Inspection on 02/07/08 for Pinford End House Nursing Home

This inspection was carried out on 2nd July 2008.

CSCI found this care home to be providing an Good 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

Pinford End House Nursing Home 12/06/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Pinford End House Nursing Home Hawstead Bury St Edmunds Suffolk IP29 5NU Lead Inspector Mrs Jan Sheppard Unannounced Inspection 2nd July 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Pinford End House Nursing Home DS0000024473.V367657.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.V367657.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 gailtimms@tiscali.co.uk 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.V367657.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. 12th June 2007 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 fees range from £700 - £750 per week. The fees do not cover hairdressing, newspapers, toiletries or chiropody. Pinford End House Nursing Home DS0000024473.V367657.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 2*. This means the people who use the service experience good quality outcomes. This unannounced inspection took place over seven and a half hours during a weekday. His was a key inspection that focused on the key standards of the Care Standards Act 2000 relating to Older People. During this inspection the inspector made a tour of the building, had in depth discussions with the homes Manager who was available throughout the day to assist. Discussions were also had with the responsible individual with the staff on duty and with a number of residents and visitors. Random spot checks were made on a number of the homes records and a number of Care Plans were read. The detail in this report reflects the findings on that day and also takes account of information sent periodically to the Commission by the homes management, information contained in the AQAA , (Annual Quality Assurance Assessment), completed by the manager and in a number of pre-inspection surveys (26) returned by residents, relatives ,staff and other health professionals who have dealings with the home. Although the inspection was completed by just one inspector the wording used in the report will refer to “ we “ as the report is written on behalf of the Commission. What the service does well: The home continues to provide good quality personal and health care support in a relaxed and homely atmosphere. Person centred individual care is delivered by sufficient numbers of qualified and experienced staff who were seen to work well together to deliver a seamless service. The home provides excellent facilities and the environment is maintained to a high standard. Residents consulted reported positively as to the care they receive “ Staff are always very kind and helpful”. “ My wishes are always listened to, staff often anticipate my needs”. “ I like the Sunday dinner”. Comments from relatives included “Pinford End staff all seem to be so loving and truly caring at all times”. Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 6 “Care for the patients is one hundred percent. Any problem is dealt with straight away. Always a member of staff to speak to.” “ Thank God for Pinford End. Generally very happy. A very difficult time for all, dealt with sensitively. Visitors not made to feel unwelcome/ a nuisance. I feel confident to pass on responsibility to them. Excellent” Comments from other visiting health care professionals included; “Gives good quality care , treats every patient individually” “ The staff are very professional in medicine management . They seek advice when needed”. “I have a great deal of respect for the work and care that Pinford End gives their palliative care patients and families”. What has improved since the last inspection? What they could do better: The Manager is aware that continuing work is needed to further all these areas of improvement. Where possible residents should be encouraged to sign their care plans. Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 7 The quality and frequency of staff supervision should be improved. Arrangements in the assisted bathrooms should be improved to provide a more homely bathing environment. 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.V367657.R01.S.doc Version 5.2 Page 8 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.V367657.R01.S.doc Version 5.2 Page 9 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 Standard 6 does not apply as this home does not accept residents for intermediate care. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service can be confident that admissions are not agreed until a full needs assessment has been carried out to satisfy that the persons needs will be met appropriately. EVIDENCE: Each new referred resident is assessed by one senior nurse who visits the prospective applicant either in their own home or more usually in hospital. Medical and social service reports are always sought so that the home can be fully informed about the prospective residents circumstances. Both the Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 10 prospective resident and ,if they agree to it, their relatives also, are invited to visit the home to view the vacant accommodation ,meet and talk with some of the residents and staff and possibly spend time and enjoy a meal in the home. Relatives of recently admitted residents reported that this admission process had been handled sensitively and that they were made to feel welcome. A resident commented “ My initial contacts with staff were very helpful” “My sons and I chose this home as the staff and everyone made us so welcome when we looked round”. The files of three recently admitted residents were seen and each contained documentation for a pre-admission assessment of needs. The areas covered included communication, mobility, personal hygiene, continence, mental state and cognition, skin integrity , any known allergies, past medical history and current personal care, medical and medication needs. The homes Statement of Purpose and Service User Guide give good up to date information on the home including clear detail as to residents Contractual obligations. The Manager explained that since the last inspection the Contract had been reviewed and that works to further update the other documentation concerning admissions were in process. All the residents who completed survey questionnaires said that they did receive enough information about the home to enable them to make an informed choice about admission. Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 11 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, 10 and 11. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents health and social care needs are well met within the home. The home has a robust medication policy and sound administration practices which ensure good safety for the residents. Residents are treated with respect and dignity. Special care is arranged for residents and their families during the time of a final illness. EVIDENCE: The residents who completed pre-inspection surveys questionnaires before this inspection all said that they received good care and prompt medical support. Those spoken with during the inspection confirmed this as did the Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 12 comments made by relatives and visitors spoken with on the day. During the inspection staff were observed to be patient and kind and to be giving residents every opportunity to make their own choices . To one resident in a wheelchair the question “ where would you like to sit this afternoon?” and to another “ would you like an outing into the garden?” were overheard. Written comments such as “ The staff are always friendly and helpful”; “ Real sympathetic care is given” “ The attitude of the staff helps to keep the dignity of older people” were made . Since the last inspection the residents care plans have been reviewed and additional details as to how care is to be delivered to meet all their assessed needs more fully recorded. The care plans of four residents were examined. These were found to be recorded with good detail particularly detailing how care was to be met following individual preferences and with due regard for any assessed risk. Plans were seen to contain Waterloo assessments, Must Nutritional assessments and individual Wound Care assessments along with the correct documentary evidence of care delivered and photographic evidence of wound healing achieved. Regular reviews of these plans were seen to have been undertaken and although these were held with the involvement of the resident ,who is freely able to access their plans whenever they wish, no signatory evidence of their involvement could be found on the care plan. Care plans seen for recently admitted residents were found to have been compiled immediately upon their admission and were then frequently updated to meet any changing needs. Over the past year the home has developed a special working relationship with the local hospice team and a number of admissions for palliative care have resulted. To prepare for this a number of staff have attended training at the hospice and the home has introduced the Liverpool Care Pathway for delivery of the specialist care needed at this time. A number of positive comments about the quality and delivery of this care were made during the gathering of pre inspection information. “ The whole family were impressed with the care given to our dying relative and the care we (the family) were shown was most appreciated” The manager said that further improvements planned for this area of care included more training for staff of all grades , bereavement support for the staff and bereavement follow up for the relatives. An audit of this aspect of the service ( Liverpool Care Pathway ) is to be carried out over the next year. Improvements have been made to the Medication systems since the last inspection so that the requirements made at the last inspection were on this occasion found to be met. Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 13 The home continues to use a MDS (monitored dosage system) supplied from a local pharmacy. The home has adequate, secure, temperature controlled storage facilities for this medication. The medicines were found to be carefully stored, to have opening dates clearly recorded and to have the stock records which tallied with the amounts held. Spot checks on the MAR sheets ( medication administration records ) found these to be accurately recorded with the reverse of the sheet and the correct code used to explain any changes to the prescribed medication administration practice. Controlled medication is kept separately in a cupboard that meets the security requirements for this class of medication. Spot checks were made on the stocks of these drugs and on the Controlled Drugs Register recording the administration of this medication. The stocks were found to tally with the register records. Medication is administered only by the qualified nurses and a list of their signatures is kept. Since the last inspection they have completed additional training and special training is on going concerning the specialist medication needs of the palliative care residents. The home is about to introduce changes to the administration of creams for the residents by the qualified carers; this improvement being seen as offering a more personalised service. The need for training for the carers, risk assessments and the safe provision of storage in residents rooms ,if not already available, were discussed with the inspector. This change should bring a quality improvement to this aspect of the service. Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 14 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. This judgement has been made using available 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 past year the home has further developed the range of activities offered thereby maintaining the excellent quality outcome for this aspect of the service that was awarded at the last inspection. The home has appointed a dedicated Activities organiser assisted for some sessions by volunteers with various areas of expertise in crafts and in art. All residents have an assessment of their activity interests and needs made initially at the time of their admission. During the past year these preferences have been reviewed with the resident to ensure that developing interests can be accommodated and that the abilities of the resident are appropriate for their planned programme. Notices about activities are displayed on the Notice board each Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 15 week and a copy is also delivered to each room. The in house activities are organised on both group and individual lines this to meet the residents varying needs. Residents who wish and are able to do so are able to access pursuits outside of the home. Since the last inspection the building of a dedicated activities room has been completed. This is a light airy and spacious room on the first floor and along with dedicated working areas some at wheelchair height it is fitted with a loop system has running water and also has a small sitting area for relaxation. This facility is extremely well equipped and the inspector was shown examples of a range of works of drawing and painting , crafts and pottery recently completed by the residents. Residents spoken with were very complimentary about the activities programme that is now available to them ;one explained about their newly discovered drawing skills. The opportunities for gardening even for immobile residents who can use the newly made raised flower beds were also mentioned by residents most appreciatively. The home operates an open visiting policy and several visitors were seen in the home on the day of this unannounced inspection. The manager said that several residents are able to spend the day out with their relatives whilst others especially those who travel a distance and able to enjoy a private meal in the home with their relative. A number of relative surveys spoke appreciatively about this approach, “ I am always made to feel very welcome in the home and am offered refreshments”. “ Staff keep me very well informed and spend time explaining what is going on”. The ethos adopted is that the residents are able to choose where and how they spend their day, either in their room or communally in one of the lounges ,or a mixture of both. They are also able to follow their own interests as they wish. Daily routines appear relaxed and flexible, with staff appearing unrushed and meals leisurely. Feedback questionnaires completed by residents prior to this inspection spoke appreciatively about these various aspects. “ The activities are good and varied, there is never any pressure to do anything but staff have helped me learn new things in my time”. Residents spoken with and evidence provided through the questionnaires were all very positive about the meals at Pinford End House. One said “ there is always a very good choice and the Chef regularly comes to talk with us asking for our ideas for new dishes and getting our feedback on the quality of recent meals served. Another said “ the meals are really tasty and hot too ( served at the right temperature) and we have beautiful home made cakes and ice cream”. The Chef Manager who was off duty on the day of this inspection came into the home and spoke with the inspector. He evidenced the range of menus which are compiled following regular consultation with the residents and it was seen that the records contain clear information on individual dietary needs along with likes and dislikes. Special products ( particular brands and flavours) are purchased and stocked to ensure that individual preferences can be accommodated. Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 16 The chef manager has recently become a member of NACC ( National Association of Care Catering) He has many years experience of restaurant and hotel catering and holds catering qualifications at NVQ level 2. He has recently completed further training on Healthier Food and Special Diets. The kitchen was subject to a successful Environmental Health Inspection on the 17th January last. The kitchen staff follow the routines given in the Making Food Safely guidelines. The kitchen produces an Annual News Letter for the home. A full breakfast menu including a cooked breakfast is available daily if required and this will be served in the residents room if they wish this. Two or three choices are available for the main lunchtime meal along with a wide range of options both hot and cold at supper time. Snacks cooked and otherwise are available during the night if required. A range of drinks, water , juices and alcoholic drinks ( beers and wines) are available as requested and were seen to be being enjoyed by several residents with their lunch on the day of this inspection Cranberry juice was said to be particularly popular. The chef explained that he is increasingly choosing to obtain his stocks from sustainable sources ( fish and meat) and to use locally grown fresh produce ( vegetables and fruit) including some from the homes own garden. He said that talking with the residents many who have lived in the locality for most of their lives had given him good information about local suppliers as well as