CARE HOMES FOR OLDER PEOPLE
Polebrook Nursing & Residential Home Polebrook Nursing Home Morgans Close Polebrook Oundle Cambs PE8 5LU Lead Inspector
Mrs Sarah Smart Unannounced Inspection 7th April 2006 09:15 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 Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Polebrook Nursing & Residential Home Address Polebrook Nursing Home Morgans Close Polebrook Oundle Cambs PE8 5LU 01832 273256 01832 741970 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) helenrussellrgn@AOL.com Birchester Medicare Limited Mrs Helen Russell Care Home 51 Category(ies) of Dementia - over 65 years of age (51), Old age, registration, with number not falling within any other category (51), of places Physical disability over 65 years of age (51), Terminally ill over 65 years of age (51) Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Convalescent Day Care (10 places) To provide care for one named service user under the age of 65 years. The total number of service users must not exceed 51. Date of last inspection 11th October 2005 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. The fees charged by the home currently range from £288.45 to £525 per week. Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced inspection was undertaken between the hours of 9.15am and 16.15. Preparation for the inspection included, review of the previous inspection report, requirements and recommendations, and notification etc, and took approximately 8 hours. 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, sample of policy review, staff rota, staff files, quality assurance, staff supervision, accident records, complaints records, partial tour of the premises, previous requirements made, and staff and service user interviews. Five service users were case tracked, and were selected by choosing one service user from each category of the homes registration. Five staff members, were spoken to at length, and several others briefly, whilst five service users and one visitor were spoken to in detail. What the service does well:
There was evidence from service users and care notes that the service users needs are met. Staff demonstrated a good knowledge of the service users in their care. Care plans were generally written to an acceptable standard, whilst wound care plans demonstrated consistent care and well written plans. Other documentation was recorded to a high standard. Healthcare assessments were recorded accurately. Service users stated that their privacy and dignity is respected at all times. Observations during the inspection reinforced this. A life and social history has been obtained from all service users in order that the planned activities are appropriate. Activities are held on a one to one and group basis, and service users said that they are able to choose whether to join in or not. Relatives and visitors are welcomed into the home. Service users stated that they can make choices about their everyday life. Service users generally said that the food was nice. Service users said that they were happy with their rooms, which were personalised. Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 Page 6 The kitchen, and all areas of the home were clean and tidy. Food was stored appropriately. Staffing levels were consistent and satisfactory. Staff working excessive hours had signed the required documentation in relation to this. Staff files were generally in good order, and contained all of the required information with the exception of one outstanding reference. Service users gave positive feedback about the staff, and pleasant communication was noted between them. Staff training was satisfactory, with the exception of one case. The overall management of the home was satisfactory. Quality management is maintained to a very high standard. Fire records and accident records were satisfactory, and Portable Appliance Tests were up to date. What has improved since the last inspection? What they could do better:
The recording of medication must be improved. Some service users appeared to be unaware that a choice is available at mealtimes, although they stated that they are given choices in other areas of this lives. Radiators and heaters in some service users rooms were extremely hot to touch, and the risk assessments did not adequately protect service users. Two cross infection risks were observed: a staff member went from one service user to another putting hand cream on without washing her hands or changing gloves, several catheter bags were found without proactive caps on the tubing ends. The storage of service users money is not considered to be in the best interests of the service users.
Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 Page 7 A risk assessment is required in relation to a service user who uses a hot water bottle. Wheelchairs were regularly used to transport service users without footrests in situ, posing a risk of injury to the service user. Bedroom doors should not be wedged open if the room is not in use. 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 DS0000012633.V288371.R01.S.doc Version 5.1 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 Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome group is good. This judgment has been made using available evidence, including a visit to the service. Service users or their representatives are involved in the choice of home, and their needs are met. EVIDENCE: A sample of service users were interviewed. Their residence at the home had been determined by relatives on their behalf in all instances. There was evidence from speaking to staff, and observing care practices and documentation, that service users needs are met. Staff demonstrated a good knowledge of the service users in their care. The home does not provide intermediate care. Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9,10 Quality in this outcome group is good. This judgment has been made using available evidence, including a visit to the service. Service users health and personal care needs are met. More robust medication management of medication would ensure service users are protected. EVIDENCE: A total of five service users were case tracked, one from each category of registration. Care plans were written to an acceptable standard, and in all but one instance reviewed timely. One care plan could have contained further information in order to give clear instruction to the reader. The care plans reflected the service users needs, and staff demonstrated an awareness of them. Wound care plans were noted to be consistent, and written to a high standard. Turn charts and food and fluid records were noted to be maintained to a high standard. In all instances consent of the use of bed rails had been obtained. Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 Page 11 Healthcare assessments were recorded accurately in all instances, and reflected the service users needs. A sample of medication was viewed. Recording had improved considerably since the last inspections. In one instance a service users eye drops were being used after their expiry date, and two further bottles did not have the date of opening recorded. A further bottle of eye drops stated that they must be stored in the fridge, however they were located in the drug trolley. A liquid medication was found to be stored in the kitchen fridge belonging to a service user who was no longer in the home. The supplementary drinks for one service user were not prescribed on the service users Medication Record Sheets. Controlled drug recording was not accurate, and the records had been incorrect for up to a month, despite a further supply being obtained by the home. An investigation must be carried out and a notification made to the Commission for Social Care Inspection. The recording of one as required medication was difficult to interpret due to a quantity of information being confined to a very small area. Service users spoken to by the inspector stated that their privacy and dignity is respected, and observations during the inspection reinforced this. Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 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 the following standard(s): 12,13,14,15 Quality in this outcome group is good. This judgment has been made using available evidence, including a visit to the service. Activities offered to service users were supportive of social care needs. EVIDENCE: The home have employed an activities coordinator, who has obtained a life and social history from all of the service users or their families, which enables her to ensure that the activities are appropriate. The activities organiser was spoken to at length about her role. She stated that the activities plan has been discontinued, and that service users are asked on a daily basis what they would like to do. The inspector was reassured that all service users receive some sort of stimulation, whether it be in a large group, or on a one to one basis. Service users stated that activities are satisfactory, and that their choice not to participate was respected. Service users stated that their relatives and visitors are welcomed into the home when they visit. One relative was spoken to who gave generally satisfactory feedback. Other visitors seen in the home appeared relaxed and satisfied with the provision of care.
Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 Page 13 Several service users were asked if they were afforded choices within the home in relation to daily care etc. On the whole feedback was very positive, although some service users appeared to be unaware that a choice of meals is available at mealtimes. The cook was heard to be asking a group of service users their choice of lunch on the day of the inspection and other service users gave positive feedback in this area. There are several dining areas within the home, and service users were also heard to be asked by staff if they would like to eat in their bedrooms. Lunch on the day of the inspection was Cornish pasty, chips and peas followed by fruit and cream. Service users stated that they generally enjoyed to food. The kitchen was visited and the cook spoken to. Food was stored appropriately in every instance, and the kitchen was clean and tidy. Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 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 the following standard(s): 16,18 Quality in this outcome group is good. This judgment has been made using available evidence, including a visit to the service. Complaints are handled well, and abuse procedures are satisfactorily protecting service users. EVIDENCE: The complaints records were viewed. The Commission for Social Care inspection has received two complaints since the last inspection, both of which have been investigated by the home to a very high standard. The findings generally found the complaint to be unsubstantiated. The complaints referred to the home by the Commission for investigation were not recorded in the complaints file. The complaints policy gave adequate information to the reader, and staff spoken to demonstrated a satisfactory knowledge of the complaints procedure. The abuse policy was noted to be satisfactory, and the previous recommendation had been met. Staff spoken to demonstrated a satisfactory knowledge of the procedure to e followed in the event of an allegation of abuse. Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 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 the following standard(s): 19,25,26 Quality in this outcome group is adequate. This judgment has been made using available evidence, including a visit to the service. One issue relating to the environment posed a hazard to service users safety, otherwise the premises were satisfactory. EVIDENCE: A sample tour of the premises was undertaken. All areas of the home were clean and tidy, and maintained to an acceptable standard. In several service users rooms the radiators or storage heaters were extremely hot to touch, and did not have low surface temperature covers in situ. The inspector viewed the risk assessments associated with these. The risk assessments did not have a hazard score, and stated that covers may be required. This must be given urgent consideration to prevent service users from being put at risk of burns. All other aspects of the premises were satisfactory. All service users spoken to stated that they were happy with their
Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 Page 16 rooms, and rooms were noted to be personalised by the individual occupying it. In several instances used overnight catheter bags were stored without caps over the end leading to a very high risk of infection. In one instance this bag was in the sitting area of the service users bedroom. A staff member was observed applying hand cream to several service users in one lounge. This was a pleasant way to interact with service users with dementia, however, she did not wash her hands or change gloves between service users, and therefore risked transferring skin infections from one to another. This had been the nature of a previous requirement which remains unmet. Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome group is good. This judgment has been made using available evidence, including a visit to the service. Staffing is generally satisfactory to meet the needs of the service users. EVIDENCE: The staff rota was viewed. Staffing levels were consistent and adequate. Staff spoken to stated that they would like more staff to allow them time to sit and talk with the service users, and two service users agreed with this. Staff were noted to have a pleasant manner with the service users in their care, and service users stated that the staff are very nice. Two staff members were noted to be working well over 40 hours per week. their staff files contained Working Time Directive opt out agreements. The inspector was advised that a total of 14 staff have completed level two or three National Vocational Qualification, whilst a further 6 are currently undergoing such training. A sample of staff files were viewed. One file contained only one reference, and good practice would be maintained if the Criminal Records Bureau check reference numbers were recorded in all cases. Otherwise the staff files were maintained to a good standard, with evidence of supervision and appraisal in most. Staff training was satisfactory.
Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome group is good. This judgment has been made using available evidence, including a visit to the service. Management of the home is satisfactory, however service users safety is not always maintained. EVIDENCE: The home is managed to a satisfactory standard, and the owner has input into the facility. Service users stated that they see the manager regularly. Quality monitoring is recorded and carried out to a very high standard. The home operates a quality group, which includes the owner and manager, and relatives. Areas identified by the questionnaires, or the group, that could be addressed, are dealt with in an action plan. Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 Page 19 One service user had an amount of money stored in the drug cupboard. The homes accountant stated that no other cash is held for service users, and if a service users wishes to make a purchase, the cost would be included in the next invoice. He added that some service users relatives choose to pay in advance for such purchases, and this money is then stored in the homes general account. Records indicated that the service users right to interest on this money is denied. On numerous occasions two staff members were observed to transport service users in wheelchairs without footrests in situ. This was brought to the attention of the nurse in charge who was heard to speak to the staff, however on a later occasion they were observed to carry out the same practice, whilst in the company of the nurse in charge. Records relating to fire checks were satisfactory, however some bedroom doors were wedged open despite there being no service users in these areas. Accident records were satisfactory and the number of accidents recorded gave no cause for concern. One service users care notes indicated that she uses a hot water bottle. There was no risk assessment written for this. Portable Appliance Tests were up to date. Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 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 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 3 8 3 9 1 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 3 3 X X X X X 2 1 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 X 4 X 3 X X 1 Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 Page 21 yes 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 OP9 Regulation 13(3), 12 Requirement Recording of medication must be accurate. This is an outstanding requirement with a timescale of 31.10.05, which remains unmet. Cross infection risks must be addressed, and practice changed. Action must be taken to protect service users from the risk of burns from heaters and radiators without low surface temperature covers. Health and welfare of service users must be promoted and maintained. Ref: wheelchair footrests. Timescale for action 05/06/06 2 3 OP26 OP25 13(3), 12 12,23 05/06/06 05/06/06 4 OP38 12 05/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP7 Good Practice Recommendations Care plans should be reviewed on a regular basis. A care plan relating to epilepsy should contain additional
DS0000012633.V288371.R01.S.doc Version 5.1 Page 22 Polebrook Nursing & Residential Home 3 OP35 instruction to staff. The manager should demonstrate how service users finances are stored securely, and in the best interests of the service users. Polebrook Nursing & Residential Home DS0000012633.V288371.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Northamptonshire Area Office 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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