Inspection on 12/06/07 for Pilgrims View

This inspection was carried out on 12th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Pilgrims View 04/07/06

Pilgrims View 16/01/06

Pilgrims View 07/07/05

Pilgrims View 04/11/04

Pilgrims View 06/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Pilgrims View Roberts Road Snodland Kent ME6 5HL Lead Inspector Wendy Mills Key Unannounced Inspection 09:30 12th June 2007 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 Pilgrims View DS0000024077.V340272.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. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pilgrims View Address Roberts Road Snodland Kent ME6 5HL 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) 01634 241906 01634 243661 www.kcht.org Kent Community Housing Trust Post Vacant Care Home 43 Category(ies) of Dementia - over 65 years of age (43) registration, with number of places Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Older people with dementia from 55 years of age and over. Date of last inspection 4th July 2006 Brief Description of the Service: Pilgrims View is care home providing personal care and accommodation for up to 43 older people specialising in the care of older people with a mental infirmity. Kent Community Housing Trust, which owns Pilgrims View, is a non-profit making Trust. The trust has twenty-two residential care homes in the Kent and London areas. It holds Investors in People Award and has an ISO 9002 Quality Standard Accreditation. Pilgrims View is situated near the centre of the small town of Snodland. There are a number of local amenities, including shops, pubs and a post office, close by. The home was originally built as a local authority home and was taken over by Kent Community Housing Trust in 1992. It is a purpose built single storey residential home, arranged in four wings. There are thirty-five single and four shared bedrooms. All the bedrooms are equipped with call alarms and TV aerial points. There are easily accessible, well-maintained and secure gardens surrounding the building. There is a stream on one side of the garden. There is car parking at the front of the home with street parking nearby. Current fees range from £442 to £463 per week. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit began at 9.30am and lasted six hours. The acting manager, assisted throughout. During the course of the inspection many of the residents were spoken to, some during the tour of the home and some in the privacy of their rooms. Relatives and members of staff were spoken to in private. A tour of the home was made, documentation, including a sample of care plans was examined in detail. Both direct and indirect observations were made throughout the visit. In addition, information received prior to this visit, from the registered providers, relatives, health and social care professionals and other sources, has been taken into account when compiling this report. All comments received about the home were very positive. Residents and relatives said that the staff are very kind. Comments such as “This is ideal, it ticks all the boxes” and “I don’t think we could have found a better place”. were made. The residents, their supporters, the acting manager and her staff are all thanked for their assistance during this inspection and for the warm welcome they gave. What the service does well: The home provides a relaxed, welcoming and friendly atmosphere. It is well maintained and clean. There are secure and pleasant gardens surrounding the building and all areas are light and airy. The acting manager has a good knowledge of best care practice. Despite having only been in post for six weeks, at the time of this visit, she was well aware of the needs of the residents and staff. The staff are kind and caring and have a very good awareness of the needs of each resident. The home promotes the general health and well-being of the residents. The administration of medicines is well managed and reviewed regularly. Good relationships are maintained with visiting health and social care professionals and appropriate arrangements are made for healthcare appointments on behalf of the residents. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 7 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 Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides the residents, their relatives and supporters, with the information they need. Appropriate pre-admission assessments are made. This ensures that only those residents who are suited to the home, and whose needs can be met, are admitted to the home. EVIDENCE: There is a Statement of Purpose and Service User Guide. These documents are reviewed regularly. Each room has a special holder, which contains a copy of the Service User Guide. This guide is illustrated but could be improved by ensuring it is more simply written. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 9 There was good evidence that appropriate pre-admission assessments are made. Care plans record assessed needs and there are risk assessments in place. The acting manger and/or the assistant manager visit prospective residents prior to admission. They carry out comprehensive assessments to make sure that the Home can meet individual needs. Relatives confirmed that an assessment visit had been made to their home. They said, “They were lovely, very kind, and asked questions to make sure they could provide what was needed”. Residents are able to visit the Home before moving in. Relatives spoke very highly of the way the staff had helped both themselves and their relatives to settle in. The home does not provide intermediate care. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. . The home promotes the general health and well-being of the residents. The privacy and dignity of the residents is maintained and the administration of medicines is well managed. EVIDENCE: Each resident had a care plan. A ten percent sample was inspected in detail. Since the last inspection the care plans have greatly improved. They contain life histories of the residents and other information such as likes and dislikes, on which choice may be made on behalf of a resident if they are unable to make this choice for themselves. There was evidence to show that the care plans are regularly reviewed. However, some subjective recording, by care staff, was noted in the daily record. It is recommended that staff receive training in they way they make entries into written records. