Inspection on 03/11/05 for Pinford End House Nursing Home

This inspection was carried out on 3rd November 2005.

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 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 02/07/08

Pinford End House Nursing Home 12/06/07

Pinford End House Nursing Home 23/02/06

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 Jane Offord Unannounced Inspection 3rd November 2005 09:30 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.V263188.R01.S.doc Version 5.0 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.V263188.R01.S.doc Version 5.0 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) of places Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd February 2005 Brief Description of the Service: Pinford End House is situated in the rural hamlet of Pinford End south of Bury St. Edmunds. The service offers nursing care for up to forty residents. There are views over the fields from most rooms and pleasant gardens laid to two sides of the house. 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 one of which includes an assisted spa bath. 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. Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday between 9.30 and 15.30. The inspector spoke to a number of staff, several residents and some visiting relatives in the course of the day. Matron was available to assist the process throughout the day. Four resident’s files and care plans were seen, three staff files, the complaints log and compliments book, a selection of menus, the staff rotas and two staff training files were also inspected. The meal at lunchtime was observed being served and a medication round was followed. The drug storage area was seen and some controlled drugs were checked. The communal rooms were all seen and a number of residents invited the inspector to see their own rooms. The kitchens and food stores were seen. On the day of inspection there was a calm atmosphere although the staff were clearly busy. Residents looked well cared for and comfortable. Interactions between residents and staff were friendly and appropriate. The home was clean, tidy and warm with no unpleasant odours. What the service does well: What has improved since the last inspection? Care staffing has been reviewed together with residents’ needs and an agreement reached to increase the number of staff on an early shift to nine. This has offered more flexibility to manage the workload during the morning. A compliments and comments book for visitors has been provided in the hall. Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 6 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. Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 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.V263188.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 People who use this service can expect to have their needs assessed before moving into the home and prospective residents and relatives can visit the home before making a final choice. EVIDENCE: Matron and a registered nurse both spoke of receiving referrals from prospective residents through social workers or the local hospital and making arrangements to go to assess their needs. They were clear that their registration allows them to offer nursing care but could not accept people with a diagnosis of dementia. One visitor told the inspector that their relative had lived out of the county prior to admission. They had wanted their relative closer to them after an illness and visited Pinford End House before negotiating with the discharging hospital for their relative’s admission to the home. They said that their relative’s health needs had been communicated to matron by written documents before their admission. Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 9 Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People who use this service can expect to be treated with respect, have their health needs met and have an individual plan of care drawn up, however they cannot be assured that the present recording of medication that has not been administered will protect them or that their final wishes will be on record. EVIDENCE: Residents’ files showed evidence of assessment of needs on admission. Headings covered pain, mobility, allergy, diet, personal hygiene, continence, sleep and choice of activities. One file recorded that the resident enjoyed watching birds and during the day it was noted that that resident had a view into the courtyard and could see the garden birds on the peanut feeders. The care plans seen had interventions for areas of care such as breathing, elimination, personal hygiene and moving and handling. One intervention was for moving a resident in a sling without causing them pain as they suffered with severe arthritis. There were Waterlow assessments for skin integrity, risk assessments for moving and handling the resident and nutrition assessments and records of residents’ weight. All documents had evidence of regular evaluation and updating. Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 11 One care plan had an intervention regarding a resident’s difficulty with swallowing. The file also contained information leaflets from the Speech and Language therapy team about how to manage the problem. All the files seen had the next of kin recorded and details of how and when they were to be contacted. One visitor said that their relative had had a number of health problems requiring several hospital stays but the staff had always kept them informed of situations as they arose. The records showed visits from health professionals such as GPs and attendance to out patients’ appointments. There was evidence that information was recorded about social contacts that the residents wanted to maintain. In one record it was noted that the resident’s religion was Roman Catholic and that they wanted the priest to visit them. Another file recorded that the resident liked their ‘friend to visit in privacy’. None of the files seen had any evidence that a discussion had taken place