Inspection on 13/12/05 for Polebank Hall

This inspection was carried out on 13th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Polebank Hall 18/07/07

Polebank Hall 16/05/06

Polebank Hall 22/06/05

Polebank Hall 21/01/05

Polebank Hall 19/08/04

Polebank Hall 24/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Polebank Hall Stockport Road Gee Cross Hyde Tameside SK14 5EZ Lead Inspector Janet Ranson Announced Inspection 13th December 2005 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 Polebank Hall DS0000005576.V264590.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. Polebank Hall DS0000005576.V264590.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Polebank Hall Address Stockport Road Gee Cross Hyde Tameside SK14 5EZ 0161 368 2171 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) Polebank Residential Care Home Limited Ms Margaret Powell Care Home 29 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (29), Old age, not falling within any other category (29), Physical disability over 65 years of age (16), Sensory Impairment over 65 years of age (3) Polebank Hall DS0000005576.V264590.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users up to 24 (DE) (E); up to 3 (SI) (E); up to 29 (MD) (E); up to 29 (OP) and up to 16 (PD) (E) 22nd June 2005 Date of last inspection Brief Description of the Service: Polebank Hall is a large detached property situated in the centre of a public park. Formerly a mill owner’s house, it now has listed building status. The building is in a poor state of repair. The property has been adapted and extended over the years to provide accommodation on three floors in 25 rooms, 11 of which have en-suite facilities, and two shared rooms both with en-suite facilities. The lounges and dining room are on the ground floor. There is also a large conservatory to the side of the building. This are is waiting for listed planning permission to be upgraded and made comfortable for the residents. Although Polebank Hall is located within a public park it does not have a secure garden space dedicated for the residents’ use. It would appear this does not have a detrimental effect on the residents who take great delight in watching the comings and goings of the general public who also use the area. Polebank Hall DS0000005576.V264590.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Polebank Hall provides personal care for up to 25 residents over 65 years of age. The company also owns Laurel Bank residential care home and a domiciliary care agency. This was an announced inspection, carried out over seven hours. Two individual care plans were examined as part of the inspection process. The plans selected concerned newly admitted residents. A total of four residents spoke with the inspector about their experiences of living at the home. The inspector also observed staff practice and interaction with the residents and their colleagues. One visitor assisted the inspector with her views of the service. Two staff discussed their roles and responsibilities. The financial director was also present for a part of the inspection. Polebank Hall continues to go through a period of change as a result of the long established registered manager and her deputy resigning their posts. At the time of this inspection, the new manager had been appointed for a short period and was beginning to create a more secure atmosphere for the residents, their families and the staff. The senior team have settled in well to the new management style and appear to be supportive and enthusiastic. According to the residents the problems concerning consistency and quality of meals have, in general, improved. The Christmas party held the previous evening had been enjoyed by the residents and their families. Good progress has been made towards improving the skills and mandatory training for the carers and housekeepers. The building, both internally and externally, continues to deteriorate despite some “patching up” usually carried out as a result of bad weather. It is understood that discussions with the local authority and others to ascertain responsibility for any building works continues. The poor condition of the building has been brought to the attention of the registered person at each inspection. An additional visit to Polebank Hall was carried out on 28th October 2005, where progress towards meeting the requirements made during the previous inspection in June was assessed. Further requirements were also made at this time. Polebank Hall DS0000005576.V264590.R01.S.doc Version 5.0 Page 6 What the service does well: 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. Polebank Hall DS0000005576.V264590.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 Polebank Hall DS0000005576.V264590.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): 3&5 Standards 3 and 5 were assessed at the previous unannounced inspection (June 2005) when they were judged to meet fully with the standards. Standard 6, intermediate care is not provided at Polebank Hall. EVIDENCE: Polebank Hall DS0000005576.V264590.R01.S.doc Version 5.0 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): Standards 7, 8, 9 and 10 were assessed at the previous unannounced inspection (June 2005) when they were judged to meet fully with the standards. EVIDENCE: Polebank Hall DS0000005576.V264590.R01.S.doc Version 5.0 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): 12, 13, 14 & 15 The residents’ individual lifestyles are respected and promoted by the actions of the carers and the home’s ethos. Visitors are made welcome and encouraged to remain in contact with the residents. Meal times are flexible and relaxed but there is no method of showing what is available for each meal. EVIDENCE: A newly appointed member of staff has devised a programme of activities. A musical quiz was being enjoyed during the morning of the inspection but the proposed Bingo session was not forthcoming. No explanation was given to the residents who had been looking forward to this. A small group of visitors spoke with the inspector. It was the first time they had been to the home. They were very impressed with the welcome they received from the staff and also appreciative of the light refreshments provided during their stay. Polebank Hall DS0000005576.V264590.R01.S.doc Version 5.0 Page 11 The Christmas and New Year menus had been displayed on the wall in the dining room. Some residents