ideas for recipes for old local dishes. Home made ice cream preserves have recently been introduced. Very good attention was seen to be given to the meal celebrating a special event such as anniversaries and birthdays and these along with theme evenings always had special food prepared and advertised by colourful menus. The Christmas menus were shown to the inspector these evidenced a very comprehensive choice illustrated in an amusing way. The home regularly gives a Christmas meal for relatives which is proving to be increasingly popular. The home has regular contact with the local dietician, residents are weighed regularly and these records along with BMI records were seen in their files. Where under weight is a concern records of food actually consumed are also kept. Supplements and extra snacks are given when required full cream milk was seen to be recommended for some residents and the chef explained that fresh green vegetables are now served every day to assist with good sight maintenance. The menus showed good evidence that special diets were accommodated along with choices meeting ethnic and religious dietary requirements. The serving of lunch was observed during this inspection. The meal, fish and chips in a variety of forms, looked attractive and smelt appetising. Staff said that this was always a popular meal , everybody liked fish and chips especially so now that a boneless fish variety is served either fried ,grilled or baked. The meal was leisurely with ample staff seen to be appropriately assisting residents who needed help. Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Practices in this home ensure that people who use the service can be confident that the policies and procedures in place will ensure that they are listened to and protected from abuse. EVIDENCE: There have been no incidents concerning Safeguarding Adults since the last inspection. All grades of staff attend training on protection of vulnerable adults and whistle blowing procedures. Ongoing refresher POVA training is offered in house following the format suggested by Action On Elder Abuse. Staff who were spoken with during this inspection were familiar with what action they should appropriately take if ever they had suspicions concerning possible abuse. No complaints have been made to the CSCI (Commission for Social Care Inspection) concerning this home since the last inspection. Two complaints made to the home by relatives were seen to have been properly recorded, investigated and written and verbal responses given within the required time limits. Both matters had been resolved to the complainers satisfaction. In both Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 18 instances these complaints related to particular arrangements and did not detract from the relatives expressed overall satisfaction with the care which their relative was receiving at the home. Relatives and residents surveys evidenced that they understood the homes Complaints policy and that they had confidence that the home would listen to them take their concerns seriously and sort out any problems. The home keeps records of any Compliments it receives and a number received since the last inspection were shared with the inspector. Pinford End House Nursing Home DS0000024473.V367657.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): 19,20 ,21,22,23,24 , 25 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from a safe, well maintained, comfortable , clean and hygienic environment which has appropriate facilities to meet their needs. EVIDENCE: Communal areas, a sample of bedrooms, the bathrooms and the laundry and kitchen were viewed during this inspection. Throughout the home was found to be very well decorated and maintained with appropriate good quality furnishings presenting a homely and comfortable environment. On the day of this inspection all areas viewed were clean and tidy with no unpleasant odours. Residents spoken to and those who completed prePinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 20 inspection surveys all confirmed that the home was always clean “ My room is cleaned every day and the home is always fresh and tidy” was one comment made. The home is surrounded by well maintained grounds and the whole clearly benefit from the attentions of a full time maintenance person and a part time gardener. On the day of this inspection a new paved area was being laid in the front of the home whilst at the rear works to complete the building of more raised garden beds and other patio areas were continuing. The residents were clearly taking a great interest in these developments and one resident who enjoys gardening from her wheelchair spoke of the radishes and other vegetables that she had grown. The single bedrooms all have en-suite toilet and washing facilities, they were seen to be attractively decorated with toning soft furnishings. Many were personalised by the resident with their own small items of furniture, pictures and ornaments. Without exception all the residents consulted said that they were happy with their rooms and that they found their environment to be homely and comfortable and to meet their expectations and needs. A range of specialist equipment including hoists profiling beds and special chairs were seen to be provided to meet individually assessed needs. The home was found to have a well equipped laundry and residents again without exception were complimentary about the laundry services. A good infection control practice is in place and red bags are used to transfer soiled linen into washing machines which have the appropriate wash cycles to meet infection control requirements. All staff have regular training in infection control measures; disposable gloves and aprons were seen to be being used and liquid soap and paper towels are