CARE HOMES FOR OLDER PEOPLE
Polebrook Nursing & Residential Home Morgans Close Polebrook Oundle PE8 5LU Lead Inspector
Sarah Smart Unannounced 25 April 2005 10.00
th 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 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. Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Polebrook Nursing & Residential Home Address Morgans Close Polebrook Oundle Cambs PE8 5LU 01832 273256 01832 741970 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Birchester Medicare Vacant Care Home with Nursing 51 Category(ies) of DE(E) Dementia - Over 65 (51) registration, with number OP Older Persons (51) of places PD(E) Physical Disability - Over 65 (51) TI(E) Terminally Ill - Over 65 (51) Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: To provide care for one named service user under the age of 65 years. Date of last inspection 26th October 2004 Brief Description of the Service: Polebrook Residential and Nursing Home is a large purpose built home situated in the village of Polebrook. The home can be found at the end of a small culde-sac, set in large grounds. The home offers all ground floor accommodation, with a mixture of single and double rooms, the majority of which have ensuite facilities. . The home has several communal rooms and a large conservatory area. Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced inspection was undertaken between the hours of 10.20am and 2.45pm. The pre-inspection questionnaire had been completed and returned to the inspector prior to the inspection. Written feedback in the form of questionnaires was received from 27 service users and 4 relatives. 10 of the service users gave positive feedback, 10 service users said that they were not happy with the food, and 14 service users said that there was a lack of activities in the home. 2 relatives answered all questions positively, 1 said that there was not sufficient staff on duty, and one commented upon the lack of activities. The primary method of inspection used was ‘case tracking’. This involves selecting a number of service users and tracking their care and experiences through review of their records, discussion with them, the care staff and observation of care practices. The following areas were covered during the inspection: case tracking, medication, statement of purpose review, staff rota, staff files, quality assurance, staff supervision, accident records, complaints records, previous requirements made, and staff and service user interviews. A tour of the premises as also undertaken. Two staff members were interviewed at length, and several others briefly, whilst seven service users were spoken to in detail. Two service users were case tracked. What the service does well:
Contracts of residency for service users were very thorough, and written to a high standard. Service user assessments of their needs contained valuable information, including an assessment of risks. Privately funded service users had an agreed care agreement which detailed the type of care they should expect. All of the service users spoken to were happy at the home. Staff morale also seemed to be acceptable. The kitchen was well managed. The staff knowledge of complaint handling and abuse handling was satisfactory, and the home have not had any complaints since the last inspection. The premises had been refurbished in some areas, with new carpets laid. The home was clean and tidy. Service users stated that they were happy with their rooms.
Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 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.
Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 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 standard(s) 1,2,3,4 Service users were very well informed by the contract of residency, however the statement of purpose was not an acceptable document. Service users needs were assessed and met. EVIDENCE: Staff at the home were unable to furnish the inspector with a copy of the statement of purpose. They made several attempts to find a copy, which the inspector had seen during a previous inspection. A copy of the service user guide was noted to contain some of the information expected in the statement of purpose, but not all. In a second instance this same document was titled statement of purpose. A copy titled service user guide was located on the front desk of the home. Service users files contained contracts of residency, which contained a valuable amount of information. In addition to the required information the contract contains information on Medical and Personal requirements, personal effects and personal mobilising and emergency details. Some contracts belonging to service users who have resided in the home for sometime do not have the room occupied stipulated, although this has been added to recent contracts. A discussion took place as to whether these contracts should be reissued, or if
Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 9 this should occur if a service user does choose to move rooms. Privately funded service user had the care required written in the form of a contract also. Assessments of service users were recorded to a high standard, and had been reviewed. The assessments had identified risks incorporated into them, which gave instant information about the service users needs. Staff spoken to demonstrated a good knowledge of the service users in their care. The nurse in charge had a very competent and professional manner and gave clear and accurate accounts of the service users needs. Service users spoken to stated that their needs are met. Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9, Service users health and personal care was met, however medication requires some attention. EVIDENCE: Care plans were written to an acceptable standard, were reviewed, and had future review dates set. In one instance a relative had signed agreement with the care plans. A brief care plan outlining the service users needs was written, and agreed by the service user or their representative, in the form of a private care agreement. Healthcare assessments were recorded in all instances. One Waterlow assessment was scored incorrectly, giving a false answer. This had been the subject of a previous requirement. The assessments were reviewed in all cases. The medication in the home is divided into two areas, those dispensed by the nurses to the service users receiving nursing care, and those given by the care staff to the service users receiving residential care. Generally the medication given by the carers was managed and recorded in an acceptable manner. The other medication had some gaps in the recording, and the entry “X” and a tick had been used in many instances, which did not appear on the key for the
Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 11 reason for omittance. This had been the subject of a previous requirement. The acting manager stated that she would discuss the recording with the pharmacist who was due to visit the home on the following day, as it was their advice to use the entry of “X”. Controlled drug storage and recording was acceptable. Prescribed creams etc for service users was found in two ensuites in rooms not belonging to that service user. This had been the subject of a previous requirement. Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Positive information was given about activities, although provisions had not improved at that time. Service users choices were respected with the exception of meals. EVIDENCE: Service users stated that activities remain limited in the home. One group of service users were in a lounge where the TV was on, and a second group were listening to some old time music. An activities organiser has now been employed, and is due to commence this week. This person was interviewed, and gave a resume of her expectations of her role, and the plans she has for activities provision in the home. Service users social history was recorded, and information about their hobbies etc was being gathered by her, although the activities plan had not been drawn up or commenced. Two service users said that they go to church regularly, and two were going out to lunch at a local school. Although the activities programme has not yet been collated, a requirement has not been made in this area. Visitors were seen in the home, and service user stated that they are made to feel welcome. Service users said that they could make choices about their care, however they all said that they are not offered a choice of food. One member of care staff also said that service users are not offered a choice of food, despite a menu board stating a choice, and a choice being recorded in the kitchen.
Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 13 The kitchen was well organised, and clean. Records required for the safety of food storage etc were maintained. The home did not record which food was eaten by which service users. Lunch looked and smelt appealing. Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 14 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 standard(s) 16, 18 partially, 17. Service users were protected, and rights respected. EVIDENCE: The home have not received any complaints since the last inspection. Staff spoken to demonstrated a good knowledge of the complaints procedure. Several service users stated that they are unsure how they will exercise their right to vote, however poling cards had arrived at the home to enable service users to visit the village poling station. Staff were distributing the poling cards to the service users. Staff spoken to demonstrated a good knowledge of the procedure in the event of an allegation of abuse, and stated that they had undergone training in this area. Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 15 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 standard(s) 19,20,21,22,23,24,25,26 The environment of the home was satisfactory to meet the needs of the service users. EVIDENCE: The main reception area of the home has recently been redecorated, and has a light and airy feel. Several carpets have also been replaced. All areas of the home are accessible to the service users. The lawn to the rear of the home had not been cut for sometime, and looked rather untidy. The home have obtained quotes for having this work carried out. The home has three lounges, and two dining areas where service users with differing needs are encouraged to sit, although enabled to wander between each area as they wish. Bathrooms, ensuites and shower rooms were all maintained acceptably. Equipment identified in the service users care plan was noted to be provided in the service users rooms. In one instance the air mattress was set incorrectly for the service users weight. This was immediately corrected by the nurse in charge. Therefore a requirement has not been made, however the inspector
Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 16 recommends that a system for regularly checking the mattress settings is introduced. Service users rooms were of adequate size, and the majority have ensuite facilities. Service users spoken to stated that they are happy with their rooms. Service users rooms viewed were personalised by the individual occupying that room, and were appropriately furnished and lit. The home was at an acceptable temperature. The home was clean and tidy and staff demonstrated a thorough knowledge and practice of limiting the risk of infection control. Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 partially Staffing levels were satisfactory to meet the needs of the service users, however staff recruitment was not robust. EVIDENCE: The staff rota indicated that there is always one trained nurse on duty on each shift, in addition to the acting manager being a nurse. During the morning, there are 7 members of care staff on duty, 6 during the afternoon, and 2 carers overnight, plus a staff member working a twilight shift. There were sufficient staff on duty. In addition there are housekeeping and catering staff. Three staff members files contained varying amounts of information. One staff file did not contain references or a Criminal Records Bureau check. A second file contained all of the required documents. The third file did not contain references. Administration staff stated that the office had recently relocated, and some files had not been located since the move. In addition filing has been delayed. The inspector was assured that the staff member whose Criminal Records Bureau check was not available would not work in the home until this situation is overcome. The staff member without references had been employed via an agency, and her references had been obtained. Staff advised that they have undergone a great deal of training recently, and have further study days on a variety of topics planned for the forthcoming weeks. Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,35,38 The home is being appropriately managed. Service users are denied access to cash, unless it is by prior arrangement. EVIDENCE: The manager is currently in an acting manager position until her fit person process is completed. The improvements within the home since her employment were noted. The service users contract advised the individual to deposit spending money with the manager. A member of admin staff stated that service users are discouraged from having money in the home. Money possibly belonging to three service users was stored in the drug cupboard, where there were extremely limited, or no, records available with it. The numbers of accidents has reduced significantly since the last inspection. The accidents recorded during the month of March were viewed, of which there were five in total. All stated that the service user was found on the floor, although this is considered a relatively low number of accidents, and caused no need for concern.
Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 19 Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 4 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 x x x 1 x x 3 Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 21 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. 2. Standard 36 1 Regulation 18 4 Timescale for action Supervision and appraisal of staff By 15.7.04 must be introduced. The statement of purpose must By 15.7.04 contain the information outlined in schedule 1. The statement of purpose must accurately reflect practices within the home, and be available to the service users. Criminal Records Bureau checks By 15.6.04 must be obtained before new staff commence employment. Healthcare assessments must be By totalled and recorded correctly, 30.11.04 in order that risks are identified at the earliest opportunity. Management and administration By of medication must be addressed 15.11.04 in the following areas: 1.medication must be given as prescribed 2.medication must only be used for the service user for whom it is prescribed. Requirement 3. 4. 29 8 19 12(1) 5. 9 13(2) 6. Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 22 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. 2. 3. 4. Refer to Standard 14 19 15 22 Good Practice Recommendations Service users should be offered a choice at mealtimes The grounds should be kept in good order, and accessible to service users. The mealls taken by individual service usersshould be recorded. The level of the settings on specialist mattresses should be checked and recorded regularly. Polebrook Nursing & Residential Home C51 S12633 Polebrook V223354 250405 Stage 2.doc Version 1.30 Page 23 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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