Inspection on 21/09/07 for Pinhay House

This inspection was carried out on 21st September 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 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

Pinhay House 23/06/06

Pinhay House 04/01/06

Pinhay House 28/07/05

Pinhay House 20/01/05

Pinhay House 29/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Pinhay House Rousdon Lyme Regis Dorset DT7 3RQ Lead Inspector Michelle Oliver Key Unannounced Inspection 21st September 2007 07:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Pinhay House DS0000022010.V335027.R02.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. Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pinhay House Address Rousdon Lyme Regis Dorset DT7 3RQ 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) 01297 445626 info@pinhayhouse.co.uk The Pinhay Partnership Mrs Carole Jane Hodges Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25) of places Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd June 2006 Brief Description of the Service: The Pinhay Partnership owns Pinhay House. It provides accommodation and personal care for up to 25 older people who may suffer from mild to moderate dementia. The home is unable to care for people with severe dementia, or people who may display aggressive or unsociable behaviour. The property is a large converted Grade II listed mansion house standing at the end of a long drive approximately 2 miles from Lyme Regis. Bedroom accommodation is situated on the ground and first floors. There is a stair lift to the first floor but there are then further steps that residents may have to negotiate. Rooms at the front of the house benefit from sea views and other rooms overlook the surrounding countryside. Pinhay House has a large entrance hall, lounge/dining room and various quiet sitting areas throughout. Many of the rooms retain interesting period features and are large, bright and airy. The home’s statement of purpose and service user guide is available at the home, which includes details about the philosophy of the home, a statement of terms and conditions and details about living at the home. This is made available to all potential residents before they make a decision about living at the home. A copy of the most recent inspection report is available on request. Information received from the home indicates that the current fees are £306£650 weekly. Services not included in this fee include hairdressing, chiropody, toiletries and personal shopping, incontinence aids, newspapers and transport at 30p per mile. Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place as part of the normal programme of inspection. One inspector carried out the site visit over the course of 10 hours. During this time we looked closely at the care and services offered to three people as a way of judging the standard of care and services generally. Where possible we spoke with these people in depth, looked at their care assessments and care plans closely, and spoke with staff about their knowledge and understanding of the plans. We looked at their bedrooms and we looked at the overall environment from their perspective. We also looked at recruitment records, staff traing record and other records. We spoke with approximately 9 others (of the 22 people living here), with the manager, deputy manager, administrator, activities person and with carers. We looked around the building at all communal areas and saw many of the bedrooms. We looked at other records including medication, staffing, accident and incident reports, training, fire safety and recruitment and complaints. Prior to the visit to the home we sent surveys to various people asking for feedback and comments. We sent surveys to people who live here but did not receive any replies, to relatives and received 3, to health and social care professionals who attend people living here and received 4; and to staff working here and received 8. Their feedback and comments are included in the report. Other information given to the commission throughout the year has been taken into account. In addition, and before we visited the home, the manager provided information about the management of the home and their own assessment of what the home does well and what they plan to improve upon. What the service does well: People living at the Pinhay house are provided with good basic care in a warm and friendly environment. Good quality food is provided and the staff are committed to giving good care. In a questionnaire received before this inspection a health care professional commented “Very good standard of communication and delivery of care recommendation”, another in response to whether the home supports individuals to live the way they choose “very flexible and adapt well to suit the needs of the individual”. Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 6 When asked, in a questionnaire, what they feel the home does well one relative commented, “Looking after elderly people requires special skills, this the care home does well” .The home is generally well maintained, furnished with good quality furniture and fittings. The home provides appropriate training for all staff to ensure that people living at the home are cared for by well trained competent staff. The recruitment procedure at the home is robust and protects people living at the home by ensuring that only suitable staff are recruited. Meals provided are of a good standard, nutritional and well presented. People said that they enjoyed the food provided. What has improved since the last inspection? What they could do better: People are not currently informed in writing that the home can meet their health, welfare and social care needs following an assessment being undertaken before admission to the