CARE HOMES FOR OLDER PEOPLE
Pirton Hall Pirton Road Shillington Hitchin Hertfordshire SG5 3HB Lead Inspector
Bijayraj Ramkhelawon Key Unannounced Inspection 15th June 2007 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.V342006.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. 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.V342006.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Pirton Hall Address Pirton Road Shillington Hitchin Hertfordshire SG5 3HB 01462 711626 01462 712019 tolladam@bupa.com www.bupa.com BUPA Care Homes (BNH) Limited 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) Mrs Kay Frances Henocq 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.V342006.R01.S.doc Version 5.2 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. 12th July 2006 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. The ‘Statement of Purpose’, ‘Service User’s Guide’ and the ‘Complaints procedure’ are available for current and prospective service users. Current scale of fees charged is £523 - £998. 98. Pirton Hall DS0000019553.V342006.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on the 15th June 2007 and took one day. Feedback from people living at the care home, visitors and staff was sought during the inspection. A completed pre-inspection questionnaire and the Annual Quality Assurance Assessment were received from the registered manager and information from these documents formed part of the overall inspection process. Policies and procedures, a sample of people’s care plans, staff files and other documents were examined. General observation including interaction between staff and people living at the care home, the management and administration of medicines, adherence to health and safety regulations, fire safety and other linked legislations were also observed. A new registered manager is now in post. What the service does well: What has improved since the last inspection?
Pirton Hall DS0000019553.V342006.R01.S.doc Version 5.2 Page 6 Risk assessment for the use of the electric bed has been carried out with clear instruction of where the handset should be placed. Fire risk assessment as recommended by Hertfordshire Fire and Rescue Service is now in place. A copy of each prescription (FP10) is being kept in the home for ease auditing and reconciliation. The call bells have been repaired and were in working order. 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 Hall DS0000019553.V342006.R01.S.doc Version 5.2 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.V342006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1-3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate information about the home was available to people living in the care home and others who are looking for a care home for themselves or their relatives. Each person living in the care home has an assessment of needs carried out prior to admission. EVIDENCE: There was an up to date ‘Statement of Purpose’ and ‘Service User’s Guide’ available for people about the care home. Care plans examined were based on the assessment of needs undertaken for each person living in the care home. Pirton Hall DS0000019553.V342006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans examined showed that service users’ health, personal and social needs were being met. However, care plans should be agreed and signed by individuals or their representatives so that they are aware of their identified needs and how these were being met. EVIDENCE: People living in the care home confirmed that they were well cared for. Care plans had all the information including assessment of needs; health and personal care being provided, risk assessments and how the needs of individuals were being met. However, care plans including the use of bedrails should be agreed and signed by people living in the care home or their representatives so that they are aware of their identified needs and how these
Pirton Hall DS0000019553.V342006.R01.S.doc Version 5.2 Page 10 were being met. Evaluation of each pressure sore should be carried out on a regular basis and the type of pressure relieving mattresses/equipment provided should be recorded in care plans so that the progress of each sore is monitored. People living in the care home were appropriately dressed, well groomed and they confirmed that staff addressed them by their preferred names. The home has a “knock and wait” policy on entering bedrooms, toilets and bathrooms. Staff members on duty were observed to deliver care and to attend to people’s needs with respect for their privacy, dignity, choice and wishes whilst actively promoting independence where possible. All personal and intimate care practices were carried out behind closed doors. A policy and procedures for care of the dying was in place. spoken to said that they were aware of this policy. Staff members The management and administration of medicines were kept in good order. Pirton Hall DS0000019553.V342006.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Autonomy and choices were exercised. A programme of planned day care activities was devised and displayed. People living in the care home confirmed that there were a variety of activities provided for them. Wholesome, wellbalanced and appealing food was served at appropriate intervals and in comfortable surroundings. EVIDENCE: A planned activity programme was displayed for the benefit of people living in the care home. The activity organiser said that the home received the local Parish Newsletters on a regular basis which informed them of local functions and activities taking place. Trips to local places of interests were planned and took place regularly. The priest visits the home on a fortnightly basis and Holy Communion is held. A group of local over 60’s also visit the home for a social gathering when tea and cakes are served. This year’s Summer Fayre is planned for the 21st July 07 and the ‘Morris Men’ are booked. A group of people from the home was also attending to the Local Village Summer fete to watch
Pirton Hall DS0000019553.V342006.R01.S.doc Version 5.2 Page 12 the aeroplanes ‘Flypast’ show. On the day of the inspection a programme was displayed for ‘Ascot Ladies Day’ when ladies are dressed up for the day in different outfits. People living in the care home confirmed that a variety of activities were provided for them during the day. The lunch was observed and tables were laid nicely and a choice of drinks including wine. People living in the care home were complementary of the food provided. Pirton Hall DS0000019553.V342006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints procedure of which people living there and visitors spoken to were aware. Training in the protection of vulnerable adults should be provided to all staff so that people living in the care home are protected. EVIDENCE: A copy of the complaints procedure was available to people living in the care home. Those spoken to said that they were aware of the complaints procedure but would prefer to speak to a member of staff or the manager if they had any concerns. Staff spoken to confirmed that not all of them have received training on the Protection of Vulnerable Adults. Four complaints have been received since the last inspection and these were dealt with in accordance with the home’s procedure. Pirton Hall DS0000019553.V342006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19- 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 people living in the care home with a pleasant environment to live. Some areas of carpet which were badly worn and threadbare must be replaced so that people living there and staff are not put at risk of tripping or falling. EVIDENCE: The home and its surroundings offered a pleasant and comfortable environment to its residents. These were kept clean and generally well maintained. Bedrooms were personalised offering a homely, lived in feel.
