Inspection on 12/06/07 for Pinford End House Nursing Home

This inspection was carried out on 12th June 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Pinford End House Nursing Home 02/07/08

Pinford End House Nursing Home 23/02/06

Pinford End House Nursing Home 03/11/05

Pinford End House Nursing Home 03/02/05

Pinford End House Nursing Home 02/09/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Pinford End House Nursing Home Hawstead Bury St Edmunds Suffolk IP29 5NU Lead Inspector Kathryn Moss Unannounced Inspection 12th June 2007 10:00 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 Pinford End House Nursing Home DS0000024473.V335289.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. Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pinford End House Nursing Home Address Hawstead Bury St Edmunds Suffolk IP29 5NU 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) 01284 388874 01284 386838 Pinford End Limited Miss Jill Hunt Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (2) of places Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home may only care for 2 service users who are under the age of 65 years (as named in the letter from Jill Hunt, Registered Manager dated 14th February 2007 to CSCI) in the category Physical Disability. 23rd February 2006 Date of last inspection Brief Description of the Service: Pinford End House is situated in the rural hamlet of Pinford End, South of Bury St. Edmunds. The service is registered to offer nursing care for up to forty older people. The accommodation is over two floors linked by a large passenger lift. Most rooms are single with en-suite toilet facilities but there is provision for couples to share a bedroom if required and have an adjoining room as a private lounge. There is a dining room and large lounge on the ground floor and a further lounge on the first floor. There are a number of bathrooms throughout the home, including an assisted spa bath and a shower room. The home has pleasant gardens laid to two sides of the house, with views over the gardens and adjacent fields from most bedrooms. The building is attractively decorated with wide corridors and large windows giving a feel of space and light. A central courtyard planted with trees and shrubs is accessible to residents and attracts garden birds to feed from the peanut holders provided. The home’s Service User Guide is provided to all residents and is available from the office. The current range of fees in the home is from £590 - £610 per week. Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that was carried out on the 12th June 2007, and lasted nine hours. The inspection included: • • • • • • Discussion with the manager and responsible individual Inspection of communal areas and a sample of bedrooms and bathrooms Inspection of laundry facilities Inspection of a sample of records and policies Conversations with 4 staff and with 2 residents Feedback questionnaires from 11 residents and 17 relatives. This report also draws on any other information relating to the home received by the CSCI since the last inspection (e.g. notifications from the home, complaints, internal monitoring reports, improvement plans, etc.), and some additional information submitted by the home following the inspection. Outcomes relating to 24 Standards were inspected: there were 4 requirements resulting from this inspection, and 9 good practice recommendations have been made. The manager, responsible individual and staff were welcoming, helpful and constructive throughout the inspection. The home provides a consistent level of care and support, with positive feedback from residents and relatives. What the service does well: Pinford End House provides a well-maintained environment, in an attractive location and with well-kept gardens. All residents’ rooms have a view of the gardens or a central courtyard, which enhances their outlook. The home is comfortably furnished and has a homely feel: one relative reported that ‘we could not wish for a better environment’. The home has a friendly and welcoming atmosphere, which was commented on by both relatives and residents. One relative reported that the resident had been made very welcome on arrival, and another felt that it is ‘a true home from home’. A resident said that ‘I like it here – I wouldn’t want to leave’. The number of positive comments received as part of this inspection reinforces the impression of this home as providing a very caring and friendly environment. The home has a committed manager and staff team, who demonstrate a good understanding of care practices and of residents’ needs. It was particularly noted that the home promotes an individual and person-centred approach, and this was reflected in the thought that went into planning meals and activities, Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 6 as well as the way care was delivered. One relative described the management and staff as ‘very friendly helpful in every way; they are extremely patient and caring’. Another relative commented that ‘There seems to be genuine concern about (the resident’s) quality of life’. The home is commended on this. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Admission processes ensure that residents can be confidant that the home can meet their needs. EVIDENCE: The home’s Statement of Purpose and Service User Guide were seen to contain relevant and up-to-date information on the home; the manager stated that these were due to be reviewed, and confirmed that all residents are given a copy of the Service User Guide on admission, and a copy is also available in the office. All eleven residents who completed feedback questionnaires felt that they had received enough information about the home to enable them to decide if it was the right place for them. Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 9 The manager confirmed that prospective residents’ needs are assessed before they are admitted to the home, and was clear that the home would not offer someone a place unless they were confidant that they could meet the person’s needs. A pre-admission assessment form was seen on the file of one new resident, and contained brief information on all the main areas of need, including information on their leisure interests and past life history. The form had not been signed and dated by the person carrying out the assessment, and it is recommended that staff make sure all forms are signed and dated. The home’s admission process was discussed with one of the nurses, who showed a good appreciation of how difficult moving to a residential care home can be for someone, and spoke of the need to get to know about each person’s likes and dislikes, and to provide residents and their families with reassurance. The nurse described ways in which they helped new residents to settle in and to meet other people in the home (e.g. introducing them to people with similar interests or backgrounds, encouraging them to come to the dining room for meals, etc.), and it was good to see the admission process being approached with care and consideration. Feedback received from residents and relatives was very positive about the home’s ability to meet their needs. Residents looked well cared for and content, and the home had suitable equipment for the range of needs that it aimed to meet (e.g. hoists, adjustable beds, pressure relief mattresses, etc). Staff spoken to were knowledgeable and informed about their work, and confirmed that they received training in the skills they need to carry out their role. Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents’ health care needs are well met within the home. medication practices could potentially put residents at risk. EVIDENCE: Residents who completed feedback questionnaires all felt that they received the care and support they needed, including medical support. Those spoken to were happy with the way staff supported them, and staff spoken to were able to give good examples of how dignity were considered and promoted when carrying out care and nursing tasks. The pre-admission assessment recorded the name that people preferred to be known by. The home maintained care documentation describing the care needs of each person and how these should be met, including an initial assessment Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 11 However, poor completed on admission, other relevant assessments (e.g. moving and handling, dependency, nutrition, risk of pressure sores), and care plans. Care records were inspected for three residents: in one case, a resident who had been living in the home for three weeks did not yet have a care plan, although assessments showed that they were at high risk in relation to nutrition and pressure areas. The manager stated that the expected practice was that initial care plans should have been developed soon after admission. The other two files contained care plans that were individual and which covered an appropriate range of needs; however, in one instance there was no care plan relating to nutrition, despite a nutrition assessment identifying the person as being at high risk. Care plans generally contained a suitable level of detail of the action required by staff to support the person to meet their needs, and it was good to see care plans including reference to encouraging residents to assist with tasks, and to enabling them to choose their own clothes. In a few cases the ‘need’ (‘problem’) and ‘goal’ being addressed were unclear: staff are encouraged to ensure care plans are clear and focused, to ensure that staff are clear on what their input is trying to achieve. There was good evidence of care plans being reviewed each month. One of the people whose records were inspected had a pressure sore at the time of the inspection, and this was referred to in their care records. A separate file was maintained for records of pressure area care being provided in the home: within this there were clear details of the action being taken to support the healing of the person’s pressure area, including a wound assessment, dressing procedures, and a care plan with regular evaluation records. This showed good monitoring and recording. Files contained clear records of contact with other healthcare professionals. The manager stated that the home is aiming to develop ‘end of life’ care practices; she reported that they have good contact with a local hospice, and that two care staff had recently attended a palliative care course. New resident’s records showed that they had been consulted on their wishes should they become ill. Daily records were maintained on each person, reflecting their personal care and welfare, and with some comments on how they had spent their day and what they had eaten (though the food eaten was not consistently recorded). Information on nutritional needs, as well as likes and dislikes, is maintained in the kitchen and printed on forms used to record what meals individuals choose each day. A carer reported that these forms are not maintained afterwards as a record of the food eaten: if no other nutrition records are routinely being maintained, it is recommended that the home could