.V365932.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 People who use the service experience good outcomes in this area. People are supported to remain independent, maintain family relationships, and meet their social aspirations. But their lifestyle could be more flexible if they were informed about relaxations in the house rules. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People attend individual and group activities to help meet their social interests. One person has paid employment, and also does charity work. They said that they are well known in the community, and that they like having these links. Another person attends dance lessons, and is looking for new social interests. Staff said they will help the person pursue these. One person attends religious meetings outside the home. This was very important to them. They said that staff read passages from the Bible to them each night. Regular meetings are organised, and trips outside the home are being considered based on people’s requests. People were looking forward to a picnic the following day, and some talked about the plans for a caravan holiday in September. People choose what activities they want to take part in. Although Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 14 one said this comprised mainly of television, radio and bingo, they said ‘Really we’re a happy band of people’. Others commented ‘I’m quite content. I like helping the staff’, ‘We’re fine here. We help each other out’, ‘I’m quite happy’. Not everyone has total freedom to come and go from the home alone. One person spoken with accepted that other arrangements were in place to make sure that they still had opportunities to join in community activities. Some people and staff thought that staffing numbers could be increased so that people who cannot leave the home alone have more opportunity to go to community events. The manager is considering ways to overcome this, such as providing extra staff when activities have been planned ahead, including the introduction of evening activities. People are encouraged to keep in touch with their friends and family. A family member said that their relative can ring them at any time if they wish to do so. Another said that the staff help their relative to write letters to them. People said that there are few house rules. They know they can only smoke in the designated smoking room, and accept this. However, people tend to go to bed by 10pm, and felt that they should not ask for a cup of tea before 6.30am the following morning. They think that this is a house rule. The manager and his assistant said that the majority of people have lived here for some time. They said that the routine of the home has become much less institutionalised and more flexible since their admission, and that this is no longer the case. People should be reminded that Pentrich is their home. As such they should be informed that they have the freedom to access all areas, and to request drinks and snacks at any time, unless there is good reason relating to their care as to why not. This restriction should be documented within their care plan and agreed with them. People said that they liked the food overall, although they said there was not enough fresh fruit and vegetables provided, and they would like more. The manager has taken note of this. There were no fresh vegetables on the premises on the day. The staff said mainly frozen vegetables are used. There is a set menu which has been planned taking into account people’s views. Although there is no advertised choice, people were satisfied that they could ask for an alternative if they wanted to. One person had dietician involvement, and another person was being monitored by the home and other health professionals because they had lost some weight. Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People who use the service experience good outcomes in this area. People receive personal and healthcare support in an individual and respectful way. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People were confident that staff knew where they needed help with their care. This was documented in their care plan, along with a record of the input provided by outside professionals, such as the community mental health team, General Practitioner, chiropodist and optical services. This helps to make sure that their health care is maintained. There were emergency specialist support plans in place where appropriate, with numbers for staff to contact should people’s mental health suddenly deteriorate. A family member said when their relative was unwell the staff were ‘brilliant’, taking the person to and from appointments. The people who live at the home are getting older. This has been recognised, and staff are having training about the ageing process, and palliative care. This will help them to understand people’s needs better as they age. People said that staff respected them, and afforded them privacy and respect. Staff explained how, in the past, they have helped people maintain intimate Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 16 relationships safely, and with support from the appropriate community specialists. The staff look after everyone’s medication on their behalf. This is documented in their care plan. Staff have received distance learning training so they know how to look after medication safely. The records seen were kept up to date, and they tallied with the stock remaining. There has been a recent burglary at the home. Because some visiting professionals do not sign the medication charts when they have administered certain medication, staff were not sure at the time whether any medication had been stolen or not. This needs further discussion with the health professionals concerned. The manager must be able to account for all medication that enters and leaves the building. Because of the burglary, temporary storage arrangements have had to be used. These were not secure. By moving things round, the manager was able to make the arrangements better. But he has now contacted the supplying chemist for proper advice about how medication should be stored. He has informed us since our visit that more suitable storage facilities are being provided by the chemist concerned. This will keep people’s medication safer. Pentrich Residential Home DS0000061162.V365932.