Inspection on 06/08/08 for Pinfold Lodge Nursing Home

This inspection was carried out on 6th August 2008.

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

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

Other inspections for this house

Pinfold Lodge Nursing Home 29/08/07

Pinfold Lodge Nursing Home 19/09/06

Pinfold Lodge Nursing Home 01/06/05

Pinfold Lodge Nursing Home 14/12/04

Pinfold Lodge Nursing Home 17/08/04

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Abbey The

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Larchfield Manor

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Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Pinfold Lodge Nursing Home 6 Sheepdyke Lane Hunmanby Filey North Yorkshire YO14 0PS Lead Inspector Anne Prankitt Key Unannounced Inspection 6th August 2008 09:45 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.V369791.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.V369791.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.V369791.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places: 34 The maximum number of service users who can be accommodated is: 34 29th August 2007 2. Date of last inspection 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. It 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. Double rooms are normally used for single occupancy. There are two passenger lifts and level access to and around the home, which provides a large communal sitting area and separate dining room. There is an assisted bathroom on each floor. The general manager informed us that people get a copy of the service users’ guide before they are admitted. People can have a copy of the last inspection report on request. And the Statement of Purpose, which gives general information about what the home provides, is displayed in the reception area. On the day of this site visit, the general manager told us that everyone at the home pays £525 per week for their stay. This does not consider the free nursing care contribution. Where people are awarded this, the provider is paid direct on their behalf. He reduces the person’s fees to take this payment into account. People pay extra for hairdressing and chiropody. Pinfold Lodge Nursing Home DS0000028007.V369791.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The key inspection included a review of the following information to provide evidence for this report: • • Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the management thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. A visit to the home by one inspector lasting about eight hours. • During the visit to the home, several people who live there, four relatives, some staff and the manager were spoken with. Three people’s care plans were looked at in detail. Another one was looked at in less detail. Two staff recruitment files and training files, some policies and procedures, and some records about health and safety in the home were also seen. Care practices were observed, where appropriate. Some time was also spent watching the general activity to get an idea about what it is like to live at Pinfold Lodge. The deputy manager is currently overseeing the day to day management of the home with the support of the general manager. The general manager oversees the management of several homes owned by the company. Both were at the home on the day of the site visit. Feedback was given to both of them at the end. What the service does well: The general manager works closely with the Commission for Social Care Inspection. She makes sure we are informed about plans for the home, and of any incidents which have happened there. This keeps us informed, and tells us that she is working hard supporting staff there to make further improvements. This will be to the benefit of the people who live there. The home provides a clean, well maintained, pleasant and friendly environment in a quiet village location. It has a nice garden for people to enjoy. Pinfold Lodge Nursing Home DS0000028007.V369791.R01.S.doc Version 5.2 Page 6 People generally get their care when and how they want it. They can make choices in their daily lives. The staff know what people’s needs are. Staff give each other good information each day to make sure that any changes are passed on. People trust that staff would take any concerns they have seriously, and think that they would take action to put things right. People’s social needs are being given more attention. The activities person works thirty hours each week. This gives her time to consider people’s individual needs, and to learn how she can help them meet these needs. People get nutritious freshly prepared food which they say is tasty and satisfying. Staff are getting lots of training so they build up an understanding of people’s different needs, and how they can assist them in meeting them in a safe and professional way. What has improved since the last inspection? Steps are being taken to make sure that the home gets enough information about people before they are admitted. This will help to decide whether the home can meet their needs, and whether the staff are trained to understand the support and care that people may require. Some improvements have already been made to the care plans. For instance, a record of people’s weight is now included in their care plan, so staff can keep a closer eye and react quickly to any changes which cause them concern. And staff now record whenever they have contacted other health professionals for advice about a person’s care. A record is also kept to show that staff check bed rails on a daily basis. This is good practice, because it shows