CARE HOMES FOR OLDER PEOPLE
Pine Trees 15 Horsepool Road Connor Downs Hayle Cornwall TR27 5DZ Lead Inspector
Diana Penrose Unannounced 11 August 2005 09:30 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 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. Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Pine Trees Address 15 Horsepool Road Connor Downs Hayle Cornwall TR27 5DZ 01736 753249 01736 759261 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Guardian Care Homes (UK) Ltd Mrs Frances Catherine Winsor Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 01/02/05 Brief Description of the Service: Pine Trees Care Home is situated in the village of Connor Downs between the towns of Camborne and Hayle. There is car parking at the front of the home and a footpath that leads to the main entrance. Well-maintained grounds with colourful flowers surround the home. The building is a detached bungalow with a modern extension. There are 23 single rooms and one shared room. Accommodation and facilities are on one floor. All bedrooms have a door opening onto a walkway surrounding the building. These cannot be accessed from the outside when closed. Suitable ramps and grab rails are in situ. Meals are prepared in a well-equipped kitchen and served in the spacious dining room, or individual bedroom if preferred. There is a large smoke free lounge with an adjacent conservatory. There is a patio outside with garden seating and tables.The home provides residential care for up to twenty-five elderly people. The home also provides day care and respite facilities. The Registered Manager is a qualified nurse who, along with a team of suitably experienced care staff, provides personal care within a relaxed and friendly atmosphere. Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Pine Trees on the 11 August 2005 and spent five and a half hours at the home. This was an unannounced visit. The purpose of the inspection was to gain an update on the progress of compliance to the requirements that were identified in the last inspection report dated 01.02.05. In addition the inspector focused on the following key areas of care: choice of home, assessment and care planning, health care, meals, adult protection, some of the environment, staffing and some management areas. On the day of inspection 18 residents were living in the home, this included one receiving respite care. The methods used to undertake the inspection were to meet with a number of residents, staff, the registered manager and registered provider to gain their views on the services that Pine Trees offer. Pine Trees’ records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. What the service does well: What has improved since the last inspection?
The home has been under new corporate management for six months and staff are getting used to the changes imposed as a result of this. The Registered Manager has attended adult protection training.
Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 Page 6 An internal audit of the premises has taken place and improvements are in progress. Some carpets have been replaced and empty rooms are in the process of being decorated along with the corridors. There has been a risk assessment undertaken in respect of the swimming pool and a plan to fence it off. Hand-washing facilities for staff have improved in some areas and alcohol hand gel is in use. The records of food provided for service users are better than before. 50 of the care staff working in the home have achieved the NVQ 2 in care or equivalent. 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. Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 3 Prospective service users are given information about the home, the information requires updating so enabling them to make an informed decision. Service users are only admitted to the home following an assessment of their needs, however, the pre admission assessment process must be expanded to address all care needs and ensure the home can provide adequate care. EVIDENCE: The Registered Manager said that service users and their family are given information about the home prior to admission. The statement of purpose was not available for inspection. Due to the re-structuring of the company this document and the service users guide require updating. A copy of the new documents must be sent to the Commission. The Registered Manager visits prospective service users whenever possible. She explained the procedure for the initial assessment of prospective service users and completed assessment forms were inspected. The forms lacked detail and the Registered Manager stated that a new company form is to be implemented. An individual plan of care is compiled from the initial assessment.
Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8 Individual care plans are generated for each service user but do not inform and direct the staff in their care provision. Service users have access to health care services as necessary to ensure their assessed needs are met. EVIDENCE: Each service user had a written care plan; the Registered Manager said the service users were involved in the compilation and the service user or their representative had signed the plans inspected. There was no evidence that the service user is involved in the monthly care plan reviews or risk assessments. The care plans require much more detail to guide and direct the staff. The service user profiles are informative; relatives are encouraged to participate with these. Day and night records are maintained but require more detail. There needs to be more specific risk assessments undertaken. There are Company care planning documents to be implemented that are much better and require more information. The Registered Manager must use the new documentation for new admissions and transfer at least one existing service users’ information onto the new documentation each month. Service users spoken with said their health needs were met and they had access to their GP or other health professionals when required. Pressure
Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 Page 10 relieving equipment and equipment for moving and handling is provided as necessary. Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13&15 Links with family, friends and the community are good and allow service users the opportunity to socialise. Dietary needs of service users are well catered for with a varied selection of food available that meets their taste and preference. EVIDENCE: There is a record of visitors to the home. Service users said they could receive visitors in private and at any time and could go out whenever they liked. There is a set menu but service users can have an alternative on request. The records have been improved. Mealtimes can be flexible and served in the dining room, lounge or bedroom. Service users said the food is excellent. Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 There is a policy in place to protect service users from possible abuse, however staff are not fully aware of the content and adult protection training has not yet taken place. EVIDENCE: The home has an adult protection policy that includes whistle blowing. It also includes local authority procedures. The Registered Manager has recently attended training with Social Services and the documents from the training day are available for staff. Some of the staff will be attending the same training when places are available. The Registered Manager intends to hold training sessions in house at well. All staff must receive adult protection training. It is recommended that staff read the adult protection policy and sign confirming they have read it. Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19&26 The home is well maintained providing a safe environment for residents, staff and visitors, the grounds are tidy but the swimming pool must be made safe for service users, staff and visitors. The home is clean and free from offensive odours; further controls could be in place to improve infection risks EVIDENCE: The home is clean warm and homely and suitable for its’ purpose. An internal audit has been undertaken and refurbishment and decoration has commenced. Storage is a problem and is being reviewed. The grounds are kept tidy with colourful flowers all around the home. There has been a risk assessment undertaken for the swimming pool and the maintenance man said there would be a fence erected around it soon. This must be done as a priority. Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 Page 14 There were no unpleasant odours in the home. The laundry was suitable for the size of the home. The carpet has been removed; there must be suitable flooring fitted that can be washed, for infection control purposes. Handwashing facilities for staff have improved since the last inspection however paper towels must be provided in the laundry room and visitors toilet. Alcohol gel was in use in the home. It is recommended that there be a sluice with a washer disinfector in the home. Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27&29 The number of staff available is sufficient to meet the needs of the service users. Recruitment procedures are robust but the record keeping does not offer maximum protection to the service users EVIDENCE: Staff were courteous and friendly, they interacted well with service users. Service users said the staff are kind and considerate and work very hard. In general service users felt there were sufficient staff. Many of the staff have worked at the home for a long time and are very loyal. When agency staff need to be employed the Registered Manager tries to have the same ones for consistency. The duty rota showed sufficient staff for the number of service users. There are robust recruitment procedures employed by the Registered Manager and she has maintained records since the new company took over in February 2005. Copies of relevant qualifications must be held on file. Many of the records for staff employed prior to February 2005 were not in the home. The Registered Manager said they must be at Head Office. An immediate requirement was made for all the recruitment records required by legislation to be held in the home. Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The management and staff promote the health, safety and welfare of service users, however further training and safety measures will enhance this. EVIDENCE: The Registered Manager endeavours to ensure that working practices are safe. Relevant service checks take place when required. Staff receive statutory training. All staff working with food must have an up to date food hygiene certificate, this was identified in the Environmental Health Officers report. The cook has yet to achieve the Intermediate Food Hygiene Certificate. There must be a cleaning rota in the kitchen to ensure some areas do not get inadvertently missed. There should be cleaning schedules for staff detailing how equipment should be cleaned and indicating the type of cleaning materials to be used. The Environmental Health Officers report must be complied with. Accident reporting complies with data protection. Health and safety risk assessments have been undertaken.
Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x x x x x x 2 Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 Page 18 yes Are there any outstanding requirements from the last inspection? 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. 1. Standard 1 Regulation 6 Requirement The statement of purpose and service users guide must be reviewed and updated and copies sent to the commission The Company assessment form for prospective service users must be implemented The Company care planning documentation must be implemented. The Registered Manager must use the new documentation for new admissions and transfer at least one existing service users’ information onto the new documentation each month All staff must receive adult protection training(previous timescale of 25/04/05 not met) The swimming pool must have a fence erected around it There must be suitable flooring in the laundry that can be washed, for Infection control purposes. (previous timescale of 06/06/05 not met) Paper towels must be provided in the laundry room and visitors toilet Copies of relevant staff qualifications must be held on Timescale for action 01/11/05 2. 3. 3 7 14 15 30/09/05 30/09/05 4. 5. 6. 18 19 26 13 13 13 31/01/06 03/10/05 13/02/06 7. 8. 26 29 13 17, 19 24/10/05 24/10/05
Page 19 Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 file 9. 10. 11. 12. 29 38 38 38 17, 19 13 13 13, 16 Recruitment records required by legislation to be held in the home. All staff working with food must have an up to date food hygiene certificate There must be a cleaning rota maintained in the kitchen The Environmental Health Officers report must be complied with. 30/09/05 28/02/06 30/09/05 24/10/05 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. 2. 3. 4. 5. 6. 7. Refer to Standard 7 7 7 18 26 38 38 Good Practice Recommendations There needs to be more specific risk assessments undertaken for service users The daily records for service users need to be more detailed There should be evidence that the service user or their representative is involved in the review of their care plan All staff should read the adult protection policy and sign confirming they have read it. There needs to be a sluice with a washer disinfector in the home There should be cleaning schedules for staff detailing how equipment should be cleaned and indicating the type of cleaning materials to be used One of the cooks should achieve the intermediate food hygiene certificate. Pine Trees D52-D04 S62885 Pine Trees V243199 110805 Stage 0.doc Version 1.40 Page 20 Commission for Social Care Inspection John keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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