available at hand washing facilities. The home has adequate provision of assisted bathrooms but on the day of this inspection they were found to be untidy and cluttered filled with stored equipment which altogether presented an inviting environment in which to take a bath. The manager agreed to address this immediately and said that plans to further upgrade the equipment in these bathrooms was being considered. The home has two lounges one large and one small and both were found to be appropriately furnished. The small one which overlooks the rear garden provides a quiet retiring place where visitors can meet with residents more privately where as the larger lounge with adjoining dining area being more in the centre of the home is used more as a gathering place . A number of the male residents meet there regularly each day at tea time and this was seen to be quite a social occasion for them. Since the last inspection refurbishment works to turn a first floor lounge area which was little used into an activities room have been completed. This space Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 21 is light and airy is very well equipped with specially designed work areas as well as space for relaxing seating. The home is to be congratulated on the imaginative development of this area where a wide range of activities were seen to be taking place. Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 22 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. This judgement has been made using available evidence including a visit to this service. People who use this service can be confident that they will be supported by appropriate numbers of skilled and fully trained staff who have been robustly recruited to protect them and can ensure the smooth running of the service. EVIDENCE: The duty rotas were seen and showed that there are two qualified nurses on duty through out the two day time shifts and one at night. They are supported by seven carers in the mornings four in the afternoons and two at night. The manager explained that these numbers are adjusted to meet the fluctuating needs of the residents this being particularly so now that more palliative care is being offered in the home. In addition the home has an administrator and the registered Manager who are supernumerary. The deputy Manager also works a number of supernumerary hours each week. The recently appointed nurse trainer also works some shifts. The home has a Chef Manager and kitchen assistants, a team of house keepers led by a recently appointed Supervisor and a Handyman/Gardener. Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 23 Evidence from the pre- inspection surveys from residents and relatives supported the view that staffing levels are sufficient to meet current needs although some staff spoken with said that ideally they would wish for more staff so that more individual time could be spent with the residents. Since the last inspection a new separate post of Housekeeper Supervisor has been created and a new Activities Organiser has been appointed. The home is currently fully staffed and is fortunate in being able to retain a very stable core staff group many of whom have worked there for many years. Good team work was observed during this inspection which was resulting in a seamless service for the residents. Support for residents was being provided in a kindly unhurried manner allowing and encouraging them to do as much for themselves as it was safely possible for them to so do. The staff were found to be familiar with the needs and preferences of the residents and a good rapport was seen to exist between them. The Manager said that agency staff are now rarely used as cover for holidays and sickness can usually be found from within the existing staff group or from the bank staff. The recruitment records for three recently appointed staff were examined and found to contain evidence that all the required checks had been made. There was evidence of a full work history, interview records two references along with identity and residency proof. There was evidence of a criminal record bureau and POVA check being undertaken prior to the member of staff starting work at the home. All new staff undertake an induction training and initially work on a supernumerary basis. The home uses the Kerrison Social Services Induction Training programme which is of three days duration. Staff reported that this induction was of a very good standard and prepared them for the role. The home currently has more than 50 of its carers holding NVQ qualification at level 2 with some also at level 3. The homes trainer said that five more staff are to commence the NVQ 2 course at a local college in September. She also said that the home is now more often able to recruit qualified carers which is advantageous. Each member of staff has a training needs profile from which a training needs matrix for the whole home is compiled. Staff all reported that they get good training opportunities both internal and external to the home. Courses attended since the last inspection have included Palliative Care, MRSA , First Aid, POVA, Mental Capacity Act , Stoma Care and Wound Care. The homes records evidenced that the mandatory training for Manual Handling, Food Hygiene, Fire awareness, Abuse Awareness , Infection Control and Health and Safety is maintained up to date. The home regularly takes nurse students on placement form the local hospital and the Manager said that two of the current bank staff team are currently undertaking their nurse training having previously been carers at the home. Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 24 Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 25 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, 36 and 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available 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. Administration practices in the home protect residents and promote a safe environment. EVIDENCE: The home benefits from a stable management team who are all well qualified and experienced professionals whose ethos is very clearly to put the needs of Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 26 the residents first. Their confident and calm approach to their work positively influences the homely and relaxed atmosphere in the home where meeting the nursing and social care needs of the residents was found to be well integrated. The registered Manager is a qualified nurse ( RGN ) and also holds the Registered Managers Award ( NVQ level 4 in Management.) She has many years experience of care home management and is knowledgeable about the care of older people. She is assisted in her management role by a group of senior nursing staff, a Trainer, a Chef Manager and a Housekeeping Supervisor who are also well qualified and experienced and each one takes a lead in managing and developing their aspect of care or service within the home. The homes Responsible Individual, who was present in the home for much of the day of this inspection, has daily telephone contact with the home and visits for two days each week. He was supportive to the process of this inspection explaining particularly about aspects of the twelve month Business Objective and Plan to which the home is now working and how this linked in with the results of the homes Quality Assurance questionnaires. All the staff were found to be very positive about their work and in promoting the quality of service given at Pinford End. During this inspection the management team were seen to be working very well together with each one demonstrating a person centred approach to meeting the needs of the residents as their top priority. Both the Manager and the responsible individual have an open door policy for staff residents and relatives and the Managers ethos is clearly one of empowering both residents and staff and this was very positively commented on by both groups during the inspection. Comment “ the management and staff are very approachable and care for the patients is one hundred percent”; comment from a relative “ Staff always know when I arrive in the home and are available for discussion” The residents all have a lockable facility in their rooms for the safe keeping of valuables and money. Whilst the home does not keep residents pension monies small amounts of cash will be held on behalf of residents at their request to ensure its good safety. Since the last inspection the arrangements for ensuring that all amounts are held individually so that these and any interest that might accrue can be individually tracked have been revised to ensure best person centred practice. Individual receipts are kept for services such as chiropody and hairdressing. Spot checks made on three of these amounts during this inspection found that they tallied with the records held. Since the last inspection the frequency of the staff and management team meetings has been revised to so that any problems and on going action plans can be discussed regularly. Appropriate minutes were seen to be kept. New arrangements for staff supervision have also been instigated since the last inspection. Each member of staff has a regular meeting which is planned ahead and recorded. Staff commented that they found these helpful but said Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 27 that in addition they knew that that they could speak with the manager as and when, when ever was needed.. The Manager said that the area of supervision was one where further developments could still be made. The home gives good priority to promoting the health safety and welfare of the residents and staff through the regular maintenance of safety checks, training and record keeping. The records relating to fire testing and the monitoring of water temperatures were found to be regularly completed along with servicing and safety checks for the homes equipment. Risk assessments for the environment were seen to be maintained up to date. Fire training from an external organisation that been undertaken by all staff during May and June 2008. The home maintains records for the servicing of fire alarms and of the regular internal testing of alarms and emergency lighting. Staff training records showed that staff receive appropriate health and safety training during their induction period and on going through regular updates. First Aid training has been undertaken since the last inspection. The training manager is now also qualified to act as the homes Manual Handling trainer. The home maintains good systems for monitoring falls and accidents. Since the last inspection a review of all the homes policies and procedures has been commenced by the manager and the training manager. Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 2 3 3 3 3 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 2 x 3 Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 29 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. Standard Regulation Requirement Timescale for action 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 OP7 OP21 Rearrangements should be made to the furniture stored in the assisted bathrooms to provide a more congenial bathing environment. 3 OP36 Further improvements are needed to the frequency and quality of staff supervision. Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 30 Good Practice Recommendations Where they are able to do so residents should be encouraged to sign their own care plans. Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Pinford End House Nursing Home DS0000024473.V367657.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!