that they are properly fitted and safe for use. Further improvements to the care plans will soon be made. The general manager has already consulted with the Commission for Social Care Inspection so that she can tell us how she intends to change the paperwork to provide better information about people’s individual needs. People in their rooms who are unable to move now have their call bells within reach so they can summon staff if they need help. People are being asked in different ways now about the care that they get, and whether this meets their needs. This gives them the opportunity influence how the service runs by telling the management what the home does well, and where they would like improvements to be made. The records kept by the kitchen staff about people’s dietary preferences have improved. The cook has also had some training about understanding special diets. This will ensure that people get a meal which they enjoy, and which their diet allows, at each mealtime. Staff also now sit with people, rather than stand Pinfold Lodge Nursing Home DS0000028007.V369791.R01.S.doc Version 5.2 Page 7 over them, at mealtimes. This makes the occasion much more social, and will stop people from feeling unduly rushed. The way that staff are recruited has got better, although it is recommended that any gaps in employment history are explored with the applicant to make sure that there is no related reason as to why they should not be employed in a care setting. A record is now kept of when ancillary staff have worked. This helps to show who is in the building at any particular time, and also demonstrates whether there are enough ancillary staff provided. There is now a rolling programme of study towards National Vocational Qualifications in Care, which staff are encouraged to work towards. This will help to achieve a well qualified workforce. What they could do better: The home could gather more information before people are admitted to ensure that enough is known about their needs to be able to tell whether the home is the right place to provide their care. The general manager realises this is vital if admissions are to be successful, and has taken steps to achieve this. The care plans could be much more individual to the person, and they could be drawn up with the involvement of the people to whom they belong. The plans and the risk assessments could be reviewed more regularly. This would help to make them much more meaningful, and a good source of information for staff to follow when deciding whether further advice or equipment is needed to maintain people’s good health. Staff could always make sure that people’s personal care is given behind closed door, so that their privacy and dignity is respected. To make it easier to keep a stock check, the way that staff keep a record about how many tablets people have left could be improved. Certain medication could be stored at a better temperature to make it more pleasant for the person if it needed to be used. A better record could be kept when people complain, including informing the person who complained of the outcome. This would help to show that the home takes complaints very seriously. Gaps in the employment history of people who apply for work could be more thoroughly explored, so they can explain any periods where they have not been employed, and why. There are several flies at the home. Action could be taken to make sure that these are eradicated. By doing so, the chance of germs being transferred by them onto food for instance will be much less than at present. Pinfold Lodge Nursing Home DS0000028007.V369791.R01.S.doc Version 5.2 Page 8 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.V369791.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.V369791.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 the service experience adequate outcomes in this area. People admitted in the future should benefit from the better admission procedures and documentation that is now in place. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The deputy manager knew what type of care the home was registered to provide. She said that people were usually visited before their admission to check what their needs were. The information collected for past admissions was not always sufficient. This could mean that not enough was found out about the person to decide whether the home would be able to meet their needs. The documentation used by staff to collect pre admission information required tick box answers only, and a written care plan was sometimes not obtained from the person’s care manager. This unsatisfactory practice increased the potential of people’s admission going wrong, or of staff being unable to meet the person’s needs. Pinfold Lodge Nursing Home DS0000028007.V369791.R01.S.doc Version 5.2 Page 11 However, the general manager has done a great deal of work with the staff at the home in order to put this right. She has introduced new documentation, which asks searching questions about people’s current health and wellbeing. The deputy manager has used this paperwork once. She said it had worked well. She was clear about who she could and could not admit to the home. She agreed that in future she would get copies of assessments written by other professionals before people were admitted. This will put her in a better position to make sure that people get all the help and support they need as soon as they arrive. People are invited to visit the home before they are admitted if they wish to, and they are given a copy of the service users’ guide so that they can see what the home provides, and whether it will be suitable for them. People are assessed by specially appointed visiting professionals to determine whether they should be awarded payment for their nursing care, which they are now entitled to receive free of charge. The general manager arranged on the day for one assessment, which had been overlooked, to be sorted out. This will ensure that the person gets the funding that they are entitled to, and that their nursing care is provided by the right staff. The home does not provide intermediate care. Therefore standard 6 is not applicable. Pinfold Lodge Nursing Home DS0000028007.V369791.