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience adequate outcomes in this area. People are confident that their complaints are taken seriously. Staff training around safeguarding and restraint is needed so people can be confident that they will act correctly and consistently should an incident occur where people need protection. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People were satisfied that their ‘grumbles’ or complaints would be listened to and acted upon if they raised them with staff. Although one relative did not know how to complain, they said ‘The staff are always helpful and if any problems I can approach them’. There have been no complaints made to the home or to the Commission for Social Care Inspection during the period since the last inspection. There is a complaints and suggestions box for people to use. The complaints procedure has been included in the Statement of Purpose. However, this document wasn’t on display. This was put right on the day. Staff knew that they must take complaints seriously. One said that she would tell the manager if a complaint was made to her so it could be dealt with properly. Staff spoken with also knew that they must tell someone straight away if they thought, or were told, that a person at the home was not being treated properly. They knew they couldn’t keep this information to themselves. However, only the manager knew that allegations should be reported to social services for investigation. None of the staff have attended safeguarding training about the protection of vulnerable adults. The manager and his assistant are attending training provided by the local authority in July. Some staff have signed up to do training after this. This training should not be Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 18 optional, and should be undertaken by all staff. In addition, the manager should get a copy of the local authority guidelines about the protection of vulnerable adults straight away, so he can be confident that he is working in line with their policy and supporting them in their responsibilities in safeguarding people. There have been no plans put into place to provide staff with training in restraint. This issue had been identified as a shortfall at the previous inspection and has still not been addressed. The manager needs to get this training organised so that if staff are faced with behaviour which challenges them they can be confident that they are acting in a safe and consistent way, in line with the policy of the home, and within the law. Pentrich Residential Home DS0000061162.V365932.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25 and 30 People who use the service experience adequate outcomes in this area. Planned improvements to the service are in the early stages, but should improve people’s living arrangements in the future, especially if their views are taken into account. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People said that the home was convenient for the local amenities. It is situated on a residential street with limited parking. There is a small patio area at the rear of the building with seating. People are hoping to have a barbeque outside when the weather gets warmer. A cleaner is employed to work five days each week. Seven people said in their surveys that the home is always fresh and clean. The remainder said that this was usually the case. One said that it was better once the toilets had been cleaned. The home looked generally clean and tidy, although the flooring in the toilet areas will be easier to keep clean once the new flooring is laid as planned. There were no unpleasant smells in the building. Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 20 The registered provider recognises that improvements are needed to the environment. Some are in the process of being planned and delivered. New carpeting and seating has been provided in the no smoking lounge, a bedroom has been decorated, and the stairways have been redecorated and fitted with new carpet. The skylight on the top floor needed repair. It had let in rain, which had spoiled the newly painted walls. The manager explained that the new shower on the top floor will soon be fitted, and washable flooring has been purchased for the toilet areas. People said that they are pleased that the décor in the house is being improved, and their recent meeting discussed how they would get the opportunity to help decide on colour schemes. The manager did not have a formal programme of refurbishment to refer to. But the registered provider now documents his visits to the home, when he makes reference to the planned improvements. A set programme of works would assist in making sure that the timetable did not fall behind. Five bedrooms provide shared accommodation. There are no privacy screens provided. Although nobody raised this as a problem, thought should be given as to how people’s privacy can be improved. People who use the smoking lounge say that the room is not warm enough in cooler weather. They said that the gas fire has not worked for some time. The heating needs to be put right so that all areas of the home are comfortable for people to live in at all times. The fire officer visited at the end of 2007, and required that better arrangements had to be made so that the final exit door could be opened without delay in the case of fire. The action taken does not meet fully with his initial requirement. But a senior staff member said that he had agreed that the action taken was satisfactory. Due to the recent break in, the registered provider is looking at how the home can be made more secure. This may include the use of CCTV cameras which will be restricted to entrance areas only. There is a separate laundry situated away from the kitchen area. This had been left unlocked, and there were chemicals in the room which were not locked away This poses unnecessary danger to people. A senior staff member said that the room was normally locked. She locked the door at the time. This must be kept locked when not in use. Pentrich Residential Home DS0000061162.V365932.