Inspection on 09/03/09 for Pippins

This inspection was carried out on 9th March 2009.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pippins 07/03/07

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Pippins Mead Lane Preston Paignton Devon TQ3 2AT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Caroline Rowland-Lapwood     Date: 0 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Pippins Mead Lane Preston Paignton Devon TQ3 2AT 01803525757 01803525848 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Celia Rosemary Griffiths Name of registered manager (if applicable) Mrs Sarah Anne Dorling Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 21. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - (Code OP) Physical disability aged 65 and over on admission (Code PD(E)) Date of last inspection Brief description of the care home 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 21 elderly people who may be physiclly frail or disabled. There is a shaft lift, but people who are dependent on a wheaelchair should be accommodated on Care Homes for Older People Page 4 of 28 care home 21 Over 65 21 21 0 0 Brief description of the care home the ground floor. There is a TV lounge, a sun lounge and a dining room. The 19 bedrooms are all have en suite facilities and two are large enough to accomodate a couple. The garden is attractive with a fountain and fishpond, a rose garden, raised beds and accessible paths around the house. Current fees range from 375-440 pounds per week. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection consisted of a visit to the home on Wednesday 4th March 2009. One inspector performed this inspection. During this time we spoke to the registered manager who is the person with day to day responsibility for the service, the chef, domestic and care staff. We spoke to or observed most of the people living at the home. We case tracked three people who use the service. Case tracking means we looked in detail at the care six people receive. We spoke to staff about their care, looked at records that related to them or made observations if they were unable to speak to us. Care Homes for Older People Page 6 of 28 We looked at three staff recruitment records, induction and training records and policies and procedures. We did this because we wanted to understand how well the systems work and what this means for people who use the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Pippins. What the care home does well: What has improved since the last inspection? What they could do better: The homes practise in relation to the recruitment process is not satisfactory. Every member of staff must have a Criminal Records Bureau Check and two written Care Homes for Older People Page 8 of 28 references in place before they commence working at the home to ensure that people are well cared for and safe. Some areas of the home need re carpeting. The Registered provider must write a report of their findings once they have completed their monthly visit. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information provided means that people and their relatives have accurate information to decide whether Pippins is the home for them to be in. The admission procedure is good and means that staff have enough information to decide whether they are able to meet the needs of the person. Evidence: The Statement of Purpose and Service User guide are found in the entrance hall of the home. Both documents include the information that is needed for people to decide whether the home is the right place for them to be. Each document reflects the services that are provided and includes information on fees, staff, room sizes, services that are provided and how to make a complaint. Before moving in to the home all people wanting to live at the home have their needs Care Homes for Older People Page 11 of 28 Evidence: assessed to ensure that the home can meet their needs. Information is gathered from the person, their family, and health and social care professionals. Staff described how each new admission to the home is made welcome and helped to settle in. Staff says they have enough information about each new person and are prepared for their admission. Each care plan contained a pre admission assessment and detailed admission assessment. This was used alongside assessments made by social services and other health care professionals. Together this information is used to put together a detailed plan care and risk assessments. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care people receive is provided in a respectful and person centered way. The care planning systems at the home are good and reflect how health and personal care needs are identified and met in a safe way. Some aspects of the management of medicines are not satisfactory and could put people at risk. Evidence: In surveys the people who live here say that they always receive the medical support they need and when spoken with they say that staff call the doctor or nurse quickly when needed. Records in peoples care plans confirm this. We looked at three care plans which show that people have their needs assessed and that actions are taken in relation to preventing falls, pressure sores and malnutrition. During the inspection people looked cared with the finer details such as eye care, nail care and appropriate Care Homes for Older People Page 13 of 28 Evidence: foot wear present. People told us that they were pleased with the attention they received from the staff. One person said they are really good, they are very nice, polite, kind and helpful. Other comments included good as gold! People living at Pippins have access to