CARE HOMES FOR OLDER PEOPLE
Petteril House Lightfoot Drive Harraby Carlisle Cumbria CA1 3BN Lead Inspector
Marian Whittam Unannounced Inspection 18th February 2009 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 Petteril House DS0000036543.V374163.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. Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Petteril House Address Lightfoot Drive Harraby Carlisle Cumbria CA1 3BN 01228 606393 01228 606402 petteril.house@cumbriacc.gov.uk www.cumbriacare.org.uk Cumbria Care 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) Mrs Helen Harrison Care Home 38 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (37) of places Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 38 service users to include: up to 38 service users in the category of OP (older people not falling within any other category) up to 17 service users in the categroy of DE(E) (Dementia over 65 years of age) Two service users may share a bedroom of at least 16 sqm usable floor space only if they have made a positive choice to do so, when one of the shared spaces becomes vacant the remaining service user has the opportunity to choose not to share, by moving to a different room if necessary. 3rd September 2008 3. Date of last inspection Brief Description of the Service: Petteril House is a residential care home registered with the Commission for Social Care Inspection to provide care and accommodation for older people. The home is owned by Cumbria County Council and run and managed by Cumbria Care. The home is located on the outskirts of Carlisle and is close to local shops and public transport routes. The property is a two storey building and is equipped with a passenger lift to assist people living there to get about the home and use the accommodation on the first floor. People live on small units, each with its own sitting and dining area and small kitchen. One unit, the Carlton, specialises in providing care to people with dementia. There are toilets and bathing facilities close to all bedrooms for people to use and some bedrooms have en suite facilities. The home is set in its own grounds and has car parking available at the front of the property. Fees charged to residents include care, accommodation, meals and laundry. Fees are charged weekly and currently range from £332.00 - £449.00 per week, depending on the level of care a person requires. People living at Petteril House pay separately for their own toiletries, newspapers and hairdressing. Information about the services provided and fees charged is included in the home’s statement of purpose and service users’ guide. A copy of the latest inspection report is also available for people to read. Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This site visit forms part of a key inspection carried out at Petteril House by two inspectors. We (The Commission For Social Care Inspection, CSCI) were in the home for a total of six hours. We assessed the handling of medicines through inspection of relevant documents, storage and meeting with the supervisors on duty and residents. The manager was on annual leave on the day of the visit. This was the second key inspection this year for Petteril House and we focused our attention on those areas where weaknesses had been found at the last visit and where requirements had been made. Information about the service was gathered in different ways: • An Annual Quality Assurance Assessment (AQAA) document completed by the manager, identifying what they thought the service does well and what could be improved. Because this visit was the second key inspection to the home within 6 months we did not ask for a new AQAA. • We looked at the service history for the home and how the management has dealt with incidents and complaints made to them. • We made observations of staff approaches, practices and interactions during the visit and as we made a tour of the premises to look at people’s environment. • We spent time talking with people living at Petteril House, with visitors and staff on the day of the visit. This was to get their views and experiences of the home. We looked at care planning documentation, pre admission assessments and information, training and development records, recruitment records, relevant policies and procedures and a sample of records required by regulation. What the service does well:
Petteril House provides a homely atmosphere and people living there are able to bring in their own things from home such as pictures, ornaments and suitable items of furniture to make their rooms more homely and personal. The standard of catering and choice of food is appreciated by the people living at Petteril House. Different dietary needs are catered for with a balanced and varied selection of good quality food and home cooked meals. Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 6 We saw during the day that care staff appeared to have a good rapport with residents and their approaches to residents were friendly and informal. Staff are aware of people’s personal preferences and work hard to meet people’s needs. People who are able to go out into the community and follow their own interests are supported to do so. The people living at Petteril House are being supported to make choices about meals and recreational activities and are able to maintain contact with family and friends. Visitors to the home told us that they are made to feel welcome and involved in the home. There are robust recruitment procedures for staff and the thoroughness of pre employment checks helps to safeguard the welfare and safety of people living in the home. What has improved since the last inspection?