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 and 35 People who use the service experience adequate outcomes in this area. Available past information identifies poor outcomes for people with regard to staff recruitment and training. But the commitment to improve in this area will help to make sure that people are cared for and protected by staff who are properly recruited and trained in the future. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Two care staff are available at all times of day. The manager works in addition, and a cleaner and cook are also employed. During the night there is one waking staff, and one on call member of staff who sleeps in the building. People living at the home and staff thought it would be beneficial to have a third staff member sometimes. A relative reflected this when they said ‘I think it’s ok as it is but maybe a bit more time and staff to take the clients out more’. The manager is seeing if this can be achieved so that more regular trips outside the home can be planned. This will be of great benefit to people who have been identified as being unable to leave the home without supervision. It will also provide opportunities for people to attend social events with staff outside the home during the evening. There have been no new starters recruited since the last key inspection. The most recent recruitment file looked at identified that the staff member had Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 22 been allowed to work with people before any references or police checks had been returned. These had been received subsequently. The manager knew that this is poor practice, and explained what steps would be taken before any further staff members are recruited. He must remember that only in extreme circumstances may staff begin to provide care before the Criminal Records Bureau check has been returned. Where they are deployed on the strength of the POVAFirst check, they must be supervised at all times. He realised that this would be very difficult to put into practice. Therefore any future recruitment and subsequent supervision must be carefully planned so that people are properly protected. The manager has obtained the full ‘Skills for Care’ induction pack so that new staff learn about good care straight away. There is a rolling programme in place for current staff to achieve National Vocational Qualifications in care. This training will help support them in providing good care. Supervision sessions for staff have fallen behind, because the manager has had other priorities since taking up post. He plans to get these back on track. This will help him to inform staff about the changes that are planned for the home for the benefit of people. It will also highlight training needs. The manager recognises that mandatory training needs to be arranged. This must be given priority. Staff however are enjoying the training opportunities that are being provided. Some are completing palliative care training, after which they will move on to infection control training. One staff member said they would soon be doing some training about the ageing process. This is good, because the population of the home are all over 55 years. The manager has also approached the college to see if training in mental health awareness can be organised. This would give staff better insight and understanding about people’s conditions, and should be pursued. Pentrich Residential Home DS0000061162.V365932.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 People who use the service experience adequate outcomes in this area. The manager is aware of what has to be done to improve outcomes for people, but needs a more structured development and audit plan to assure good outcomes for people will be achieved and maintained. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The registered provider has shown some commitment in working with us. Since the last key inspection, he has sent us a completed self assessment, an improvement plan, and other information to tell us what he is doing to make the service better for people. He has also recruited a new manager. The new manager stated that he is a mental health nurse, and has experience of working in hospital settings. This is his first management post in this type of service. He stated that he is studying towards a management qualification. He needs to make an application with the Commission for Social Care Inspection so that he can become registered manager at Pentrich. The manager Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 24 recognises that there is a lot to do at the home, especially around staff training, to make sure that the home is run in people’s best interests with regards to their health and safety. The provision of mandatory training must take priority, and must be completed as soon as possible. He and the registered provider explained in their improvement plan what action they intend to take to achieve this. For instance, the registered provider has just completed a train the trainer course, so he is able to give staff training about general health and safety. Before the site visit, the manager had contacted the fire service to arrange fire safety training which was overdue, but had not secured any dates. He was asked at the site visit to make sure that this was followed up straight away. He has told us since that fire training has now been organised, and will be undertaken by all staff in July. This training must be kept up to date in the future, so that staff take the right action should a fire break out. None of the staff have moving and handling training. This is not seen as a priority by the manager because the people living at the home are mobile, and do not require any assistance. However, this training must also be given so that staff work in a safe way and in line with the law. Once the necessary mandatory training has been set up, the manager should develop a training and development plan, so that staff skills can be kept maintained and training up to date. Staff said that the home has been managed by a number of different people. This was evident when looking at the numerous auditing systems which have been used over time. Despite these management changes, staff and people living at the service remained positive, and were satisfied with the support and input that the new manager offers. Staff thought that the manager ‘would be good for the home’, that he was ‘supportive’, and that they would speak to him if they