CARE HOMES FOR OLDER PEOPLE
Pirton Hall Pirton Road Shillington Hitchin Hertfordshire SG5 3HB Lead Inspector
Alison Jessop Unannounced Inspection 15th February 2006 01:00 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.V284418.R01.S.doc Version 5.1 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.V284418.R01.S.doc Version 5.1 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 (BNH) 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.V284418.R01.S.doc Version 5.1 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 Illness under the age of 50. 1st November 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.V284418.R01.S.doc Version 5.1 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 service users feedback was very positive. What the service does well:
Pirton Hall is a beautiful period house, located 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. Service users bedrooms are spacious and most rooms offer breath taking views of the countryside. Service users bedrooms contain their own personal belongings and offer a very homely feel. Care practice observed was sensitive and respectful. One service user said ‘I have lived here for three years and I have no complaints.’ Service users who are cared for in bed were observed to be comfortable and standards of care are high. Care plans are clear and are reviewed regularly in order to reflect the changing needs of service users. There is a regular and varied programme of activities of which service users appear to enjoy. The staff are enthusiastic about the activities and offer group and individual activities appropriately. Service users are involved in planning the menu and the chef ensures that a balanced diet is available. Service users are encouraged to eat their 5 a day fruit and vegetables. The menu is displayed each day and food is attractively served. Staff receive regular mandatory and other training and the staff induction programme meets the Skills for Care Induction Standards. Pirton Hall DS0000019553.V284418.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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.V284418.R01.S.doc Version 5.1 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.V284418.R01.S.doc Version 5.1 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): Standards non inspected on this occasion. EVIDENCE: Pirton Hall DS0000019553.V284418.R01.S.doc Version 5.1 Page 9 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 & 10 Care plans generally are clear and are used as working documents in daily practice. Regular reviews ensure that service users changing needs continue to be met. However, care must be taken to ensure all needs are recorded. EVIDENCE: A care plan for one service user who has sight impairment did not include how her needs in relation to social intervention and activities are to be met. An extra carer has been added to the afternoon rota, which appears to have improved waiting times for service users to be assisted from the dining room after lunch. One service user stated ‘I don’t have to wait so long to be assisted to go to the toilet after lunch.’ One service user also stated ‘we are only allowed to have a bath once a week.’ The nurse confirmed that this is usually the case unless there is a particular reason why service users require another bath. The service users care plan stated ‘twice weekly bath.’ This suggests that the service user is unaware that she would be able to bathe more than once a week should this be required. Unused medicines are now being returned to the GP surgery, where its waste management is arranged.
Pirton Hall DS0000019553.V284418.R01.S.doc Version 5.1 Page 10 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): 15 Survey’s carried out with service users on food preferences ensure that individual preferences can be met. EVIDENCE: The activity co-ordinator carries out a survey to find out service users food preferences. The chef then co-ordinates a menu ensuring that a balanced diet is available. The menu is presented daily on entry to the dining room and on a display table inside the dining room. Supper offers a choice of a hot or cold snack. A recent Environmental Health inspection was carried out at which no requirements were made. Pirton Hall DS0000019553.V284418.R01.S.doc Version 5.1 Page 11 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): 18 The Hertfordshire Adult Protection Procedure is available to staff who are able to refer to this document and ensure that the correct procedure is followed should they have any concerns. EVIDENCE: Staff receive training on Protection of Vulnerable Adults as part of their induction. Although a copy of the Hertfordshire Procedure is available it was suggested that the summary of the procedure, which, includes contact numbers should also be available on the staff notice board. Pirton Hall DS0000019553.V284418.R01.S.doc Version 5.1 Page 12 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 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. Some areas of carpet were seen to need replacement to maintain the high standard of décor throughout the home. EVIDENCE: 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. Many areas of the carpet are gathered and cause a risk to health and safety. Pirton Hall DS0000019553.V284418.R01.S.doc Version 5.1 Page 13 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): 27,28,29 &30 Staffing levels have been increased in the afternoon, ensuring that service users personal care needs can be met after lunch in a manner to suit service users, protecting their dignity. EVIDENCE: Since the previous inspection staffing levels have been increased to cover the period after lunch as service users said that they had to wait long periods of time to leave the dining room. Four carers and one nurse are now available during the afternoon shift and service users confirmed that this has made an improvement. A comprehensive training programme is available for staff and mandatory training such as Moving and Handling is attended annually ensuring that safe methods continue to be used. The induction programme appears to meet Skills for Care Induction Standards. Staff spoken to confirmed that they receive regular training. Each member of staff has an individual training file, where training courses attended are recorded and certificates stored. Other training attended included Dementia Awareness, Pressure Area Care, Ageing and Ageism. Staff are also updated by a monthly newsletter, which is attached to their payslip. Staff sign to confirm that they have received this. Records pertaining to recruitment were unavailable as the Registered Manager was on leave.
Pirton Hall DS0000019553.V284418.R01.S.doc Version 5.1 Page 14 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): 31,33, 35 Although records pertaining to recruitment and service users finances are safeguarded by restricting access to other staff in the home, records are therefore unavailable for inspection in the Registered Managers absence. This Regulation has not been met as records must be available for inspection at all times. EVIDENCE: Recruitment records have not been available during this inspection year as the Registered Manager is the sole person who has access to these records, the standard has not therefore been met as these records must be available for inspection at all times. A system must be introduced to ensure that all records are available for inspection at all times. Records pertaining to service users finances were also unavailable for inspection, as the Bursar was not at the home on the day of the inspection.
Pirton Hall DS0000019553.V284418.R01.S.doc Version 5.1 Page 15 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X X X X X X STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X X Pirton Hall DS0000019553.V284418.R01.S.doc Version 5.1 Page 16 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 OP7 Regulation 15(1) Requirement Care plans must include how service users needs relating to specialist needs such as sensory impairment are to be met. Service users must be aware that they can request assistance with bathing other than when specified on their care plan in order to maintain their dignity. The green carpet on the stairs and first floor must be replaced. Records pertaining to staff recruitment and service users finances must be available for inspection at all times. Timescale for action 15/03/06 2. OP10 12(4)(a) 30/04/06 3. 4. OP19 OP29 13(4)(a)& (c). 17(3)(b) 31/05/06 30/04/06 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 OP18 Good Practice Recommendations It is recommended that the summary of the Hertfordshire Protection of Vulnerable Adults Procedure is displayed on the staff notice board.
DS0000019553.V284418.R01.S.doc Version 5.1 Page 17 Pirton Hall Pirton Hall DS0000019553.V284418.R01.S.doc Version 5.1 Page 18 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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