CARE HOMES FOR OLDER PEOPLE
Pinfold Lodge Nursing Home 6 Sheepdyke Lane Hunmanby Filey North Yorkshire YO14 0PS Lead Inspector
Jean Dobbin Unannounced Inspection 29th August 2007 09:00 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 Pinfold Lodge Nursing Home DS0000028007.V345887.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. Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 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 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) Complete Care Homes Ltd Mr Jeremy Peter Harry Brockett Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Age range 60 years upwards Date of last inspection 19th September 2006 Brief Description of the Service: Pinfold Lodge provides personal and general nursing care and accommodation for up to 34 people over 60 years of age. It is in Hunmanby village and is within walking distance of the local amenities. Pinfold Lodge is a detached house situated in its own grounds with parking facilities for visitors and staff. The accommodation is provided in both single and double bedrooms over two floors. The double bedrooms 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. Prospective service users are invited to look around the home before moving in. Information is provided to them in the form of a brochure that reflects the Statement of Purpose. A copy of the most recent inspection report is also made available on request. Details provided in August 2007 state that the weekly fees are between £450.00 and £525.00 with additional charges made for hairdressing and chiropody, and personal items like newspapers and toiletries. Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is what was used to write this report. • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for, before the inspection. This is called an Annual Quality Assurance Assessment (AQAA). Information from surveys, which were sent to people who live at Pinfold Lodge, their relatives, and other professional people who visit the home. 10 were sent to people at the home and 6 were returned. 4 were sent to people’s relatives and all were returned. 2 were sent to GPs and 1 was completed. A visit to the home by one inspector, which lasted about 8 hours. This visit included talking to residents and visitors, and to staff and the senior nurse on duty about their work and the training they had done. It also included checking some of the records, policies and procedures that the home has to keep. • Information about what was found during the inspection was given at the end of the visit to the senior nurse on duty and to two senior managers, who work for the organisation that owns Pinfold Lodge. Feedback was provided to the registered manager the following day by telephone. What the service does well:
All prospective residents are assessed prior to moving to the home. This reassures them that staff at the home can care and support them properly should they move there, as well as allowing the home to check that they can care for them appropriately. Pinfold Lodge provides a very homely environment, which is warm and comfortable. One person described it as “a home from home”. A relative said in their survey, “I couldn’t have chosen a better care home for my relative”. People living at the home look well cared for and staff were seen responding in a kindly, respectful way. One person said, “They always have time to listen to what I say.” Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 6 The meals are nutritious and nicely presented, and are ordered on the day they are to be eaten. This means people do not have to ‘order for tomorrow’ and can look forward to favourite dishes. The overlap of care staff on an afternoon means that staff have more time to sit and talk, and generally interact with the people who live there. This contributes to a family environment where people are respected and valued. The gardens and house are well maintained, which makes the home a nice place to live and work in. What has improved since the last inspection? What they could do better:
The care planning records describing how people are to be supported in the home must be more individual. This means that they should describe what carers have to do to help people to be as independent as they can be and to stay in charge of their own lives as far as possible. They should be written in such a way that an unfamiliar nurse working at the home would know what she had to do. They should also be written in discussion with the person or their representative so that they have the chance to say what matters to them. This was a requirement at the last inspection. The way ‘risk’ is managed at the home must be reviewed. Individual assessment of risk must be undertaken for all people who live there. Those people assessed as ‘at risk’ must have a plan in place describing how that risk is to be managed and minimised. These assessments must be properly reviewed, both regularly and following any event that affects that person. This is so that people can be kept as safe as possible, whilst recognising their right to take risks. There needs to be a robust system in place so that changes in people’s weight can be recognised and addressed in a consistent way. This is so that people’s welfare can be protected. There should be comprehensive records kept of all contacts, made with healthcare professionals, whether visits to the home or by telephone. This
Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 7 includes specialist nurses and the chiropodist. This will help the home to show that they are meeting people’s healthcare needs. All boxed medication should be counted weekly. This is to check that the actual number of tablets tallies with the expected amount as a way of confirming that people are receiving their tablets according to their prescription. Any differences should be investigated so that they can be accounted for. There should be records in place of what people like and don’t like to eat, and this should be made available to the kitchen staff. This is especially important for those people unable to speak for themselves. This means people are more likely to receive foods that they enjoy eating. People requiring help at mealtimes should be assisted by care staff who are sitting with them. Sitting with someone respects their dignity, does not draw attention to the fact that they need help and also makes the mealtime more of a social occasion. The manager needs to make sure that cooks employed at the home have some understanding of how meals can be fortified to provide more calories. This will enable people at risk of malnourishment to receive the right kinds of foods. There must be a rota in place for all staff working at the home, not just the care staff. This will provide evidence of who works when, as well as complying with the law. The home should continue to encourage and support carers to achieve a National Vocational Qualification Level 2 in Care. People are more likely to receive safe, consistent care from carers who have a good understanding of their work. The home’s recruitment processes must be followed more closely. Two references must be obtained and proof of identity should be recorded to show the home’s commitment to keeping people safe. The manager should consider studying for the Registered Manager’s Award, as this would provide information and support to help with running a care home. The home needs to develop its systems of monitoring itself even more so that it can check that it is running well and that people living there can influence how it runs. Bedrails must be checked and maintained regularly in order to keep people safe and prevent them coming to harm. Records should be kept to show that this is being done. This was a previous requirement from the last inspection. Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 8 The home should seek guidance from the Environmental Health officer about record keeping in the kitchen to make sure they are complying with the law, in order to protect people from harm. People living at the home, who are unable to move around without assistance, must be able to reach their call bell at all times so that they can summon assistance easily so that they are less likely to come to harm. 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. Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People who use this service experience good quality outcomes in this area. The pre admission assessment ensures that individual care needs can be met at the home. The prospective resident receives information and help to enable them to choose whether Pinfold Lodge is the right place for them. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: All the care records looked at contained an assessment completed before the person moves to the home to confirm that the home can meet all their care needs. The registered manager completes these assessments, either in the person’s home or in the hospital. A brochure about the home is sent to all people making enquiries about moving there. One person said in their survey that their relatives looked
Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 11 around several homes before deciding on Pinfold Lodge because “the home was clean and the atmosphere very friendly.” A Statement of Purpose and Service User Guide is available to read and gives details of the services provided by Pinfold Lodge. A copy of the recent report, produced by the Commission for Social Care Inspection is also kept at the home and this also can be asked for, to read. Carers spoken with said that they are told about the new person before they arrive so that they can welcome them and also know about the kind of care they will need. Intermediate care is not provided at Pinfold Lodge. Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience adequate quality outcomes in this area. Whilst people’s care needs are generally well met, the record keeping is poor and some people may be being put at risk as a result. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: A total of five care plans were looked at, three of them in detail. These records describe the care that individuals need to help them to retain some independence and control of their lives. The manager says that the care plans have improved since the last inspection, and are generally looked at each month to check they are still valid. However they still do not record the care that people need, nor assess individual risk for the people living there, in enough detail. People looked well cared for and said they were very satisfied with the care, but the written records did not reflect
Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 13 that care. They were not individualised so that people with very different needs had very similar plans of care. Two people had wounds requiring dressings however there were no care plans to describe the dressing, nor how often it was to be done. Another person had fallen and had had to go to casualty. There was no record to describe how the staff would support and care for them whilst they recovered from the fall. This person had had a number of falls yet there was no risk assessment in place to see how the home could try and reduce how often these falls were happening. There was no assessment of whether bedrails would help. When spoken with, this person was in their room, but did not have their call bell to hand. And although they had a plan in place to say what help was needed to move them from one place to another this had not been reviewed following their fall and subsequent injury. There were some assessments in place for the risk of developing bedsores, and how people are to be moved within the home. This moving and handling assessment needs to be in more detail to describe the type of hoist and size of sling when appropriate. All people who move to the home need an assessment to decide whether they are at risk of malnourishment because of a poor appetite or other problem. Similarly everyone needs an assessment to see if they are at risk of falling. Then the home can look at what they can do to reduce and manage these risks. All these assessments need to be done properly to keep people safe. People are seen by their GP in private and one person spoken with confirmed this. All people get weighed each month, though these records need to be kept in individual care files rather than on one chart. One person was noted to have lost a stone in weight in seven months. Nobody seemed to have noticed this. The nurse on duty requested an urgent visit from the GP. Whilst the care records have a page for recording visits from healthcare professionals some visits or telephone conversations with the doctor were not recorded. Visits from other professionals were also not always recorded, which made it difficult to check whether people’s healthcare needs were being met. One GP responded to the survey to say they were generally satisfied with the care provided at Pinfold Lodge. All these shortfalls were discussed in detail with the manager. Despite these observations people said they were well cared for. Comments made include, “I couldn’t wish for better care and support from all the staff at the home” and “I feel my dignity is put first and foremost”. One relative responded in their survey that, “the care is faultless”. Carers were observed talking gently and kindly to people. They knew the people well and could often anticipate what they wanted. Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 14 Medication systems were looked at. These were generally satisfactory with no missing signatures on the medication records or the controlled drugs records. The home currently do not routinely count the non-blister packed drugs to make sure that the anticipated number is the same as the actual number. This good practice would be a way of checking that drugs are being given and signed for according to their prescription. Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience good quality outcomes in this area. Whilst people enjoy their day-to-day lives the dining experience could be improved with better record keeping and promotion of choice and independence, so that people’s individuality can be respected. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People are encouraged to make decisions about how they spend their time. Visitors are welcomed any time and one comment in the survey said that the home “accepts family friend and visitors at any time”. One person said that they decide when to go to bed and get up and the staff support them in that choice. A relative commented, “The residents are given choices as we have seen this when we visit.” There is no activities organiser at the home and the carers said that they spend time with people in the afternoon after the late shift start work. One person said, “If I can’t take part I love to watch the other residents. I enjoy that”. Entertainers visit each month and the hairdresser visits weekly. There
Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 16 was an assortment of games and activities in the lounge and some of the people played dominoes in the afternoon. One person said they had a newspaper delivered each day. Another spoken with had a strong catholic faith and explained that they received Holy Communion at the home every two to three weeks. The Anglican clergy also visit regularly. There are no formal residents’ and relatives’ meetings held though a Questionnaire has been used to try to gain the views of the people who live there. Meals for the day are ordered after breakfast. On the day of the site visit there was lamb hotpot, potatoes, green beans and carrot and swede. Fish fingers were an alternative choice. People spoken with were very complementary about the meals and said that the cook would make you something else if neither choice was acceptable. The dessert had been changed from sponge to tinned fruit and ice cream as it was one person’s birthday and there was to be a birthday tea that day. Staff were observed at coffee time giving biscuits to people with their hot drink. People should be allowed to choose their own biscuits as this encourages their independence and promotes choice. The dining room was very attractively presented with cloth table covers and napkins. There were sauces and condiments on each table and an assortment of drinks were available, to have with the meal. A number of people needed assistance. Whilst one carer sat, assisting in a discreet manner, two others were helping people whilst standing up. Meals should be a relaxing social occasion and this type of assistance neither promotes that environment nor shows sensitivity to people’s needs. One person, who could not speak because of their medical condition, had been given lamb at lunchtime. There were no records to say what this person likes to eat, or indeed whether they were vegetarian. People who cannot voice their preferences must have these details written down so that staff can be confident that they receive a varied diet that they can enjoy. This was discussed with the manager. The cook on duty was not sure how they would fortify meals so that people at risk of malnourishment, for whatever reason, could receive extra calories. This too was discussed with the manager, who agreed to follow this up. Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience good quality outcomes in this area. People have their complaints addressed properly and staff are alert to signs of abuse in order to keep people safe. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Almost all the surveys completed by both people living at Pinfold Lodge, and their relatives, and people spoken with on the day said that they were aware of the complaints process and knew to whom they should talk with if they were unhappy. One person said, “I know who to speak to but I am very happy here”. The complaints process is displayed in the home and is included in the service User Guide. Comment cards are also available in case people want to write down their concerns. People can be reassured that complaints will be acknowledged and investigated properly. The Commission has received one complaint about the home since the last inspection. A staff member made this complaint and a senior manager carried out an investigation, with the manager informing the Commission of his findings. Despite this, one of the areas raised as part of the complaint, was
Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 18 noted at the site visit to have not been addressed. This was discussed with the manager. Staff at the home receive Safeguarding adults training from an external trainer. One carer spoken with was very aware of their responsibilities should they hear or see something that concerned them. Two people at the home receive visits from an Age Concern volunteer because family members do not live locally. The manager should consider displaying information about local advocacy services so that other people and visitors can be aware of the type of service that these agencies provide. Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use this service experience good quality outcomes in this area. The environment at Pinfold Lodge contributes to the standard of living enjoyed by the people who live there. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home is an attractive detached house on the outskirts of Hunmanby. It tries to promote a ‘homely’ atmosphere, rather than that of an institution. It has lovely gardens and a patio area, accessed from the lounge, where people can sit out. This is going to be improved still further with the help of some monies from Scarborough Council. The home has two floors and private rooms, which all have en suite facilities, are on both levels. There are two passenger lifts. On the day of the visit a
Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 20 tour of the home showed it to be clean, comfortable and well maintained. There were no unpleasant smells. There are two assisted baths and a large shower room. Different aids are available to assist with moving people and the home has a number of electric beds. There was adequate storage space and as a result, the corridors were not cluttered. Those private rooms looked at were nicely decorated and were all very different. People had brought in their own personal effects and several had their own phone. There is a dining room, and one large lounge, which is partly split by a wall into two smaller areas. New chairs and occasional tables have recently been bought for the lounge. A discussion could be held with people there, to see if the present seating arrangement should be changed to encourage conversation and present a more homely atmosphere. The laundry area is well equipped. People said that clothes were well cared for. Carers and cleaning staff were seen wearing aprons and gloves when carrying out their work. Hand wash gel was also available in the home. Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience good quality outcomes in this area. Whilst staff are well trained to meet the needs of the people living there the recruitment systems need to be better to protect people from harm. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: On the day of the site visit there was one nurse working in the morning, one on the late shift and one through the night. The nurse on duty said that sometimes there are more nurses on, and the rota confirmed this. There are generally a total of six staff on duty on the morning, four on the late shift and two at night. Generally the staff do not work twelve-hour shifts during the day. Two domestics, a cook, kitchen assistant and laundry person were also working. The home also employs part time maintenance and gardening staff. There is no rota however to record the shifts worked by the ancillary staff and this should be introduced so that the home can maintain records of all people working at the home. On the day of the visit there seemed to be enough carers to meet the needs of the people living there. One person spoken with said they felt very safe at the
Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 22 home. Another commented, “I feel as though the staff are my extended family. They are very patient and understanding”. One person though replied in their survey that there was insufficient staff. This affected the level of care their relative was able to receive and meant there wasn’t enough supervision for people sitting in the lounge. They had removed their relative from the home. This was discussed with the manager. Carers spoken with felt that there was a good ‘team spirit’ and the nursing staff were happy to answer their questions so that they can increase their knowledge and understanding. Two care staff are on an Overseas Nursing programme, which on completion, means that they can work as trained nurses in this country. The home has re established links recently to enable care staff to work towards a National Vocational Qualification Level 2 in Care. At this time about 45 of care staff have this qualification. People are more likely to receive safe, consistent care from staff who have a good understanding of their role. One carer said they had received fire safety and health and safety training this year. Several carers were also attending dementia awareness training to give them more insight into this condition. Two recruitment records were looked at. Both had Criminal Records Bureau checks carried out before they started work to check that they were not barred from working in a care setting because of a previous offence. Both staff files though had some recruitment documents missing. One file contained only one reference and the application form did not provide a full employment history. Neither file provided any proof of the person’s identity, although the nurse on duty said that evidence like the passport and birth certificate were checked at interview. This though was not recorded anywhere. These shortfalls in the recruitment process may be putting people at the home at risk. One carer was spoken with who had started work at the home in the last year. They explained that when they started they had worked for several days as an ‘extra’ person so that they could observe other more experienced staff at work. They found this process very helpful. They were also given a ‘buddy’ who could support them whilst they were learning their role. They were given an Induction book, which describes some of the policies and processes used by the home. They have also had some informal discussions with the manager to check that they were enjoying and managing the work all right. Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use this service experience adequate quality outcomes in this area. The home is generally well run though shortfalls in health and safety systems may be putting people at risk. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The registered manager is an experienced nurse, who has worked in care homes for a number of years, but has not started working to achieve the Registered Manager’s Award. He is well liked at the home and carers spoken with felt he was very approachable. One person said that they saw the manager once or twice a day and would speak with him if they were unhappy.
Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 24 Talking with the manager on the day after the site visit showed that he has a good understanding of the needs of the people who live there. The manager has used a questionnaire to find the views of the people who live there. These results need to explored and displayed in the home. This will show people that their views are taken seriously and can help to shape how the home runs. The manager needs to look at gaining the views of other people who have an interest in how the home operates as well as looking at other ways the home can monitor itself to check that it is running well. People’s finances were not formally checked at this site visit. There has been no evidence to suggest that people’s financial interests have not been protected properly at the home. Whilst records of accidents are kept, the manager needs to provide evidence that he is checking these regularly to look for trends, to see whether changes would reduce the risk of other accidents happening. This would demonstrate the home’s commitment to protecting the health and safety of both the people who live there, and the staff. A carer spoken with confirmed that they had received fire and health and safety training earlier this year. The home does not keep a formal written record of when staff attend training. This would be good practice, as it would enable the manager to easily check when training is due and confirm to him that everyone is ‘up to date’ with their annual compulsory training. This would show the home’s commitment to protecting the health and safety of the staff and people living there. The carer said that whilst they had no formal supervision sessions they said the manager regularly talked informally to them about their work and how they were doing. The manager needs to record these discussions to show that they took place and to enable him to check whether requests, which were raised in discussion, had been addressed. Staff meetings are carried out about twice yearly and are minuted. Fire alarm checks and emergency lighting checks are carried out regularly. Water temperature monitoring is also carried out regularly to minimise the risk of people getting scalded from water that is too hot. Random service certificate checks on gas, legionella checks and Portable Appliance Testing were in date. A recent lift service had been done. The report said that although the lift was serviceable some recommendations had been made relating to how the lift operates. A discussion was held with the senior managers as to whether they planned to address these recommendations. Whilst bed rail risk assessments are generally in place there is still no evidence of regular maintenance checks on them. This was a previous requirement. Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 25 These checks are required to make sure that the bed rails are working properly so that people can be kept safe. This was discussed with the manager. The cook on duty said she did not routinely probe food prior to serving to make sure it was still hot enough. Similarly whilst one kitchen staff member said that records were kept of fridge and freezer temperatures the cook on duty was unaware of these records. These systems are in place to minimise the risks of people getting food poisoning. This too was discussed with the manager Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 1 Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 (2(b)) Requirement Care planning records must be written in greater detail to reflect people’s different needs and to show how people are supported to stay in charge of their own lives as far as possible. They should be written with the person so they can say what matters to them. This was outstanding from the previous inspection. 2 OP7 13 (4) All people living at the home must have an assessment of risk included in their care plan. All identified risks require written records of how the risk is to be managed, in order to keep people safe. 31/10/07 Timescale for action 30/11/07 3 OP8 17(1)(a) Sch 3(m) There must be a robust and 30/09/07 consistent way of monitoring and reacting to changes in people’s weight. This is so that people’s welfare can be protected. A roster must be kept of the hours worked by ancillary staff. This will demonstrate that the
DS0000028007.V345887.R01.S.doc 4 OP27 17(2) Sch4(7) 30/09/07 Pinfold Lodge Nursing Home Version 5.2 Page 28 home is employing enough staff to meet the needs of the people and the size of the home. 5 OP29 19 Sch 4 The registered person is required to undertake the required recruitment checks on all staff and have the required records in place before that person is deployed at the home. This is so that people can be protected from harm. This was outstanding from the previous inspection. 6 OP38 13(4)(c) Records must be kept as evidence that bed rails have been checked on a regular basis to ensure that they are safely fitted in order to keep people safe. This was outstanding from the previous inspection. 7 OP38 13(4) All people unable to move 29/08/07 independently must be able to reach a call bell to summon staff, so as to promote their safety. 30/09/07 29/08/07 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 OP8 Good Practice Recommendations A chronological record of all contacts with external healthcare professionals should be kept in the person’s file. This would demonstrate guidance is being sought and people’s healthcare needs are being met. It would also provide a more consistent approach. Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 29 2. OP9 It would be good practice for nurses to count non-blister packed drugs weekly. This would check that the actual number of tablets is the same as the expected number and would confirm that drugs are being given and signed for according to their prescription. 1. There should be records of people’s dietary preferences, which are made available to the catering staff. This should ensure people receive the meals that they enjoy eating 2. People requiring help with their meals should be assisted by a carer seated at their side, who can then assist in a sensitive and discreet manner. 3. The manager should arrange some training so that catering staff have a better understanding of special diets and how extra calories can be provided. This is so that people’s nutritional needs can be met. There should be continued encouragement to enable care staff to undertake and achieve an NVQ qualification in Care so that people are more likely to receive safe consistent care. The registered manager should undertake study to gain the Registered Manager’s Award so that people and staff can benefit from the new learning and ideas that the course would provide. It is recommended that the quality assurance system be further developed so that people are able to influence how the home runs. Advice from the Environmental Health officer should be sought to check that record keeping in the kitchen is adequate to minimise the risk of people getting food poisoning. 3. OP15 4. OP28 5. OP31 6. OP33 7. OP38 Pinfold Lodge Nursing Home DS0000028007.V345887.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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