CARE HOMES FOR OLDER PEOPLE
Pinhay House Pinhay House Rousdon Lyme Regis Dorset DT7 3RQ Lead Inspector
Anita Sutcliffe Unannounced Inspection 09:30 4 . January 2006
th 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.V256921.R01.S.doc Version 5.1 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.V256921.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Pinhay House Address Pinhay House Rousdon Lyme Regis Dorset DT7 3RQ 01297 445626 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) 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.V256921.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd. November 2005 Brief Description of the Service: Pinhay House 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 Pinhay Partnership owns it. 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 further steps that service users may have to negotiate. There are `sea views to the front of the house and other rooms overlook the surrounding countryside. There is 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. Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection began at 9:30 am and took place over 4 ¼ hours. Standards looked at on this occasion were the key standards not included at the July inspection and those where the needs for improvement had been identified at that, and an additional visit in November. Prior to the inspection the home completed a CSCI questionnaire and comments were received from 12 residents and 6 family members. During the inspection visit the inspector shared a meal with service users (residents) and joined five of them in the sitting room for discussion. Much of the house was visited, including the laundry and staff room. Two care plans, the complaints policy, fire safety record, planned menu, activities sheet, recruitment, induction and training files were seen. The owners and senior carer were available throughout the visit and provided information. What the service does well: What has improved since the last inspection?
The majority of radiators have now been covered to reduce the risk of contact burns; the timescale for the last remaining few has been extended because of difficulty sourcing some to fit the unusual shape and size of the larger radiators. The ongoing programme of maintenance has included window frames which are now safer and more draught proof. Medication, risk assessment, care planning, staff approach to privacy and dignity and hot water safety had each been addressed between the July inspection and the additional visit inspection in November. Safety has further been ensured through the purchase of clear screening to protect service users who might fall against the large, unique and attractive, single plane glass in certain bedrooms. Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 Page 6 Staff said how much staffing numbers at the home had improved, and felt that they had more time to spend with residents now. A reflexologist now visits the home; those who attend say it is very enjoyable. 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. Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 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 Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 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): Not inspected on this occasion. EVIDENCE: Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 Page 9 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): 8 & 10 Residents’ would benefit from formalised monitoring of their weight and diet. Residents are treated with respect and with full regard for their privacy and dignity. EVIDENCE: The Standard of health care needs was not inspected in full during this inspection, but was met at the July inspection. However, whilst inspecting food and nutrition it was established that diet and weight were not routinely monitored at the home, only as an “observational thing” and as necessary. Residents with dementia would benefit from an established method of doing this, so that any concerns can be identified quickly. (See also Standard 15) Residents spoke highly of all staff at the home. They confirmed that they are treated with respect. Staff interaction with residents was courteous. Each resident has his or her own room and privacy is respected. Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 Page 10 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): 15 Residents receive a nutritious varied diet, which meets individual choice and health care requirements. EVIDENCE: Three residents were extremely happy with the food provided. “Very good”, “choice always available if you ask” and “cook gets you anything you like” were comments received. The menu showed variety, and the cook said that quality ingredients were used at the home. The lunch sampled during the inspection was roast lamb, potatoes, green beans and carrot. It was well presented and very tasty. There was a choice of sweet. The dining room is attractive and nicely laid. The home makes a risk assessment of dietary needs and residents are encouraged to make their likes and dislikes known. (See also Standard 8) Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 Page 11 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, 17 & 18 Residents benefit from the homes approach to complaints, and are protected from abuse. Rights are protected through the home’s approach to person-centred care. EVIDENCE: The owners said that no complaints had been recorded since the July inspection. Residents confirmed that they would know whom to complaint to, and feel confident to do so: “I would go to the one in charge”. No complaints about the home have been received at the CSCI. The complaints procedure was openly displayed in the Statement of Purpose hung in the entrance hall, where it is accessible to residents and visitors. Residents said that they felt completely safe at the home. The whistle-blowing policy, to be used if staff have concerns for residents’ welfare, is kept where they can easily find it. In the staff room a poster reminds staff of the signs of abuse. Training in the protection of vulnerable adults had been provided through Dorset Social Services, and abuse is to be discussed in the February staff meeting. The homeowners said that each resident is registered to vote and is supported to do so. Residents confirmed that they prefer the postal vote. Advocacy details are displayed in the entrance hall for residents and visitors to use as required.
Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 Page 12 Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 Page 13 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, 25 & 26 The home is clean, extremely homely, well maintained and meets residents needs. EVIDENCE: The home can boast many unique features, including stunning sea views. Residents made many comments about the local farm animals and creatures around the home. The environment is very much enjoyed. The sitting room is unusual in that there are settees and comfortable fabric chairs. It is completely non-institutional. The home is warm, light and very pleasant. Bedrooms differ, and some are very large. All contain personal items and reflect individual taste. Bathrooms are also pleasant, well decorated and adorned with pictures and plants. Residents said they were very comfortable at the home. The final few, non-standard size, radiators are being covered to ensure safety from burns, and large, single paned windows are receiving a plastic safety coating. The home appeared well maintained.
Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 Page 14 Bedding and towels are commercially cleaned off-site and personal clothing is washed in modern commercial washing machines. The design and layout of the laundry room does not lend itself easily to preventing cross infection, but the steps taken by the home reduce any risk significantly. Liquid hand soap and protective clothing also help and the home was extremely clean and odour free. Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 Page 15 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, 28, 29 & 30 Residents benefit from the caring attitude, numbers and competence of staff, although further induction and qualifications would be of benefit. Recruitment practice does not fully safeguard residents. EVIDENCE: Staff said that their numbers were much improved and were pleased that they can now spend more time with residents. Two residents felt that more staff should be employed; comment received prior to the visit indicated that staffing numbers were sufficient. Residents’ agreed that their needs were fully met, and clearly considered the care staff as friends. Residents and their family are very pleased with the care provided at the home and feel staff are competent. Comments received included: “ideal home”, “good attention to small but important details” and “an excellent residential home”. Staff receive training and are well supervised in their daily work. However, the induction training of recently employed staff has lacked formality (see Standard 36) and the home does not always succeed in ensuring that each staff member receives mandatory training within accepted timescales. Care staff are encouraged to take the NVQ 2 qualification in care, but the home did not achieve the 50 minimum as set in the National Minimum Standards. Of three staff recruitment records two did not contain any references. The owner said that the staff were known prior to employment, but agreed that references had been an over sight. The list of person unsuitable to work with
Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 Page 16 vulnerable adults, and the CRB disclosure, is not being consistently sought prior to employment. It was said that staff worked in a supervised capacity, and without personal contact with residents, until they are received. A newly employed member of staff was observed working along side an experienced staff member. Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 Page 17 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): 31, 32, 33, 35 & 38 The home is well managed and run in the bet interest of residents, whose diverse and individual needs are recognised and met. Quality assurance is not managed efficiently. Health and safety are maintained at the home. EVIDENCE: The manager is a registered nurse who maintains her competence and knowledge through training in both care and management. She works closely with senior staff toward high standards. She made a positive choice not to undertake the Registered Managers Award. However, this should be reconsidered so that good practice continues to be assured. The management of quality assurance has been on more of an ad hoc basis than systematically approached. The owners spoke of improving the format of
Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 Page 18 a previously used questionnaire, which they are preparing to repeat. The owners are always pleased to speak with residents and family, and staff are encouraged to attend meetings. However, no system has yet been established on which regular review and improvement can be based. Steps have been taken to further ensure health and safety at the home, and individual and generic risk assessments are in place. The home appeared well maintained and staff are trained to work safely. Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 Page 19 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 4 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X X 3 Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 Page 20 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 OP25 Regulation 13(4) Requirement Timescale for action 28/02/06 2. OP29 19 Schedule 2 3. OP36 18(1)(c) (i) 4. OP33 24(1) Radiators must be guarded to prevent the risks of accidental burns. (Timescale extended by agreement) The registered person shall not 10/01/06 employ a person to work at the care home unless the person is fit to work at the care home [to establish fitness the information and documents specified in Schedule 2, 1 – 9 must be obtained; in this case 2 references and a CRB disclosure with POVA list check] The registered person shall, 10/01/06 having regard to the size of the care home, statement of purpose and the number and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform [This refers to the inconsistency of induction training provided for new staff at the home] The registered person shall 31/03/06
DS0000022010.V256921.R01.S.doc Version 5.1 Pinhay House Page 21 establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. [This refers to the lack of consistency in the home’s approach] 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 OP8 Good Practice Recommendations A record should be maintained of nutrition, including weight gain or loss, and appropriate action taken. Pinhay House DS0000022010.V256921.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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