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 the service experience adequate outcomes in this area. People’s care is not always reflected in their care plans, but changes are being made quickly to improve this. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The current care plans are pre printed, and it was not always possible to see why people had been admitted. This means that everyone’s basic plan starts off the same. Providing such paperwork does not allow staff to write about people’s personal needs, interests and identified risks in an individual way. It is also difficult for staff to add information about people’s care needs which change over time. The care plans had not been reviewed regularly, which increases the chance of the information being out of date and no longer appropriate. This is perhaps because they are currently more of a paper exercise than a working document, because they do not always reflect the good care that people usually get. Pinfold Lodge Nursing Home DS0000028007.V369791.R01.S.doc Version 5.2 Page 13 However, where staff have had the opportunity to write freely about people, the information is much better, because they have tried hard to build up a picture about the person, and what affects their wellbeing. There was some good information in these areas, which explained what can affect people’s mood for instance. Despite these shortfalls, staff know people well and they get a good report before each shift so they have verbal information about how people’s needs have changed. Currently, this verbal information is probably more valuable to them that the written care plan. In support of this, people were all highly satisfied with the care that they get. The general manager is fully aware of the shortfalls, and is working alongside staff to make major changes to the care plans. She says that they will be totally re written to make them much more personalised, and to reflect people’s overall needs in a much more individual way. As part of this process, staff should make every effort to involve the person, and if necessary their family, when drawing up the new information. This will help to ensure that people get consistent care as they wish to receive it, and decisions about risk management are made with their agreement where possible. Some work has already started. Assessments have been written to identify and monitor areas of risk to people from falls and malnutrition. Staff now check bed safety rails daily to make sure that they are safe for use. They also keep a record to show that they have done this. And staff are forging better links with the falls assessor and tissue viability nurse. The records now show when staff have requested the advice of health professionals where their assistance is needed. One person was receiving regular physiotherapy treatment, and was pleased that they were improving. They said that staff were very good at supporting the care they needed. The Community Psychiatric Nurse is also used as a source of advice and guidance where staff feel they need extra help, and their advice had been written down and shared with staff. One person’s assessment showed that they were at increased risk from poor nutrition and fragile skin. Staff had not considered the provision of a special mattress, or advice from the dietitian. However, assurance was given that this would be followed up the next day. This will help to maintain the person’s health. People and their relatives were unanimous that the staff at the home are caring and attentive. One person had taken the time to complete a written compliment about a member of care staff, commending them on the good attention they had given. People said ‘I like it here – it’s all fine’, ‘I get a really good bath’. A relative said ‘I’m extremely happy with the care – it is very Pinfold Lodge Nursing Home DS0000028007.V369791.R01.S.doc Version 5.2 Page 14 positive and homely here’. Another said that their relative was ‘getting better all the time’. Throughout the course of the site visit, people were spoken to with dignity and respect. They were not rushed by staff, who gave support when this was requested. People living at the home have just completed a questionnaire asking their views on how the home promotes their privacy and dignity. People were very positive in their response, although on two occasions during the site visit, the bathroom door had been left open by staff when people were either bathing, or using the toilet. On one occasion, people passing on the corridor could hear what was happening in the room. The general manager dealt with this straight away. In response to their surveys, people thought that they are given little chance to take risks in their lives. This could be because staff want to keep people safe. However, the general manager intended to discuss this issue at the resident’s and relatives forum, to check that people did not feel that their freedom was restricted in any way, or whether they fully understood what she was asking. This will reassure them that she is listening to and acting