home .Not all people living at the home have their risk of falling assessed. This means that unnecessary risks to peoples’ health or safety may not be identified or eliminated. There is a lack of understanding of safeguarding procedures and how they work. Fire doors are being wedged open at the home and not all staff have received training in the prevention of fire. This means that adequate arrangements have not been followed to prevent or contain a fire. The level of detail recorded in some care plans does not always provide up to date information required to meet peoples’ changing needs. Once opened, the Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 7 date that creams/ ointments should not be used beyond is nor being recorded consistently. This means that creams/ointments may be used beyond the efficacy period. People who may be suffering from dementia may not have the opportunity to exercise their choice in relation to leisure and social activities. The laundry floor is not impermeable or easily cleanable to prevent the spread of infection and to maintain hygiene. Details of all Staff on duty at any time during the day or night are not currently recorded on the homes’ staff rota. Insufficient numbers of staff may be on duty at some times during the day. This means that peoples’ care needs are at risk of not being met. 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. Pinhay House DS0000022010.V335027.R02.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 Pinhay House DS0000022010.V335027.R02.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): 1, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have good information about the home that helps them to make a decision about where to live. The people who come to live here will have their needs assessed and the staff will be able to meet those needs. EVIDENCE: The home appreciates the importance of people having sufficient information when choosing a care home. The home’s Statement of Purpose provides people with information about the home including its aims and objectives, philosophy of care, services and facilities and Terms and Conditions of the Home. Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 10 The home has also developed a brochure, which include photographs and the home’s newsletter. The brochure also includes details of what people can expect and gives a clear account of services provided, quality of the accommodation, qualifications and experience of the staff and how to make a complaint. The Statement of Purpose is available to enquirers and people living at the home, a copy is kept on a notice board in the hall, and all enquirers are given a copy of the home’s brochure. This ensures that people are provided with up to date information about the home before they make a choice to live there. Before a person moves into the home an assessments of their individual health, welfare and social care needs are undertaken by either the manager or her deputy. This is to ensure that the home can be confident that staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. People can also be confident that their needs can be met. The home writes to people to welcome them to the home but does not confirm that their assessed needs can be met. To do this would further promote person centred care. Before deciding to make Pinhay House their home, people are invited to spend time in the home to meet other residents, staff and to be able to ask any questions they may have. One person spoken to during this visit said that their son had arranged the admission and they were “not disappointed with his choice”. The home’s admission procedure ensures that only people whose health, welfare and social care needs can be fully met by the home choose to live there. The home does not admit people who need intermediate care. Pinhay House DS0000022010.V335027.R02.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live here have their health and medication needs planned and met. Further improvements would ensure that care is delivered in a person centred way. The privacy and dignity of the people who live here is respected. EVIDENCE: Plans of care have improved since the last inspection. We looked at three people’s care plans and all showed that appropriate assessments are undertaken in relation to the risk of people developing pressure sores and in relation to how much nutritional support the person might need. These assessments are generally followed up with plans of action and are regularly reviewed, but improvement is needed to ensure that all changes to a person’s Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 12 plan of care are included. For example,a doctor had written instructions for a dietary supplement to be given to a person who was not able to take a normal diet. This information had been written in a section in the file allocated for doctor and health care professionals comments and instructions. This information not been entered in the plan of care which had been written following a risk assessment had identified that the person was at risk of poor nutritional intake. Six weeks later, when the doctor visited, the recording stated that the person was weaker and not eating. There was no record of whether the person had been given the prescibed supplement. The lack of this information having been included in the care plan relating to nutrition potentially puts people at risk of their health care needs not being fully met. During the first weeks spent in the home time is spent with people in order to get to know the person and gather information including individual preferences in relation to entertainment and interests, spirituality, food and drink, clothes, bedtime, bathtime, skin, teeth and nails, hair, history, mobility, and