Inspection on 14/02/08 for Plymbridge House

This inspection was carried out on 14th February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Plymbridge House 20/02/07

Plymbridge House 13/09/06

Plymbridge House 30/01/06

Plymbridge House 06/07/05

Plymbridge House 30/11/04

Plymbridge House 06/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Plymbridge House 3 Plymbridge Road Plympton Devon PL7 4LD Lead Inspector Brendan Hannon Key Unannounced Inspection 14th February 2008 09:30 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 Plymbridge House DS0000041564.V359583.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. Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Plymbridge House Address 3 Plymbridge Road Plympton Devon PL7 4LD 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) 01752 345720 plymbridge@peninsulacarehomes.co.uk www.peninsularcarehomes.co.uk Peninsula Care Homes Ltd Kathleen Shopland Care Home 32 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (32), of places Physical disability over 65 years of age (32) Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users from the age of 60 may be admitted to the home. Date of last inspection 20th February 2007 Brief Description of the Service: Plymbridge House is a detached property situated in the Pymouth suburb of Plympton. The Home is registered to provide residential accommodation and personal care, for a maximum of 32 persons over the age of 65 for reasons of old age who may also have dementia or physical disability. The home has 32 single bedrooms, 16 of which have en-suite facilities: 7 of these have en suite baths. There are 3 bathrooms, all fitted with bath hoists and one with a shower cubicle. On the ground floor there are 3 lounge rooms and a dining room. A stair lift provides access from the ground floor to both 1st and 2nd floor levels. There is a call bell system throughout the home. People that live at the home are enabled to access any health or social care services they require. The garden is attractive, spacious and accessible to the people that use the service. Current fees are either according to the Local authority funding matrix or £300 - £375 per week. Additional charges are made for chiropody, hairdressing, newspapers and magazines, toiletries and non-prescribed continence products. The report from the last CSCI inspection is found in the entrance hall of the home. Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The previous key inspection for this service was carried out on 20th February 2007 and the home was rated at that time as delivering good quality outcomes for the people that use the service. This key inspection on 14th February 2008 was unannounced. Preparation for the inspection included analysis of the CSCI Annual Quality Assurance Assessment (AQAA), the last inspection report, and contacts with the home over the last 12 months. An inspection plan was developed from this information. We (the Commission) were in the home from 9.30am to 6.00pm. We spent time with, or spoke to some of the people that use the service and to some of their relatives during the day of inspection. A sample of the people that use the service and their relatives were sent survey forms. There was a very good and significant response from the people surveyed. Eight people that use the service responded and nine relatives responded. The Registered Manager was spoken with at length during the inspection and we also spoke with some of the staff. We fully inspected the building and the garden areas. The care of three people was examined in detail. An opinion on the service was sought from a District Nurse that was in the home early on the inspection day. Various areas of documentation were inspected to evidence compliance with the National Minimum Standards. Documents inspected included assessments of peoples’ needs and their care plans and risk assessments. Also various records were inspected including medication administration records, health records, personnel recruitment and training records, and health and safety records. All the information gathered during the inspection was considered in the writing of this report. What the service does well: The home has a stable staff team who seek to provide a homely and comfortable place for people to live. The home obtains assessment information on the needs of people before they are offered a place at the care home. This helps to ensure that the needs of people entering the home can be met by the service. Peoples’ personal care, and health needs are well supported by the home. Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 6 Peoples’ need for support to maintain their relationships and friendships outside the home is met. The building is warm, comfortable and adequately maintained. The building meets the needs of the people that live there. The people that live at the home benefit from care staff that have been adequately trained, are dedicated and are well supported by the Registered Manager. The majority of the care staff have achieved a qualification in care delivery. Meals are of good quality and all the responses about the food provided at the home were very positive. What has improved since the last inspection? What they could do better: Some of the survey responses commented on the level of activity provided within and outside the home. One relative commented that the people that use the service, ‘could have more activities/outings for them, and (the service could) keep them a bit more occupied.’ There must be better arrangements to meet this unmet need. The outside/garden spaces to the rear and side of the building are pleasant but are not safe for most of the people that live at Plymbridge House to use on their own. There is at present limited activity in the home and more consideration needs to be given to group and individual activities that people will engage with. Similarly there needs to be more consideration of the type of activities, and the provision of support that can be made available, for people to enjoy outside the home, either individually or in small groups. Care is delivered in a structured manner. Sometimes peoples’ choices to be somewhere else in the building or to do something different from the service’s wishes are outweighed by the needs of the care system. There should be more consideration for people’s choice unless there is a demonstrated risk to the persons safety. Whilst staff meet the day-to-day care needs of people with dementia, their level of knowledge and training in this area is often limited. The management Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 7 of the service has yet to implement work practices that are specific to meeting the needs of people with dementia. All the staff should have training in the delivery of dementia care. The management of the service should give more consideration to identifying the specialist needs of people with dementia and how to meet these needs in the daily care practice of the service. All the bedrooms at Plymbridge House should have a lock available on the door to allow the person using the room the opportunity for privacy by locking the door from the inside, the opportunity for security by having a key operated lock on the outside, and with the additional safety of an outside override facility. Once the facility is in place a person may choose not to use the lock, and similarly if a person would not be safe using the lock then it may be disabled and this decision documented. 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. Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 8 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 Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 9 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): 1,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s pre-admission processes ensure that people that are considering using the service and their supporters are provided with information about the home, as well as having the opportunity to experience the home, before admission. This enables people to make a properly informed decision. EVIDENCE: Information about the home including the homes Statement of Purpose is clearly displayed in the entrance hall. People that are potentially considering using the service are shown the Statement of Purpose and also have access to the homes latest CSCI report. The Statement of Purpose is available in other formats such as in large print or on disc. A brochure is sent to any person enquiring about using the service. People considering using the service and their relatives are welcome to visit the home before deciding to use the care home. Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 10 The records of two recently admitted people were examined. The assessments carried out before admission were wide ranging and provided adequate detail from which each persons general care needs could be identified and from which a care plan was developed. The service is continuing to develop skills in the delivery of support to people with dementia care needs. This development though continuing is still at an early stage. Further development in the following areas should be considered; adaptations in the environment inside and outside the building, dementia training for all care staff, specific assessment of peoples needs due to dementia and detailed planning of the care necessary to meet these needs. Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 11 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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessed care needs are met by committed staff. These needs are well met by planned care. Medicines are handled safely. People are treated with respect and dignity. EVIDENCE: All the responses from the people that use the service and their relatives were that the personal care provided is good. A visiting district nurse commented on the good quality of the care and the homes close working relationship with the District Nursing service. All the relatives met during the inspection or that replied to the survey were positive about the quality of care delivered by the home. One relative commented, ‘They are very good with my’ (relative). ‘She is always looked after and well cared for.’ The planning of care is satisfactory. All the people using the service had an assessment of their needs and a plan of how the service would meet these Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 12 needs. All the care plans were signed by either the person using the service or a relative. For physical needs the planning is good. This is delivering good outcomes for people. For example one lady’s mobility had improved since she arrived at the home through the help given by staff to support her to walk regularly. Peoples’ continence has also been assisted by regular planned toileting regimes. Health related charts were seen in use and these were being appropriately used and comprehensively completed. Basic health checks and appointments are well supported and managed so that every person can be assured that their health needs are being well met. Psychological and emotional needs are not so well planned. Assessment is generalised and the homes skills in this area should be further developed. However since the last inspection a record of incidents is being kept as necessary to help assess and work with peoples’ behaviours. There are risk assessments in place for each person and as necessary a separate moving and handling risk assessment. Some restrictions of choice and freedom are noted in care planning or peoples individual risk assessments. However restrictions such as; non entry to the kitchen, not going out without an escort, non use of keys, restricted movement within the home, and limited use of alcohol were not routinely documented. It is important that such restrictions of normal choices and freedoms are documented, discussed and regularly reviewed to ensure that every person maintains as much choice and freedom as possible. It was noted that the specialist weighing scales are shared between 5 homes in the group and that as a result some of the people at Plymbridge House are weighed only once every 2 months. The home uses a weekly monitored dosage system to administer medication. Only staff that have received appropriate training administer medication. Medication is stored securely. The records of medication administration were well maintained. At the moment none of the people using the service are managing their own medication. The people that entrust their medication to the safekeeping of the home can be assured that it is being appropriately managed. People say they are treated with respect. Staff were observed knocking before entering rooms and reminded to do so by a sign on each door. Staff were observed talking with people that use the service in a respectful good humoured manner. Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 13 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each person should be assessed and supported to enjoy an active stimulating and enjoyable lifestyle both inside and outside the building. The people that use the service should be supported to retain as much control as possible over their freedom to choose within their daily lives. The people that live at Plymbridge House enjoy a nutritious, varied diet, which meets their food preferences and their health care requirements. EVIDENCE: The Registered Manager explained that the home had suffered a period of very intensive need from the middle of 2007 till the new year of 2008. The level of staffing did not change significantly during this period. The Registered Manager explained that the demands encountered by the staff had an effect on the quantity and quality of activities that could be made available to the people that use the service both inside and outside the home. There were a number of comments made in surveys returned form the relatives of people that live at the home that suggested there should be more activities and stimulation for the people that use the service. One person Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 14 wrote, ‘Could have something to stimulate clients e.g., sing alongs or exercise routines.’ Another relative wrote ‘I feel they can have something where they can walk’ ‘ With games or walks with someone seeing that they don’t come to harm.’ Anther relative wrote ‘They could have more activities/outings for them, and keep them a bit more occupied’. The Registered Manager stated that now that the level of personal care need had reduced the staff would have more time to spend supporting people with group and individual activities. She said that some of the regular, organised activities that would now restart would include music and movement, musical entertainment, bingo and indoor games. The opportunity to go out of the building remains very limited and few people go out of the home on a regular basis. The Register Manager said that she felt only 9 of the 32 people at the home could go out safely. Where people do get out of the home this is usually with their relatives and not through support from the service. Staff have managed to take some people on outings, using their own vehicles or using mobility taxis. The Registered Manager spoke of group activities/outings planned but then cancelled through an apparent lack of interest. Examples of this were planned group outings to a local carol service and a local pantomime during the Christmas period. Creative methods should be found to support people individually and in small groups to take part in activities outside the home. External activity should become a regular part of most peoples’ lives. People are supported to follow their faith. There are visits from local ministers of religion to the home. The potential of going to local church services should be explored to enable people to be part of a congregation. Participation in such events would enable people to re connect with the local community. An important principle of the care delivered by the home is to protect people and keep them safe at all times. This caring approach from the Registered Manager and staff is commendable. However more opportunity should be given to the people that use the service to affect choice in their day to day lives. If people are unable to manage choices for themselves their chosen advocate should be enabled to help make their views known. For example the Registered Manager said that people were supported to come down in the mornings but dissuaded from returning to their bedrooms during the day so that the staff could ensure that they were safe and their needs were met. This approach does not allow people the freedom to choose where they wish to be, or to move around as they wish, within the building. Freedom of choice should only be curbed if it can be demonstrated that the right to choice is outweighed by risk or is not in a person’s best interests. These decisions Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 15 should come from an appropriate multi disciplinary forum and should be documented in their care planning. Meals at the home received many positive comments both during the inspection from people that use the service and their relatives and also through the survey process. Through observation of the kitchen, food stocks, extensive preparation of the food with consideration for each person, and through documentation, it was evident that the cook and the Registered Manager go to a great deal of effort to meet the dietary needs of the people that live at Plymbridge House. Specialist diets are well catered for and diet is closely monitored to ensure it is adequate to meet peoples’ health care needs. The quality of the food produced for the people that use the service continues to be commended. Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 16 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people that use the service benefit from the way complaints and concerns are managed by the service, and people are protected from abuse. EVIDENCE: There is a complaints procedure. A copy of this procedure is placed by the front door of the home. This is accompanied by a complaints book which relatives can use to draw attention to an issue without having to arrange to see the manager. The home has made a record of a number of issues raised by relatives and they have recorded the action taken in each case to address these issues. A considerable number of survey questionnaires were returned to the CSCI to assist with this inspection. All of the 17 surveys returned indicated that staff and management do listen and act on what is said by both people living at the home and by their relatives. The evidence shows that people know who to speak with if they are unhappy with something in the home. The service has all the appropriate anti abuse policies and procedures in place. Adult protection training has been received within the home by the staff team. The organisation has improved the quality of this training. The home’s whistle blowing policy is accessible to staff. People that use the service are protected from potential abuse by the awareness of the staff and management. Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 17 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): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, pleasant, and well maintained. The gardens should be made a space that can can be easily enjoyed by the people that use the service. Peoples’ privacy and dignity should be supported by the availability of bedroom door locks as a standard facility. EVIDENCE: The home environment continues to be improved. The refurbishment, and as necessary replacement, of the windows was completed last year. New equipment has been installed in the laundry. The lower ground floor bathroom has been refitted. The carpeting in the ground floor communal areas has been replaced and the dining room floor has been replaced. The ongoing refurbishment of the building ensures a pleasant, safe environment for the people that live at the home. Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 18 The communal accommodation at Plymbridge House is spacious and furnished and decorated in a comfortable, domestic style. Individual bedrooms were seen to be personalised to people’s individual tastes. There are some signs around the home to help people find their way about. There is currently a safely closed off but highly visible area of building site to the front of the home. We were told that a further extension is proposed to this side of the building at some time in the future though the Registered manager was not able to give a date for this work to begin. This area has been in this condition for some time. The condition of this area restricts access and should be considered when seeking to provide a pleasant environment in all areas of the home. Peoples’ relatives commented during the inspection about the negative image this area brings to the home. The people that live at the home can only have access to the rear of the building with staff supervision and support. Though there are pleasant areas of patio and green spaces the garden areas have steps, a number of different levels and slopes. A discussion took place with the Registered Manager about using gates at specific points within the gardens to create areas where people could access the gardens without staff supervision and remain safe. All ideas regarding the use of the gardens should be explored to ensure that everyone can, as they wish, be supported to spend some time out of the building. Making the gardens a safe, and pleasant space would assist in meeting this need in the summer months. This issue is of particular concern as the Registered Manager said that many of the people that use the service have difficulty leaving the home for outings. Many of the bedroom doors do not have either a privacy or a key type lock fitted as a standard facility. This facility would allow people the option of locking their door safely for privacy or locking their door after they have gone out to ensure the security of their personal belongings. People do not have a lockable facility as standard within their rooms. This facility would allow people to safely lock away items of value to them in their rooms without locking their bedroom door. The bedrooms were personalised with regard to peoples’ wishes. Some were highly personalised and others were kept quite basic. A large number of new beds have been purchased and put in place. The home was generally clean and fresh throughout. Staff have the facilities to wash and dry their hands after providing personal care and this reduces the likelihood of cross infection. A new chemical cleaning system has been introduced into the laundry. The laundry has been refitted to meet all the potential needs that the service may be required to meet. Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 19 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People that use the service benefit from care staff that have been appropriately recruited, and checked, and are adequately trained. EVIDENCE: The core staff team is stable. The Registered Manager stated that the normal staffing level is; five care staff from 8.00am till 2.00pm, and four care staff from 2.00pm till 8.00pm. These staffing numbers may include the Registered Manager. There are two waking care staff at night. The Registered Manager stated that this staffing level was adequate to meet the needs of the people that use the service. The Registered Manager stated that the staff team would rather provide additional hours from within the team rather than use agency staffing. The Registered Manager has 3 days per week assigned off the care staff rota to carry out administrative duties. All of the 17 surveys returned indicated that there are sufficient staff on duty. Some surveys noted occasionally that the staff are kept very busy meeting peoples needs. In addition to the care staffing hours there are considerable ancillary/domestic staff hours including a cook 5 days per week, two domestic/cleaning staff 7 Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 20 mornings per week, the equivalent of one full time laundry assistant and maintenance hours over 5 days of the week. Two staff personnel files were sampled for care staff that were recruited in the second half of 2007. These files had a Criminal Records Bureau (CRB) clearance, a Protection of Vulnerable Adults (POVA) register check, two appropriate written references, and an appropriately completed application form. The sample of staff documentation showed that staff had been appropriately recruited, checked and employed by the home. The staff receive statutory basic training, which includes First Aid, Moving and Handling and Fire safety. The home is registered to provide care for people with dementia. Only 7 of the 19 care staff have received some introductory training in how to deliver this specialist type of care. Staff trained in this area of care delivery will be able to understand and meet the complex needs of the people with these needs. Currently 13 of the 19 care staff have achieved National Vocational Qualification (NVQ) level 2, or above, qualification in care. 68 of the care staff team hold a qualification in care. A further two staff are engaged on NVQ courses at present which gives the possibility of the home achieving 79 of care staff qualified. This is a commendable level of staff qualification. The care staff turnover over the last 12 months has been at an acceptable level of 20 . A lower level of staff turnover supports the consistency of care delivery. The home has a structured system of induction detailing the specific training that new staff will receive during their initial probationary period. The Registered Manager will, with the support of the organisation, explore the Skills for Care induction requirements to ensure that all elements of this specification is covered within the homes induction programme. Thorough induction training will give newly employed staff the skills they need to provide care appropriately. Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 21 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): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed with the best interests of people that use the service as a priority. EVIDENCE: Kathy Shopland, the Registered Manager, has the Registered Managers Award qualification and has many years of experience in providing care. She has a qualification in community mental health care, has received dementia care training for managers and is a qualified Moving and Handling trainer. The Registered Manager stated that staff supervision is being carried out only in a group meeting and that staff are observed in practice. This provides basic and adequate supervision of the care staff practice but does not allow discussion of individual staff practice and individual training needs. This low Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 22 level of formal supervision is not enough to individually improve staff care practice and as a result promote ongoing improvement in the quality of care received by the people using the service. Much effort has been made to ensure a quality service at the home. A quality assurance system has been running annually since 2005. The last round of quality assurance was carried out in March 2007. All residents and family were surveyed for their opinion of the service. Twenty-eight responses were received and collated towards ongoing improvement of the service. Few residents are able to manage their own financial affairs, but the home will keep money safely on behalf of residents. When identified as a need, or requested, lockable storage is provided in peoples’ bedrooms. The following paragraphs specifically covers Health and Safety in the home. The Registered Manager stated that all but one window above ground floor level has a restricted opening to ensure that risk of falls is eliminated. The Registered Manager also stated that all radiators have been covered to prevent risks from hot surfaces and all hot water outlets available to people that use the service have been regulated to prevent risk from scalding water. The laundry has been renovated and there is an appropriate industrial washing machine and dryer. Soiled laundry is washed in red sealable bags. Some open sluicing does take place and aprons, goggles, face masks and gloves are available to the staff to allow them proper protection from air and water born infection. All stair lifts and hoists are being regularly checked and serviced. The home’s shaft lift is being regularly serviced by an appropriate contractor. The electrical wiring certificate for the building dated October 2006 was seen and remains valid till 2011. Domestic electrical items such as televisions and bedside lights were tested for electrical safety on 11/08/07. The accident records were seen and these records are being kept appropriately. The Environmental Health Department of Plymouth City Council carried out a routine inspection of the food preparation facilities on 06/09/07. Fly screens were required to be fitted to the main windows of the kitchen, so that they could be opened to allow appropriate ventilation of the cooking area. This requirement has not been complied with. In general health and safety in the home is adequately managed to protect the health and safety of the people that use the service. Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 23 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 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 24 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. 3. Standard OP12 Regulation 16(2)(m) Requirement Residents must be supported to gain stimulation through leisure and recreational activities both inside and outside the home. (This is the second time that this requirement has been made) Timescale for action 30/08/08 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 OP4 Good Practice Recommendations The home should develop an understanding and ability to deliver the specialist care needed by people with dementia through; adaptations in the building, mandatory care staff dementia training, assessment of specialist needs, and care planning to support delivery of care to meet these identified needs. Assessment and care records should clearly document who has been involved in making decisions regarding any necessary restrictions of choice or freedoms and what these restrictions are. Records should be signed and dated. DS0000041564.V359583.R01.S.doc Version 5.2 Page 25 2. OP7 Plymbridge House 3. OP14 4 5 6 OP19 OP19 OP24 7 OP36 8 OP38 The service should adopt an individualised approach to care assessment, care planning and care delivery so that the people that use the service are allowed as far as possible to make their own choices in their daily lives. The enclosed building site area to the front of the building should be improved to allow improved access and create a welcoming impression at the front of the home. Opportunities should be explored to create safe areas within the gardens so that everyone that lives at the home can enjoy time outside with or without staff support. To support people’s privacy and the security of people’s personal belongings, an individualised key type lock that can be overridden from the outside in the event of emergency, should be fitted to every bedroom door. All such bedroom door locks should be supported by a master key system. Care staff should have regular individual supervision meetings with an appropriate line manager to discuss the individual care staff members care practice and training needs. As required by the Environmental Health department of Plymouth City Council on 06/09/07 fly screens for the kitchen windows should be fitted to allow increased ventilation of the kitchen. Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colstn Avenue Bristol BS1 4UA 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 Plymbridge House DS0000041564.V359583.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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