a range of health care services both at the home and in the community. People have access to local and national NHS services and routine screening programmes. Each person has a GP who attends when staff request a visit. Health care needs are monitored in well written care plans. One health care professional said in a returned survey Piippins is a very caring and homely place. The manager is extremely hands on and all the staff are kind and supportive to the residents. Another said The care is individualized and they encourage independence. Medications are generally managed well at the home with the exception of medication requiring refrigeration and being stored in the fridge door. This needs to be kept in a safe lockable place and stored at the correct temperature to ensure it is safe for people to have. Medicines are supplied mainly in a monitored dose system. The medication trolley was clean, tidy and securely stored. A spot check of controlled drugs was performed and found to be correct and managed well. We discussed the use of a bound book for the recording of controlled drugs and the home was in the process of purchasing one.The records of administration were clear. To aid identification of the person to receive medication the records have photographs of each individual person living at the home who were in receipt of medication. All medications for disposal are recorded and signed for on collection as per the company and government policy. People who use the service are encouraged to join in with physical exercise programmes provided. The use of walking aids were encouraged and people had space to wander as they chose. People who use the service were treated with respect during the inspection. They were offered choice regarding meals and activities and addressed using their chosen term of address. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The varied, well organised social and therapeutic activities provided for people is good. People also benefit from a wholesome balanced diet. Evidence: People we spoke with said they were very happy at the home. Surveys confirmed this. One person wrote The home is a very happy place to be and another wrote They do their best to make everyone happy. Without exception, people told us that they chose the time of rising and retiring, with or without assistance. Staff were seen and heard to knock and wait before entering bedrooms. Surveys told us that people were pleased with the activities. One person wrote There is always something going on. Some people told us that they chose to remain in their rooms as, I have everything I need here. Others said they joined in some of the activities. Formal activities such as bingo, exercise sessions, films, musicians, animal visits and craft events continue. Care Homes for Older People Page 15 of 28 Evidence: Three people attend Church each Sunday morning, they are taken and collected by staff at the home. A regular Communion service is provided at the home. People said that in the summer they make use of the enclosed garden and staff will bring them tea/coffee there. In surveys the people who live at the home say that theyalways or usually like the meals served. Written comments included, its a bit boring, The food is good no complaints and Its difficult to please everyone all the time. The majority of people spoken with during our visit told us the food was good, hot and that there was always plenty of it. Other comments included, The food is really excellent, I couldnt fault it and There is always a choice, its really good. A daily choice of main meal is provided and dietary needs are also considered. Jugs of juice are sited around the home so that staff can easily give drinks to people and hot drinks are frequently offered. Fresh fruit is available. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their relatives can be confident that their complaints and concerns will be listened to and acted on. The knowledge procedures and training in place for the Protection of Vulnerable Adults help to protect people. However some aspects of the homes recruitment practice could put people living there at risk ( see standard 29). Evidence: People told us they felt able to complain to staff and the manager in the home. Surveys also told us that people were able to complain. Comments included Yes I do know how to complain but have not needed to do so. and We have never needed to complain The complaints procedure is displayed in the home for the benefit of people who use the service, staff and visitors to the home and includes how to contact the Commission for Social Care Inspection. The procedure is also displayed in the Statement of Purpose and Service Users Guide. The home has a record which is organised and clearly shows any complaints in along with the outcomes following an investigation. The CSCI received has received no complaints since the last time we inspected ( 7th March 2007). Staff we spoke to said they felt able to talk to the manager about any worries or concerns. The home also operates a supervision and appraisal system in Care Homes for Older People Page 17 of 28 Evidence: which staff raised concerns that are discussed, recorded and acted upon. Staff told us they would have no hesitation to complain if a situation arose and would certainly report poor practice. Staff said they had attended Protection of vulnerable adult (POVA) training and had been informed of the different types of abuse and how to report them. All staff were aware they could speak with the CSCI if they were concerned about abuse. People living at the home said they felt safe at all times. Most staff have a criminal records bureau police check and a POVA register check performed before they are able to work. However it was found that two people did not have these checks nor had two written references been sought prior to their employment. This is poor practice and could put people living at the home at risk. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pippins is a safe, hygienic and pleasant place to live and work. Minor improvements to the inside of the home could improve it further. Evidence: Pippins is an attractive house, which has been made suitable for accommodating frail elderly people, 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 people 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. The new dining area is a lovely light and spacious place which all the people we spoke with complimented. All bedroom and bathroom doors are now fitted with locks that are suitable for the occupants, to provide privacy. Some people 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. All bedrooms were Care Homes for Older People Page 19 of 28 Evidence: decorated to satisfactory standards, some were more modern than others, we were told that this is an ongoing programme. One bedroom carpet we saw was old and stained and in need of replacement and some of the new carpets that had been recently layed had been damaged by the fire door guards and were in need of attention. The garden was well tended and people said they were able to get outside and enjoy it when the weather allowed. The kitchen was clean, well organised and tidy. Cleaning and maintenance checks were in place in addition to the safer food better business food standard agency checks. Staff had access to gloves, aprons and hand soap. Hand gel was available throughout the home. The laundry was clean, tidy and well organised. People told us there were not any major issues with laundry. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well cared for by a stable well trained staff group. Recruitment processes are not robust and could put people living at the home at risk. Evidence: Off duty records are maintained and show that staffing levels are stable and supplied in sufficient numbers to meet the needs of people who use the service. In addition to the care staff additional ancillary staff are employed to clean , cook and maintain the home. The care staff have received training in both general care duties such as manual handling, food hygiene, fire safety, health and safety and infection control. Some care staff has had additional training to understand the more complex needs of mental health problems including dementia. Staff told us that many care staff has an NVQ in care at level 2 or above. Recruitment is generally well managed at the home. However two staff recruitment folders showed that the recruitment process was inconsistent with not all staff having two written references or a Criminal Record Check (CRB) . This practice could put people at risk. All staff files showed evidence that staff had completed an induction programme and Care Homes for Older People Page 21 of 28 Evidence: had had a recent supervision session. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The competent Manager and staff manage the home in an effective and efficient way. Evidence: The Registered Manager is experienced and competent. One staff survey read The manager is very approachable and supportive. The home is owned by an individual who provides the manager and staff with support and guidance. The manager is supported by a skilled staff group who collectively manage the home. The process of managing other peoples money is safe, appropriate and auditable. Records and receipts kept were clear and well organised. Other records were well maintained at the home. Confidential information is appropriately stored and records are safely stored. Financial systems were not closely inspected on this visits. However, Insurance Care Homes for Older People Page 23 of 28 Evidence: certificates were displayed in the home and show sufficient cover. Staff told us there are clear lines of management at the home. Staff said they felt the home was well organised and appreciated the open door policy of the manager . Staff said the manager is very approachable, supportive and maintained confidentiality when personal issues are shared. Staff said they could come and discuss issues at any time. Staff told us there are staff meetings where new information is shared and is also an opportunity for staff to share ideas and concerns. Quality assurance is maintained by performing customer surveys, the last one being done in November 2008, we were told another survey is about to be sent out. Regulation 26 (Provider inspections) take place. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 19(5)d `The Registered Person shall 30/04/2007 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. Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The Registered person must ensure the safe storage of all medication in the home. (This refers to medication kept in the domestic kitchen fridge). Medication needing refrigeration must be stored as per instruction so that the people who it is prescribed for are kept safe. 30/04/2009 2 19 23 The Registered person must replace the carpet in one bedroom. This will ensure people will live in a comfortable and clean environment. 30/06/2009 3 38 26 The Registered person must 30/04/2009 carry out a visit of the care home as per Regulation 26 at least once a month and prepare a written report with their findings following this. Care Homes for Older People Page 26 of 28 This will enhance and support the management of the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!