upon their comments. Nobody presently living at the home looks after their own medication. However, locked facilities are provided if anyone wanted to in the future, and it was agreed that it was safe for them to do so. Trained staff handle people’s medication, which is kept locked safely away. By checking the number of tablets remaining in the blister packs supplied by the chemist, it was determined that this medication had been given regularly, and according to doctor’s orders. It was more difficult to check the medication supplied in boxes, because the amount in the trolley did not tally with the recorded stock balance. The general manager has checked this, and has given assurance that after checking another set of records, the balance in each case is correct. She has agreed to simplify the way this information is recorded, so that staff auditing the stock can see at a glance that number of tablets remaining is correct. One item was stored in the fridge unnecessarily. By storing it this way, it could cause discomfort for the person if it was used. The general manager agreed to remove it. There has been one medication error reported to the Commission for Social Care Inspection by the home since the last key inspection. Whilst we were informed that the staff member had been told to ‘check more carefully’ in future, we advised that the staff member should complete some written reflection. This gives staff the opportunity to think about their actions, and how they can affect the welfare of people. Pinfold Lodge Nursing Home DS0000028007.V369791.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 the service experience good outcomes in this area. Care is taken to meet people’s social needs in a range of ways, and choice and individuality are seen as important in their lives. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home now has recently employed an activities person to work thirty hours each week. She explained that she is getting to know people’s interests, which she will then be writing down so that staff can read what people like to do socially. She helps people at mealtimes, which are recognised as a social activity. Each day she tries to spend time with people individually. Afternoons are usually dedicated to group activities. People said they enjoyed what was on offer. Especially the trips into the village, where many people lived before being admitted. One person said they enjoyed the painting and cake decorating they had recently joined in with. The local church visits regularly to provide a communion service. The Roman Catholic priest also visits. The general manager intends to make some enquiries on behalf of one person whose social needs may be more difficult to meet alongside everyone else’s. This will help to make their life more fulfilled, and shows that overall, people’s Pinfold Lodge Nursing Home DS0000028007.V369791.R01.S.doc Version 5.2 Page 16 social and spiritual needs are recognised, and action is being taken to help meet them. Visitors were seen coming and going during the course of the day. Visitors spoken with praised the home and the staff who work there. They said it is very homely and friendly, and they are always made to feel welcome when they visit their family. The home will soon hold a summer fayre. This gives people the opportunity to mix with others living in the village. There was lots of interesting things for people to look at in preparation, like raffle prizes and competitions. People said that they get opportunities to make choices in their daily lives. A staff member could think of ways that she tried to provide people with choices, such as offering a choice of clothing, making sure people got a choice of meal, and by being flexible, so that one day in a person’s life did not have to be the same as the next. The dining area was nicely set out. It was well used by people at the main mealtime. People get three meals each day. They can have a cooked breakfast if they wish, and drinks and snacks are available at any time. The cook has undertaken training about record keeping, food hygiene and healthy eating since the last site visit. At this visit, she knew about who needed a special diet to maintain their health, and how to make additions to people’s diet so that they maintained their weight when this is a problem to them. She gets a list of people’s likes, dislikes and allergies when they first move in. This means that she can be sure that she is giving them a diet which they will enjoy, and which will not make them ill. The main meal smelled good and looked very appetising, and included meat and freshly cooked vegetables. People had all chosen turkey dinner for their main course. Those who needed help were offered this discreetly, and staff sat with them during the course of the meal so people did not have cause to feel rushed. People who could not manage solid food had each component of their meal served on their plate separately. This makes it more attractive, and allows people to taste each part of their meal separately. The environmental health officer has visited since the last key inspection. He made some recommendations about record keeping. He also advised getting some colour coded knives to make it easier for the cook to use the right knife for the right job. Staff need to remember to sign to say that they have completed cleaning tasks when the work has been done. However the kitchen looked clean and tidy. Pinfold Lodge Nursing Home DS0000028007.V369791.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 the service experience good outcomes in this area. People are confident that their complaints would be taken seriously. But the lack of thorough recording means that in practice this cannot be evidenced. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The complaints procedure was displayed in the hallway of the home. It is also included in the service users’ guide, which people get before they are admitted. People and their families said that they would be happy to tell the staff or to the manager if they had any concerns. They were confident that any complaint would be taken seriously and put right. One person said ‘I think staff would listen if I had any grumbles’. And a relative said ‘I have no complaints but I’m quite happy they would be dealt with if an issue arose’. Staff spoken with knew that they must listen to people’s concerns, and pass them on to someone more senior. This also included any allegations of abuse that they may be told about, or suspect. There is clear guidance displayed in the office, which tells senior staff what they have to do if they are told about or suspect that abuse might have happened to a person living at the home. It reminds the staff member of their responsibility in reporting all allegations to the local authority for investigation. This will help to keep vulnerable people safe, and will mean that the right people can investigate any allegation straight away. Pinfold Lodge Nursing Home DS0000028007.V369791.R01.S.doc Version 5.2 Page 18 Staff who have not yet had training in safeguarding people (they call this POVA (Protection of Vulnerable Adult) training) will soon be provided with an update. This will make sure that all staff know their responsibilities, and that they act in a consistent way to protect people. There have been two complaints made to the home in the last year. One was about poor record keeping, which the general manager has dealt with. She has recorded the action she has taken, and who she has spoken to during her investigation. She had also kept a record to show that she had received feedback that the person who raised the concerns was now satisfied. The second complaint from a person living at the home was not well documented. There was no record kept of any support or supervision given to staff, or of any statements collected from them at the time the investigation took place. Nobody had recorded in the person’s care plan the recommended action to be taken by staff following the complaint. This could lead to inconsistent care. And the record kept of the investigation and subsequent outcome did not provide enough information to show that the person had been consulted about the action taken, or whether they were satisfied with the outcome. The deputy manager was able to tell us what had been done to put the matter right at the time. But this lack of recorded information makes complaints difficult to review when deciding how they can be dealt with better in the future. Pinfold Lodge Nursing Home DS0000028007.V369791.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 the service experience good outcomes in this area. People live in a warm homely environment which meets their needs. We have made this judgement using a range of evidence including a visit to this service EVIDENCE: The environment was warm, pleasant and comfortable. The communal lounge was full of interesting things for people to look at and touch, such as ornaments, activities materials and books. People were enjoying the views from the lounge. A new patio area is being prepared at the back of the building. This will mean that there will soon be level access provided for people from the sitting area into the garden, which is well tended and attractive. People said that they like their private accommodation. Each bedroom seen was different, containing people’s personal belongings. The general manager has ordered ‘do not disturb’ signs. These will be given to everyone in the Pinfold Lodge Nursing Home DS0000028007.V369791.R01.S.doc Version 5.2 Page 20 home, so that they can let staff know when they want to be left alone in their room to enjoy some privacy. The communal toilets on the ground floor are small, so are not used very much by people who need assistance from staff, or who use equipment to help them mobilise, because there is not enough room for them to do so safely and privately. This means that they have the use of one toilet in the main bathroom. Although this could cause problems if the bathroom was in use, nobody raised it as an issue. The fire officer has not visited for over a year. At his last visit, he was satisfied with the fire safety risk assessment that the home had completed. One newly fitted fire door leading to an area not used by people living at the home had been wedged open for easy access by staff. This was removed straight away when staff were reminded that it was not safe practice, and must not happen. The laundry person was satisfied with the two available washers and drier she has available for her use. They are located in a separate laundry room. She said that she is provided with protective gloves and aprons, and that she knows where to go for information if she were to come into contact with hazardous chemicals. Care staff tell her when people have an infection. They deliver soiled clothing in sealed dissolvable bags, which can be put straight into the washing machine without having to remove the contents first. This helps to keep the risk from cross infection to a minimum. Pinfold Lodge Nursing Home DS0000028007.V369791.