CARE HOMES FOR OLDER PEOPLE
Pinfold Lodge 6 Sheepdyke Lane Hunmanby Filey YO14 OPS Lead Inspector
Mary Slattery Unannounced 1 June 2005 at 10:00am
st 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. Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Pinfold Lodge Nursing Home Address 6 Sheepdyke Lane Hunmanby Filey North Yorkshire YO14 0PS 01723 891069 01723 892575 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) Complete Homes Limited Jeremy Peter Harry Brocket Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Yes Service users from the age of 60 years of age. Date of last inspection 14th December 2004. Brief Description of the Service: Pinfold Lodge provides personal and general nursing care and accommodation for up to 34 prople from 60 years of age. The home is located in Humnanby and is within walking distance of the village centre and its amenities. Pinflod Lodge is a detached premises situated in its own grounds with parking facilities for visitors and staff. The accommodation provided in both single and double bedrooms over two floors. The double bedroms are used for single occupancy. There are two passenger lifts and level access to and around the home. The home is owned by Complete Care Homes Limited and was first registered with the Commission in 2002. Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection carried out on the 1st June 2005. The inspection took 4 hours plus 2 hours preparation time. A tour of the premises was carried out which included the service users private accommodation. A selection of the home’s records were looked at and time was spent observing the activity in the home, talking and listening to service users and staff. The focus of the inspection was on a number of key standards, inspecting the case records of service users to establish if they corresponded with their experiences in the home. The registered manager was available throughout the inspection and the findings were discussed and agreed at the close of the inspection. What the service does well:
The home was warm, clean and comfortable at the time of the inspection. Good information has been collected about the service users recently admitted to the home and clear care plans have been implemented. They have developed good links with the local community, have a good selection of social activities and visitors are always welcome. All of the service users bedrooms are well decorated and they are encouraged and helped to personalise their rooms. The service users said they were well cared for and they liked the staff. All of the service users looked well cared for and are encouraged to retain as much independence as possible and to express their views about all aspects of life in the home. Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 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. Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 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 Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 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 and 4. People are provided with information about what the home provides and information is gathered about people moving into the home to ensure that their needs can be met. EVIDENCE: The statement of purpose and the service user guide are made available to prospective service users and their representatives to enable them to make an informed choice about moving into the home. The service users currently living in the home do not have individual copies of the service user guide to refer to. The qualified nursing staff visit prospective services users to carryout the initial assessment to ensure that their identified needs can be met by the home and that any specialist equipment they need is provided prior to or upon admission. There are no arrangements in place for service users and/or their representatives to confirm that they agree with the assessment done by the staff.
Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 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, and10. There are systems in place to meet service users health care needs. EVIDENCE: The care plans of service users recently admitted to the home gave information about their personal care and nursing care needs. There was a social history, risk assessments for moving and handling and falls and care plans for the prevention of and the treatment of pressure ulcers. The daily records showed that their needs had been attended to and there was information about contacts with external health care professionals, relatives, social activities and of any changes in their conditions. The care plans of those service users who have lived in the home for a period of time need to be fully reviewed and updated to include detailed plans of care for the management of pain, the prevention of pressure ulcers and risk assessments where bed safety rails are used. The service users appeared well cared for, well groomed and there was plenty of equipment being used to assist service them with their mobility.
Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 Page 10 The service users met with reported that they were well cared for, they were comfortable and that the staff were kind and responded well to their needs. Staff were observed knocking on service users bedroom doors before entering, speaking in an appropriate manner and making sure that when they were assisting service users this was done in private. Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 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) 14 and 15. Service users make some decisions about how they live their lives and they are provided with a varied nutritious diet. EVIDENCE: The service users said that there is no restriction on visitors and that their families are involved in aspects of their care and assisting them in personalising their rooms. Service users where able are encouraged and supported to walk into the village and to enjoy the social life in the home. Each service users has a notice board in their room with information about forthcoming events and the names of their nurse and keyworker. The menus showed that service users are provided with a well balanced nutritious diet. There was concern that at times the cooked meals were not always hot when they received them. This concern had been brought to the attention of the manager and action is being taken to remedy this. The time between meals does not allow for proper digestion or for the building up of an appetite for the next meal.
Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 Page 12 Medication was being given out whilst service users were eating their lunch. Medication that needs to be taken with food should only be administered at this time. Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The lack of abuse awareness training and poor recruitment practices does not ensure that service users are protected from abuse. EVIDENCE: The registered manager has obtained a copy of the local authorities policy for the protection of vulnerable adults but has not given all staff the opportunity to read and discuss the policy. No arrangements have been made for staff to attend abuse awareness training or to become familiar with the policies reporting procedure. Care staff have been employed in the home prior to the required references being taken up and the required CRB and POVA checks undertaken. Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 21, 22, 24 and 26. The standard of the environment is good providing service users with a clean and homely place to live. EVIDENCE: All of the service users bedrooms are decorated and furnished to a good standard. Their rooms are arranged to suit their tastes and physical needs. They are provided with lockable storage space for valuables and a number of relatives have been involved in decorating and arranging their rooms with them. There was a good supply of moving and handling equipment and pressure relieving mattress and cushions. Service users have sufficient numbers of toilets but there is insufficient numbers of usable bathing facilities for them. The shower room is used as a store room and this needs situation needs to be changed. Privacy locks have not been fitted to all the communal toilets and bathrooms.
Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 Page 15 The bed safety rails were not fitted with bumpers this leaves service users at risk of injury. Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 Page 16 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) 29 and 30. There are sufficient staff on duty to meet the needs of the service users. Failure to carryout the required checks on staff places service users at risk from harm. EVIDENCE: The qualified nursing staff employed have the relevant qualifications and care staff are working towards NVQ. There were no records in place to confirm that new staff had been subject to an induction into the homes policies and practices and no records to show that staff have been deemed competent in their roles. The required records for newly appointed staff were not in place and there are no arrangements in place for the formal supervision of staff. Arrangements need to be made for fire safety, moving and handling and abuse awareness training. Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 Page 17 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) 33, 36 and 38. The registered manager is aware of the areas in the home that need to be improved upon. EVIDENCE: The service users views are sought and staff were observed discussing the events of the day and making arrangements to fit in with each service users needs and wishes. Service users said that they were listened to and every effort was made by the make their lives better. The staff are supervised on a daily basis but there are no arrangements in place for them to receive supervision on a one to one basis. There is a health and safety policy and procedure in place and training for staff on fire safety, moving and handling and COSHH needs to be arranged.
Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 2
COMPLAINTS AND PROTECTION x x 1 3 x 3 x x STAFFING Standard No Score 27 x 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 x x 3 x x 1 x 1 Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 Page 19 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 7 Regulation 15(1) 2(b) Requirement The registered person is required to make arrangements to review the care plans of service users who have lived in the home for a period of time and have care plans in place to meet specific needs. The registered person is required to make arrangements for abuse awareness traing for all staff and for them to understand the reporting procedure. The registered person is required to provide sufficient numbers of usable bathing facilities for the number of service users accommodated. The registered person is required to fit all bed safety rails with bumpers. The registered person is required to undetake the required checks on all staff and have the required records in place. The registered person is required to make arrangements for staff to undertake induction training and health and safety training and formal supervision. Timescale for action 30th July 2005. 2. 18 13(6) 30th July 3005. 3. 21 23(j) 30th July 2005. 4. 5. 24 29 13(4)( c ) 17 Schedule 4 18(1)( c (i) 30th June 2005. 30th June 2005. 30th July 2005. 6. 30 Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 Page 20 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. Refer to Standard 1 4 14 15 Good Practice Recommendations It is recommended that all service users are given a copy of the service user guide for reference. It is recommended that arrangements be made for service users and/or their representative to sign in agreement to the assessment. It is recommended that a review of the current systems in place for the administration of medication at meal times is reviewed and changes made to the institutional practice. It is recommended that changes are made to meal times to allow sufficient time for digastion and to build up an appetite for the next meal. Pinfold Lodge J53_J04_S28007_Pinfold Lodge_V228031_010605_stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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