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 11 A new clinical room has been created and medicines trolleys obtained. This has greatly improved the storage of medicines. The layout of this new room would benefit from an assessment to see if more efficient use could be made of the space now available. The temperature of the room was well within safety standards. All staff who administer medicines have received training. The Medication Administration Record (MAR) sheets inspected had been completed appropriately. There have been no medication errors since the last inspection. A Team Leader was spoken to. She demonstrated a very good understanding of all issues surrounding the administration of medicines in a care home. Nutrition is well managed in the home. Nutritional monitoring is in place and nutritional assessments are made. Residents are weighed regularly and food and fluid intake is measured if risk assessments indicate that this is necessary. Comments from health and social care professionals suggest that the Home maintains good working relationship with them. Records show that appropriate health care appointments are made on behalf of the residents. Direct and indirect observation and discussion with residents’ relatives confirmed that the staff treat residents with respect and promote their privacy and dignity. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to live fulfilling lives and their relatives are supported. More should be done to involve the residents in the daily activities of the home. EVIDENCE: Relatives said they are very happy with the freedom of movement that is encouraged within the home. Direct and indirect observation showed that there are several residents who like to be on the move. Staff were seen to support them and help to form some purpose to this wandering. The acting manager said that she would like to encourage more involvement of the residents in the activities of daily living. For example, staff could encourage the residents to participate in gardening activities or household tasks such as dusting and laying the tables. However, she has only been in post for six weeks and she has not been able to do this as yet. Some residents said that they would like more to do and some relatives felt that there is room for improvement in respect of activities. Other relatives said that they couldn’t be happier with the activities on offer and the way the staff encouraged their relative. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 13 Relatives said that they are made very welcome to the home and that the staff give them support and help if they have concerns. They said that the staff always make time to talk to them and let them know how things are going. There is a room set aside and equipped for hairdressing. On the day of this visit there was a clothes party in progress and the hairdresser was visiting. Residents said they were very pleased to have the opportunity to buy new clothes and have their hair done and there was much interest in both activities. Several residents said that they had enjoyed having their hair done. One said, “I feel much better for that”. All the residents looked very well turned out and were dressed in welllaundered clothes that were suitable to the season. Conversation with the laundry staff showed that there is a good understanding of the importance of correct care and sorting of laundry, so that residents can look their best in the clothes of their choosing. There is a great deal of flexibility in the way personal preferences are met. Residents can choose when they get up and when they go to bed. Past histories and likes and dislikes are noted in the care plans and staff showed a good understanding of the importance of meeting individual needs. There is a key worker system. This means that individual staff members take responsibility for noting the choices and needs of residents assigned to them. This helps the staff to build closer relationships with individual residents. Mealtimes are viewed very much as a social occasion. One resident, in particular saw lunchtime as a treat, “An opportunity to “go out and meet up with everyone”. Nutrition is well managed in the home. Nutritional monitoring is in place and nutritional assessments are made. There is a four-week menu and a choice of two main meals. The main meal is taken at lunchtime. On the day of this visit there was a plentiful supply of good quality fresh produce in the home. Residents said that they enjoy their meals and have plenty to eat. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sound policies and procedures for the handling of complaints and concerns and the protection of vulnerable adults (POVA). Staff are trained in these areas and demonstrate a god awareness of their responsibility to protect the residents from all forms of abuse at all times. EVIDENCE: There is an up-to-date complaints policy and procedure. It is clearly written, and easy to understand. Those spoken with had a good understanding of how to make a complaint but said that they had not had cause to make a formal complaint. Some said that they had no complaints whatsoever, whilst others said that if they had any day-to-day concerns, for example, a missing garment, they would just mention it to staff and were confident that they would “sort it out”. Records of complaints are kept and include details of investigation and action taken. There has been only one formal complaint since the last inspection. This was not substantiated. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 15 There are clear policies and procedures for responding to suspicion or evidence of abuse or neglect. Staff spoken with have a sound knowledge of adult protection procedures and said that they would have no hesitation in reporting any concerns immediately. They said that they felt the key worker system works well to ensure that the residents are protected. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is safe, well-maintained and homely. This gives the residents a pleasant and secure place in which they can maintain as much independence as possible. EVIDENCE: A tour of the home was made in the company of the acting manager. Four residents joined us for this. The home is a single storey building with four wings that link to each other. This provides easy access and allows freedom of movement for the residents. All the bedrooms have attractive number plates on the doors. However, the colours of the bedroom doors are all very similar. Use of different colours may help some confused residents to find their way around the home with more ease. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 17 Since the last inspection one of the lounge/dining rooms has been extended and fully refurbished. This has made a good improvement to the space, airiness and light in this part of the building. A new bedroom has been created with an ensuite toilet and washbasin. An application to register this with the CSCI, as an additional room, will be made in the near future. There are colourful, safe and well-maintained gardens surrounding the home. Residents said that they are happy with their bedrooms. Relatives said that they are very pleased that the environment is so spacious and comfortable. On the day of this visit the home was very clean and free from offensive odours. However, the sink in one bedroom appeared very wet behind the taps. It is suggested that regular checks are made on the fine detail of cleaning. The laundry is well equipped and conversation with the laundry staff confirmed that there is a very good awareness of infection control measures and clothes care. No health and safety hazards were noted during a tour of the home. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels, staff induction programmes, staff and recruitment procedures are good. Staff are knowledgeable and kind. This means that the residents are cared for by a well-informed and cheerful staff. EVIDENCE: Residents and their relatives said that the staff are very kind and helpful. One said that she couldn’t “fault them”, another greeted the staff with great enthusiasm and said she was so pleased to see them and that she was so lucky to have such lovely people around her. Examination of staff files, including those of recently recruited staff, showed that all appropriate checks are made prior to offering work at the home. Staff were interviewed individually and in private. They said that they “love working at the home”. They spoke very positively about the support they had been given when starting work at the home and praised the quality of the induction process. They said that the team leaders are particularly helpful and knowledgeable Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 19 The acting manager has produced a training matrix and arranged outstanding training for staff. Training includes statutory requirement such as moving and handling and specialist training such as dementia care and the administration of medicines. Some staff training had slipped due to the changes in manager at the home over the past year. (The retirement of the registered manager, the move of the previous acting manager to deal with issues in another home within the trust and the current position of another acting manager in charge of the home). The acting manager is taking steps to ensure all training is upto-date. One team leader was spoken to. She showed a very good awareness of best care practice. In particular she was knowledgeable about the management and administration of medicines. She commended for her diligence. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and the views of residents, their supporters and staff are listened to and acted upon. However, the home would benefit from more stability and consistency of leadership. EVIDENCE: Since the last inspection the registered manager has retired. The trust appointed an acting manager at the beginning of this year but she was moved to another home within the trust to deal with issues there, some tow months ago. The current acting manager made herself available throughout this visit and was very knowledgeable and helpful. She has previous experience as deputy manager at a similar home within KCHT. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 21 At the time of this visit, the trust was interviewing for the substantive post of manager for the home. This means that there is potentially another change in manager at the home. The Trust must work to ensure that there is stability of management in the home as soon as possible. Staff and relatives said that the all the managers had been kind, approachable and helpful. However, some relatives said they would like to know that there is consistent management for the home and that there is a permanent manager in post. Conversation with the current acting manager showed that she already has a good overview of both residents’ and staff needs. During the six weeks in post she has made clear progress, staff training needs have been identified, and work has started on a continuous improvement plan. Staff spoke highly of her ability and the way in which she had taken over the running of the home but they said that they all now want to know “who their boss is to be”. Most residents are unable to manage their own finances. Where possible, residents’ families or their representatives to give assistance with this. There was a sound system of holding and recording residents’ personal monies. Records examined comply with Regulations. They are maintained and stored in a satisfactory and safe way. Quality questionnaires and sent on a regular basis to relatives to ask them about their views on the way the home is run. Where possible the views of residents are sought but this is not always reliable due to their failing mental capacity. Other means of ascertaining their views as used, for example, listening to what their relatives and key workers say about their past preferences and day-to-day wishes. Health and safety records were in good order and no health and safety hazards were noted on the day of this visit. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 17 X 18 3 3 3 X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 X X 3 Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 23 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 OP32 Good Practice Recommendations It is strongly recommended that the trust ensure a permanent manager is in place at the home as soon as possible. Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 © 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 Pilgrims View DS0000024077.V340272.R01.S.doc Version 5.2 Page 25 - 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!