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 the service experience good outcomes in this area. People are cared for by enough staff, in whom training and supervision is being invested to provide safe, consistent standards of care. We have made this judgement using a range of evidence including a visit to this service EVIDENCE: On the day of the site visit staff had enough time to chat with people in between care tasks. People in their rooms had access to their remote bells, which means that they can ask for staff help by pressing the button whenever they need it. The call bells did not ring for long periods. This suggests that people got their care quickly when they asked for it. Staff are getting a range of training to help them to understand the different needs of people. Some have achieved, or are studying towards, National Vocational Qualifications in Care, distance learning in dementia awareness, palliative care and nutrition and health. This will assure people that they are being cared for by a care team who are becoming well qualified with up to date information about how care should be provided. Before employing new staff, information is collected to decide whether the applicant is suitable to care for vulnerable people. This includes getting two references, one of which is obtained from their current employer, to check why they are leaving. A check is also made to make sure that the person is not Pinfold Lodge Nursing Home DS0000028007.V369791.R01.S.doc Version 5.2 Page 22 included on the POVAFirst list. This list informs employers whether an individual is barred from working from vulnerable people. In both files seen, the staff had been employed after the POVAFirst check had been returned, but before a full police check had been obtained. The general manager said that in both cases the staff were needed quickly in order to maintain staffing levels. She is aware that unless the circumstances are extreme, the full police check should be returned before the person begins to work with people. However, she gave her assurance that the staff members never worked unsupervised until all the information about them came back. It is important during staff recruitment however to check the reasons for gaps in a person’s previous employment to make sure they are suitable to employ. This had not been done in the records seen. A new staff member said that they got an initial basic induction when they started at the home, after which they are now working through their full induction. They have had lots of support from the general manager during this period to help them adjust to their new role. They were also aware that there were plans to introduce supervision to staff. This will help to promote good consistent care because the opportunity will arise to discuss individual training needs and general care practice. Staff meetings have already been organised. They give good opportunities for staff of different levels to consult with each other to help develop the service. Pinfold Lodge Nursing Home DS0000028007.V369791.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 the service experience good outcomes in this area. Arrangements have been organised so that the current management arrangements are not detrimental to the service people get. People are being consulted to make sure the service is run in their best interests. Certain health and safety matters need to be improved upon so that people are protected from unnecessary risk from harm. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Presently, the deputy manager is responsible for the day to day management of the home with the support of the general manager. Staff spoke highly of both, and said that they were open and approachable. One said that the general manager was ‘making lots of changes for the better’. This open management culture makes it easy for staff to go to them if they ever have Pinfold Lodge Nursing Home DS0000028007.V369791.R01.S.doc Version 5.2 Page 24 any work related problems that they need to discuss. The deputy manager has recently completed a management course, which she said is helping her in her current role. It will be better when trained staff return from their holidays because she will have more protected time to carry out the management duties that she is currently undertaking. The home has started to gather information from people more formally, so that they can check more efficiently whether the home is running in their best interests, and listening to what people say. This includes asking them to complete a satisfaction questionnaire about privacy and dignity. A meeting had been organised for people and their families on the afternoon of the site visit. This gave the general manager the opportunity to mix with relatives, to discuss the results of the survey and to tell them what was going to happen as a result. It would be advisable to send questionnaires to professionals who visit the home so that they too can give their views about how it meets the needs of their clients living there. The general manager intends to introduce this straight away. People’s finances are normally handled by family members or advocates, although the deputy manager said that the home would try to support anyone who wanted to manage their own. Locked facilities are provided so that valuables can be stored safely in people’s rooms. If people wish, they can ask the home to look after their personal allowance on their behalf. The home asks people’s family for money when their account runs low. The deputy manager keeps individual records of when money enters or leaves their account. This money is accessible to people at all times. This means that they can have it at short notice if, for instance, they were to be taken out unexpectedly by their family. The information provided before and during the site visit