were not happy. The manager needs to focus on developing his own clear systems of audit so that the process of monitoring how the home is progressing becomes clear and effective. This will help him to get a better overview of where the service needs to improve, and where it is doing well. Meetings have been set up for people who live at the home. Their views are sought and discussed, and they talk about general issues within the home. For instance, one person was able to explain what action they have to take if the fire alarm goes off. Surveys are not currently sent to people, their relatives, or professionals in the community who support them. This should be introduced, to give a wider range of people the opportunity to comment on the way the home operates for the benefit of the people who live there. The results should then be published, so everyone can see what action is being taken in response to their collective comments. A sample of service certificates looked at were up to date. There was no certificate available to show that the fire alarm system has been serviced. The Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 25 manager agreed to look into this, and has now provided dates by which this work will be completed. He also intends to complete an up to date fire safety risk assessment for the home following the advice of the fire safety officer, because the information currently available is confusing. The cook was on holidays. Care staff cooked for people in her absence. When staff fill in the checks required by the environmental health officer, they need to make sure that they keep a record to show that food is being served at a safe temperature to reduce the risk from food poisoning. These were missing in several places. Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 26 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 2 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 1 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 1 X Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 27 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 YA23 Regulation 13(7) Requirement The registered person must ensure that staff receive training in the use of restraint techniques. Timescale of 31/01/08 not met Professionals visiting the home to administer medication must be consulted with to organise a better system of communication about what medication received into the home previously has been administered. A clear record must be kept of when it was administered and by whom, so that the stock record is correct. This will help to prevent avoidable errors in administration and auditing. The smoking room must provide adequate heating so that it is a comfortable place to sit all times of year for those people who choose to use it. Quality assurance systems and self monitoring systems must be developed, including: • Pentrich Residential Home Timescale for action 31/07/08 2 YA20 13 30/06/08 3 YA24 23 31/07/08 4 YA39 24 31/08/08 Formally seeking the views Version 5.2 Page 28 DS0000061162.V365932.R01.S.doc • of people living at the home, their relatives, and visiting professionals on a periodic basis, to see what the home does well, and where it needs to improve. Regular management audit and overview of systems and practice, such as care plans, medication, staff training and people’s finances. 5 YA42 13 6 YA42 13 7 YA42 23 The information should be used when deciding upon future plans for the home based on people’s feedback, so that it is run in their best interests. Training must be organised in 31/08/08 moving and handling so that all staff know how to work in a safe and lawful way when assisting people. When staff fill in the checks 03/06/08 required by the environmental health officer, they need to make sure that they keep a record to show that food is being served at a safe temperature to reduce the risk from food poisoning. A fire safety risk assessment 31/07/08 must be completed so that any areas of risk to people can be clearly identified, and action taken. 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 YA1 Good Practice Recommendations The Statement of Purpose should be amended to make sure that anyone reading it gets clear information about DS0000061162.V365932.R01.S.doc Version 5.2 Page 29 Pentrich Residential Home who runs the home, and what it does and does not provide. People should get a copy of the service users’ guide before they are admitted, to help them make an informed decision about whether it is the right place for them to live. People’s right to make decisions and choices for themselves should be regularly reviewed and recorded. This would help to ensure that as far as possible people are making decisions and leading their lives, as they would wish. Thought should be given to how staff are deployed so that: people assessed as unable to leave the home have more opportunities to do so accompanied. • more evening events can be organised for everyone. People should be informed that they have the freedom to access all areas of the home at all times, and that access to drinks and snacks are not restricted, unless there is good reason relating to their care as to why not. Any restrictions should be documented within their care plan and agreed with them. People should be provided with a regular supply of fresh fruit and vegetables in accordance with their wishes and preferences. The registered person should ensure that to assist in the safeguarding of people, all staff are trained in ‘Safeguarding Adults’ procedures. The option of screening should be available to people who share their bedroom, so that they have more privacy. So that staff have a better understanding about specific conditions, plans to access training in mental health awareness should be pursued. A staff training and development plan should be devised so that the manager can see which staff need training, and when. This will help to make sure that training does not fall behind, so that staff give people care which meets their needs in a safe way, and which complies with the law. • 2 YA6 3 YA13 YA33 4 YA16 5 6 7 8 9 YA17 YA23 YA25 YA32 YA35 Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Pentrich Residential Home DS0000061162.V365932.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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