consider keeping these forms to provide an ongoing nutrition record. The home’s Medication Administration Policy was not reviewed on this occasion, and staff medication training was not specifically discussed. The home was observed to have appropriate and secure storage facilities for medication, including a controlled drugs cabinet and a medication fridge. It Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 12 was noted that some controlled drugs had not been returned to the pharmacist several weeks after they were no longer required, and were not being stored in the controlled drugs cabinet. The manager was advised to make sure this was addressed. The manager confirmed that the home had arrangements for the disposal of drugs no longer required in the home. Bottles of liquid medication were not all being dated on opening, and this is recommended. Where several residents were prescribed the same liquid medication, due to storage difficulties one bottle at a time was being used for all those who needed this: the home was reminded that medication prescribed to any individual should not be used for any other person. Medication Administration Records (MAR) were inspected, and several areas of concern were highlighted. Although details of medication were pre-printed on the MAR by the pharmacist, additional entries made by staff were not always signed and dated. Medication received by the home was not clearly recorded, or the number of tablets carried over from a previous month; medication returned to the pharmacist was being recorded, but records did not show the name of the person each medication had been prescribed for. There was therefore no clear record of how many tablets were in the home at any point in time. Records of medication administered were generally clear and complete, but some omissions in the records were seen, and there was some inconsistent use of codes for the non-administration of drugs. It was therefore difficult to accurately audit stocks and records. Prescribed ointments were not being signed for by the staff member who had administered them, and the home was advised to review this. It is important that medication practices are consistent and rigorous, in order to protect residents’ welfare. Because medication issues had also been identified on previous inspections, an Immediate Requirement letter was sent to the home after the inspection, requiring that these issues be addressed without delay. The manager subsequently confirmed that appropriate action had been taken to address medication practices. Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 13 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home provides a good lifestyle that offers choice and meets peoples’ social and recreational needs. EVIDENCE: During the inspection it was good to see that residents could choose to spend their day where they liked and how they liked, and were able to pursue their own interests (e.g. one person fed the birds in the grounds). Daily routines appeared relaxed and flexible, with staff appearing unrushed and meals leisurely. Many of the residents chose to spend a lot of their time in their rooms, including at meal times: one person spoken to was very clear that this was their choice, and they appreciated being able to do this. Their room was homely and well personalised, reflecting that it was ‘their space’. Another person liked the fact that a group of male residents met in the dining room at teatime, and that this had become quite a social occasion for them. Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 14 Feedback questionnaires were completed by residents several months prior to this inspection: at that time a number of residents reported that they felt that there were not enough activities taking place in the home. However, on the inspection the manager reported that the home had already recognised that activities were an area they needed to develop, and had highlighted this in the home’s annual business plan. The manager had applied for a grant to convert an upstairs lounge into an activities resource, and recently appointed an activities co-ordinator to work in the home three afternoons a week, supported on a voluntary basis by a retired art teacher. Although they had only been in post a few months, there were already great improvements in the level and range of activities available, both in and out of the home. The activities coordinator was enthusiastic about their role, showed an imaginative and person-centred approach, and had plans for the development of the work. Both the activities co-ordinator and the manager demonstrated a commitment to the therapeutic value and benefits of activities, and to ensuring that activities were appropriate and meaningful; this is commended. Activities included gardening (hanging baskets, planting seeds, etc.), art (drawing, watercolours, pottery), reminiscence, and one-to-one time with residents. The activities co-ordinator meets with all new residents to discuss their interests and completes a questionnaire about what they like to do. As yet they had not had opportunity to transfer this information onto people’s personal care files and are encouraged to do so, and also to develop individual records of the activities people participate in. Both residents and staff spoken to were very positive about the improved activities. Although care staff have limited time for supporting recreational activities, the manager stated that they do try to do some individual activities in the mornings (e.g. nail care). Relatives consulted as part of this