CARE HOMES FOR OLDER PEOPLE
Pippins Mead Lane Preston Paignton Devon TQ3 2AT Lead Inspector
Stella Lindsay Key Inspection (unannounced) 7th March 2007 9:45 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 Pippins DS0000068074.V327719.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. Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Pippins Address Mead Lane Preston Paignton Devon TQ3 2AT 01803 525757 01803 525848 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) Celia Rosemary Griffiths Mrs Sarah Anne Dorling Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17), Physical disability over 65 years of age of places (17) Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th May 2006 Brief Description of the Service: Pippins is an attractive detached property in a residential area of Paignton, on the level for local facilities including the park, the library and the sea front. Residential care is provided for up to 17 elderly people who may be physically frail or disabled. There is a shaft lift, but people who are dependent on a wheelchair should be accommodated on the ground floor. There are a TV lounge and a sun lounge, and a dining room. The 15 bedrooms all have en suite facilities, and two are large enough to accommodate a couple. The garden is most attractive, with a fountain and fishpond, a rose garden, raised beds, fruit trees, and accessible paths all around the house. Current fees range from £370 to £435. Copies of previous CSCI reports are offered to enquirers on request, and a copy is available in the entrance hall. Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on a Wednesday in March 2007. It involved a partial tour of the premises, and examination of care records, staff files, health and safety records and the medication system. The inspector met with the Registered Provider, Mrs Rosemary Griffiths, and the Registered Manager, Mrs Sarah Dorling, four staff on duty and six residents. Surveys were received from a random sample of staff and residents’ relatives, and their views are represented in the text. What the service does well: What has improved since the last inspection?
The new owner had, as a priority, carried out work to assure safety within the home. The electrical and emergency alarm systems had been inspected and upgraded as necessary. All remaining radiators had been provided with covers to assure the safety of residents, and upstairs windows had been provided with restrictors. Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 6 Residents were delighted that a new set of dining chairs had been purchased, upholstered to give comfort at mealtimes. New table-cloths arrived on the day of this inspection, to match the new chairs and maintain a fresh and stylish appearance. The quality of food had improved, and the residents were happy with all menus. Several pointed out that fruit is now out in bowls for them. All bedroom and bathroom doors are now fitted with locks that are suitable for the occupants, to provide privacy. Some residents had chosen to be key holders. All residents had been provided with lockable storage boxes, to be secured within their bedrooms, so that they could safeguard their own money and possessions. A new microwave had been provided for the kitchen, and a new freezer in the outside store. A new telephone system had been purchased, with cordless handsets. This will enable the waking night staff to arouse the person sleeping in. During the day the Manager will carry one and be easily contactable while out of the office. Also, an in-coming call could be taken to a resident’s room for privacy. The Manager’s time as supernumerary had been increased, to give her the time she needs for good management of the service. A computer had been provided with Internet connection, to give the home an email service and access to information. These improvements had been implemented with commendable energy and commitment. What they could do better:
All requirements remaining from previous inspections had been met. No surveys returned or residents spoken with had anything they thought should be improved. The new Service Provider has plans for the development of the home, which include the provision of an office for the Manager on the ground floor and a staff room, which will be a great help in the smooth running of the home. It is recommended that the refurbishment of the laundry be included in these plans, to assure that all areas are readily cleanable, so that good standards of hygiene can be maintained. Also, the temperature of medications stored should be monitored, until they can be re-sited. It is also recommended that the plans be represented as a report, so that they can be discussed with residents and other interested parties. The system of recruitment was generally sound, resulting in the employment of caring and reliable staff. However, CRB checks must always be carried out
Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 7 before staff are allowed to work with vulnerable people, and in one case this had not yet occurred. 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. Pippins DS0000068074.V327719.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 Pippins DS0000068074.V327719.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clear and accurate information is provided, and preadmission assessment is carried out with care. Intermediate care is not offered at Pippins. 1,3 EVIDENCE: The Registered Provider had produced a Statement of Purpose for the Home, and up-dated it as staff details and qualifications had altered. The home has its own pre-admission assessment form, to ensure that the Manager has sufficient information about the client’s care needs on which to base a decision as to whether or not Pippins can offer appropriate care. It covers any medical diagnosis, including psychological and mental health needs. The level of mobility and dexterity is considered, and any history of falls. Sensory problems and communication needs are assessed. Dietary requirements are recorded. Social and religious needs are documented. Personal risk factors are considered. Prospective residents are offered a short stay or trial period. To conclude there is a summary, giving the decision as to
Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 10 whether or not the home can offer care suitable for the applicant. Two preadmission assessment forms which had been completed recently were examined, and seen to have been considered carefully. The residents had come for a trial stay, and were entirely positive about their move. A relative who returned a comment card stated that the Manager had given ‘ample support’ in organising the move when their mother had moved into Pippins. Pippins DS0000068074.V327719.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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are consistently very well met, with evidence of good multidisciplinary work taking place on a regular basis. 7,8,9,10 EVIDENCE: Pippins has very good and useful care plans. The inspector examined three. Each started with a Personal Profile, to give the reader an introduction to the resident’s life, achievements, family and interests of all sorts. There were clearly written summaries of what the resident required each day, following assessment of their needs. The care plans are checked every month, with a new summary of any changes written each month, and one of the Senior Carers is detailed to check that each key-worker has completed this task on time each month. Nutritional assessments had been carried out, and weight charts kept where necessary. Showers and baths were recorded, as well as any health issues that were observed. Detailed records were kept of Doctors’ visits, and other records, including those from opticians, were seen. The Enablement Team had been involved and were due again to assess and advise on the care of
Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 12 residents at particular risk of falling. Other health professionals had been involved, and GP reviews of medication had been requested. One resident with diet-controlled diabetes was pleased to tell the inspector how much better they feel, after having lived at Pippins for some time, due to the good care and food. There is a clearly written policy and procedure on the administration of medication, and the staff were seen to be implementing it with care. Separate booklets are kept for the recording of medication whose dosage is periodically altered by the GP. The temperature in the medication cupboard should be monitored, and plans made for protective action if it should rise to 25 degrees centigrade. There were no Controlled Drugs, or any medications needing a secure refrigerator. Good locks had been fitted to doors of all bedrooms and bathrooms, to protect the privacy of residents while enabling access by staff in an emergency. Residents were seen to be treated with respect at all times. Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 13 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents feel that they are able to make choices, and enjoy their meals and their social activities. 12,13,14,15 EVIDENCE: The residents who spoke to the inspector were happy with their arrangements for bathing, laundry and having their room cleaned. Their preferred daily routines and social interests are recorded, and they are encouraged to follow their own interests and participate in activities within and outside the home. The home has a friendly atmosphere, and a lively social life. Most residents come to the sun lounge for morning coffee and afternoon tea, and all come for lunch and supper. The staff provide social activities every afternoon, including reminiscence, quizzes, exercises and ball games. Individuals are taken for walks round the garden, or given manicures. A record is kept for each resident, not only of what they have done, but also of how successful it was and whether they enjoyed it. Residents visit or are taken to local Churches, the library and the Blind Club. The home supports family connections, and keeps in touch with relatives. All comment cards returned by relatives agreed that the home is good at keeping in touch, for example, ‘The staff and management always keep me informed of
Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 14 the ongoing situation with my mother in the home’, and also that they find a warm friendly atmosphere when they visit. The white board in the entrance hall displayed the menu choices of the day, as well as the names of the staff on duty. Good quality ingredients are provided, including plenty of fresh vegetables and fruit. Two roast meals per week are very popular, and a choice is offered at all other meals, and alternatives always available. On the day of this inspection pot roast was served and the residents agreed that it was delicious. With it were crisp roast potatoes, cabbage, swede, and mixed vegetables. The cook said that she offers a variety of vegetables to provide choice for the residents, and the menus bear this out. Gravy was brought separately, and condiments were on the table. For desert there was a choice of yoghurt or apple crumble and cream. There is a good variety of food available at supper, for instance a choice of mushroom soup, or bacon or tuna sandwiches; broccoli & Stilton soup, toasted teacake, or cheese sandwich. Special diets are provided for in a positive way, and encouragement to eat given when necessary. Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident that their views are heard, and staff are aware of good practice in this area. 16,18 EVIDENCE: There is a complaints policy that is reviewed periodically to ensure that it is thorough and appropriate, and it is displayed in the Hall and included in the information for prospective residents. Residents are also reminded periodically of what to do if they wish to make a complaint. The policy includes the sending a letter of acknowledgement within 2 days, and a letter outlining the result of the investigation within 28 days. The address for the CSCI local office is given. There is a formal complaints record book, but none had been received since the last inspection. None had been received by the CSCI. Residents told the inspector they would tell the Manager if they were worried about anything, and they were sure she would be able to sort it out. The Policy on dealing with abuse was clearly written, including what must be done in the event of any allegation being made. Staff had received training in the Protection of Vulnerable Adults. Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Pippins is an attractive, safe and well maintained home. It is clean and comfortable. 19,20,24,25,26 EVIDENCE: Pippins is an attractive house, which has been made suitable for accommodating frail elderly residents, with a shaft lift, mobility aids and adaptations to aid independence. A handrail had been fitted beside the front door, to help safe access. There is a redecoration programme running in the home and the building was well maintained and decorated to a high standard throughout. The home was clean with high standards of hygiene evident. The inspector did not visit every room on this occasion, but residents and relatives returning comment cards paid tribute to the standard of cleanliness maintained. The TV lounge is shady and quiet, while the sun lounge is bright and gives easy access to the garden.
Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 17 A set of new dining chairs had been provided, which pleased the residents very much, as they could now sit in comfort at mealtimes. The new owner had as a priority carried out work to assure safety within the home. The electrical and emergency alarm systems had been inspected and upgraded as necessary. All remaining radiators had been provided with covers to assure the safety of residents, and upstairs windows had been provided with restrictors. A new microwave had been provided for the kitchen, and a new freezer in the outside store. All bedroom and bathroom doors are now fitted with locks that are suitable for the occupants, to provide privacy. Some residents had chosen to be key holders. All had been provided with lockable storage boxes, to be secured within their bedrooms, so that they could safeguard their own money and possessions. Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 18 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. Staff have excellent caring attitudes and are well trained to give the care needed by residents at Pippins. The recruitment system is sound, but there had been a lapse in the gathering of checks for the protection of residents. 27,28,29 30 EVIDENCE: Residents and relatives returning comment cards were most appreciative of the staff at Pippins. ‘The very best thing Pippins does is employ the highest quality, caring staff,’ and ‘It is excellent – mainly the staff,’ were typical quotes. A written rota is kept, which shows that there are two care staff on duty as well as a cook from 8 – 2pm every day. The Manager is additional four or five days per week, except when covering for unplanned absences. This is an improvement from the last inspection, when she had very little time allowed for management duties. There is a cook employed from 8 – 2pm every day, and a handyman/gardener had just been engaged. There is normally a general assistant/cleaner to do cleaning and laundry from 8 – 2pm four/five days per week, but they were not available at the time of this inspection, and staff were covering the extra work with input from the Manager. At night there is one Night Care Assistant, and one person on sleeping-in duty, to be called if necessary. The Registered Manager has stated that she would engage an extra carer if one were needed, for example during the serious illness of a resident.
Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 19 NVQ achievement is excellent at Pippins, with 90 of care staff having achieved at least NVQ2 or equivalent. There is a sound system for recruitment at Pippins, with an application form that records an employment history, and two references taken up for each recruit. However, due to pressure of needing staff a new staff member had started work without the necessary CRB clearance or POVA check. This is not acceptable, as it places residents in potential danger. There is a very good culture of learning, with a variety of training provided and encouraged, that is pertinent to the varying needs of the residents. As well as the mandatory training such as Moving and Handling, and Abuse Awareness, staff had attended training sessions on catheter care, care of ulcers and skin wounds, nutrition, falls, and diabetes. Further training on compression hosiery and documentation was expected. Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 20 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The owner and manager work well and energetically to give clear leadership, consistently providing a good and responsive service. 31,33,35,36,38 EVIDENCE: Since 28th September 2006 Pippins has been under new ownership, with Mrs Rosemary Griffiths now being the Registered Provider. She has a long career as a qualified nurse, and has been the owner and manager of a care home and a children’s day nursery. She has implemented improvements at Pippins with commendable energy and commitment, with the emphasis on health and safety, and the comfort and well being of residents. The Manager’s time as supernumerary had been increased, to give her the time she needs for good management of the service. The Manager at Pippins, Mrs Sarah Dorling, has twenty years experience in providing care to disabled and elderly people, of which the past seven years
Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 21 has been in a management capacity in residential care. She achieved distinction in NVQ2 and has completed NVQ4 in Care, and the Registered Managers’ Award. She also has achieved the Advanced Management in Care with the City & Guilds. She has demonstrated her ability to implement and maintain good systems of care, support staff, listen to residents and provide a flexible and responsive service. Staff who spoke to the inspector agreed that communication within the team is very good. One staff member who returned a survey to the CSCI said that, ‘The owner has the residents’ interests at heart and the Manager really puts herself out to make sure the residents are happy and well cared for.’ Staff meetings are held regularly, the latest having been on 10th January which covered a variety of issues including training, key working, and recognizing and meeting the changing needs of residents. Seniors’ meetings are also held. There is a very good system of staff supervision. All staff have one to one consultations with the Manager, with records kept. These include discussion of the home’s policies, which staff must sign to say when they have read and understood. The Senior Carers are responsible for observation of care tasks and feedback on performance. Feedback from residents is gathered informally by the Manager, who visits residents frequently to discuss their well being, and Residents’ Meetings are held. Questionnaires had been sent annually to health professionals who visit the home. The Registered Provider has plans for the development of the service and stated that she will present these in a report for discussion with residents. The Manager does not handle money on behalf of any resident. Some handle their own financial affairs, while others have families or solicitors to help them. There is a policy on the safe handling of residents’ valuables. The fire precaution system and electrical system had been serviced and brought to a good standard to assure residents’ safety. Fire training had been provided, and the policy regarding action to be taken in an emergency had been reviewed. All remaining radiators had been provided with covers to assure the safety of residents, and upstairs windows had been provided with restrictors. A computer had been provided with Internet connection, to give the home an email service and access to information. Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 22 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 3 3 STAFFING Standard No Score 27 3 28 4 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 4 X 3 Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 23 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 OP29 Regulation 19(5)d Requirement ‘The Registered Person shall not employ a person to work at the care home unless… full and satisfactory information is available in relation to him (her).’ CRB clearances must be obtained on behalf of all persons working at the home. Timescale for action 30/04/07 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 OP9 OP26 OP33 Good Practice Recommendations The temperature of the medicine cupboard should be monitored, in case the contents need protection from high temperatures. The walls and floor of the laundry should have smooth surfaces so that they can be easily cleaned, to maintain a hygienic environment. The Registered Provider should produce a report of her development plans for the home, to enable and encourage feedback from the residents. Pippins DS0000068074.V327719.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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
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