independence. This information is recorded in plans of care and enables staff to have a full understanding of individual needs and wishes. Plans of care include an assessment of risks of falls but not for all people. A care plan looked at showed that a person had a history of falling before moving to the home but a risk assessment had not been carried out. To undertake an assessment of risk in relation to falls for all people living at the home would ensure that people are protected from potential harm. Staff say they are given clear instructions about peoples’ needs and plans of care to ensure that people living at the home are treated as individuals. Care plans show that people living here have access to professional health care such as chiropodists, opticians and specialists. During this visit a reflexologist visited the home to see some people privately. When asked they said they had been visiting the home for about 56years and “loves” the home, “lovely atmosphere, people cared for so well”. However, further improvement is needed to ensure that all relevant information is incorporated in plans of care so as to focus on person centred care and meet peoples’ needs. An example of relevant information not being recorded is when a person returned to the home after a period spent in hospital. There had been a change in their care needs and the plans of care had not been updated to include current information. This potentially puts the person at risk of not having their care needs met. People living at the home said that they always or usually receive the care and support they need and always receive the medical support that they need. When spoken with people say that staff are very quick to call for the doctor when they are not well and this was confirmed by local GP’s. During this inspection a doctor visited a person after staff had noted a change that morning and requested the doctor to visit. The doctor confirmed that the visit was necessary. Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 13 Also, a district nurse visited the home to see one person and was asked to visit another person as staff had noted a change and wanted the district nurses’ advice. After visiting the person the district nurse agreed that some treatment was needed. People confirmed that they are treated with respect and their privacy is protected. Care staff confirmed this when telling us about the home’s privacy and dignity policy, when seen knocking before entering peoples’ rooms and when seen being discreet in offering to provide personal care or assistance. All personal care was carried out in private and people wear their own clothes, which are very well cared for. People in their rooms were comfortable and all but one had their call bells close to hand. Only staff who are appropriately trained administer medicines at the home. Staff demonstrated a good knowledge and understanding of the importance of the safe handling, storage and recording of medications and carries this out to a good standard. Whilst visiting two residents’ rooms opened containers of creams/ ointments were seen with no indication of when they had been opened or expire. Creams lose their efficacy when open for more than 3 months. Pinhay House DS0000022010.V335027.R02.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 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live here benefit from having easy contact with their friends and family and from a varied and wholesome diet. Although the Home provides a varied activities programme, which many people can join in, this may not provide adequate stimulation and interest for all people currently living at the Home. EVIDENCE: The home provides people with a full activity schedule and a weekly schedule is posted on two notice boards in the home. During the first weeks spent in the home time is spent with people in order to get to know the person and gather information including individual preferences in relation to entertainment and interests. This is to ensure that people have their social, cultural, religious and recreational needs met by the home. Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 15 The home has two activity organisers who carry out one to one and group meetings to discuss any issues and suggestions. Activities such as board games, outings, reading, skittles, gentle exercise and musical sessions are enjoyed at the home. During this visit some people were enjoying a game of skittles in the lounge. However, people who were unable to join in just sat and were not encouraged to take part or to be engaged in conversation. According to information recorded in plans of care, one person had enjoyed sewing, likes any paper, books or magazines, and listening to music before moving into the home. There was no evidence of this person being involved with sewing and was sitting in the lounge, during this visit, with no books, papers, magazines and, despite there being a radio and music system in the room, no music playing. One person enjoyed going out for car trips before moving to the home. According to the assessment of risk undertaken in relation to car travel staff had assessed this risk being “not applicable”. This was discussed with the deputy manager who said that she thought it possible that trips out in a car could be organised for this person. However, some people spoke about being involved in planting the many colourful pots in the garden, going out to the Seaton tramway and enjoying a trip out to the Sidmouth donkey sanctuary. Comments included on a questionnaire before this inspection included “Lack of evidence that the residents get many opportunities for outings-we alternate our visiting days and they always appear to be in even on fine weather days” This was discussed with the