Since the last key inspection at Petteril House the new manager and the staff in the home have shown great commitment to improving the areas of weakness found at the last visit. They have been working hard to make sure the requirements and recommendations made at the previous inspection are met or have made significant progress towards making the improvements. The new manager communicates a clear sense of direction on managing change and workloads and provides leadership that relates to the aims and purpose of the home. The new manager now does a pre admission assessment, on all planned admissions, in addition to the information from the referring social worker. This helps make sure that when the manager accepts an admission they are sure the home can meet that person’s needs. Improvements in care practices and recording have been made and people’s mental health is now consistently monitored. Thorough nutritional and pressure area screening is being done consistently for people and recorded within their individual care plans. The manager is now doing audits of medication and care plans to help highlight anything staff may need to address or complete. Improvements have been made in handling medicines prescribed to be taken ‘as required’ by people and there are now protocols in place for their use to guide and inform staff on safe use and potential side effects for people. This improvement helps staff make sure that such medicines are given only when residents need them and allows easier monitoring. The administration of controlled drugs is being fully recorded to minimise the risk of error, duplication or omission. All medicines and the quantities being received into the home are now consistently checked and recorded and those disposed of as well as a stock balance being kept. This helps ensure that there is an audit trail and that all medicines received can be accounted for. The internal environment of the home has also been improved and the work to improve the laundry and sluice arrangements to promote greater infection control measures has been dealt with as a matter of urgency. There are now
Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 7 separate clean and dirt laundry areas so that clean linen and clothing are not at risk of contamination from items to be washed or sluiced. This is good infection control practice, in line with The Department of Health’s published professional guidance. We found that improvements had been made in the area where the communal phone is situated and this means that people could now sit down and get easy access to the communal telephone. We found that equipment was no longer being stored where it limited people’s access to the telephone. We found, from our tour of the building, visiting and speaking with people in their own rooms and from care plan assessments and records that people were being accommodated in rooms that allowed them to bring in some of their own possessions and equipment. People are not now being admitted into bedrooms that do not meet their assessed needs and relevant environmental standards. This helps make sure that an individual’s physical needs and lifestyle choices are being promoted. Since the last inspection the manager has carried out review of staffing arrangements and deployment in order to make better use of the staff resources available. This has included altering the staffing arrangements for the unit that was previously split over two floors. The changes made have improved the access people have to staff on their unit and improved their supervision and support. The storage and security of people’s records has been improved so all records are kept securely in line with legislation. The storage of substances that might be hazardous to people’s heath has also been improved and are now kept securely when not in use. What they could do better:
We advised the supervisors on duty of the importance of having a full and accurate record of all prescribed medication the person is receiving on the medication administration record. We recommended this should be done not only because it provides an audit trail to account for the use of all medicines received into the home but also because it essential that an up to date record of all current medicines prescribed for each person is kept. To support this we recommended that clear records be kept in people’s care plans of the visits made by health care professionals and the actions taken by them. This would show what they had done, such as administering medication or what had been advised for management of individual conditions. During the visit one person was going out with their family and they took their medicines out with them. This had been recorded on the MAR chart as a dose omitted, which was not the case. When it is not possible to get a supply of medicines to take out from the pharmacist the manager should make sure that a record is kept of what has been done and noted correctly on the MAR chart. This helps ensure that all medicines can be fully accounted for. Although great improvements have been made in detailed and individualised care plans we found one person whose care plan had not been completed with
Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 8 them. They had come in as an emergency admission five days previously and had detailed admission notes but staff had not begun to develop a care plan with them yet. We recommended that the process of developing the person’s care plan should be done promptly following their admission. This helps makes sure assessed needs and any changes in need are clear for all staff. The manager should make sure that the complaints log and records are easily available for staff to use and for inspection by CSCI. Staff individual training and development records still need work doing on them to bring them up to date and clearly show what training is needed by staff, what has been done and when. This helps make sure that all the training staff need to fulfil their roles is planned and carried and no one is missed. This is especially important to ensure mandatory training is done to protect residents’ welfare. 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. Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 9 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 Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 10 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): NMS 1, 2, 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People coming to live at Petteril House are provided with information about the home and have their needs assessed before admission to help ensure their individual needs and preferences can be met there. EVIDENCE: Information about this home and the services it provides is available in the Statement of Purpose/service user guide that is on display in the foyer of the home. This is specific to the home and also includes comments from people living in the home. A copy of the latest inspection report is also available in the foyer for people to read. General information is also on display regarding equality and diversity in the service and age related issues and support that may be of interest to people living there and their representatives.
Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 11 An individual care needs assessment is carried out under care management arrangements by someone qualified to do this for each prospective resident. This is done by a social worker before people are placed in the home and the manager obtains a copy of the assessment for information. The manager now routinely does a pre admission assessment, in addition to the information from the referring social worker. Doing this helps make sure that when the manager accepts a planned admission they are sure the home can meet that person’s needs and they have the facilities they need to live the life they want. We found that people who had come to live there recently, with planned admissions, had clear pre admission assessments in place to provide baseline information to help staff develop their individual plans and make sure staff had the information to support people in the way they wanted. Recently several people have been admitted for short term stays and as emergencies at short notice. These people had assessments provided by social services giving relevant information and had an assessment of individual needs and by the supervisors done on admission. This provided basic information for staff supporting them until more detailed assessments were done with people as they settled into the home. We looked at the care plan for one person who had come in as an emergency five days ago. There was satisfactory information on admission but work had not started with them on detailed assessments for their care plan. From records of recent admissions we could see that people had terms and conditions of residency signed by themselves or their representatives. This way people are made aware of their rights and responsibilities whilst living in the home. The home does not provide intermediate care. Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 12 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): NMS 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Petteril House have their health and personal care needs assessed but inconsistencies in recording instructions and actions may lead to gaps in information affecting people’s care. EVIDENCE: Overall the home has clear individual care plans for residents, based on initial assessments and risk assessments, setting out assessed health, social and personal care needs and these are being reviewed and updated. Supervisory staff were in the last stages of transferring people’s care plans over to a new more individualised format for care planning. The home’s supervisory staff have put a lot of effort into completing this work to achieve an improvement in working with people to create more personal and individualised care plans. This helps carers work with people living there to help them achieve what they want and expect from their life in the home.
Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 13 The care plans were more clearly set out and easy to follow. The information provided covered areas such as a person’s mobility, diet, health care needs, personal care and their social and religious preferences. Appropriate assessments and equipment to prevent pressure sores is in use, individual mental health is being monitored and effective nutritional screening is being done and weights recorded, monitored and appropriate action taken if needed. During the visit we looked at people’s care plans and a sample of six care plans in more detail. We also spent time talking with these people and others living in the home to see if their needs and preferences were being reflected in their plans and if staff were supporting them to achieve the care they wanted. Generally we found that plans were detailed and reflected what people needed and wanted. However, on some occasions there were no dates or signatures on the assessment documents or dates of admission on care plans. When carrying out assessments and on admission staff need to make sure they sign and make dates clear in the record. This is so it is clear when an assessment was carried out and who did it. One person who had come in as an emergency admission five days previously had detailed admission notes but staff had not begun to develop a care plan with them yet. The care plan is the end point of the assessment of the individual setting out in detail the action that needs to be taken by staff to make sure that all aspects of the health, social and personal care needs of the person are being met. We recommended that the process of developing the person’s care plan should be done promptly following their admission. This helps makes sure assessed needs and any changes in need are clear for all staff. We discussed this with the supervisors and they began attending to this during the visit. It was evident in the new care plans that people’s particular wishes and individual goals were being recognised and respected. The manager is doing informal audits of medication records and systems and of care plans to help monitor for quality and compliance with procedure and correct any omissions or problems quickly. The action plan is to make these audits more formal within definite timescales. We looked at the medication handling, records and practices and found that these had also improved since the last inspection to further protect the interests of people living there. All medicines and the quantities being received into the home are now consistently checked and recorded and those disposed of as well as a stock balance being kept. However, we found that some creams and injections had been recorded as having been received into the home but were not being recorded on the medicine administration record (MAR) charts to provide a complete record of medicines a person had prescribed for them and that they were receiving. We discussed this with the supervisors who told us that this happened because the district nurse was administering these medicines, as part of that person’s treatment. We advised on the importance of each person having a full and accurate medication administration record of all prescribed medication that the staff manage and receive into the home for their use. We recommended this should be done
Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 14 because it provides an audit trail to account for the use of all medicines received into the home and also because it is essential that an up to date record of all current medicines prescribed for each person is kept. We recommended that to support this a clear record be kept in peoples’ care plans of all visits by health care professionals and the actions taken by them or any management advised. During the visit one person was going out with their family and they took their medicines with them. This had been recorded on the MAR chart as a dose omitted which was not the case. When it is not possible to get a supply of a medicine to take out from the pharmacist we recommended that the manager should make sure that what has been done is clearly recorded. This should also be recorded accurately on the MAR chart. This ensures that all medicines can be fully accounted for. Several people have medicines prescribed to be take ‘as required and there were protocols in place for their use to guide and inform staff on safe use and potential side effects for people. This improvement helps staff make sure that such medicines are given only when residents need them and allows easier monitoring of when maximum doses are reached. Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 15 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): NMS 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at Petteril House are being supported to make choices about meals and recreational activities and are able to maintain contact with family and friends. EVIDENCE: The home encourages relatives and friends to visit and residents say there are no restrictions on when people can visit them. We spoke to a visitor who said they were pleased with their husbands care and that the staff always made them welcome. Care plans generally had personal and background information about people’s preferred social and religious activities and some useful personal profiles and preferences in the ‘all about me’ section of their plan. This is useful information that can be used effectively in promoting a person’s own perspective on recreation and what holds meaning for them. This is especially valuable when people have difficulty communicating what they want easily. There were records kept of the activities people had chosen to take part in and if they had enjoyed them.
Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 16 There is a programme of activities on display on the units that covers the week and staff do one to one activities such as chatting, reading newspapers with people and doing manicures when they can. The home does not have its own activities coordinator. From what people told us and the records held on what people had been doing for recreation we could see that staff support people on the to units to take part in group activities as they wish, such as dominoes, cards, ball games and bingo. Some people we talked to preferred not to take part in organised activities and this was made clear in their plans and also what interaction they did want and prefer. One person liked staff to “pop in for a chat” or just say “hello” as they went past the door. Some people choose to go out into the community or into Carlisle or go out with their families. We talked with people living there and they told us they had a choice about what they did during the day. We saw that staff do support people living there to take part in activities in groups and individually and to make choices in their daily lives. The hairdresser was visiting the home on the day of the visit. Several people were sitting in the hairdressing room chatting as they waited and with others having their hair done, it was a pleasant and sociable occasion. Provision is made for people to follow their individual religious preferences. Communion takes place on a monthly basis in the day care unit on the same site and a Roman Catholic nun comes in to visit some people each week who want this pastoral support. One person has visitors from their church but has not attended services for some time. Their religious beliefs were an important part of their personal and social life before they came into the home and they said they missed this. We discussed with the supervisors how this could be achieved for them in a way that might suit their particular situation. We spoke to the cook and visited the kitchen, which was clean and tidy with the fridges and freezers well stocked, as was the dry goods store. The home achieved a 4 star rating at its last inspection by the environmental health department. We talked to people living in the home about the choice of food they were offered and they told us that there was a choice of meals and one said that the food was “tip-top” and that, “One thing about this home is you can’t fault the food”. People said that they chose what they wanted from the menu and could take their meals where they wanted and some people preferred to have their meals in their bedrooms. We spent some time on the units at lunchtime and it was a relaxed and sociable occasion. People were assisted with their meals if they required this and some people had cutlery aids to help promote their independence at meal times. There are some diabetics to prepare food for at present and the special diets needed are also provided. Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 17 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): NMS 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an accessible complaints procedure and there are adult protection procedures in place to help protect resident’s welfare but poor access to complaints recording documents may reduce the effectiveness of the system to safeguard people’s interests. EVIDENCE: The service has a complaints procedure that is displayed in the home and within the service guide. We were not able to assess the complaints recording log with the records of all complaints and details of their investigation and the actions taken, as the records could not be found for inspection. There was no record available other than a brief note on comments and compliments received. These made brief reference to a previous safeguarding referral but we could see any detailed records of this investigation that had taken place and outcomes. Although the supervisory staff were able to tell us what these were. We recommended that the manager should make sure that the complaints logging documents are easily accessible for staff to use and records of any allegations and their outcomes are kept and available for inspection by CSCI. Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 18 The service has safeguarding procedures and multi agency guidance on safeguarding vulnerable adults. Since the last inspection there have not been any matters referred under safeguarding procedures. The manager is reporting all incidents and events in the home to CSCI as required by regulation. The home has policies and procedures for staff on ‘whistle blowing’ to support them in reporting bad practice. There is also a copy of the Department of Health Guidance ‘No Secrets’ for further guidance on passing on concerns to the appropriate agencies to protect the welfare and interests of people living there. Staff training records are not fully up to date as yet so we were unable to assess from records if all staff had up to date training on safeguarding vulnerable adults. However we could see that some training was planned for a limited number of staff and staff we spoke with knew about the process. The manager should make sure that all staff have training on safeguarding vulnerable adults and that this is clearly recorded on staff training files when it is done. The home’s supervisors have had training on adult protection and preventing abuse. The home did not deal with any resident’s personal finances only small amounts of spending money for safekeeping. Practices and procedures are in place to protect resident’s financial interests. Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 19 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): NMS 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Petteril House enjoy a comfortable, safe and homely living environment that suits their needs and lifestyles. EVIDENCE: There is an annual programme of maintenance and improvement agreed with the accommodation manager for the home. Several bedrooms have been redecorated to an attractive standard and to improve bathing facilities a new ‘rise and fall’ bath has been installed. There are toilet and bathing facilities accessible to people living there, four bedrooms have en suite facilities and the others all have wash basins for people to use. The home has a range of adaptations and moving and handling equipment and a passenger lift to help people maintain their independence and to get about the home. One bedroom
Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 20 has a temporary overhead hoist fitted to improve and assist with one person’s assessed moving and handling needs. At the time of the visit one assisted bath chair could not be used as the manager was waiting for a ‘safety belt’ to be fitted to reduce the risk of anyone falling out of the chair whilst being moved in and out of the bath. The manager had identified that this was a risk with that type of assisted bathing aid and was addressing this. Staff and people living there we talked to felt they were managing at present and people were not being prevented from having their baths as they wanted. We advised that the safety device was fitted as soon as possible to make sure there were always sufficient assisted bathing facilities to fully meet the needs of everyone in the home. There are communal lounge and dining areas on all the units in the home and these are comfortable and warm. The home is generally comfortable and homely and people living there are able to personalise their rooms. There are up to date maintenance records for the testing of emergency equipment, call bells, call systems and emergency lighting. Call bells are easily accessible in areas used by residents to summon assistance if they need it. We found that improvements had been made to the environment in the area where the communal phone is situated and this meant that people could now get easy access to the communal telephone. There was also now a seat available for anyone making a call and equipment was no longer being stored where it limited people’s access to the telephone. From our tour of the building, visiting and speaking with people in their own rooms and from care plan assessments and records we could see that people were being given accommodation that did allow for the use of their equipment and personal items that met their needs and lifestyle choices. The home was generally clean and tidy and on the day of the visit a team of contract cleaners were in the home giving it a thorough deep clean. The service currently has a vacancy for a domestic. There is a small laundry on site with suitable washing machines and driers. Significant improvements have been made in the laundry to promote good hygiene and infection control to protect the welfare of people living in the home. There are now separate clean and dirt laundry areas so that clean linen and clothing are not in risk of contamination from items to be washed or sluiced. It is good infection control practice, in line with The Department of Health’s published professional guidance, to have soiled linen and manual sluicing facilities separate from where clean laundry is kept. There are also manual sluice facilities on the EMI unit and on the first and second floors. Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 21 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): NMS 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Petteril House receive care and support from a staff team who know them well and have been through a robust recruitment process to help safeguard their welfare and interests. EVIDENCE: We looked at staff rotas for the previous 2 weeks, spoke with people living there, observed staff deployment during the visit and discussed staff levels generally with the staff on duty and supervisors. Since the last inspection a thorough review of staffing arrangements has been by the manager of staff deployment and shift patterns in order to make better use of the staff resources available. This has included altering the arrangements for the unit that was previously split over two floors. This has significantly improved the access people have to staff on their unit and for improved supervision and support for people living on the units to better meet their identified needs. It also promotes greater flexibility, individualised and more person centred care. Staff told us that they thought the changes were generally working well. On day duty there were two staff on the EMI unit and two support workers on the ground and first floors. Usually there are six support workers providing
Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 22 care and support and this means that where two people are needed for some moving and handling procedures it can be done more promptly than previously when staff were more widely deployed. On night duty there are still three support workers recognising the need for additional supervision and support to meet individual needs at night, especially for people with dementia. Despite the staff compliment being down due to long term staff sickness and some vacancies supervisors are working with permanent staff to make sure the shifts are covered and so far have not had to use agency staff. This promotes continuity and shows a level of cooperation and commitment by staff to maintain safe and effective staffing levels in the home. The manager is currently recruiting for staff to fill the vacancies. Staff training is being provided and National Vocational Qualifications (NVQ) training is well established and supported and over 50 of staff have achieved this care qualification. New care staff are given a thorough a five day induction period before they start work. All staff have their own individual professional development files with information on the training they have attended and qualifications achieved. These were not all up to date as yet and records were not complete so it was difficult to assess what training had been done and when and if it needed updating. Training records should be kept up to date and clearly show what training has been done and what is still needed. In this way the manager can be sure that staff receive all the training and updates they need to carry out their roles and no one is missed. The new manager has begun to address this and from what records were available and from what staff told us it was evident that training was taking place although it might not be on record. We looked at the staff files and recruitment process for new members of staff. These contained all the necessary checks including Criminal Records Bureau (CRB) and, Protection of vulnerable adults (POVA) register checks and taking up two references. This robust process helps to protect the safety and welfare of people living in the home. Staff we talked with during the visit had been consulted about the changes that had been made to systems in the home since the last inspection. They told us that they felt morale had improved amongst the staff team that they were working better together and felt supported by the new manager. People living in the home we talked with told us that the staff were, “very good” and a relative we spoke with that they were “great. Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 23 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): NMS 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current management systems at Petteril House support the ongoing improvements in practice and the necessary development of the service in a way that involves the people living there. EVIDENCE: After a period of temporary management the home now has a new permanent manager in post. The new home manager still needs to be registered with CSCI, and is beginning this registration process. The new manager has relevant experience and qualifications working with older people and managing a residential care home. During the period of temporary management a complete audit of the service was carried out to identify all areas of weakness
Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 24 and create an action plan of what had to be done to improve the service overall and to meet the requirements made at the last visit. The new manager, who had only been in post a month at the time of the visit, has implemented many of the changes and other identified areas are beginning to be addressed. When the entire action plan has been fully implemented a significant amount of work will have been done to improve and develop this home for the people who live there. The new manager is providing clear leadership and guidance to staff and supervisors and is being well supported by the supervisors who are working closely with her to fully achieve the action plan. The service has regular staff and residents meetings and these are recorded. These showed us that both the people living in the home and staff working there were consulted and kept informed on the reorganisation in the units and the way staff work in the home. This allows for people’s views to be expressed and promote an open and more inclusive atmosphere within the home. Records indicate and staff confirmed that regular formal supervision is being given to them to support their practices. The service has an organisational quality monitoring system that relates to the organisation’s business plan and enables the manager to measure the home’s progress against Cumbria Care’s key targets. Policies and procedures are reviewed corporately and updated in the home when needed. An internal health and safety audit is also completed on an annual basis by the organisation. There was evidence of regular visits to the home by the Operations Manager for the home to monitor practices, speak with people living there and inspect the premises. The home is responsible for small amounts of residents’ monies used to pay for personal items. Records are kept with all receipts held on file and expenditure signed out by two members of staff as a safeguard for the residents. We found that improvements have been made in the safe storage of both confidential records and the storage of substances that may be hazardous to health. Both of these improvements promote the interests and safety of people living there. Records show that servicing and maintenance of equipment is being done, that electrical testing of portable appliances lifts and hoists, and alarms are being serviced, and that periodic electrical testing has been done. Records indicate that fire training for staff has now been brought up to date. Overall the standard of record keeping has been improved but care still need to be taken to ensure that all records required by regulation are up to date and accessible. This includes the complaints records and correspondence and these should be available for inspection and records providing evidence of staff qualifications achieved and mandatory training completed should be up to date. Ensuring these helps promote people’s rights and best interests. Currently management and staff attention is focused upon achieving all the priority improvements required at the last inspection and identified from the internal management audit. Many of these have been successfully achieved in
Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 25 a relatively short period of time. This is an indication of the management and care team’s commitment to raising standards generally across the home and to managing the changes needed to improve systems in the home. The challenge for the management and for staff will be in continuing to maintain these and demonstrate consistent improvement and development in the long term. Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 2 3 Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 27 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 OP7 Good Practice Recommendations We recommended that the process of developing the person’s care plan following an emergency admission should be started promptly. This helps makes sure assessed needs and any changes in need are clear for all staff. When carrying out assessments and on admission staff should make sure they sign and make dates clear in the record. This is so it is clear when an assessment was carried out and who did it. We recommended that all visits from and treatments given by health care professionals be clearly recorded in people’s care plans and the actions taken by them or management that is advised. When it is not possible to get a supply of medicines from the pharmacist for a person to take out we recommend that the manager makes sure a clear record is kept of what has been done and an accurate record made on the
DS0000036543.V374163.R01.S.doc Version 5.2 Page 28 2. OP7 3. OP7 4. OP9 Petteril House 5. OP9 6. OP16 7. OP18 8. 9. OP30 OP37 MAR chart. This makes sure all medicines can be fully accounted for. We recommended that each person living in the home should have a full and accurate medication administration record of all prescribed medication that the staff manage and receive into the home for their use, including those being administered by the District Nurse. This provides an audit trail to account for the use of all medicines received into the home and gives an up to date record of all current medicines prescribed for each person. The manager should make sure that the complaints log and records are easily available for staff to use and for inspection by CSCI and that there are clear records on all complaints and allegations received and their outcomes. The manager should make sure all care staff have up to date training on protecting vulnerable adults, so all care staff in the home are aware of their responsibilities and the action to take and this should be recorded in staff training files when done. Staff individual training and development records should be kept up to date and clearly show what training is needed, what has been done and when. The manager should make sure that all records required by regulation for the protection of people living in the home are accessible and up to date. This includes complaints logs and evidence of training. Petteril House DS0000036543.V374163.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection NW Area Office Unit 1, 2nd Floor Tustin Court Port Way 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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