Inspection on 08/09/05 for Pinxton Manor Nursing Home

This inspection was carried out on 8th September 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Pinxton Manor Nursing Home 19/01/09

Pinxton Manor Nursing Home 14/11/06

Pinxton Manor Nursing Home 04/07/05

Pinxton Manor Nursing Home 23/11/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Pinxton Manor Care Home Church Street West Pinxton Derbyshire NG16 6NA Lead Inspector Rose Veale Unannounced Inspection on 08 September 2005 at 11:00am 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 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. Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Pinxton Manor Care Home Address Church Street West, Pinxton, Derbyshire, NG16 6NA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01773 819191 Pinxton Manor Ltd Mrs. Shona Akbar Care Home with nursing 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: NONE Date of last inspection 04/07/05 Brief Description of the Service: Pinxton Manor is situated in the village of Pinxton, close to Junction 28 of the M1, on the boundaries of Derbyshire and Nottinghamshire. The home is modern and purpose built. Accommodation for residents is on the ground and first floors of the home. There is a garden and large patio area accesible to residents. The home provides personal care and nursing care for up to 40 older people. Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was undertaken in response to an anonymous complaint received by CSCI, and also as part of an adult protection investigation. There were 38 residents accommodated in the home on the day of the inspection, plus 2 residents in hospital. Residents and staff were spoken with during the inspection. The manager was on annual leave. The Service and Administration manager and the owner of the home were both available and very helpful throughout the inspection. The inspection took place over 5½ hours and focused specifically on the care records of residents who were selffunding, staffing levels, staff recruitment, staff training, and the home’s moving and handling policy. What the service does well: What has improved since the last inspection? What they could do better: The records of the care needed by residents and the care provided each day had some gaps. Further work was needed to ensure assessment of residents’ needs was regularly reviewed and that all assessed needs were included on care plans. The daily records needed more detail about residents’ general condition and how their needs had been met. The staff records and the staff rota also had shortcomings identified which needed addressing. Issues were raised regarding the long hours worked by some staff and also working long stretches of shifts without a break. Although it was clear that staff worked these hours by choice, the situation needed to be reviewed as a health and safety issue. Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 Page 6 The moving and handling policy at the home was outdated and needed to be reviewed to include current good practice. Proper records were needed of staff training in moving and handling to ensure that the training provided was suitable. 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. Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 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 standard(s) 3 The assessment information was generally good ensuring residents’ needs were, in the main, covered by the care plans produced. However, assessments were not regularly reviewed, and all assessed needs were not included in the care plans. EVIDENCE: The records of three residents were examined. The residents were all selffunding, that is, funding their care without any assistance from social services. Two of the residents were assessed as needing nursing care and so were receiving the Registered Nursing Care Contribution from the Primary Care Trust, (PCT), generally referred to as ‘free nursing care’. Two records were for residents who had been admitted prior to the introduction of National Minimum Standards for care homes. These records contained assessment information covering the usual activities of daily living. The third record was for a more recently admitted resident. The assessment information included the home’s assessment, plus the assessment for ‘free nursing care’ carried out by a nurse from the PCT. A care plan had been produced for each resident. Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 Page 9 Further assessments had been made following admission, including moving and handling needs, tissue viability, nutrition, and level of dependency. One resident had been noted as having a poor appetite and weight loss, but no nutritional assessment had been made. The assessments had mostly been regularly reviewed and updated, although some had not been reviewed for July and August. One moving and handling assessment had not been reviewed for over a year. Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 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 standard(s) 7 The care plans seen were generally detailed enough to ensure staff were aware of how to meet residents’ needs. However, care plans did not include all the assessed needs of residents and were not regularly reviewed, potentially compromising the care provided for residents. EVIDENCE: The care plans and associated records for three residents were examined. Two of the care plans were the standardised, pre-printed, plans used in the home. These had been individualised for each resident. The third plan was not a standard one and did not contain as much detail about the care required and the action needed by staff to meet the resident’s needs. Some plans seen had not been signed or dated by the person writing them. One resident did not have a relevant care plan regarding a recent major change in condition and needs. Two of the care plans seen had been reviewed and updated monthly to date. The third had not been reviewed since June 2005. The daily records were seen. The entries did not always contain sufficient information about how the residents’ needs had been met, or about the Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 Page 11 residents’ general condition. The entries were all dated and signed, but the designation of the writer was not noted, e.g. RN (registered nurse), or care assistant. Correction fluid had been used on some records, instead of the writer putting a line through any word written in error and initialling. Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 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 standard(s) EVIDENCE: These standards were not assessed at this inspection. Standard 13 was assessed and met at the last inspection. Other standards will be assessed at the next inspection. Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 Page 13 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 standard(s) EVIDENCE: These standards were not assessed at this inspection. Standard 18 was assessed and almost met at the last inspection. A recommendation made regarding Standard 18 will be followed up at the next inspection. Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 Page 14 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 standard(s) EVIDENCE: These standards were not assessed at this inspection. Standards 19, 21, 24 and 26 were assessed at the last inspection. Standards 21 and 24 were met, Standards 19 and 26 were almost met. Requirements and recommendations made regarding Standards 19 and 26 will be followed up at the next inspection. Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Staffing levels, hours worked by staff, staff training and staff records were not appropriately addressed by the home to ensure the safety and welfare of residents and staff. EVIDENCE: The staff rotas for were examined for the months of August and September 2005. It was noted that staffing levels had been increased from 1st September. It was planned that there would be 6 care assistants on duty in the home throughout the day, (from 7.30am to 8pm), plus a nurse. Previously, the planned staffing levels were 6 care assistants up to 2pm, then 5 covering from 2 to 8pm. The night staff levels remained unchanged with 3 care assistants plus a nurse working from 8pm to 8am. The increase in staffing was said to be in response to increased dependency of residents in the home. It was noted that the increased levels were not achieved for all days on the planned rota for September due to staff holidays and a care assistant recently leaving the home. It was said that the home planned to recruit new staff to cover the shortfall. The August rota for the nurses was found to be incorrect. Nurses had swapped shifts but the rota had not been amended. The rota was immediately corrected using the records kept in the home of the hours actually worked by staff. The care assistants’ rota was said to be only amended by the manager or the Service and Administration manager and was a true record of the shifts worked. Care assistants spoken with confirmed that they had worked the shifts as recorded on the rota. Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 Page 16 The August and September rotas for the nurses showed that the manager worked as the nurse in charge on at least 5 to 8 shifts per week, some of these as double shifts, (i.e. working from 7.30am to 8pm). The owner confirmed that this was the manager’s usual working arrangement. The manager was said to complete necessary managerial and administration tasks before and after working shifts as the nurse in charge. This time was not documented on the rotas. It was clear that the Service and Administration manager carried out the majority of the administration tasks in the home. The August rota for the care assistants shows that there were many days when the staffing levels fell below those specified by the home, i.e. below the levels of 6 care assistants for the morning shift, 5 care assistants for the afternoon shift, and 3 care assistants for the night shift. This appeared to be due to cover needed for staff sickness and holidays. There were 2 care assistants included in the staffing levels who were aged under eighteen. As recommended in the National Minimum Standards for care homes for older people, these care assistants were not involved in the personal care of residents, except as observers. They were said to be involved in tasks such as giving out meals and drinks, and assisting other staff by fetching and carrying. This was confirmed by speaking to staff at the home. As these care assistants could not fully participate in all the work required to provide care for residents, they should not be included in the staffing levels. The August rota for care assistants showed that some staff regularly worked well in excess of 50 hours per week, sometimes up to between 70 and 90 hours per week. It was said that these staff chose to work these hours. Staff files seen contained an opt-out of the European working time directive signed by staff. Staff spoken with confirmed that they had the choice of whether to work extra hours. There were two care assistants who had worked long stretches of shifts without a break, for example, 14 and 23 night shifts. This pattern continued into the September rota with one care assistant apparently working the entire month without a break. This was discussed with the owner who agreed to cover some of these shifts, using agency staff if necessary. The records of 7 staff were examined. The Service and Administration manager said that a review of staff files had taken place following the last inspection when some items were missing from files. It was found that some items were still missing from files. Three of the files seen had one reference supplied instead of two, and one had no references. One file had no photograph of the member of staff. Six of the seven files had satisfactory Criminal Records Bureau, (CRB), disclosures. The one outstanding CRB disclosure was for a recently employed member of staff who was working under supervision. The owner