CARE HOMES FOR OLDER PEOPLE
Perth House Care Home Athlone Close Chaddesden Derby DE21 4BP Lead Inspector
Steve Smith Unannounced Inspection 30th January 2006 09:30 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 Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 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. Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Perth House Care Home Address Athlone Close Chaddesden Derby DE21 4BP 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) 01332 717550 01332 717550 Not given Derby City Council Kevin James Jowett Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th May 2005 Brief Description of the Service: Perth House is situated within a residential area of Derby city. It is registered to provide residential care for 39 Older People. All bedrooms are single and are provided across two floors, which are connected by a shaft lift and staircase. A variety of communal areas are provided. A commercial type of kitchen and laundry service the Home. All areas of the Home are accessible to Residents and seating is provided in the Homes garden. The Home has a car park. Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place within 2.5 hours. Discussion was held with the Manager. Records were examined and a tour of the Home took place. What the service does well: What has improved since the last inspection?
All new Residents were now supplied with a statement of terms and conditions of occupancy or contract for staying in the Home. The recording in Residents files had improved. The Manager now ensures that all signature gaps on the Medication Administration Record sheets are followed up by him and a record is made of this on the reverse of the relevant sheet. The Home now has details of the Public Interest Disclosure Act 1998 and the Dept of Health guidance called ‘No Secrets’.
Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 Page 6 The record of complaints was now always available within the Home, and in the Residents Guide, the Residents’ record of the complaints procedure now ensured that they were informed of the timescale within which the Home would seek to address each complaint. Various repairs have been carried out around the Home, and an accurate record is kept of Residents choice of furniture to be provided within their bedrooms. Covered containers have been provided to transport dirty laundry around the Home Residents clothing is now appropriately marked with their names The Registered Providers now ensure that the Home is ‘inspected’, by their representatives, and an unannounced basis at least once a month. The requirements laid down by the Environmental Health Officer in 2004 have now been addressed. What they could do better:
The Residents Guide did not contain information on the Home’s physical environment standards, and whether or not they were met. The Residents Guide also did not contain all necessary required information. Each Resident’s file or Medication Administration Record sheet should contain a photograph of the Resident. Whenever Residents needs were formally reviewed a record needed to be made of the Resident’s rights to choice, freedom and decision making. Before new Residents moved to the Home the Registered Providers needed to provide a statement to prospective Residents to say that the Home was able to meet the Resident’s needs in respect of their health and welfare. The Manager said that staff still did not knock upon able Residents doors before entering their bedrooms. The Registered Providers and Manager were encouraged to meet the staffing levels suggested by the Residential Forum. To complete the quality assurance issues within the Home the Manager needed to include the views of relatives, GPs, District Nurses, Chiropodists, etc, on how well the Home was achieving goals for the Residents. A number of staff required training. The Manager needed to obtain information on the Management of Health and Safety at Work Regulations 1999, the Workplace (Health, Safety and Welfare)
Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 Page 7 Regulations 1992 and the Provision and Use of Work Equipment Regulations 1992. Finally, the Manager should complete risk assessments on all practice issues undertaken by catering staff and domestic staff. The Manager was also recommended to provide a written statement of the policy, organisation and arrangements for maintaining safe working practices in 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. Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 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 Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 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): Standard 1 The Registered Provider’s Residents Guide was not appropriately completed, and therefore did not meet the Residents needs or provided all of the relevant information on the Care Home. EVIDENCE: This Standard was not inspected on this visit to the Home. However, the Manager said that the Home’s statement of purpose contained the details of the physical environment Standards but these had not been summarised within the Residents Guide to the Home. Similarly, the Manager also said that Residents Guide had not been completed, in line with Regulation 5 and Standards 1.2 and 1.3. Standard 6 does not apply to this Home. Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 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): Standards 7, 8 & 10. The Residents plans of care did not meet the standards laid down by the Regulations governing the Home. However, health care records were addressing the needs of all Residents. EVIDENCE: Standard 7 was not examined during this inspection of the Home. However, while reviewing the Requirements of the last inspection it became apparent that the Registered Providers and Manager had not completed all of the items required in that section of the report: A photograph was still needed for each Resident’s file or Medication Administration Record sheet. This item should have been addressed from the inspection report dated 27 July 2004. The Manager had not discussed with the Residents or their relatives the limitation of each Resident concerning their ability to make choices, have freedom of movement around the Home, or their ability to make Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 Page 11 decisions. This item should have been addressed from the inspection report dated 18 October 2004. The Registered Providers were found to be still not providing information to prospective Residents, in writing, to say that the Home would be able to meet their needs in respect of their health and welfare. This item was also outstanding from the inspection report dated 18 October 2004. Staff of the Home were appropriately maintaining the records of Residents health needs, which included a record of meals provided for each Resident. Standard 10 was not examined on this visit to the Home. However, while reviewing the Requirements of the last inspection it became apparent that the Manager had not addressed the issue of staff inappropriately entering able Residents bedrooms. Staff still did not knock and await a response from the Resident before entering their bedroom; they simply knocked, paused and entered. The Manager said this still was an issue within the Home. Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 Page 12 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): These Standards were not examined during this inspection of the Home. EVIDENCE: Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 Page 13 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): These Standards were not examined during this inspection of the Home. EVIDENCE: Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 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): These Standards were not examined during this inspection of the Home. EVIDENCE: Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 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): Standard 27 The Registered Providers were not providing sufficient care staffing, when compared to the Residential Forum, to meet the assessed needs of Residents. EVIDENCE: Staffing provided in the Home was compared with the details provided by the Residential Forum. The three weeks, beginning the 9 January to the 23 January 2006, were examined. This showed that weekly care staffing for day and night shifts was provided at 507 hours, 517.75 hours and 542 hours respectively. The Residential Forum figure for staff time provided at the ‘Low Dependency’ level for 39 Residents was 659 hours each week. This meant that the Registered Providers were providing between 117 hours and 152 hours less than the figure recommended by the Residential Forum. If some Residents fell within the ‘Medium Dependency’ level then the staffing provided would be even less favourable. The Manager’s time was not included within this calculation, as recommended by the Residential Forum. Staff induction and foundation training was provided for all new staff that came to work in the Home. The Manager also said that all care staff were provided with at least three paid days training a year. All staff also had an individual training and development assessment and profile. Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 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): Standard 31, 33, 35 & 38. The Manager was appropriately qualified and the Registered Providers regularly ensured that the Home was inspected, to ensure good standards were maintained for Residents. The Home also met the Quality Assurance issues that ensured Residents’ care was maintained at a positive standard. EVIDENCE: The Manager was able to say that he had completed his training to NVQ level 4 in Management and Care. It was also found that the Registered Providers ensured that the Home was ‘inspected’ on at least a monthly basis, reporting any concerns to the Manager. The work undertaken by the Manager to meet the Quality Assurance standards was examined. It was found that the Home had an annual development plan, and Residents had been surveyed and took part in Residents’ Meeting and Amenities Meetings. The Manager said that staff would be able to demonstrate
Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 Page 17 a commitment to lifelong learning for each Resident, although the views of family, friends and stakeholders, such as Doctors Nurses etc, were not sort on how well the Home was achieving goals for Residents. A small amount of Residents money was kept in the Home for everyday expenditure. Records of these were examined. Money were appropriately stored and securely held. Records were kept, and a sample of these was examined, and found to be satisfactory. The training provided for staff was examined. This showed that the Registered Providers had ensured that all care staff had received the three yearly training in Moving and Handling. Fire Safety training was also examined and it was found that 5 members of staff had not received the required amount of training. All but 4 staff were qualified in Fire Aid, but all senior staff and night staff needed to become qualified as First Aiders. It was found that 10 staff were due for refresher training in Food Hygiene. It was also found that all staff required training in Infection Control. All Residents had been risk assessed to determine their vulnerability and measures had been put in place to provide protection where necessary. The Manager said that the Home did not have information on the Workplace (Health, Safety and Welfare) Regulations of 1992 or the Workplace (Health, Safety and Welfare) Regulations of 1992, or the Provision and Use of Work Equipment Regulations of 1992. Risk assessments had been carried out for all safe working practices in the Home that related to the care staffs tasks. However, this was also needed for catering and domestic staff tasks. The Manager said that he had not provided a written statement of the policy, organisation and arrangements for maintaining those safe working practices. The Manager ensured that all accidents, injuries and incidents of illness or communicable disease were recorded and reported to the relevant government bodies. He also had ensured that fire safety notices were posted in relevant places around the Home. Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 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 2 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 2 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? Yes 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 The statement of purpose contains information on the physical environmental standards but this has not been summarised in Residents Guide. (This issue should have been addressed from the inspection report dated 18 October 2004) The Registered Providers must complete the Residents Guide as laid down in Regulation 5 and Standard 1.2 and 1.3. (This issue should have been addressed from the inspection report dated 18 October 2004) A photograph of each Resident must be available in each Resident’s file. (This issue should have been addressed from the inspection report dated 27 July 2004) Each file must contain details of the limitations placed on Resident, as agreed by each Resident or their representative, on the Resident’s ability to make choices, their freedom of
DS0000036250.V281946.R01.S.doc Timescale for action 1 OP1 4 27/03/06 2 OP1 5 27/03/06 3 OP7 17 & Sch. 3 27/03/06 4 OP7 17& Sch. 3 27/03/06 Perth House Care Home Version 5.1 Page 20 5 OP7 14 6 OP10 12 7 OP33 24 8 OP38 23 9 10 OP38 OP38 13 & 18 18 11 OP38 18 movement inside and outside the Home and their ability to make decisions. (This issue should have been addressed from the inspection report dated 18 October 2004) Each Resident’s file must contain information from the Registered Providers to say that the services provided in the Home are suitable to meet the Resident’s assessed needs in respect of their health and welfare. (This issue should have been addressed from the inspection report dated 18 October 2004) The Manager must ensure that staff are aware of the need to knock and await a response from the Residents before entering bedrooms. The Manager and care team need to decide which Residents this must apply to, given Residents differing abilities. An effective quality assurance and quality monitoring system must be introduced, to ensure that the views of Residents’ relatives, GPs, District Nurses, Chiropodists, etc are obtained on how the Home is achieving goals for Residents. The Registered Providers must provide Fire Training for the five members of staff without this qualification. The 4 members of the care staff, identified during the inspection, must receive training in First Aid. Food Hygiene training must be provided for the 10 member of care staff needing this. The Manager must ensure the services provided by the Home comply with the Management of Health and Safety at Work
DS0000036250.V281946.R01.S.doc 27/03/06 27/03/06 31/05/06 31/05/06 31/05/06 30/06/06 27/03/06 Perth House Care Home Version 5.1 Page 21 12 OP38 13 & 18 Regulations 1999, the Workplace (Health, Safety and Welfare) Regulations 1992 and the Provision and Use of Work Equipment Regulations 1992. The Manager must provide risk assessments on all working practice issues undertaken by catering staff and domestic staff. 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP1 Good Practice Recommendations The Registered Providers and Manager should make available to Residents, and their families, information on how to make contact with the local Health Authority. (This issue should have been addressed from the inspection report dated 18 October 2004) The Registered Providers should provide day care and night care staffing at least in line with that required by the Residential Forum. This figure is not to include the Managers working time. (This issue should have been addressed from the inspection report dated 18 October 2004) Sufficient senior members of staff should be trained as First Aiders to ensure that at least one First Aider can be on duty, on each shift, both day and night. The Manager should ensure that all necessary staff receive training in Infection Control. The Manager should provide a written statement of the policy, organisation and arrangements for maintaining safe working practices in the Home. 1 2 OP27 3 4 5 OP38 OP38 OP38 Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Perth House Care Home DS0000036250.V281946.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