and the visitors could be seen looking at them and making positive comments. There is a system of taking the residents’ choice of meals during the day for catering purposes, however the daily menu should be made available on each table or on a wipe clean board. There has been a recent history of dissatisfaction with the quality of meals and the manner in which they have been presented. According to a group of residents and a newly appointed carer, this has now been resolved. It was agreed that the quality of the cooking has improved. The practice of handling cups by the rim to the residents is unhygienic and should be addressed by the provision of suitable saucers. This has been brought the attention of the registered person in previous reports. Polebank Hall DS0000005576.V264590.R01.S.doc Version 5.0 Page 12 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 & 18 The residents were confident that their complaints would be addressed. The absence of formal training in the Protection of Vulnerable Adults could result in a resident being put at risk. EVIDENCE: A resident described how she had made a complaint to the management. She was satisfied that her complaint had been taken seriously and the outcome continues to meet her needs. The home has a policy and procedure to respond to allegations of abuse. In discussion, a carer demonstrated her intuitive awareness of abuse and described how she would report concerns to the manager or registered provider. A programme of formal training in the Protection of Vulnerable Adults (POVA) has commenced as required at the last inspection and remains within the given timescale Polebank Hall DS0000005576.V264590.R01.S.doc Version 5.0 Page 13 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 & 26 Polebank Hall is clean with a good standard of hygiene and free from offensive odours. EVIDENCE: At the previous inspection there was a requirement that the area to the front of the building be maintained in a safe condition. This area, which is also used as a car park for visitors to the home and the park, has been greatly improved, and re-surfaced and made safe. A group of visitors and a newly appointed carer commented on the lack of offensive odours associated with incontinence, within the home. Polebank Hall has a good standard of hygiene and is kept in a clean state by a team of housekeepers. Polebank Hall DS0000005576.V264590.R01.S.doc Version 5.0 Page 14 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 & 30 The home employs staff in sufficient numbers to meet the residents’ assessed needs. Further training is required to ensure carers’ competence. Standard 29 was assessed at the previous unannounced inspection (June 2005) when it was judged to meet fully with the standard. EVIDENCE: Recruitment has continued to ensure the skill mix of the care staff. A new rota has been implemented giving a more even coverage throughout the day. The staff state there is good teamwork and it was observed there is a balance of age and experience within the staff group. It was noted that the carers were sitting and talking with the residents in a relaxed and respectful manner. The ratio of carers with a National Vocational Qualification (NVQ) at level 2 has greatly improved and now stands at 50 with other staff enrolled on the course. The housekeepers have also been enrolled on the NVQ at level 1. Polebank Hall DS0000005576.V264590.R01.S.doc Version 5.0 Page 15 The manager has set up programmes of mandatory training concerning health and safety, manual handling, food and hygiene as required at the previous inspection and remains within the given timescale. The home is registered to provide care for older people with dementia. It is vital that the carers have access to training in dementia awareness. Polebank Hall DS0000005576.V264590.R01.S.doc Version 5.0 Page 16 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 & 38 Failure to provide mandatory training could affect the health, safety and welfare of residents, visitor and staff. Standards 33 and 35 were assessed at the previous unannounced inspection where they were judged to meet fully with the standards. EVIDENCE: The newly appointed manager was present throughout this, his first, inspection. He has made several changes to practices carried out in the home. It is considered too soon to assess the impact of these changes. The manager is now required to make application to the commission for Social Care Inspection for registration. Polebank Hall DS0000005576.V264590.R01.S.doc Version 5.0 Page 17 As previously noted within this report (Standards 28 and 30) a system of mandatory training has been set up but remains a requirement within the given timescale. When and until all the staff have received all the mandatory training concerning health and safety, manual handling, food and hygiene and the protection of vulnerable adults, the welfare of the residents and staff cannot be guaranteed. Polebank Hall DS0000005576.V264590.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X 2 Polebank Hall DS0000005576.V264590.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP12 Regulation 12(3) Requirement Timescale for action 01/02/06 2 OP14 3 OP18 4 5 OP30 OP31 6 OP38 The registered person must ensure that saucers are provided when giving hot drinks to residents. 12(2) The registered person must ensure the residents have access to a written menu with all the choices displayed. 12(1) The registered person must ensure all the staff receive training in the Protection of Vulnerable Adults. (Previous timescale of 01/10/05 not met). 12(1)(b) The registered person must ensure the carers have access to dementia awareness training. 9(1)(2)(a) The registered person must (b)(c) ensure the newly appointed manager applies to the CSCI to be registered as a fit person. (Previous timescale of 01/12/05 not met). 13(5) The registered person must 23(4)(d) ensure all staff receive 16(2) mandatory training in health and safety; safe lifting techniques; first aid; fire awareness; infection control and food hygiene. DS0000005576.V264590.R01.S.doc 01/03/06 01/03/06 01/03/06 01/02/05 01/03/06 Polebank Hall Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Polebank Hall DS0000005576.V264590.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD National Enquiry Line: 0845 015 0120 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. 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