CARE HOMES FOR OLDER PEOPLE
Penwortham Grange and Lodge Care Home Peterfield House Moss Acre Road Penwortham Preston Lancashire PR1 9NJ Lead Inspector
Mrs Marie Cordingley Unannounced Inspection 27th February 2008 10:00 X10015.doc Version 1.40 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 Penwortham Grange and Lodge Care Home DS0000070491.V356419.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 Older People. 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. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Penwortham Grange and Lodge Care Home Address Peterfield House Moss Acre Road Penwortham Preston Lancashire PR1 9NJ 0845 6032558 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) www.orchardcarehomes.com Orchard Care Homes.Com Limited Mrs Lisa Melanie Jayne Kelsall Care Home 86 Category(ies) of Dementia (42), Old age, not falling within any registration, with number other category (44) of places Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - PC, to people of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 44) Dementia - Code DE (maximum number of places: 42) The maximum number of people who can be accommodated is 86. Date of last inspection N/A Brief Description of the Service: Penwortham Grange and Lodge is a large residential home registered to provide care and accommodation for up to 86 people. The home is arranged in two separate units, one providing accommodation for up to 44 older people and the other providing accommodation for up to 42 people who have Dementia. The home is situated in the Penwortham area of Preston. It is located in a residential area and there are a number of transport links, facilities and amenities close by. All accommodation at the home is provided on a single room basis. Residents’ bedrooms are well equipped with en-suite facilities including a shower, television, DVD and a mini fridge. There are four large communal areas as well as four smaller quiet rooms and safe outdoor space for the use of residents. Care is provided on a 24 hour basis including waking watch care throughout the night. At the time of our visit we were advised weekly fees for the home range from £485 to £570. All this information and more can be found in the Service User Guide which is available from the home on request. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating of this service is 1 star. This means that people using this service experience adequate quality outcomes.
The inspection of this home included a site visit which was carried out over one and a half days. During this visit we spent time talking with residents, staff and the registered manager of the home. In addition, we viewed a variety of paperwork including a selection of residents’ care plans and staff training records. We also carried out a tour of the home viewing residents’ bedrooms and communal areas. As part of the inspection we carried out a case tracking exercise, which involved us looking closely at the care provided to selected residents from the point of their admission to the home. Prior to our visit, we wrote to the registered manager and asked her to fill in a very detailed self assessment questionnaire. This questionnaire provided us with a lot of information about the home and its management, and was returned to us within agreed timescales. We also wrote to a selection of residents, their relatives and staff members and asked them to take part in a written survey. As part of the survey, people were asked to share their opinions about various aspects of the service provided. We received a number of completed surveys. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 6 What the service does well:
We received a number of responses to our written survey and the majority were generally positive about the standard of care provided. Residents and their relatives made a number of comments which included; ‘A very good level of care provided.’ ‘Generally, we are pleased with this home.’ ‘All the current staff members are very good.’ Throughout our visit we observed carers providing care and interacting with residents. We noted that carers approached residents in a kind and respectful manner, and residents appeared comfortable and relaxed. Those people who responded to our written survey were generally very happy with the attitude and approach of carers. One relative told us that staff always made them feel welcome when they visited the home. We looked at a number of residents’ care plans and found that the format used by the home is of a very good design. The document is very comprehensive and provides a separate section to assess and plan for each area of need, for example, personal care, mobility and nutrition. If used to its full potential, the system would ensure that carers had a detailed picture of each resident’s care needs and the support they require. The system used for assessing risk to residents in various areas, for example falling or developing pressure sores, is very thorough. There is a dedicated assessment for each area of risk and when a resident is found to be at risk, separate guidance is completed and added to the resident’s care plan. We viewed menus and found that residents are provided with good choice and variety of meals. We were advised by the registered manager that menus have been developed in conjunction with a nutritionist to ensure that residents are provided with a varied and balanced diet. Menus are also adapted seasonally so as to provide further choice and variety. People who live at the home have access to a small kitchen area so that they can help themselves to snacks and drinks at any time. The home is very spacious and has been designed with the needs of older people in mind. There are a number of communal areas within the home as well as safe outdoor space for people to access. Residents all have their own bedrooms which are very well equipped. Each resident has their own en suite shower facility, as well as Sky television, a DVD and mini fridge in their bedroom. The registered manager of the home demonstrates a very positive approach to training and this was reflected by comments made by staff members both in writing and in discussion. One staff member said ‘’ I’ve never worked anywhere where there is so much training, it all helps you to be better at your job.’’
Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 7 There is a comprehensive core training programme in place, which covers all areas of mandatory training such as moving and handling and also includes additional training in areas such as caring for people who have Dementia. At the time of our visit, all the carers were in the process of carrying out a course in Dementia awareness. We were also able to confirm that out of 37 staff members, 30 hold National Vocational Qualifications in care at level 2 or above. The registered manager advised us that she aims to ensure that every carer obtains this qualification in the near future. There are a number of systems in place to assist management in monitoring quality and identifying areas for development. A number of these processes include residents and their representatives. At the time of our visit the registered manager was in the process of holding a meeting for residents and their families. The meeting was well attended and the manager made efforts throughout it to encourage people to express their views and opinions about the home. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? This was the home’s first key inspection since its registration in September 2007. However we carried out a random inspection in December 2007 and identified a number of concerns. We made a number of requirements and recommendations following the random inspection. The management of the home responded positively to the requirements and recommendations we made and provided us with a plan as to how they would address them. We were able to determine during this visit that they had been addressed and as a result, some improvements had been made. This was also reflected in some comments we received from staff, residents and their relatives as part of our written survey. One relative wrote ‘We have noticed a steady improvement at the home over recent weeks.’ Assessment procedures have been improved and only people who have received appropriate training are involved in the process. Managers now ensure that they gain a thorough picture of a prospective resident’s care needs before they are admitted to the home. This means that people moving to the home can be assured it is the right place to meet their needs and that they will receive the support they need straight away. We were able to confirm during our site visit that there was a written care plan in place for every resident which described their care needs and provided guidance to staff in the support people required. In discussion, carers demonstrated a good understanding of people’s needs. Systems for managing people’s medicines have been improved resulting in increased safety for residents. At the time of our visit there were Medication Administration Records in place for all residents requiring help in this area. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 9 What they could do better:
The format used by the home for care planning is very comprehensive and if used to its full potential would mean that carers have a detailed picture of all residents’ care needs and the support they require. However, in the selection of care plans we viewed, some areas had not been fully completed. It is very important that staff are provided with as much information as possible about residents’ individual needs and preferences, so that they can plan and provide their care in a person centred manner. For residents who have more complex needs associated with their behaviour, a separate behaviour support plan is developed. This plan tells carers about the behaviours a certain resident may display and how they should be supported on these occasions. However, some of the plans we viewed didn’t contain accurate, up to date information and in one case, failed to address quite significant issues. It is very important that this information is regularly updated and provides carers with all the relevant information they need to approach challenging situations confidently and consistently. We found that the home had made improvements to systems for managing people’s medicines but identified some areas which require further improvement. Medicines must be given to residents at the correct time as receiving medicines at the wrong time could stop them working correctly. Information on how medicines should be used should form part of the residents’ care plans, particularly for medicines prescribed as “when required”, to ensure they are administered correctly. Medicines must be stored at the correct temperature to ensure they are not spoilt. A legally compliant controlled drug cupboard must be available to store controlled drugs to help ensure they are not mishandled or misused. In response to our written survey and during conversations we held throughout the visit, people told us that they did not feel there are enough activities for residents to take part in. In addition, some people commented that they didn’t think that activities are being provided in accordance with residents’ individual needs and wishes, and that more planning is needed to ensure residents’ activities are person centred. One person whose relative is a resident told us ‘’They just seem to do bingo and singalongs and she hates all that.’’ There have not been any opportunities for residents to take part in trips outside the home since it opened in September 2007. This is despite the fact that the home’s Service User Guide refers to ‘regular trips out to places of interest’ in the home’s customer promise. Whilst we were able to establish that residents are provided with a good variety of food and plenty of choice, we received mixed feedback from people
Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 10 about the quality of food provided. People who responded to our written survey and some of those we spoke to during our visit described meals as ‘’a bit hit and miss’’ and, ‘’sometimes better than others.’’ The mixed feedback we received was discussed with the manager who explained that she had herself identified some issues in relation to the quality of food and as a result, had made some staff changes. The manager told us that she felt that the quality was now improved and would continue to monitor it closely. A common concern raised with us by people we consulted was that of staffing levels. In general, we were told that staffing levels didn’t allow for things like activities, as staff on duty were always very busy providing personal care. One staff member who completed a survey wrote ‘More staff need to be allocated so that we can spend time with residents.’ A relative stated ‘There always seems to be a shortage of staff.’ We discussed this with the manager who explained that as the home was not yet fully occupied, a full staff team was not in place. However, at the time of our visit the manager was in the process of recruiting additional carers for each area of the home. 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. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 11 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 12 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Standard 6 is not applicable to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering a move to the home are provided with enough information to help them make their decision. Carers have a good understanding of people’s needs as soon as they move into the home. This means that people can be assured they will receive the help they need straight away. EVIDENCE: Generally, people we consulted were satisfied that they had received enough information about the home prior to moving in. One person we spoke to confirmed that she had been able to visit the home prior to her move, to have a look around and meet staff and other residents. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 13 A Service User Guide is provided to people considering a move to the home, which gives useful information about daily life and also explains the home’s philosophy of care. We were advised by the registered manager that the Service User Guide is available in a number of formats including large print and audio. The home’s admission procedure has been improved so that enough information is obtained about prospective residents to ensure that their needs can be met and that the home is right for them. At the time of our visit we were advised that only staff who have received training in assessment carry out this process. The home does admit people on an unplanned basis in certain emergency circumstances. However, there are procedures in place to ensure that necessary information about the resident is obtained quickly so that their care can be planned as soon as possible. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 14 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are some gaps in care planning information but carers have an understanding of residents’ needs. Medicines are not always given to residents at the correct times and as a result their health and wellbeing is at risk. EVIDENCE: The home has a good care planning system in place whereby each area of daily need is assessed and planned for. The format is very comprehensive and includes all areas of daily life including personal care, mobility, nutrition and social activities. We found some examples in care plans where good detail had been included to help staff provide care in the way that residents wanted. For example, one resident’s personal care section described how she liked to wear perfume and make up every day.
Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 15 All the staff members we spoke to demonstrated a good understanding of individual resident’s needs. However, we also found some areas of care plans that had not been completed. In one example we looked at, there was no information about the resident’s preferences in relation to social activities and hobbies, despite the fact that this information had been given to the home by the resident’s family. There are good processes in place for assessing the level of risk to each resident in areas such as falling or developing pressure sores. For each area of risk there is an individual assessment which considers all the relevant factors. When a resident is determined as being at a certain level of risk, separate guidance is put in place for carers to assist them in ensuring that the risk is kept to a minimum. In most cases, risk assessments we viewed had been regularly reviewed, although in one example we found that some relevant information had been missed off when the risk assessment had been updated. As part of the inspection a specialist pharmacist inspector looked at the handling of medicines. We looked at the recording of medicines and found records of medicines receipt, administration, disposal and self-medication were detailed and usually accurate, which helps prevent mistakes when handling medicines. We checked medicines records against current stock and found that most medicines could now be easily audited, these checks showed most medicines were usually given correctly, ‘as prescribed’. However our checks did find some mistakes, notably for medicines not contained in the blister system supplied by the pharmacy, and we told the managers about them. Staff had forgotten to replace a pain relief patch for one resident, which would have resulted in reduced pain relief and another resident did not get their morning medicines on the day of our visit. Records showed, and a staff member confirmed, that another resident only got one antibiotic tablet instead of the prescribed two on four consecutive occasions. Failing to get prescribed medicines could seriously affect the health and wellbeing of residents. We looked at the timing of medicines administration and saw that all medicines were given after food, however staff had failed to identify medicines that should be given before food. We gave some advice on how best to organise this as giving medicines at the wrong time can affect the way they work and in some cases increase the chances of side effects. We saw some evidence of formal training for medicines handling and staff had their competence assessed by managers before they were allowed to administer medicines. Regular weekly checks by the managers had identified some mistakes, which they had acted upon to help prevent them happening again. We gave further advice on how to improve the content and recording of these checks to ensure all mistakes are identified. Having good checks helps ensure staff are competent and helps to show whether medicines are being administered correctly.
Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 16 Care plans for medicines prescribed as ‘when required’ were not always detailed enough and not always up to date. One medicine used for anxiety had no information regarding when it should be administered and ‘when required’ medicines used for pain relief and angina were not considered in the care plans. Having clear written plans is important to ensure residents get their medicines only when they need them. We found medicines storage to be secure, clean and well organised. However all of the medicines storage rooms were too warm and one of the fridges was too cold. Storing medicines at the wrong temperature can spoil them and affect the way they work. We looked at how controlled drugs were stored and found they did not fully meet the requirements of law. Records of controlled drug handling were made in a suitable register and the entries we checked were detailed and accurate. Having suitable arrangements for controlled drugs helps prevent mishandling and misuse. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some activities are provided but people are not being provided with activities to suit their individual needs and preferences on a regular basis. People are provided with a varied menu with plenty of choice, however the quality of the meals served has varied at times. EVIDENCE: In response to our written survey and during conversations we held throughout the visit, people told us that they did not feel there were enough activities for residents to take part in. We looked at records of activities and these showed that there were some activities provided, but not on a regular basis. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 18 Some of the residents’ care plans we viewed didn’t contain any information about their preferences in relation to hobbies and activities. In one resident’s case, records showed that their family, during the pre admission assessment, had given lots of information about the things they enjoyed doing, but none of this information had been transferred to the resident’s care plan. This information is essential to ensure that person centred activities that suit people’s individual needs are provided. One relative of a resident told us that the home ‘only did things like bingo and singalongs’ and said that their family member ‘hated all that’. Residents at the home have not been given the opportunity to take part in any trips out since the home opened in September 07. In discussion, the registered manager recognised the need to improve the provision of activities and demonstrated that she had made plans to address the issue. People we spoke to told us that they were able to have visitors at any time and that they were always able to receive their visitors in private. One relative who completed our written survey wrote ‘’We are always made to feel welcome when we visit.’ We received a mixed response from people we consulted about the quality of food provided at the home. Some people told us that the quality of food had varied and on some occasion had been disappointing. One resident described the food as ‘a bit hit and miss’ another resident mentioned that sometimes food was not hot enough when it was served. We discussed this with the manager and she advised us that she herself had identified some issues in relation to the quality of food. The manager explained that the situation had been addressed with catering staff and some changes made to the catering team. We were advised that the situation was now resolved and that the manager intended to closely monitor the quality of meals served to ensure that improved standards were maintained. We viewed a selection of menus which showed a good variety of meals and confirmed that residents are provided with at least three choices for each meal on a daily basis. Menus have been devised in conjunction with a nutritionist to ensure that residents receive a well balanced and nutritious diet. We talked to staff about how they ensured that every resident was given the opportunity to make choices about what they ate. Staff told us that they ensured any residents who may not find a written menu useful, would be shown the different options available and asked to point out the one they would like. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 19 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are processes in place to enable people to raise concerns and to ensure that any concerns that are raised, are dealt with thoroughly and within agreed timescales. EVIDENCE: The home has a complaints procedures in place which is clearly written and easy to understand. This procedure is included in the Service User Guide and also posted in various areas around the home. However, several people who responded to our written survey said they weren’t sure how to make a complaint. This was discussed with the manager who agreed to take additional measures in making people aware of the procedure. The registered manager advised us that the complaint procedure is available in a number of formats including audio and large print. Records of all complaints are made and kept within the home. The manager regularly monitors these, as does the area manager during her visits. We noted that there had been several complaints made since the home’s registration with regards to various aspects of the service.
Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 20 These were discussed with the manager who felt that the complaints had been raised during a difficult time for the home as it was being established and experiencing some teething problems. Records showed that all the complaints received at the home had been dealt with thoroughly, and within appropriate timescales. The manager demonstrated that the complaints had been taken seriously and remedial action had been taken where necessary. All the staff members we spoke to showed a good understanding of Safeguarding procedures and told us that they had confidence in the manager to deal with any such issues quickly and effectively. Staff training records confirmed that all staff have been provided with training in Safeguarding as part of their induction. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 21 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at this home are provided with a good standard of accommodation. EVIDENCE: The home opened in September 2007 and was purpose built in accordance with the needs of older people. It is a very spacious home with a variety of communal areas for people to access including safe outdoor space. All the bedrooms are single and very well equipped. Each resident has their own en–suite shower, flat screen television, DVD and mini fridge. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 22 The home is very well maintained and decorated and furnished to a high standard. However, in discussion with people during our visit there was a general feeling that the environment could be made more homely and the manager advised us that there were plans to address this. In particular, plans are in place to add more items of interest such as pictures and ornaments in the unit for people who have Dementia. At the time of our visit we found all areas of the home to be clean and comfortable. However some people who responded to our written survey told us that they felt standards of cleanliness at the home had slipped at times. In discussion, the manager told us that she was aware of this and had reviewed arrangements to ensure that each area had more domestic staff cover. The registered manager is aware of the Department of Health guidance ‘Essential Steps’ and is in the process of implementing various aspects of this guidance within the home. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People receive their care from well trained staff who have been carefully recruited. Current staffing levels at the home do not enable carers to regularly provide support in areas such as social activities. EVIDENCE: A large number of people we consulted told us that they did not think the staffing levels at the home were adequate. In general people felt that current levels were enough to meet residents’ basic health and welfare needs, but didn’t allow staff to spend time with residents or support them in social activities. We discussed the issue of staffing levels with the manager who advised us that due to the fact that the home was not yet fully occupied, a full complement of staff was not yet in place. However, at the time of our visit the process of recruiting additional staff was underway. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 24 There are thorough processes in place to ensure that only suitable people are offered employment. The manager confirmed that candidates must undergo a series of background checks before they are offered a post within the home. Such checks include a full employment history, a Criminal Records Bureau disclosure and written references. All the staff we spoke to were very complimentary about the training they have received and felt that the training had helped them to develop their skills as carers. There is a comprehensive core training programme in place, which covers all areas of mandatory training such as moving and handling and also includes additional training in areas such as caring for people who have Dementia. At the time of our visit all the carers were in the process of carrying out a course in Dementia awareness. We were also able to confirm that out of 37 staff members, 30 hold National Vocational Qualifications in care at level 2 or above. The registered manager advised us that she aims to ensure that every carer obtains this qualification in the near future. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 25 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager of the home monitors all aspects of the service and is able to identify and address areas that need to be developed. Staff must work in accordance with the home’s health and safety policies to ensure the safety and wellbeing of residents. EVIDENCE: The home’s manager is suitably experienced and qualified and has worked closely with the Commission since the home’s registration. The manager has kept us informed of significant events and has responded positively to requirements and recommendations we have made previously.
Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 26 We were able to determine that requirements and recommendations we made following our random inspection in December 2007 had been addressed and as a result a number of improvements made. This was also reflected in feedback we received from people we consulted. One relative wrote ‘We have noticed a steady improvement at this home in recent weeks.’ There are a number of systems in place to help the manager monitor quality and a number of these systems involve residents and their families. On the day of our site visit there was a meeting going on within the home for residents and their relatives. The meeting was well attended and people were encouraged to express any concerns they had or ideas for improvement. Staff at the home help some residents look after small amounts of money for every day expenses. Records are kept and we viewed these and found them to be in good order. The system for holding residents’ money is well organised and ensures that residents’ money is not pooled and is kept separately. There is a health and safety policy in place which is supported by a number of separate policies and procedures for example fire safety, COSHH (control of substances hazardous to health) and infection control. Training records confirmed that all staff have carried out mandatory health and safety training such as moving and handling and fire safety. In addition, there are systems in place to alert the manager automatically when a staff member is due to take refresher training. During our visit we became aware that there were cleaning fluids and other items that could prove to be dangerous which had been left in an area where residents could access them. This was not in accordance with the home’s procedures and when made aware the manager acted to remedy the situation immediately. However it is important that staff work in accordance with the home’s health and safety procedures at all times. Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 (1) & (2) Requirement Timescale for action 31/03/08 2. OP9 3. 4. OP9 OP9 5. OP8 6. OP12 Residents’ care plans must contain all the relevant information about their individual needs and preferences so that staff are aware of the support they should provide. 13(2) Medicines must be given to residents at the correct time as receiving medicines at the wrong time could stop them work correctly. 13(2) Medicines must be stored at the correct temperature to ensure they are not spoilt. 13(2) A legally compliant controlled drug cupboard must be available to store controlled drugs to help ensure they are not mishandled or misused. 13 (4) (c ) When carrying out risk assessments in relation to individual residents it must be ensured that all the relevant information is taken into account so that risks can be reduced or eliminated. 16 (2) Residents must be provided with (m) & (n) regular opportunities to take part in activities that are in line with
DS0000070491.V356419.R01.S.doc 27/03/08 27/03/08 27/05/08 27/03/08 31/03/08 Penwortham Grange and Lodge Care Home Version 5.2 Page 29 7. 8. 9 OP15 OP27 OP38 their individual needs and wishes. 16 (2) (i) Meals served to residents must 27/02/08 be of acceptable quality at all times. 18 (1) (a) Staffing levels must be adequate 27/02/08 to meet the needs of residents at all times. 13 (4) (c ) Health and safety procedures 27/02/08 must be followed at all times to ensure the safety and wellbeing of residents. 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 OP7 Good Practice Recommendations Behaviour support plans should be regularly reviewed to include all the relevant information staff need to approach challenging situations consistently and confidently. Information on how medicines should be used should form part of the residents’ care plans, particularly for medicines prescribed as “when required”, to help ensure they are administered correctly. Residents’ care plans should include details of their likes and dislikes in relation to hobbies and activities so that activities can be planned in a person centred manner. Residents should be offered the chance to take part in trips outside of the home on a regular basis. There should be more information in residents’ care plans about their dietary needs and preferences so that staff are fully aware of them. Staff should be provided with training in working with people with complex needs. With regards to the unit for people with Dementia, consideration should be given to the environment and how this can be adapted in line with current good practice. 2. OP9 3. 4. 5. 6. 7 OP12 OP12 OP15 OP30 OP19 Penwortham Grange and Lodge Care Home DS0000070491.V356419.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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