inspection confirmed that they felt welcome in the home at any time, and could visit residents in private. Residents spoken to confirmed this, and the visitor’s book showed regular visitors to the home at all times of day. A church service is held in the home every two weeks, and various community groups visit the home (e.g. hand bell ringers). The home has its own minibus, enabling trips out (e.g. regular trips to a local coffee morning). It was good to hear that the home was making arrangements to support one resident visit a relative, and another to attend a wedding. Residents spoken to and providing feedback through questionnaires were all positive about the meals at Pinford End House, confirming that there was always a choice, and that there was good variety. One person observed that ‘the chef goes to a lot of trouble meeting my requirements’, and it was noted on the inspection that there was good attention to individual needs and wishes. The kitchen manager maintained clear information on people’s dietary needs, likes and dislikes, and went to considerable effort to ensure that residents’ preferences were catered for, with individual products purchased for various people (e.g. particular yogurts, flavoured waters, etc.). Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 15 The home has a very wide range of different weekly menus (with several sets of different menus, each covering 12 week spans), resulting in minimal repetition of menus and good variety of meals. The home carries out an annual food survey and the kitchen manager regularly talks to residents about the food. Menus showed a good range of balanced meals, with two or three choices of main meal each day (plus alternatives); food stocks were of good quality and quantity. It was also good to see the home providing a wide range of food options at suppertime (cheese and biscuits, individual pots of yoghurt and rice pudding, cup-a-soups, sandwiches, etc.), and making a range of drinks (beer, wine, etc.) available on request. It was good to hear the kitchen manager talk about the importance of meals as social occasions, and there appeared to be time and effort spent on making meals a good experience. In particular, a lot of thought was put into making each Christmas a special event, with each resident being given a booklet of special Christmas menus: one resident reported their family was ‘envious’ of this! The kitchen operated efficiently and had produced a comprehensive procedures manual, which detailed kitchen staff roles and daily responsibilities: this had enabled the kitchen to operate with minimal disruption when the kitchen manager was off work for a period of time. Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 16 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. We have made this judgement using a range of evidence including a visit to this service. Practices in the home ensure that residents feel safe and are confidant that any concerns will be taken seriously. EVIDENCE: The home’s complaints procedure was included in the Statement of Purpose and Service User Guide; it was not reviewed on this occasion. The home was seen to maintain a record of complaints that showed two complaints received in the last year, both of which appeared to have been appropriately investigated and responded to. The nature of what constitutes a complaint was discussed with the manager, who said that the home currently recorded any concern that a person wished to make formal, but did not usually record verbal concerns that were dealt with at the time they were raised. The home is encouraged to record all concerns and complaints (formal and informal) that require any action by staff to resolve them. All residents who completed feedback questionnaires confirmed that they knew who to speak to if they were not happy, and knew how to make a complaint. Those spoken to on the inspection stated that they felt able to speak up if they had concerns. Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 17 Although the home has copies of Suffolk County Council’s Vulnerable Adults Protection guidance and referral process, it does not have its own internal POVA (Protection of Vulnerable Adults) policy describing its policy and procedure for responding to allegations of abuse; this should be developed. The home had a Whistle Blowing policy but the content mainly referred to the home’s procedure for investigating concerns, rather than explaining Whistle Blowing procedures; it is recommended this be revised. The manager stated that POVA training is covered as part of new care staff ‘Skills for Care’ induction, and that a Vulnerable Adult video training pack is used for in-house training updates; the manager stated that nursing staff also attend this training. A training summary submitted following the inspection showed the completion of induction training by care staff, but did not include details of any POVA training completed by nursing or ancillary staff. The training manager confirmed that Abuse Awareness training was due to be provided in September 2007, and should ensure that all staff (care, nursing and ancillary) complete this training. Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents benefit from a well-maintained, comfortable, clean and hygienic environment. EVIDENCE: Communal areas and a sample of bedrooms and bathrooms were viewed on this inspection. Areas seen were well decorated and maintained, and appropriately furnished, presenting a homely environment. The grounds to the home are attractive and well maintained, and all bedrooms benefit from a view of the grounds or of an internal courtyard. The home employs a full time maintenance person and also a part-time gardener (plus additional contractors to maintain lawns and hedges). Bedrooms are decorated as and when needed, and when they become vacant: all were single rooms with ensuite Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 19 toilet facilities. The Manager stated that the home has a decoration plan for the corridors, and the dining room was decorated last year. The maintenance person maintains records of work carried out and also an ‘inside decoration’ record, which showed when rooms were decorated. Since the last inspection the home had swopped the rooms previously used for the main lounge and the dining room, to resolve previous issues about the former lounge’s layout (as it is an area that also provides a walk-through from different areas of the home). The new lounge was comfortable and homely, and there were also a few armchairs in the dining area, providing an alternative seating area on the ground floor. The home had a first floor lounge that was mainly used for activities, and the manager had applied for a grant to develop this area further. On the day of the inspection, all areas of the home viewed were clean and tidy, with no unpleasant odour. Residents spoken to, and those who completed feedback questionnaires, all confirmed that the home was always clean, and were positive about the efficiency of the laundry. The home had policies and procedures covering infection control, and disposable gloves and aprons were seen to be available to staff throughout the home. Staff training in infection control was not specifically discussed, but staff were observed to follow correct practices. The home’s laundry was suitably equipped and good infection control practices were in place: washing machines had appropriate wash cycles to meet infection control requirements, and staff used red bags to transfer soiled linen into the washing machines. Sluice facilities were not inspected on this occasion. Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 20 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. We have made this judgement using a range of evidence including a visit to this service. The home’s recruitment and training practices ensure that residents’ needs are met by the number and skills of staff. EVIDENCE: The home currently maintains staffing levels of two qualified nurses and seven carers in the mornings, and two nurses and four carers in the afternoons; night staffing levels are one nurse and two carers, plus an additional carer from 7pm to 10pm (as night staff come on duty at 7pm). Rotas showed that this level of staffing was regularly maintained. It was good to see the responsible individual regularly monitoring staffing levels, and the manager demonstrated a responsible approach to ensuring staffing levels meet people’s needs. Many day staff often worked a full day (7am to 7pm), but did not work an excessive number of long shifts per week. An additional activities person was employed three afternoons a week (supported by a volunteer). The home sometimes uses agency staff to cover shortages, but tries to ensure regular carers: an agency carer spoken to during the inspection confirmed that they worked in the home regularly. Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 21 The files of two staff were inspected for evidence of the home’s recruitment practices, and both files contained evidence that the required information and checks had been obtained before the staff started work, showing safe recruitment practice. In one instance the last employer had not been approached for a reference: although the manager was able to explain the reasons for this, it is recommended that last employer references always be sought, and any non-response recorded. Where a photo of the applicant was missing, the manager was already aware that this needed to be obtained. In one file, a declaration of criminal record had not been completed by the applicant and the manager was reminded to check that all parts of application forms have been complete. The home’s induction process included the mentoring of new carers by a senior carer, enabling staff started on a POVAfirst check (pending receipt of the full Criminal Records Bureau check) to be supervised. The manager confirmed that checks were carried out to confirm that registration of qualified nurses. The home has its own trainer, who is also an NVQ assessor. New care staff complete a comprehensive induction covering the Skills for Care ‘Common Induction Standards’: this included attendance at an external five day induction course (three days covering core training and a further two days covering moving and handling training), and completion of an internal workbook covering the Common Induction Standards. Evidence of a completed induction showed it was clearly recorded and signed off by the trainer, and it was good to see the home treating the induction as important and relevant training that leads on to NVQ training. A summary of training provided by the home showed that 14 out of 27 care staff had completed NVQ level 2 or above; several staff had also completed NVQ level 3 and two more were in the process of doing this, and a further two staff were in the process of doing NVQ level2. This is a good level of qualification amongst care staff, and meets Standard 28. Training evidence was not reviewed in detail on this occasion: a summary of staff training submitted showed that all care staff had completed core training at induction, and that the majority of care and nursing staff had attended training in fire safety, moving and handling and food hygiene during 2006. There was also evidence of a range of other training being completed by various staff, including: Parkinsons’ Disease, Stoma Care, Challenging Behaviour, etc. Domestic staff had attended Fire Safety and Food Hygiene training: it is recommended that they also receive infection control and moving and handling training (as well as POVA training, as mentioned earlier). The trainer confirmed that mandatory training included fire awareness, moving and handling (incorporating Health and Safety), and food hygiene training each year; she is to attend training to deliver first aid training in-house. Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents benefit from the sound management of the home, and the home’s person-centred ethos ensures it is run in their best interests. Practices in the home protect residents, and promote a safe environment. EVIDENCE: The home’s manager is a qualified nurse (RGN) and completed the Registered Manager’s Award (NVQ level 4 in management) last year. Throughout the inspection she showed good understanding of all issues, and demonstrated a commitment to carrying out any action required. She promoted a personcentred approach to the care in the home, and an ethos of empowering both Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 23 residents and staff. This was good to see. The home’s deputy manager left last year, and the manager subsequently had to cover the deputy’s nursing shifts until further nursing staff could be recruited. The manager explained that this had meant that she had been unable to carry out all her management tasks (e.g. formal supervisions and staff meetings), but had clearly identified the areas that needed action. She confirmed that more nursing staff had now been recruited and that the outstanding management tasks would be addressed. Both staff and residents were very positive about the manager, finding her approachable and supportive. It was also good to see that the Responsible Individual was regularly present in the home, and was supportive of the work the manager and staff were doing. The home has an annual ‘Business Objective and Plan’ (annual development plan), covering relevant areas for the home’s development (e.g. Training and Development, marketing, activities, maintenance, care standards, etc.); there was evidence that this was reviewed during the year. This shows a planned approach to developing the home each year, which is good to see. The manager stated that the home has a feedback questionnaire that has been used to seek residents’ views on the home: she reported that this was last used about a year ago, and that although responses were reviewed and action taken to address any issues identified, no summary report has previously been produced. The manager stated that the home also has a questionnaire that is used to seek the views of new residents on the admission process, and a food questionnaire has previously been used with residents; verbal feedback is also regularly sought from residents. However, no other surveys are currently used to formally seek feedback from other stakeholders (e.g. relatives or other professionals involved with the home). There was evidence that some practices in the home are regularly monitored (e.g. monthly audit reports on falls and pressure areas, to monitor trends), but it is recommended that internal auditing processes could be developed further (e.g. systems for monitoring medication stocks and records). The manager stated that they are hoping to implement a self-audit on the home, and this is encouraged. Residents have a lockable cash tin fixed inside their wardrobe to enable them to look after their own money where able. The home does not deal with any resident’s pensions, but on request will look after small amounts of money on behalf of residents. It was noted that residents’ money held for safekeeping was not kept individually, but was pooled within a central cash box: this meant that it was not possible to audit any individual person’s money against their records and receipts. Whilst systems for storing, handling and recording residents’ monies were safe, it is recommended that the possibility of implementing a more individual and person-centred approach be explored. Clear individual records are maintained, and receipts kept for all purchases: although individual’s money held cannot be audited, the total residents’ cash held is audited against records each month. The manager stated that this money is mainly only used to pay for chiropody and hairdressing, and that families provide most other items. The home provides all toiletries free of Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 24 charge, which is commendable: the administrator buys range of individual toiletries from supermarkets, and these are available to residents. The home was seen to have a Health and Safety policy, covering employer and employee responsibilities. Staff training records showed that staff received appropriate health and safety training through their induction and through regular updates. The home has a staff member trained to deliver moving and handling training, and the kitchen manager is trained to deliver food hygiene training. As noted in the last section, domestic staff should also attend moving and handling training in relation to the moving and handling of loads. No first aid training had recently been completed by staff: however, the home was aware that updated training was needed and