of the home contacted the CRB on the day of the inspection to chase up the disclosure. Each of the staff files seen contained the home’s induction programme with competencies to be achieved by the member of staff. These induction records Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 Page 17 had been completed in one file, but not in the other six. The home kept records of all staff training on a training matrix. This gave the year training had been undertaken, but not specific dates. The staff files did not include individual training records, though some brief details of training were noted on two files seen. There was no record of the content of any training carried out. The training matrix showed that most of the care assistants had undergone training in moving and handling in 2005 and 2004. Moving and handling training for staff employed in August had not been recorded. Staff spoken with said that moving and handling training was delivered in-house by the manager, though one member of staff had attended an external training day with a local training provider. Staff spoken with said that they were not involved directly in moving and handling until training had been carried out. The manager had recently attended a moving and handling course with a local training provider. The owner said that this was a moving and handling trainer’s course. On further investigation it was found that this course was not a trainer’s course but a standard updating course. There was no record of staff receiving training regarding the protection of vulnerable adults from abuse, though some staff had covered this as part of NVQ training. Staff spoken with at this inspection and the previous inspection were aware of adult protection issues and procedures. Following discussion, the owner arranged for in-house training to be undertaken by care staff the week after the inspection. This was to be delivered by staff from another home who had attended the relevant training course with Derbyshire County Council. Arrangements were also made for the Service and Administration manager to attend this course. At this inspection and the previous inspection, staff said they were pleased with the training offered by the home. The home had a high percentage of care staff who had achieved NVQ at level 2 or 3. Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 38 The home’s moving and handling policy did not reflect current good practice and needed urgent review to ensure the safety and welfare of residents and staff. EVIDENCE: The home’s policy for moving and handling was examined. The policy appeared outdated as it was entitled ‘Lifting and Handling Policy’ and referred throughout to ‘lifting’. Some of the accompanying pictures of moving and handling procedures appeared to show outdated techniques and equipment. The policy had been signed as being reviewed annually. There were gaps identified in other records as detailed under Standards 27, 29 and 30. Standard 38 was not fully assessed. The specific issue of moving and handling procedures in the home was looked at. Two residents spoken with confirmed that staff assisted them to move and transfer in the way detailed in their care Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 Page 19 plans. Staff spoken with described using hoists to move and transfer residents. Staff were observed to be using hoists during the inspection. It was not possible to fully assess the training given to staff as no records were kept of the content. It was said that a recent moving and handling training session delivered by the manager lasted for about 45 minutes. Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 1 28 x 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x 2 2 Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 Page 21 YES Are there any outstanding requirements from the last inspection? 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. 2. 3. 4. 5. 6. Standard 3 7 7 27 27 27 Regulation 14(2) 15(1) 15(2) Schedule 4 (7) Schedule 4 (7) 18(1)(a) Requirement Assessments of residents needs must be kept under review Residents must have a care plan which includes all of their assessed needs Residents care plans must be reviewed at least monthly, in line with current good practice The duty rota must be a correct record of the staff working at the home The duty rota must include all hours worked by the manager, including supernumerary time The Registered Person must make certain that there are sufficient staff on duty at all times to ensure the health and welfare of residents Records must be kept of staff induction Records must be kept of all staff training All staff must have training in adult protection issues, awareness and procedures All staff must have moving and handling training apropriate to their work so that they are suitably competent Timescale for action 31/10/05 31/10/05 31/10/05 14/10/05 14/10/05 14/10/05 7. 8. 9. 10. 30 30 30 30 18(1)( c) Schedule 4 18(1)( c) 13(5) 18(1)( c) 31/10/05 31/10/05 30/11/05 31/12/05 Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 7 27 27 Good Practice Recommendations The standard care plans should be used for all residents Care staff under the age of eighteen should not be included in the staffing levels on the rota A review and risk assessment should be undertaken of staff working excessive weekly hours, or working many shifts together without a break, to ensure their health and welfare is not being compromised. The content of training received by staff should be recorded and signed by the member of staff as a true record The moving and handling policy should be reviewed and updated to reflect current good practice 4. 5. 30 38 Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection South Point Cardinal Square Nottingham Road Derby, DE1 3QT 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 Pinxton Manor Care Home C52 C02 S62064 Pinxton Manor V248732 080905 Stage 4.doc Version 1.40 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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