Inspection on 16/12/08 for Pfera Hall

This inspection was carried out on 16th December 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Pfera Hall 27/11/07

Pfera Hall 05/12/06

Pfera Hall 22/06/06

Pfera Hall 10/03/06

Pfera Hall 22/08/05

Pfera Hall 23/03/05

Pfera Hall 02/09/04

Pfera Hall 16/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address:     Pfera Hall Bromsberrow Road The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Adam Parker     Date: 1 6 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Stones Holdings Limited Pfera Hall Bromsberrow Road 01531650880 01531650833 manager@pferahall.co.uk Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 19 Number of places (if applicable): Under 65 Over 65 0 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: 19 19 The maximum number of service users who can be accommodated is 19. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) Mental disorder excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Pfera Hall is registered to provide care with nursing for up to 19 people with learning disabilities and mental health difficulties. It is near the village of Redmarley, between Ledbury and Gloucester. The home is set in substantial grounds and is surrounded by countryside. The home is divided into three units named Nimrod, Dorabella and Winston, though at the time of writing Dorabella and Nimrod were empty. Each unit has a lounge, kitchen, dining area and laundry as well as bathroom and toilet facilities. A separate wing houses the managers office, reception and day care facilities. The home has Care Homes for Adults (18-65 years) Page 4 of 26 Brief description of the care home several vehicles in order that service users can access the wider community. Information about the current range of fees was not gathered at this inspection. The Service Users Guide includes information about what is included in the fees. Prospective service users and their representatives are provided with information about the home including copies of the Statement of Purpose and Service Users Guide. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The visit to the service included a tour of the premises, examination of documentation and medication systems and discussions with a person using the service, staff and management. As well as a visit to the service, three survey forms were received from people who use the service. An (Annual Quality Assurance Assessment) AQAA was completed and provided for the inspection. Care Homes for Adults (18-65 years) Page 6 of 26 Care Homes for Adults (18-65 years) Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive comprehensive assessments to ensure that their needs can be met before they are admitted to the home. Evidence: Admissions are arranged through an admissions manager who is based in another service that the provider operates. The information obtained for the person most recently admitted to the service was looked at. This included a case conference report and Care Programme Approach documents. A risk assessment with a support plan had also been completed by the home. The person had spent a day in the home on a trial visit to the home during which an observation chart had been completed. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments together with documentation on any restrictions on people using the service give staff clear information on how needs can be met as well promoting safety and supporting decisions that people make. Evidence: Plans for the care and support of three people using the service were looked at. Care plans were in a printed format and had been reviewed on a monthly basis. Some of those looked at dealt with needs such as eating and drinking, smoking, relationships and for keeping a persons individual room clean and tidy. It was noted that care plans made use of specific information about a person that had been gathered at assessment. Care plans had been signed by the person using the service as well as staff signing to confirm they have understood the care plans. One care plan reflected how a person using the service had been supported to make a decision regarding smoking and related health issues. Any restrictions on access to Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: various parts of the environment had been recorded on a specific form. For one person it had been recorded that they had been offered a key to their room but had decided to hand this back to staff. The home had contact details for advocacy services on display as well as information about the Mental Capacity Act 2005. Risk assessments had been completed for a number of issues such as overnight home stays and relationships. following the assessment of any particular risk, a risk assessment support plan had been produced detailing any actions that needed to be taken to manage and reduce the risk. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to take part in appropriate activities outside of the home, have some links with the local community and pursue a range of leisure interests in order to enhance their lifestyle. Evidence: One person had been attending a college and others had been making use of facilities outside of the home through the use of leisure centres, gyms, libraries and cinemas A range of leisure activities are provided for people using the service including swimming,horse riding,golf and visits to local pubs. On a survey form one person commented I like going to the pub on the weekend. During the inspection visit a number of people were visiting a riding stables where a Christmas themed event was being held. The day care service based in the home had continued to provide a range of activities Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: for people enabling them to develop skills such as cooking, planning and budgeting for meals and shopping. The home supports people to maintain relationships with friends and relatives. As well as visits to people using the service, home visits had also been organised. One person was involved in caring for doves and fish and had a care plan to guide staff in supporting them with this. Most people who use the service make their own breakfast and lunch with various degrees of supervision. The evening meal is cooked in the unit. People have input into both the selection of meals and with the preparation. Detailed records of dietary intake are kept and were examined during the inspection visit. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their health and personal care needs met and there are generally good systems in place for the administration of their medication. Evidence: A number of care plans were looked at for people who needed degrees of personal care or support. A key worker report for one person noted that they attended to their own personal hygiene although staff washed the persons hair. Health Action planning had been introduced since the previous inspection and the manager explained how this approach was being used. Files for people using the service contained evidence of health care needs being met through General Practitioner (GP) and hospital appointments as well as contact with Community Psychiatric Nurses (CPN) and a Chiropodist. One persons care plan clearly described when CPN input was needed and included their contact details in the persons care plan. Peoples weights were being checked and recorded where the need for this had been identified. Regular nursing reports contained information on peoples current physical Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: and mental health state. Medication storage, administration and recording was looked at. Medication was stored securely with storage temperature monitoring in place. Medication administration charts contained photographs of people for recognition purposes and were in good order. Where handwritten directions had been made these had been signed by the person making the entry with a second signature by the person checking the entry. People had signed consent forms for taking their medication and there were protocols in place for medication prescribed on an as required basis, with one person having a detailed plan based on a traffic light system. As well as the administration charts the folder also contained information about homely remedies and various guidance. A medication error had been reported to the Commission in 2008. This was discussed with our pharmacist inspector and the home have been able to demonstrate how systems have improved since the error. Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in places that enable complaints and concerns to be raised by people using the service or on their behalf. Training is given to staff to safeguard people from possible harm or abuse. Evidence: The home keeps a record of complaints received. The most recent complaint dealt with was from a person using the service. This had been fully investigated and a response given to the person. Three survey forms were received from people using the service and they all indicated that they knew how to make a complaint. Training in protecting vulnerable adults is provided in house and had been attended by the majority of staff working in the home. A number of staff had also attended training in protecting vulnerable adults provided by the local authority. Information from the local authority in the form of the Alerters guide was on display in the home. Attending the enhanced adult protection training provided by the local authority should be given consideration by the manager. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Within the one unit open at the time of the inspection visit there have been some improvements to certain areas of the environment particularly toilets and bathrooms. In addition the home was working at managing the challenge of keeping some rooms in a clean and odour free state in order that people are living in a safe,clean and pleasant environment. Evidence: At the time of the inspection visit, out of the three units in the home only Winston was open. Dorabella was checked and was in much the same condition as it had been at the previous inspection. In Nimrod was work was needed to bring one toilet up to an acceptable standard. The manager confirmed that this work had been requested to be carried out by the maintenance department. Some individual rooms in Winston were looked at. Some showed examples of various degrees of personalisation. One room however was very sparse and this was in line with the needs of the particular person occupying the room. A discussion was held regarding this with the registered manager. There had been a notable improvement with the cleanliness and freshness of the room since the previous inspection. Ample out door space is available in the grounds of the home. Care Homes for Adults (18-65 years) Page 18 of 26 Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment and selection procedures are robust ensuring that people using the service are safeguarded. Staff have access to a training programme that will equip them to meet the specific needs of people using the service. Evidence: The home was still working towards achieving 50 of its care staff (excluding registered nurses) with an NVQ. A recommendation regarding this from the previous inspection is repeated in this report. A comprehensive annual training programme was provided for staff which included areas relevant to the needs of people using the service such as managing challenging behaviour (including refresher sessions), understanding autism, understanding self harm and mental health awareness. The documents for a number of recently recruited members of staff were seen. All the required information and documentation had been obtained. This demonstrated that the home was following robust procedures in terms of protecting people who use the service. New staff received an induction programme which included the Learning Disability Qualification (LDQ). Training is also provided in values, attitudes and diversity. Care Homes for Adults (18-65 years) Page 20 of 26 Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed with a variety of quality assurance audits and safety checks to ensure that the home is run in the best interests of people who use the service. Evidence: The manager of the home had a background in mental health nursing and had been in post for a year. Her most recent training had been in Health and Safety and Food Hygiene. She had applied for registration with the Commission. The home had used clinical governance meetings as a way of looking at quality issues in the home. These meetings involve registered nurses and the quality assurance manager for the registered provider. Other meetings held for team leaders and support workers were used to provide feedback on how the home was operating. The acting manager described how she had kept in touch with the day to day life of the home by working shifts alongside her management role. An annual client satisfaction survey has been used as well as surveys from relatives of people using the service and health and social care professionals from funding authorities. Residents meetings are Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: held to discuss issues about the service and living in a group. Recent survey forms had been received and were awaiting an evaluation of the information on them. The home receives visits from a representative of the registered provider under the arrangements of the Care Homes Regulations 2001. The most recent report on file in the home was November 2008 however there were a number of months in 2008 where there were no reports in the file. This should be looked into to check if the home has copies of reports of all the visits made. Staff have received training in safe working practices in first aid, food safety, manual handling, health and safety and fire safety. The home has ensured the servicing and maintenance of electrical and central heating systems and appliances. Cleaning materials were securely stored with no decanting from large to small containers evident. Although the home has a policy on legionella, no specific assessment had been done of the risk. This should be completed with reference to information published by the Health and Safety Executive. The home has completed a fire risk assessment and it was reported that the fire safety officer had visited in November 2008. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 23 Give consideration to the manager of the home attending the enhanced training in protecting vulnerable adults provided by the local authority. Continue progress towards getting at least 50 of the care staff qualified to NVQ level 2 in health and social care or a suitable equivalent. The home should check that it has copies of all reports of visits carried out under Regulation 26. A risk assessment for Legionella should be completed taking into account guidelines from the Health and Safety Executive. 2 32 3 4 39 42 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - 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!