CARE HOMES FOR OLDER PEOPLE
Pirton Hall Pirton Road Shillington Hitchin Hertfordshire SG5 3HB Lead Inspector
Alison Jessop Unannounced Inspection 1st November 2005 10:00 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 Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 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. Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Pirton Hall Address Pirton Road Shillington Hitchin Hertfordshire SG5 3HB 01462 711626 01462 712019 tolladam@bupa.com 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) BUPA Care Homes Limited Mary Tolladay Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Terminally ill (4), Terminally ill over 65 of places years of age (33) Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Any service user admitted to the home with a known diagnosis of terminal illness is accommodated in a single bedroom only. This home may not accommodate Service Users with a Terminal Illnes under the age of 50. 24th February 2005 Date of last inspection Brief Description of the Service: Pirton Hall is a care home providing nursing care and accommodation for up to 33 persons for reason of old age and/or terminal illness. It is owed by BUPA Nursing Homes Limited. The home is a period building on a former country estate. There are extensive attractive grounds with good views of the surrounding countryside. The nearest village shops are about a mile away in Shillington. The market town of Hitchin is a couple of miles away. The home does not have its own transport. Service users accommodation is on three floors connected by a passenger lift. The ground floor consists of a central lobby, the manager’s office, library, lounge, conservatory, dining room, kitchen and servery, laundry, 5 single bedrooms, 2 double bedrooms and a traditional bath and shower room. The first floor consists of 6 single and 6 double bedrooms, a nurse station, a medicine room and a bathroom. The second floor consists of 6 single bedrooms, the hairdressing salon and one bathroom. Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over half a day by one Regulatory Inspector. The registered manager was away on leave and therefore records relating to staffing and recruitment were unavailable. Most of the time was spent talking to service users, staff and visitors, however some time was spent in the office scrutinising records. The atmosphere in the home was very relaxed and a religious service was held in the lounge during the afternoon. What the service does well: What has improved since the last inspection?
Procedures in relation to the administration, recording, handling, receipt and storage are satisfactory. A new procedure was introduced following the last inspection, which ensures that any gaps on medication administration recording sheets are identified and explained. The complaints procedure has been updated and reflects the Commission for Social Care Inspection.
Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 6 No risks to the Health and Safety of service users were identified. 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. Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 & 6 Prospective service users and their families/representatives are given the opportunity to visit the home prior to making a decision to move in. Information about the home and the terms and conditions are explained during the visit and various information leaflets are available to take away. This ensures that the prospective service users and their representatives are able to make an informed choice. EVIDENCE: A variety of glossy information leaflets are displayed in the reception area and service users confirmed that they are aware of where to find information should this be required. One service user who was staying for a respite break confirmed that she had been given the opportunity to have a look around the home, meet the staff and residents prior to her stay. She also had a copy of her terms and conditions, which included a copy of the complaints procedure. Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 9 A copy of service users initial needs assessment was available for inspection on each service users care plan. Standard 6 – Pirton Hall does not provide Intermediate Care. Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 Service users who are cared for in bed were observed to be comfortable and standards are care are high. Pressure relieving equipment, regular attendance and fluid intake assist with pressure sore prevention and cure. EVIDENCE: Care plans observed were clear and appear to be used as working documents in daily practice. They had also been reviewed regularly. During the inspection two service users who use a wheelchair were observed sitting in the dining room after lunch. Both service users stated that they have to wait along time before staff can assist them to use the toilet after lunch. One gentleman stated ‘I usually have to wait for staff to take me to the toilet, they have so many people to take at this time I just have to wait my turn. I am afraid I was a bit embarrassed last week as they didn’t get to me in time’. Refer to Standard 27-staff complement. Risk assessments were observed for each service user including moving and handling, falls, pressure sores, nutrition, continence, bathing, use of recliner chairs, wheelchairs and cot sides.
Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 11 On the day of the inspection the chiropodist visited the home and his service was offered to all service users including those on a respite stay. Procedures in relation to the administration, storage, recording, handling and receipt of medication were satisfactory. Two gaps on MAR sheets were observed however a new procedure has been introduced since the last inspection in which an audit of MAR sheets is carried out and any gaps identified are logged in a separate book. This is appears to be effective and staff said that they are happy that this has been introduced. There were a number of medicines locked away in a separate cupboard, which were waiting to be returned. The nurse in charge stated that the home appears to be experiencing difficulties in this area, as the pharmacist is not taking this regularly. This may have changed due to a new NHS contracts being introduced whereby the community pharmacist must hold a Waste Management Licence. Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 14 There is a varied programme of activities in the home, which have a high uptake from service users. An events book observed in the conservatory was filled with photos of service users enjoying various outings and events. Staff in the home ensure that all service users receive appropriate stimulation. EVIDENCE: The activity co-ordinator on the day of the inspection was enthusiastic about the programme of activities whilst displaying sensitivity to individuals needs. She stated that a training course with NAPA had been very useful and had assisted her to understand the role and aims of the activity co-ordinator. The local vicar carried out a service in the lounge in the afternoon and a high attendance level was observed. Service users confirmed that they enjoy the variety of activities available. Photos in the events book demonstrated the enjoyment that service users get from the outings and other activities. Not only do service users participate in the activity but assist in the planning. A number of service users were taken to the shop to choose the plants that they would be planting in the gardening group. One service users care plan included how she was going to receive social stimulation, as she is very frail and was being cared for in bed. As she was unable to attend the group activities an individual programme had been planned. The service user was listening to a talking book during the afternoon.
Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. The complaints procedure, (along with a form) is available to service users prior to admission and is also displayed in the main reception area. This ensures that service users have accessibility should they decide to use this to raise concerns. EVIDENCE: Service users spoken to confirmed that they are aware of how to make a complaint should they wish to do so. One complaint, which has been outstanding for several months, continues to be upheld. Although the manager has dealt with this as far as possible, the complainant continues to be dissatisfied with the investigation and therefore this has been passed onto the regional manager. Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. Pirton Hall is a beautiful period house, set in the heart of the countryside. The house is attractively decorated in its period style and is exceptionally clean offering service users a pleasant environment to live. EVIDENCE: The house is exceptionally clean and tidy and staff clearly have respect for their surroundings. Service users bedrooms are spacious and most apart from the upper floor offer breath taking views of the countryside. Service users bedrooms contain their own personal belongings and offer a very homely feel. The home has ample supplies of specialist equipment in order to meet service users needs. One service user on respite said ‘I really enjoyed having a bath in the specialist bath, it was very relaxing and staff were there to assist me.’ The large garden is accessible to service users and a pleasant patio area which is decorated with seasonal pots is enjoyed throughout the year. Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 15 The green carpet on each of the small staircases is very worn and one area in the hallway has been taped in order to prevent trips. Although this has been made safe, it is recommended that this carpet is replaced as it may present future risks to health and safety. Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Staffing levels after lunch appear to be insufficient and the ratio of staff to service users requiring a high level of care are low. This has meant that service users have to wait long periods of time for assistance. EVIDENCE: On the afternoon of the inspection there were three carers and one nurse on duty. The current number of service users who required hoisting was 14 and due to BUPA policy, staff cannot hoist unless there is two members of staff present. The nurse was unavailable to assist with toileting after lunch as she was attending to a nursing task. Therefore those service users who required hoisting had to wait until two carers were available. This inevitably meant a long wait. This also raised concerns about the homes registration category for four terminally ill places. Should all four beds be filled, this would place further strains on meeting needs. Staff spoken to said that more staff to assist with toileting after lunch would be very helpful. Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 Health and Safety risk assessments and regular health and safety checks had been carried out ensuring that service users are living in a safe and secure environment. EVIDENCE: Records for all health & safety procedures were inspected and were satisfactory. The maintenance officer is responsible for carrying out all checks and no issues were raised. Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 18 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 19 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 OP10 Regulation 12(4)(a) Requirement Timescale for action 14/11/05 2 OP9 13(2) The registered person must make suitable arrangements for service users to be appropriately assisted to the toilet within a time scale that protects their dignity. The registered person must find 30/11/05 a suitable and safe system to dispose of unwanted medication. Staffing levels must be 31/12/05 continually reviewed and staffing levels must be flexible in order to be able to accommodate the changing needs of the service users. A copy of a review of staffing levels must be submitted to CSCI. 3 OP27 18(1)(a) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No.
Pirton Hall Refer to Good Practice Recommendations
DS0000019553.V262574.R01.S.doc Version 5.0 Page 20 1 Standard OP19 The green carpet on the small staircases is worn and it is advisable that this replaced within the next few months, as it may become a risk to health and safety. Pirton Hall DS0000019553.V262574.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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