showed that the premises are kept maintained so that they are safe to live in. The maintenance man undertakes in house checks, for instance, to make sure that hot water is maintained at a safe temperature to reduce the risk to people from scalds. The hot water in the sluice room is not regulated. This means that it gets very hot. The door was left unlocked, but the general manager is going to make sure that staff now keep it locked shut. This will keep people safer from unnecessary risks. The maintenance man also checks the fire alarms. It has been the practice of the home to complete this check monthly. The general manager decided to change this to a weekly check. This will help to monitor the system more closely, to ensure that it will work effectively if fire should break out. Both the general manager and the deputy recognised that some mandatory training has fallen behind. They are working hard to put this right. All staff have already had a recent update in fire safety training. A programme is in place so that all other training including moving and handling, first aid, Pinfold Lodge Nursing Home DS0000028007.V369791.R01.S.doc Version 5.2 Page 25 infection control and food hygiene training will also be brought up to date. The general manager said that mandatory training will be completed for all staff by the end of October 2008. It is important that this is not allowed to fall behind again. By keeping staff training up to date, people can be more confident that they will be cared for in a safe way. Denture cleansing tablets were left in people’s rooms. Staff had not completed a risk assessment to see if anyone living at the home was at risk from this arrangement. These tablets can cause harm if a person was to put a tablet in their mouth. The general manager agreed to check straight away to make sure that there was somewhere to lock the tablets away in the rooms of people who were able to manage them safely. There were a number of flies in the building which were troublesome, especially where food was nearby. Although food in the kitchen was covered up, flies could spoil the mealtime experience for people there. There is also the possibility that the insects may carry infection. Some preliminary enquiries have been made by the company to get some equipment which is safe for people living at the home, but which will get rid of the flies. This needs to be followed up. Pinfold Lodge Nursing Home DS0000028007.V369791.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 2 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 Pinfold Lodge Nursing Home DS0000028007.V369791.R01.S.doc Version 5.2 Page 27 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. 1 Standard OP3 Regulation 14 Requirement In the future, a full assessment must be carried out for everyone referred to the home before they are admitted, including a copy of the care manager’s care plan, information from the hospital, and a full assessment completed by the home wherever the person is self funding or without a care management assessment. This will help to decide what the person’s needs are, whether staff have the right training to meet them, and whether the home is permitted to care for them. Care must be taken to keep risk assessments up to date, and to use the information when deciding what equipment people need to maintain their health and well being. For instance, special mattresses where people are at risk from developing pressure sores and poor nutrition. People’s privacy and dignity must be protected and maintained when personal care is being provided. DS0000028007.V369791.R01.S.doc Timescale for action 06/08/08 2 OP8 13 06/08/08 3 OP10 12 06/08/08 Pinfold Lodge Nursing Home Version 5.2 Page 28 4 OP38 13 To help prevent the spread of infection, and to make the environment more pleasant for people, action must be taken to eradicate the flies which are apparent around the home. 31/08/08 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 OP7 Good Practice Recommendations Plans to review the care plans should be implemented as soon as possible. This way, staff will be able to use the plan as a working document in order to provide people with consistent care which manages risks in an appropriate and measured way. People and/or their families should be involved in the implementation and review of their care plans from the offset. This will make sure that what is written down reflects people’s needs, abilities wishes and aspirations. The way that the stock balance of medication is recorded should be easily identifiable to anyone looking at the medication records. This means that at any time a stock check can be carried out if there are concerns about discrepancies. Care should be taken to make sure that suppositories are stored at such a temperature that they do not cause unnecessary discomfort to the person concerned should they need to be administered. It is strongly recommended that a full record of any complaint, including acknowledgement of feedback to the person, is kept. This will provide evidence that complaints are dealt with in a timely period, and that the complainant has been informed of the outcome of the investigation. The employment history of prospective staff should always be fully explored where there are gaps between jobs. This will give more information about what the person was doing at the time, and whether this makes any difference to their fitness to work with vulnerable people. DS0000028007.V369791.R01.S.doc Version 5.2 Page 29 2 OP9 3 OP16 4 OP29 Pinfold Lodge Nursing Home Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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