with the resident or their chosen representative about the resident’s final wishes. The daily records seen were appropriate and recorded residents’ moods and activities as well as their health needs. ‘ Enjoyed lunch with their daughter’, ‘Sad today about the death of another resident’, ‘Attended Harvest Festival service’. The lunchtime medication administration round was observed. Practice was safe and residents were given their medication at a pace to suit them and in the form they could manage i.e. syrup, tablet, dispersible. The medication administration records (MAR sheets) were examined and there were no gaps in the signature boxes noted. However the codes that are used if medication is not administered for any reason contain ‘o –other’. When this is used there is no explanation recorded. One MAR sheet had recorded several days of ‘o’ for pain relief. Daily records should also have an entry to record why medication has not been given. The controlled drugs (CDs) register and store were seen. Two residents’ CDs were checked and tallied with the record in the register. Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People who use this service can expect to be encouraged to maintain contact with family and friends, to be able to choose how they spend their time and to receive a balanced diet. EVIDENCE: On the day of inspection there were a number of visitors spending time with residents. The spouse of one resident said they visit for most of the day three or four times a week. They are offered a meal when they stay. The resident said, ‘If you have to be in a place like this you couldn’t pick a better one’. One resident, who had previously been in sheltered accommodation and had been anxious about losing their independence, told the inspector that ‘It was working out very well’. They regularly attend the cathedral in Bury St. Edmunds for services and meetings. Another resident said they would like to go home but would probably miss the company if they did. They liked to keep their room door open and people popped in for a chat or staff called a greeting as they passed, ‘It is a cheerful home with laughter in it’. Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 13 There was a list of activities on the notice board in the entrance hall and one resident showed the inspector their copy. They said they particularly liked the quizzes but there were also visiting entertainers. The dates that Holy Communion was celebrated in the home were displayed. There was also information about a Christmas show to be put on by the staff for all the residents and their families. A selection of menus were seen and showed a wide range of dishes to choose from. Lunch menu offered a choice of two main cooked dishes, one meat or fish and a vegetarian option, two desserts and cheese and biscuits. There were omelettes, salads and jacket potatoes with a variety of fillings available too. On the day of inspection the main meat option was roast chicken served with roast potatoes and fresh vegetables. The meals seen looked well presented and hot. There was a choice of drinks to accompany the lunch. Only one resident expressed dissatisfaction with the meals at the home all other people including staff who took their meals at the home said they enjoyed the food offered. The chef was aware of residents individual likes and dislikes and had records to assist in meeting special needs such as a resident who ‘hates cheese’. Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People who use this service can expect that any complaint will be taken seriously and investigated and that they will be protected from abuse. EVIDENCE: The complaints log was seen and showed a small number of complaints with full details of how they were dealt with. Residents and visitors spoken with had not had cause to make a complaint but were clear about how to do so if the need arose. There was evidence seen in the training files that Protection of Vulnerable Adults (POVA) training has taken place recently. All staff spoken with confirmed that they had had the training and were clear about their duty of care. Domestic staff and kitchen staff confirmed that they too received POVA instruction. Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25, 26 People who use this service can expect to live in a clean, well-maintained home, in personalised rooms with specialist equipment available to maximise their independence. EVIDENCE: On the day of inspection the home was clean and tidy with no unpleasant odours anywhere. The housekeeper said that the domestic team had one member on long-term sick leave, which had meant that the cleaning rota had had to be adjusted so the standard could be maintained. Matron confirmed that they had recently appointed to the team so that the workload should ease. In spite of the difficulties the standard of cleaning was high and commented on by several residents and visitors. The service employs two maintenance people to attend to repairs and decorating around the home. There are also two gardeners for keeping the lawns and hedges under control. Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 16 The residents’ rooms that were seen were all suitably furnished with coordinating soft furnishings and light furniture. Most residents had their own television and radio in their room. All the rooms seen had personal photographs, ornaments and paintings in them. Armchairs varied to suit the needs of the resident and there were specialised pressure relieving mattresses on a number of the beds. The care plans seen documented moving and handling methods for individual residents. There was evidence of a variety of hoists and moving aids in the building. Bed rails were protected with soft covers to prevent skin damage. Corridors and doorways were wide enough to accommodate wheelchairs without difficulty. The water temperature in one bathroom and one toilet was tested and in both cases was close to 43c. There were paper towels and liquid soap available at all hand-washing facilities. Staff spoken with were able to detail the procedure for managing a resident with an infection to prevent cross infection occurring. All rooms have large windows with a pleasant outlook. The gardens are accessible from the dining room and corridor downstairs and have ramps available to allow wheelchair users to benefit from the outside. Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 People who use this service can expect that the number of staff and the training they receive will allow their needs to be met, however they cannot be assured that the present recruitment checks will be sufficient to protect them. EVIDENCE: The staff rotas were seen and showed that during the daytime shifts there were two registered nurses on duty with seven carers in the morning and five carers on during the afternoon. One registered nurse with two carers covered the night shift with an additional carer working from 19.00-22.00 to help get residents settled for the night. Minutes of a staff meeting that were seen recorded a discussion about the need to increase the number of carers on the early shift. Matron confirmed that this proposal had been taken to the Managing Director who had agreed to increase numbers to seven carers from six. The staff spoken with felt that staffing numbers were better suited to the dependency of the residents after the change. Staff files seen did not all contain evidence that personal identification had been seen. One file only had the copy of a birth certificate and no photograph of the member of staff. Although all files had POVA 1st and Criminal Record Bureau checks (CRB) the POVA 1st confirmations had not been received before the staff had taken up the post. Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 18 Staff said they had had induction training when they commenced their work. This had included fire awareness, moving and handling, food hygiene, health and safety and Control of Substances Hazardous to Health (COSHH). There was evidence in the training files seen that these subjects were covered early and updated at regular intervals. There is an in-house trainer who is a registered nurse and an NVQ assessor. They organise the training programme and maintain training records of individual staff. Training needs are identified during supervision or by observation. Specialists can be accessed for certain subjects with relevance to certain residents such as the stoma care nurse or continence advisor. There seems to be a strong commitment to a well-informed, competent work force, which is supported financially by management. Staff said they appreciate the level of training offered. Training is tailored to meet needs so for example a newly employed chef has had training sessions on supervision so they can take over the supervision of the kitchen staff. Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 36, 37, 38 People who use this service can expect to live in a home that is well managed with policies and procedures that protect their health and safety and that they are cared for by appropriately supervised staff. EVIDENCE: The matron and trained staff said that they had clear standards of care that everyone was expected to adhere to. They were open to new ideas and changes in working practice if it benefited the residents. Staff meetings were held regularly and the discussions were wide ranging but senior staff were approachable at any time. This was confirmed in discussions with other staff members. Working interactions observed were relaxed and professional. Matron said, and a resident and visitor confirmed, that residents’ views about food and the menus on offer had recently been sought to try to develop the choice in line with residents’ wishes. Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 20 All the staff spoken with had received supervision on a regular basis. They said they felt comfortable to raise any issues during their supervision and identify training needs. Dates for supervision meetings were seen in the training files. Staff personal files and training files were kept in locked cabinets. Residents’ personal details were also kept locked but their care plans were kept in their rooms so the document was ‘live’ and available for reference by the carers. During the inspection the kitchen was visited and food storage was seen. Temperatures of refrigerators and freezers are taken daily and recorded. They were all within safe range for storage of food. Temperatures taken on delivered food and probe temperatures on cooked food were also safe. Stored food was correctly labelled and started packets had ‘use by’ dates on them. Cooked and raw meat was stored separately. Maintenance records and certificates were seen for the lift, fire alarms, the nurse call system, emergency lighting and pressure relieving mattresses. Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 21 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 3 X X 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 4 3 3 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 X 29 1 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X X 3 3 3 Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1` Standard OP9 Regulation 13(2) Requirement The codes used for the nonadministration of medication must clearly indicate the reason and record the same in the daily records of the resident. The checks required for identification of prospective employees must be undertaken and proof retained. All new staff members must have a clear POVA 1st check obtained before commencing work in the home. Timescale for action 03/11/05 2 OP29 19(1)(b) 03/11/05 3 OP29 19(1)(b) 03/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations A resident’s final wishes should be ascertained and recorded as part of their care needs. Pinford End House Nursing Home DS0000024473.V263188.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 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.V263188.R01.S.doc Version 5.0 Page 24 - 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. 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