CARE HOMES FOR OLDER PEOPLE
Perrins House Nursing Home Moorlands Road Malvern Worcestershire WR14 2TZ Lead Inspector
Y South Unannounced Inspection 27th October 2005 1.45pm 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 Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 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. Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Perrins House Nursing Home Address Moorlands Road Malvern Worcestershire WR14 2TZ 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) 01684 562701 01684 821544 Friends of the Elderly Catherine Henrietta Kenward Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43), Physical disability over 65 years of age of places (43) Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5th July 2005 Brief Description of the Service: Perrins House is located in extensive grounds on the outskirts of Malvern overlooking the common. It was constructed in 1972. The family home (Davenham) and grounds were bequeathed to The ‘Friends of the Elderly’ by Mrs Perrins in memory of her late husband, Mr Dyson Perrins. The ‘Friends of the Elderly’ are a registered charity. Perrins House has well appointed communal rooms that have views across the mature gardens. The home is registered to accommodate 43 service users of either sex. All rooms can be used for nursing care with the exception of those on the lower ground floor. These do not currently have lift access although the installation of one is nearly complete. All bedrooms are for single occupancy and have en-suite facilities. The home is already fitted with two other shaft lifts to facilitate movement between floors. These lifts do not descend to the three bedrooms on the lower floor therefore the occupants of these rooms currently need to be able to negotiate stairs. Mrs Lorna Long is the responsible individual for the registered provider Friends of the Elderly and she is also the Director of Care. Mrs Catherine Thurlow is the Area Manager and Mrs Catherine Kenward is the registered manager of the home. Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place over two hours from 1.45pm until 4.30pm. The registered manager and the deputy manager assisted the inspector. She also spoke to two residents, one visitor and four members of staff. A partial tour of the building and a range of documents were seen. The focus of the inspection was on the recommendations that had been made following the previous inspection, and standards concerned with protection and rights, staffing and quality. A service questionnaire was completed by the home prior to this inspection and returned to the Commission for Social Care Inspection. The manager was asked to distribute other questionnaires regarding the service to residents, relatives and health care professionals. The completion of these is voluntary but proves useful in assessing the various views that are held. Twenty-three responses were received. What the service does well:
Perrins house is a purpose built nursing home that provides a high standard of accommodation for the people who live there. The bedrooms are all single and en-suite. They are attractively maintained and can be furnished either by the occupant or the provider. There are attractive well-furnished communal rooms and a beautifully maintained garden. The staff are well recruited and relate to the residents in a courteous, kindly manner. They receive training, which is kept under review and regularly updated. Positive responses received in the questionnaires that were returned included;
Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 6 ‘We are all very happy here. The staff are excellent. Excellent care. My mother is always clean and spotless. The staff are wonderful, understanding and kind. I am delighted with the care, atmosphere and surroundings. I have never regretted giving up my house to come here. First class nursing care. Nothing but praise for the staff who are generally thoughtful and considerate. Nothing is too much trouble for them. I cannot imagine a pleasanter place to spend ones last years. A very happy and contented home with kind and caring staff. Our lovely garden is appreciated. An excellent nursing home. I am impressed by the standard of care. The staff are considerate and helpful. They cannot be faulted. A beautiful place. I cannot find fault with a single item, we are looked after so wonderfully. I am impressed by the high standards of care I see whenever I visit the home. The staff are respectful and attentive. When I am old this is where I want to go. What has improved since the last inspection? What they could do better:
Two recommendations had been made following the previous inspection. This nursing home shares the laundry that is in its sister home Davenham. This causes health and safety issues relating to infection control and the loads that need to be carried between the buildings. Serious consideration should be given as to how this lack of facility can be addressed. However no action had been taken regarding this. Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 7 It was recommended that more information should be available in care plans to enable staff to support people with their interests and activities without being intrusive. Some of the information has been improved. All care plans should be developed accordingly. Then staff will be more knowledgeable about how they can provide stimulation and support for each individual. 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. Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 8 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 Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed during this inspection. However the residents who spoke to the inspector expressed their appreciation and satisfaction with their choice of home and this was endorsed in many of the questionnaire responses that were received. Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed during this inspection. However the residents who spoke to the inspector expressed their appreciation of the nursing care they received and the kindness and care of all staff. This was endorsed in many of the questionnaire responses that were received. Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed during this inspection. However one recommendation had been made following the previous inspection that the information regarding service users interests and activities should be developed in their care plans and advice be available to staff as to how individuals can be supported. Two care plans were assessed during this inspection. The detail in one document was acceptable but more development was needed in the other. Therefore the recommendation will be repeated. The questionnaire respondents indicated that they considered the home provided suitable activities and two residents said that they were happy with the opportunities they had. One person said that some of the less able residents would benefit from more 1:1 stimulation and support. Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18, The residents’ are able to raise concerns and be confident that they will receive a response. There are systems in place that ensure residents’ legal rights are protected. Residents receive protection from abuse through the training and support staff receive. EVIDENCE: Every resident had received a copy of the complaint procedure in the home’s brochure when they moved into the home. Copies were displayed in the home and the manager confirmed that she spoke to each resident at least weekly. Residents who spoke to the inspector said that they had no complaints and the care they received was excellent. Nonetheless one questionnaire respondent said they were unaware how to make a complaint. The new catering firm had provided a comments and complaints book. It was seen to contain three positive and three negative comments that had been made by residents during October. The manager said that the catering manager went to see everyone who made a comment. Six questionnaire respondents made negative comments regarding the food.
Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 13 No other complaints had been received in the home. However a questionnaire respondent said that they considered that too many decisions were made without reference to the residents. The current residents do not need advocacy services. The manager was advised to obtain information so that it was available should the need arise. All residents were entered on the electoral role although the manager said that there was little interest at election times. All recruited staff were subject to a check of the POVA registered by the Criminal Register Bureau. If concerns arose appropriate action was taken. Staff were supported and received training in recognising and responding to suspicions of abuse of vulnerable people and coping with verbal and physical aggression. Appropriate policies and procedures were available and implemented to provide safe storage for valuables. Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The residents are able to live in a comfortable and attractive home that has the facilities and equipment necessary to meet their needs. EVIDENCE: A partial tour of the home was undertaken. It was observed that the home was maintained and furnished to a very high standard. Work was in progress to redecorate a bedroom, the installation of the third lift to the lower ground floor had nearly been completed, a ramp was being built and a new bathroom installed. Improvements continued to be made to the facilities and provision of equipment. However there has been no progress in addressing the recommendation to improve the laundry facilities, which are currently in a separate building. Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29, 30. Sufficient well recruited and trained staff are available to meet the current needs of the residents. EVIDENCE: The duty roster was seen to be acceptable and there was evidence that vacant shifts were covered to maintain staffing levels. There were currently two care vacancies. However recently three polish staff had been recruited. The records indicated that an acceptable recruitment process had been used and the manager said that they were proving to be an asset to the home. The provider has a strong commitment to training and the records indicate that the provision is well planned and managed. Staff confirmed that they were happy in their work. They felt well supported and trained and were part of a strong team. Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35. Standards are continuously monitored and views obtained so that quality is maintained and concerns are identified and addressed. The management of valuables held in safekeeping works in the best interests of the residents. EVIDENCE: A quality assurance system was in use consisting of monitoring, risk assessments and visits in accordance with the requirements of regulation 26. Residents were asked to complete questionnaires each year and these were analysed by the provider’s head office. Feedback was not given to residents or used to update the views in the Service Users Guide. This was recommended as an area for development.
Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 17 Policies and procedures were regularly reviewed and when necessary amended by the personnel at the head office. Appropriate security and documentation was maintained for valuables held in safekeeping for residents. No health and safety hazards were observed in the areas that were being decorated or where the building work was taking place. Staff confirmed that they received training in fire safety and it was mentioned that some residents were distressed by the need to keep their bedroom doors closed, as these were fire doors. However the manager told the inspector that finance had been identified to fit sonic door closures where required and it was hoped this work would soon commence. Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 18 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 4 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 19 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. Standard Regulation Requirement Timescale for action 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 OP12 Good Practice Recommendations The information regarding service users interests and activities should be developed in their care plans and advice be available as to how individuals can be supported. An improvement in the laundry facilities should be considered. Ideally each home, especially those providing a nursing service, should have independent facilities. It is recommended that a detailed analysis is made available to the residents of the responses received to the annual quality questionnaires and these be incorporated in the Service Users’ Guide to ensure the views are up to date. 2 3 OP26 OP33 Perrins House Nursing Home DS0000004132.V251202.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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