the home’s trainer is due to complete training to be a first aid trainer. The home maintained evidence of visits by the Fire Officer. An issue relating to the need for self-closing bedroom doors had not been addressed since the last fire inspection in June 2006, but the home subsequently confirmed that an independent survey of door closures has now been arranged. Evidence was seen that the home had a fire risk assessment, and a fire safety file included details of an induction tour of the building for new staff. There was no evidence of a fire drill since October 2006: the manager stated that a drill had been carried out as part of fire training, and that this had been deemed sufficient. It was suggested that the fire officer be consulted on this, as staff should attend unannounced drills to ensure they understand response procedures. Previous records of drills did not show which staff attended, and this should be recorded. The home maintained records of the servicing of fire alarms, and of the regular internal testing of alarms and emergency lighting. Information submitted by the home earlier in the year (a pre-inspection questionnaire) showed that the servicing of equipment and utilities is regularly maintained by the home. Further evidence was therefore not inspected on this occasion. The date of the last electrical installation inspection was queried, and the responsible individual subsequently confirmed that this was overdue and would be addressed; evidence of current testing of portable electrical equipment was seen. The home regularly checked the temperature of hot tap water to monitor the risk of scalding, and to ensure central hot water storage temperatures are maintained at a level to prevent risk of Legionella. Risk assessments on safe working practices were not reviewed on this occasion. The home maintained good systems for monitoring falls and accidents. Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 26 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 (1) Requirement To ensure that residents receive the care they require, staff must have clear information on how to meet residents’ needs. Care plans must therefore be developed as soon as possible after admission, and should cover all key needs. Medication storage, recording and administration practices must protect residents. Practices must therefore be reviewed to ensure that: 1. The storage of controlled drugs meets legal requirements at all times; 2. Medication is only administered to the person named on the dispensing instructions; 3. All medication received into the home is clearly recorded; 4. Drugs no longer required are promptly disposed of; 5. Any reasons for medication not being administered are clearly and consistently recorded 6. Prescribed ointments are signed for by the person administering them. DS0000024473.V335289.R01.S.doc Timescale for action 31/07/07 2. OP9 13 (2) 13/07/07 Pinford End House Nursing Home Version 5.2 Page 27 3 OP18 13(6) 4 OP33 24 Medication recording issues and the storage of controlled drugs are a repeat requirement (last timescale 23.2.06). To ensure that staff understand what to do in the event of suspicion or allegation of abuse, and the action that the home would take, the home must implement a clear POVA policy and procedure. To demonstrate that the home ensures that it is run in the best interests of residents and responds to residents’ feedback, the home must produce a report on any review of the quality of care that is carried out in the home. 30/08/07 31/03/08 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 2 Refer to Standard OP8 OP12 Good Practice Recommendations To assist in monitoring residents’ welfare, it is recommended that the home maintain nutrition records showing the food eaten by each person each day. It is recommended that the home develop records relating to the social and recreational activities engaged in by residents, and the outcomes from this activity. It is recommended that care plans clearly describe the support each person needs from staff to encourage or enable them to receive stimulation and to occupy their time. It is recommended that all complaints and concerns are recorded, both formal and informal, verbal and written. It is recommended that the home ensure that its Whistle Blowing policy clearly describes what this involves. DS0000024473.V335289.R01.S.doc Version 5.2 Page 28 3 4 OP16 OP18 Pinford End House Nursing Home 5 6 7 OP18 OP30 OP33 The home should ensure that all staff attend regular POVA training (i.e. care, nursing and ancillary staff). It is recommended that domestic staff also complete moving and handling training and infection control training. It is recommended that the home develop systems for internally auditing practices and care standards within the home. It is recommended that the home seeks the views of other stakeholders (e.g. relatives and other professionals) as part of its annual review of care in the home. It is recommended that the home explore whether monies looked after on behalf of residents can be stored in a more individual way. This is in order to promote a person centred approach, and to safeguard residents through enabling the auditing of any monies held for safekeeping. It is recommended that the manager ensure that all staff attend regular fire drills, and that the names of those attending is recorded. 8 OP35 9 OP38 Pinford End House Nursing Home DS0000024473.V335289.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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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