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Inspection on 12/09/07 for Pirton Grange Nursing Home

Also see our care home review for Pirton Grange Nursing Home for more information

This inspection was carried out on 12th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is very well presented to prospective clients both in general appearance and in the excellent sources of information provided to enable prospective service users to decide if the home will suit them. Arrangements for pre-admission visits and trial periods are seen by service users and staff as very helpful to settling in to the home. The home has very good assessment procedures and care planning systems in place and service users are confident that their personal needs are understood and can be met. The staff are seen to have excellent relationships with the residents interacting naturally, with empathy and delivering care as the person wishes, achieving a high level of satisfaction and sense of wellbeing amongst the residents. The home gives a high priority to obtaining service users views and demonstrate a commitment and flexibility in adapting services to address wishes where there is consensus. The home demonstrates a good commitment to staff training.

What has improved since the last inspection?

The home has had a major building development on site, which is nearing completion when service users will be able to move in to allow a major refurbishment of the current premises. In the interim remedial work has been ongoing to maintain the appearance of the home in a satisfactory state. The home has formed a residents committee and a relatives committee, "Friends of Pirton". Introduced a quality assurance questionnaire, new menu`sPirton Grange Nursing HomeDS0000004133.V347243.R01.S.docVersion 5.2Page 6to account for the individuals preference. Holidays, outings and day to day activities have increased.

What the care home could do better:

Action to improve the physical environment of the home remains to be undertaken and should include to reduction of the remaining double rooms and the fitting of appropriate locks. Assessment of needs and care planning are overall of a very good standard but should be audited by the manager to ensure identified needs or risks are not overlooked. The medicines room was of a comfortable ambient temperature during the inspection, there should be a systematic process of monitoring this and means of preventing overheating from the sun on the window. Staff are currently re-sheathing used hypodermic needles and require education to stop the practice. Good hand washing practice at staff outlets is compromised by the very hot water and should be controlled by mixer tap or a mixing valve. All accidents recorded require auditing to ensure trends can be identified and action taken to minimise the risks. All staff require appropriate supervision meetings formally recorded and at the rate identified in the standard.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Pirton Grange Nursing Home The Grange Pirton Wadborough Worcestershire WR8 9EF Lead Inspector Mr Richard Eaves Unannounced Inspection 12th September 2007 09:00 Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 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 Pirton Grange Nursing Home DS0000004133.V347243.R01.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 and Care Homes for Adults 18 – 65*. 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. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pirton Grange Nursing Home Address The Grange Pirton Wadborough Worcestershire WR8 9EF 01905 821544 01905 821257 admin@pirtongrange.co.uk 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) Pirton Grange Limited vacant post Care Home 34 Category(ies) of Physical disability (34), Physical disability over registration, with number 65 years of age (34) of places Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is primarily for people with a physical disability, but may also accommodate people with an associated mental disorder. The home may also accommodate 2 named persons over the age of 65 years whose needs fall within category OP. 20th September 2006 Date of last inspection Brief Description of the Service: Pirton Grange is a period building providing accommodation to a total of 34 residents on the three floors within the home. A passenger lift and a staircase access the floors to the building. The home is situated in the village of Pirton, approximately five miles south of Worcester. It is registered to provide twentyfour hour nurse-led care for residents, and is staffed by registered nurses and care assistants throughout the twenty-four hour period. Weekly fees range from £950 through to £1500 and includes everything apart from personal clothing. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection visit was undertaken by an Inspector from the Commission for Social Care Inspection using the following information: reports from the organisation relating to the conduct of the home, records maintained at the home, the annual quality assurance self assessment, comment card responses from service users and relatives and reports by other agencies. The inspection involved a full tour of the property including, a number of bedrooms, the communal rooms and service areas and provided an opportunity to speak with most of the service users. What the service does well: What has improved since the last inspection? The home has had a major building development on site, which is nearing completion when service users will be able to move in to allow a major refurbishment of the current premises. In the interim remedial work has been ongoing to maintain the appearance of the home in a satisfactory state. The home has formed a residents committee and a relatives committee, Friends of Pirton. Introduced a quality assurance questionnaire, new menus Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 6 to account for the individuals preference. Holidays, outings and day to day activities have increased. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 – 5. Quality in this outcome area is excellent. The homes statement of purpose and service user guide are good sources of information providing details of the service enabling service users and families to make informed decisions about admission to the home. Pre-admission assessments are undertaken by the most experienced staff and confirmation is given to the service users that their needs can be met by the home and further confirmed by contract at the time of admission. Service users are invited to visit and trial the home before committing themselves to staying at the home. This judgement has been made using available evidence including a visit to this service. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 9 EVIDENCE: The homes statement of purpose and service user guide are good sources of information providing details of the service enabling service users and families to make informed decisions about admission to the home. Pre-admission assessments are undertaken by the most experienced staff and confirmation is given to the service users that their needs can be met by the home and further confirmed by contract at the time of admission. Service users are invited to visit and receive a full work up provided by the home before committing themselves to staying at the home and having a respite system most prospective clients will have benefited from previous short stays and will be familiar with the home. Evidence from 4 randomly selected case files and discussions with the service users selected for case tracking show the assessment process to be comprehensive and involving of them. The assessed needs are reviewed as part of the care plan review process. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6 - 10. Quality in this outcome are is good. Care needs are comprehensively identified in Care Plans and the necessary directions of actions required to ensure that service users care needs are fully met and health is promoted. Care Plans are regularly reviewed and revised as necessary. Service users are fully involved in all aspects of life at the home and are supported to make decisions for themselves and encouraged to be as independent as possible, even though this may mean taking risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Most of the service users at Pirton Grange have very complex nursing and general care needs. A random sampling of 4 Case files were case tracked and Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 11 showed related Care Planning documentation to be well organised, current, clearly written and comprehensively encompassed the range of ‘care areas’ necessary to ensure the delivery of care appropriate to the needs of each Resident. Good contingency plans are available for conditions such as epilepsy that may have serious side effects. Care Plans evidence that Residents are closely involved in decisions regarding their lifestyle some spoken with were able to confirm this. The Home has developed a comprehensive set of individual and generic risk assessments, including; pressure area relief, nutrition and bed rail use these were seen to be reviewed on a regular basis. Risk assessment for taking trips out is currently generic but work is underway to develop individual ones. One service user with an assessed risk of developing pressure sores had no risk reduction plan and another at risk of falls and requiring bed rails had no risk assessments although they were seen in other files. The home promotes independence while ensuring they also promote service users health and safety. Care records included details about individual social activities, outings undertaken, clubs they were attending, and family contacts. The home retains a visual record of all activities that residents have engaged in and have undertaken. Residents spoken to confirm they went out had contact with their families and were encouraged to pursue their hobbies. Service users were able to confirm that they make their own decisions in most aspects of their lives and participate in the service user committee that also influences events at the home. Confidentiality of records and other aspects of personal information are maintained securely and included in staff training. The newly appointed manager is encouraging service users to take an interest in what is included in their file in addition to participating in care planning and reviews. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 13 Standards 12 - 17. Quality in this outcome area is excellent. Staff support service users to access opportunities for their personal development and health promotion. The involvement of family and friends is encouraged in agreement with the service users wishes. The home provides a varied leisure, social and recreational activities that provide interest and pleasure for service users. Meals at the home are wholesome and meet the nutritional needs of service users while providing for choice and personal taste. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observation and discussion with Management and Residents showed routines to be flexible to suit the needs of individuals. An open visiting policy is operated with Relatives/Friends being encouraged to become involved in the service delivery, Residents’ care records give details of social activities and record each resident’s preferences for activities. The home employs dedicated staff that are responsible for activities and therapies. An Activities Organiser is employed for 40 hours each week, and this provision is based on flexibility and the needs of residents. A reflexologist provides treatment for residents at no additional cost and the home also contracts to provide physiotherapy input. A beauty therapist visits weekly on Wednesdays. On the day of inspection a group of six were out to Bristol Zoo as had another group the previous day, also occurring over this day would be shopping trips and one attending a hairdressing salon. Other trips in recent days have been to the Motor Cycle Museum, a landscape park, a garden centre, restaurants, pub, Stourport and the cinema. Service users have individual programmes and some have attended College and some take day trips to visit home Over the summer a group took a caravan holiday at Bream and another group are holidaying in Cyprus during October. Opposite the main entrance there is a porta-cabin where service users can participate in crafts, group exercise, do puzzle and watch films. Many activities occur during the evenings leaving the day to do their own thing. While much of life is in and around the home there is a good relationship and involvement with the village including such as supporting each others summer fetes. Some service users attend church regularly. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 14 The service users choose their own daily routines and many spoken with said that staff enabled them to take their choices, they also said that they stayed in their room or participated with others as they wished. Staff were observed to knock before entering bedrooms and show respect in their interactions. Approved locking devices are not fitted to bedroom doors although one service had previously had a facility to lock his door when out of the room. The home provides a 4-week menu that includes choice with additional choices also available to accommodate residents’ likes and dislikes. Feedback from residents was very complementary about the choice, quantity and quality of the food provided. All aspects of meals and meal times are discussed at the service user committee influencing content and times of meals, a recent change was to change the main meal to the evening and service users individually confirmed that this was well received. An examination of the menu system confirmed that meals provided were nutritionally balanced, varied and reflective of the choice and preferences of younger people. The manager described how some medical conditions such as Huntington’s Disease (HD) presented challenges to nursing staff to ensure that people’s energy intake matched their output i.e. sometimes in the region of 7000 calories a day. Care records confirmed that nutritional intake requirements for people with Huntington’s Disease was being effectively met through careful and skilled nursing intervention with the support of regular visits by a Dietician Fresh fruit and vegetables are available daily, snacks are also available throughout the 24 hours, a drinks and confectionary is available from a dispenser. In discussion with a number of service users they said the food was “very good”, “I really enjoy the meals here”, and all wished to communicate how much they appreciate the range and quality of food provided at the Home. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18 – 20. Quality in this outcome are is good. Service users are assisted to maximise their independence and control over their lives and staff respect their privacy and dignity and give support to achieve this. Healthcare needs are well documented and compiled with the input of the individual service user. The care plans give clear directions to ensure that service users’ healthcare needs are assessed, recognised and addressed. Arrangements for the administration of medication are good and ensure service users medication needs will be safely met. This judgement has been made using available evidence including a visit to this service. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 16 EVIDENCE: The home routines are flexible although service users are encouraged to accommodate meal times and medication regimes within their personal routines they are generally encouraged to make independent choices. The Home operates a ‘named nurse system’ with specific responsibilities for particular individuals and a key worker system among the carers. Registered General Nurses provide nursing care within the Home, with external specialist nurses used as needed. Generally, the manner in which Staff meet Residents’ complex nursing care needs is commendable. Service users have their physical, emotional and mental health needs met and the care plans evidence general practitioner and other health care professionals input, including consultant reviews at the home. The home has a good relationship with their general practitioner who undertakes pre-planned visits to the home once a month and more frequently when the need arises. A local chemist provides medication and the pharmacist provides advice as required and provides a report of quarterly inspection. Currently no service users are assessed as able to self administer and control their own medications. An inspection of controlled drugs shows that these are secure and recorded correctly. Arrangements for the receipt, storage, administration, recording and disposal of medicines comply with the homes policy and this standard. The manager may wish to check how the medication room temperature is best monitored and maintained below 25°c. The medicines room is kept tidy and well organised. Evidence was seen that re-sheathing of used hypodermic needles was occurring and action is required to stop this. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23. Quality in this outcome are is excellent. The home complaints and protection policies are robust providing a safe environment in which service users feel they can voice concerns and that these will be listened and responded to. Staff demonstrate excellent knowledge and understanding of adult protection issues which contributes to an environment that is safe from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A clear and concise Complaints Procedure is displayed in the main hallway, which includes reference to the Commission for Social Care Inspection as the regulatory body, together with contact details. There is evidence of recording minor concerns and good evidence of a positive response to these concerns. Policies relating to the protection of Residents from abuse were observed to be in place and readily accessible, these included, ‘Whistle Blowing’, ‘Abuse Awareness’ and ‘Adult Protection’. Staff training files indicated that Staff had received training in respect of these Policies. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30. Quality in this outcome area is adequate. The Home provides a comfortable, attractive, safe and ‘homely’ place to live. Specialist equipment, consistent with the needs of the Residents and the demands of tasks carried out by care staff, is available to facilitate the provision of care. The home is clean, hygienic and free from odours. EVIDENCE: Pirton Grange is a period building standing in its own grounds providing accommodation to a total of 34 residents on the three floors within the home. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 19 A passenger lift and a staircase access the floors to the building. The home is situated in the village of Pirton, approximately five miles south of Worcester. The home provides two lounge areas, a small dining room and a mix of single and double rooms. A major development is underway and nearing completion and when registered a full refurbishment of the current home is to be undertaken. Service users say that they like the home and will elect to remain in the current building following the refurbishment. Individual bedrooms have been personalised and many have high tech music systems , sky tv, broadband connected computers and overall make their bedrooms as they wish. The home is maintained clean, comfortable and safe by remedial work as required until the full programme of work can be undertaken. The laundry is well equipped with sluicing and disinfection programmes on the washing machine. Each floor is fitted with a sluice disinfection machine. The management and organisation of the maintenance and servicing records is of a very high standard ensuring a safe environment. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31 – 36. Quality in this outcome area is good. Staff are clear as to their individual roles and responsibilities and are enthusiastic, sufficient in numbers, well trained, supportive and committed to maximising the service users quality of life. The recruitment practices and staff training contribute to ensuring service users benefit from the skills and knowledge of the staff. This will be further enhanced by full implementation of formal supervision. This judgement has been made using available evidence including a visit to this service. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 21 EVIDENCE: The current staffing rota, and those from the immediately preceding weeks, were examined. Staffing numbers and skill-mix is of a high standard and enables a high quality service provision meeting the care needs of the Service Users. A sample of three staff files were inspected and show that recruitment procedures are completed to a good standard with appropriate checks of Personal Identification Number, for qualified Nurses and Criminal Record Bureau in place, appointments of staff with positive CRB must have a formal risk assessment confirmed by a senior manager. Job descriptions appeared satisfactory for roles and support the underlying values of the home. Staff are subject to a thorough, and relevant, orientation/induction programme, which is followed by comprehensive ‘foundation’ training, e.g. ‘manual handling and lifting’, ‘fire safety’, ‘infection control’. In addition, the Home enjoys an excellent record for the continuing development of staff, and supporting staff in undertaking appropriate training based on a well-structured plan for determining individual training needs. The current level of NVQ Level 2 attainment is 53 with a number of carers also achieving NVQ 3 and the assessors award. Formal supervision has fallen away during the absence of a registered manager but is being reinstated and senior staff who will supervise colleagues are undergoing training for this role. Staff meetings are also being reinstated with the qualified nurses having already had a meeting and a carers meeting is planned. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 23 Standards 37 - 39 & 42. Quality in this outcome area is good. Leadership of this home is good and staff demonstrate an awareness of their roles and responsibilities. The managers approach is open and positive and develops positive relationships amongst service users and with staff. The home regularly reviews its performance which includes seeking the views of service users and their families. Environment management and staff training in respect of health and safety ensures service users safety and welfare are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manger received confirmation of her appointment recently and a request for an application for registration made. The manager is well regarded and liked by the service users and staff alike and this is apparent from the comment cards and in speaking with service users and staff as well as observing the interactions over the day. The home has a quality assurance system that includes a regular audit system by the manager and audits by the quality assurance manager who also undertakes the Regulation 26 monitoring visits. Service users, relatives and other stakeholders views are sought and there is a residents committee and recently formed ‘Friends of Pirton’ committee of relatives. Both committees are influential in the management of the home. Documentation was seen of a full range of servicing, maintenance and regular monitoring of services and equipment is undertaken, staff receive training in health and safety and first aid. Monitoring of hot water is good and records show that the standard of 43°c is achieved consistently, anti scald testing and legionella prevention are also undertaken. Fire safety including tests, staff training and equipment maintenance were seen to be up to date. Records of all accidents are recorded, using data protection compliant documentation and reported as necessary. Induction and foundation training is provided to Skills for Care standards. Overall the premises were observed to be well managed to meet safety requirements. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 3 2 4 3 4 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 4 34 3 35 3 36 2 CONDUCT AND MANAGEMENT Standard No Score 37 2 38 X 39 3 40 X 41 X 42 3 43 X 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Pirton Grange Nursing Home Score 3 3 3 X DS0000004133.V347243.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 YA24 Regulation 13 Requirement Provide and implement an ongoing redecoration program to enhance the home’s appearance. Previous timescale not met due to the new build not yet complete. The manager should ensure service user privacy is promoted by fitting of an approved locking device to bedroom doors. The manager must ensure staff receive the support and supervision they require to carry out their jobs by providing regular recorded supervision meetings. Timescale for action 31/12/07 2. YA16 23(2)(e) 31/12/07 3. YA36 18(2) 31/12/07 Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The manager must ensure a care plan/risk reduction plan is developed for all assessed needs/risks. E.g. persons with unsteady walk must have a falls risk assessment and risk reduction plan a person with a raised pressure sore risk must have a plan to prevent the development of a sore. The manager must ensure that medicines are stored at a temperature not exceeding 25°c by monitoring the temperature of the medication room and keeping a record. Action must be taken to inform staff of the risks from resheathing used hypodermic needles. The manager should audit accidents to identify possible trends. Good hand washing practice should be promoted by the control of hot water at staff hand wash outlets. 2. YA20 3. 4. YA42 YA42 Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park, Droitwich Road, Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Pirton Grange Nursing Home DS0000004133.V347243.R01.S.doc Version 5.2 Page 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. 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