Pirton Hall DS0000019553.V342006.R01.S.doc Version 5.2 Page 15 People spoken to said that they were happy with their bedrooms and other facilities provided for them. The home has adequate number of domestic staff and records showed that staff have been provided with training in hygiene and infection control. However, the green carpet on each of the small staircases was badly worn and threadbare and must be replaced to prevent people from tripping or falling (The home has received an estimate for the replacement of the carpets and are awaiting delivery). The upstairs bathrooms were being used as storage where old wheelchairs, commodes, walking frames etc were stored. These should be removed to provide free access to these facilities. Pirton Hall DS0000019553.V342006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The skills and experience of staff were varied. There was an enthusiastic, dedicated and caring staff team. Adequate numbers of staff were rostered on duty, ensuring that individual’s personal care needs can be met in a manner that respects and protects their privacy and dignity. EVIDENCE: There was adequate number of staff rostered on duty per shift during the day and night. Staff files examined had all the relevant documents required by this Standard. Staff spoken to confirmed that they have received appropriate training, this included statutory training. They also said that they received regular supervision and an annual appraisal and they have been given a copy of the General Social Care Council Code of Conduct. Currently, there were 21 care staff working at the care home of whom 10 had completed their NVQ Level 2 and 2 Level 3. Pirton Hall DS0000019553.V342006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31-38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were policies and procedures in place to ensure that individual’s rights were protected. There was an enthusiastic, dedicated and caring staff team who took great pride in the service provision. Staff received regular planned supervision. The health, safety and welfare of people living in the care home and staff were promoted and protected. Pirton Hall DS0000019553.V342006.R01.S.doc Version 5.2 Page 18 EVIDENCE: Staff confirmed that the registered manager operated an open door policy to staff, people living in the care home and to their representatives. Good professional interaction between staff and residents was observed. Staff confirmed that they had undertaken all the mandatory training. All statutory records were available for inspection and maintained in accordance with legislation. Staff spoken to were aware that people living in the care home can access their records and information held about them in accordance with the Data Protection Act 1998. There were policies and procedures in place to ensure that the health, safety and welfare of individuals. There was a satisfactory system for the management of residents’ money handed over for safe keeping with receipts for expenditures and records kept. All accidents and injuries were recorded in the accident book and RIDDOR forms have been completed where applicable. The CSCI has been kept informed of all incidents. A valid insurance certificate was displayed in the reception area and this offered cover of no less than £5 million. Pirton Hall DS0000019553.V342006.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Pirton Hall DS0000019553.V342006.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? 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 OP19 Regulation 13(4)(a) &(c). Requirement The green carpet on the stairs and first floor must be replaced (Outstanding since last inspection of 15/02/06) Timescale for action 10/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations a) Care plans should be agreed and signed by people living in the care home or their representatives. b) Risk assessment for the use of bedrails should also be agreed and signed by people living in the care home or their representatives. a) Evaluation of each pressure sore should be carried out on a regular basis. b) Type of pressure relieving mattresses/equipment provided should be recorded in care plans. All staff should be provided with training in ‘protection of vulnerable adults’. Bathrooms should not be used for storage. 2. OP8 3. 4. OP18 OP22 Pirton Hall DS0000019553.V342006.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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