provider and manager who spoke about a recent “ garden party” held indoors because of poor weather. They also said that they are planning to use the home’s mini bus more to enable people to go out more often. They agreed that it is not always possible to take people outside into the gardens if they have less than the full compliment. However, on several occasions during the summer staff have stayed on for an extra couple of hours and taken people into the garden. Staff and those who had enjoyed the event confirmed this. However, some people spoke about being involved in planting the many colourful pots in the garden, going out to the Seaton tramway and enjoying a trip out to the Sidmouth donkey sanctuary. People are encouraged to visit people living at the home at any time. During this visit many visitors came to the home and were made to feel welcome by the staff. People are given the choice of being served their meals either in their rooms or in the comfortable dining room. Lunch served during this inspection was well presented and nutritious. Staff supported people, needing assistance with eating, sensitively and discreetly. Comments made by residents included “food is very good”. All meals are cooked on the premises and use mainly fresh ingredients. Hot and cold drinks are available throughout the day. A choice of meals is always available at lunch and the evening meal. Since the last inspection people are asked, when making their choice of evening meal, what they would like for breakfast the following day. People are provided with a cooked breakfast at least once a week, which some people said they Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 16 thoroughly enjoy and look forward to. People say they make choices in their daily lives. These include the times they get up and go to bed, what they wear and where they eat their meals. Pinhay House DS0000022010.V335027.R02.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 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live here have their complaints listened to and acted upon. There is a lack of understanding of safeguarding procedures and how they work. EVIDENCE: The Commission has received no complaints about this service, since the last inspection. The home has received one complaint, which was dealt with within the time period stated within the home’s complaints policy. This was confirmed by looking at records maintained of the investigation undertaken and the response to the person who had brought the matter to the home’s attention. During discussions, people said that they felt comfortable speaking with staff about any ‘grumbles’ and would report any complaints to the manager, or deputy, but had not had cause to”. Staff confirmed that they know the importance of taking people’s views seriously and Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 18 of listening and responding to any issues raised. Staff said they would report back to the manager or supervisor any requests, comments or complaints made by people living at the home. A copy of the home’s complaint procedure is made available in the service user guide, one of which is given to each person living at the home. People spoken to said they feel safe and secure, staff are generally kind very helpful, respectful and that nothing was ever too much trouble for them. Staff have undertaken Adult Protection training since the last inspection and were able to discuss different forms of abuse. They all said that they would not hesitate to report any suspicion of poor practice. Information received from the home prior to this inspection states “We have a robust procedure in place for responding to suspicion or evidence of abuse or neglect e.g. whistle blowing policy. We ensure the safety and protection of our service users, passing on any concerns to CSCI, in accordance with the Public Interest Disclosure Act and the Department of Health. All allegations and incidents are followed up promptly, action taken and recorded. Policies and practices of the Home ensure that physical and/or verbal aggression by a service user is understood and dealt with promptly”. An allegation of abuse has been made recently by a person living at the home. The home did contact a GP to visit and assess the person’s health needs and tried to make contact with a relevant mental health worker. However, a formal safeguarding alert was not made at that time by the home. This was made later by the mental health worker following a visit to the person who had made the allegation. This issue continues to be looked into at the time of writing this report. Pinhay House DS0000022010.V335027.R02.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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live here can be assured of a homely, clean and safe environment. EVIDENCE: Pinhay House is well maintained and provides comfortable accommodation including a lounge, several smaller sitting areas and a dining room. Peoples’ rooms were homely and most had been personalised with their own belongings and some small items of furniture; all were well decorated and fresh. Information received before this inspection included the following comments: Terrace is currently screened and can not be used by residents and is unsafe, areas of damp in the home, toilets not clean, gardens neglected, lawn mown but no planting. These comments were discussed with the provider. Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 20 The terrace had been screened off during the summer and repair work was hindered by bad weather, the repairs have now been completed. The house is an old building and does have some problems of damp. Some areas are visible but these have been dealt with. All toilets seen during this visit were spotlessly clean, as was the entire home. The gardens were neat and tidy, several pots of brilliantly coloured plants, some planted by people living at the home, were seen on stands, on the lawn and on the terrace. The home is very well furnished and maintained to a high standard; a maintenance man works at the home and ensures necessary repairs are carried out. The inspector had a full tour of the building unaccompanied and all the areas were extremely clean and fresh. Hand washing facilities are provided in all rooms and bathrooms to ensure good hygiene practice at the home. At the time of this visit the dining room, which had temporarily been out of use because of new double glazed windows being fitted, was being returned to normal. People were pleased with this and commented on “how well the job has been done.” The widows replaced old windows that could be “ drafty” according to some people. The laundry facilities have improved since the last inspection and were clean and well organised. Handwashing facilities, antibacterial gel dispensers aprons and gloves are provided in the washroom. However work is still required to ensure the floor is easily cleanable to further promote the prevention of infection. Information received before this inspection included plans for redecoration and improving the flooring, however, the washing machines will have to be re-plumbed and temporarily re-located and this presents a problem as the facility is so well used. Bed linen and towels are provided by a linen hire service, domestic washing is done by the home according to care instructions. Everybody was well dressed at the time of this visit and several said that their clothes are well looked after. Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at this home benefit from good recruitment practices and a staff group who are well trained. Peoples’ needs are generally met by the numbers of staff on duty; however, a lack of evening domestic staff support puts additional pressure on care staff to meet needs of people in a timely way EVIDENCE: There are usually 4 carers on duty from7.30.am-3.30pm and 3 carers from 3.30 – 9pm. We were told that in addition the manager, deputy manager, an administrator, a chef, a domestic, an activities person and maintenance are also on duty during the day. We looked at 4 weekly staff rotas. These did not show which staff were on duty during the day and night, only the shifts worked by the care assistants were recorded. Also, when staff had stayed on duty to take people out the extra time was not recorded. The rotas must include details of all staff on duty at any time during the day or night to ensure that people living at the home are being looked after by sufficient appropriately trained staff who can meet their assessed needs. Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 22 People living at the home say that staff are always or usually available when needed, that they listen and act on what is said and that they are well cared for by staff. All staff when coming on duty are given handover period when up to date information is shared. This ensures that well-informed staff care for people living at the home. During this visit there were only 2 carers on duty after 4.30 pm, as one staff member was off sick. A cook is not employed at the home during the evening so staff are involved in the preparation and serving of the evening meal. Many people are prescribed medication that needs to be administered by staff during the evening meal. One carer in the kitchen and the other giving out medication effectively leaves no carer available to assist people with personal care or to be available to respond to calls. The carers said that when a person needs assistance one or both would stop what they were doing as people take precedence at the home. The carer also said that usually 3 carers would be on duty in the evening but often several people needed two carers to assist them. This potentially puts people at risk of their care needs not being met. The manager reports the percentage of staff trained or training to NVQ2 or 3 has increased to 66 and an Assistant to the Registered Manager will undertake the Registered Managers Award in September 2007. The home operates a generally good recruitment procedure that clearly highlights the processes to be followed. Three randomly selected staff recruitment files were checked. These contained all the checks recommended to ensure that suitable staff are recruited. These include written references, a police check and proof of identity. Ensuring the recruitment procedure is consistent and that all required information is obtained for all employees will protects people, as only those who have undergone this robust procedure will be employed to work at the home. All new staff undergo a period of induction training when they are employed at the home, which includes principles of care, safe working practice, abuse and whistleblowing policy. The manager has introduced a DVD-led programme for training to cover induction training and this will be ongoing. We spoke to two care staff who described their period of induction training, which includes watching DVD’s and completing a set of questions to establish what they have learned. This is then gone through with the manager who can clarify any issues that the carer may have. This ensures that people living at the home are well cared for by trained competent staff. Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a well managed home that is working hard towards trying to make sure the home is run in their best interests. Health and safety is managed well, but improvements to fire safety will further protect people living at the home EVIDENCE: The registered manager has been running the home for 19 years and has a Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 24 background in nursing. The Registered Manager and the Assistant Manager are in day to day control of the home. Prior to this inspection a pre inspection questionnaire was completed by the manager giving information about the management of the home and how the home has carried out improvements based on the feedback from the last inspection. The manager and staff have worked hard to meet the requirements made at the last inspection. Records are securely stored and would be made available to people living at the home, or their representative, with their consent. Records are kept in lockable filing cabinets, and those seen were up to date. Peoples’ feedback about such things as the quality of their life at the home, staffing, meals, cleanliness and activities is sought on a daily basis. A quality assurance survey has been undertaken by the home and the results have been audited. The results of this survey will be included in the home’s statement of purpose and be made available to other interested parties. The home plans to undertake annual surveys to ensure that people living at the home are given a say in the home’s running. Residents meetings are held regularly at the home and people are encouraged to discuss any topics they wish. The result of the most recent survey will be fed back to people during the next meeting. Most people living at the home choose to have personal finances looked after by their family or legal representatives. The owners handle financial affairs for one person living at the home. Records of these monies were seen. They were well recorded accurate and up to date. The manager reports that mandatory training is given a high priority and includes fire training, first aid, food hygiene, dementia, medication, infection control and moving and handling. This was confirmed by staff who said that the extent and type of training is ‘really good’ and helps them to do their job. One member of staff, recently employed at the home, had not received training in fire prevention. Records confirm that fire alarms and emergency lighting tests have been carried out regularly. Information received before this inspection indicated that all equipment is well maintained regularly. However, during a tour of the building two fire doors, one leading to a passage leading to the kitchen and the other leading directly into the kitchen was wedged open. This was discussed with staff and the manager, who said the doors were only wedged open when meals were being served. This is not acceptable. The door to a person’s room directly opposite the kitchen was also wedged open. This puts the person at risk of harm. Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 25 The provider said that wiring is already in place to install magnetic door closures. When these are fitted this will allow for the doors to remain open as they will automatically close in the event of a fire. The provider phoned a contractor during this visit and arranged for the closures to be fitted by the 6th October, and confirmed that the doors will be kept closed until they are fitted. Since the inspection the provider has confirmed this to the Commission in writing that this has been completed. Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 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 1 Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 28 STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14[1][d] Requirement The home must inform people in writing that the home can meet their health, welfare and social care needs following an assessment being undertaken before admission to the home. Unnecessary risks to the health or safety of people living at the home must be identified and as far as possible, eliminated. Timescale for action 01/10/07 2. OP7 13[2][c] 01/11/07 3. OP18 13[6] This relates to assessment of risk associated with falling are undertaken for all living at the home. All staff must be aware of the 01/10/07 procedures to be followed in the event of an allegation of abuse being made. This is to prevent people living at the home suffering abuse or being put at risk of abuse. 4 OP38 23[4][c][ 1] Adequate arrangements must be made for containing fires to ensure that all people living at the home are kept safe. In the meantime all fire doors must be kept shut at all times. This relates to 2 fire doors being wedged open. Arrangements must be made for all staff to receive suitable training in fire prevention. 06/10/07 Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 29 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 The level of detail contained within care plans should be kept under review to ensure that staff have all the information required to meet peoples’ changing needs The date of opening or expiry of opened creams/ ointments should be indicated to ensure that creams/ointments are not being used beyond the efficacy period. People who may be suffering from dementia should have the opportunity to exercise their choice in relation to leisure and social activities. The laundry floor should be easily cleanable and impermeable to prevent the spread of infection and to maintain hygiene. The home should maintain staff rotas showing which staff are on duty at any time during the day or night. This is to ensure that sufficient staff are caring for people. Staff should always be employed in such numbers to enable them to meet all people’s needs- you should review the numbers of domestic staff available in the home 2. OP9 3. 4. 5. 6. OP12 OP26 OP27 OP27 Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Pinhay House DS0000022010.V335027.R02.S.doc Version 5.2 Page 31 - 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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