CARE HOMES FOR OLDER PEOPLE
Polsloe House Ltd Polsloe House 22 Park Road Redruth Cornwall TR15 2JG Lead Inspector
Stephen Baber Key Unannounced Inspection 29th August 2006 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 Polsloe House Ltd DS0000062250.V296681.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. Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Polsloe House Ltd Address Polsloe House 22 Park Road Redruth Cornwall TR15 2JG 01209 215337 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) Polsloe House Ltd Mary Butland Care Home 13 Category(ies) of Dementia - over 65 years of age (2), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2), Old age, not falling within any other category (13) Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th November 2005 Brief Description of the Service: Polsloe House is a detached building set in its own grounds, which the service users said they enjoy especially in the better weather. It is situated near to the town of Redruth with all its services and facilities accessible to the home. Polsloe is close to local General Practitioners surgeries with Camborne and Redruth Hospital one and a half miles away. The registered providers Mr and Mrs Butland have owned the home for nearly 2 years. There are 11 single rooms and one double room. Five of the rooms have ensuite facilities. Accommodation is spread out over two floors with toilets and bathrooms near to service users bedrooms. Polsloe offers full personal care and residential accommodation to older people, including up to two people with dementia or with other mental health needs. Management describes the aims, services and facilities clearly in the Statement of Purpose and Service User Guide. The home sets out to provide a high quality service that responds to individual needs and preferences. Management are generally able to take service users to hospital and medical appointments or appropriate arrangements are arranged. Polsloe has a stable group of mature staff that have worked at the home for some time offering continuity of service. All the service users were consulted and they gave me very good feedback on the care and comfort they receive from management and staff. I also spoke with two representatives who visit weekly. They said that they are satisfied with what they have seen when they visit and that their relation was very happy. Weekly fees paid vary from £425 to £475. Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Commission are making changes to the regulations and inspection of social care agencies. Inspecting for Better Lives (IBL). We are modernising the way we inspect all social care services and will be more proportionate, more focus on the experience of people using services and focus on providers to ensure quality. The inspector visited Polsloe on the 29th august 2006 and spent six and half-hours at the home. This was a key inspection visit. On the day of inspection 12 service users were resident in the home. The inspector met with 10 service users, a number of staff and the relations of one service user to gain their views on the service that Polsloe provide. In addition the records, policies and procedures and premises were inspected. This report summarises the findings of this inspection. What the service does well:
The home provides a comfortable homely environment that is clean and safe for service users, staff and visitors. There is ample sitting and dining space and suitable washing and toilet facilities. There is a non-smoking policy in the home but those who wish to smoke can do so in the conservatory. There is a friendly welcoming atmosphere and one service user said “It is a happy ship, if the staff are happy you can’t go wrong”. Comments from service users generally include “It’s a lovely home”, “Staff are kind and caring”, “I am very happy here and I like my room” and “Staff stay here which is always a good sign”. Service users said they are well cared for in the home. Each had a written care plan detailing their individual needs and guiding staff on how needs are met. The plans were compiled with the service user, reviewed regularly and signed. Doctors, Nurses and other healthcare professionals visit the home to provide care when necessary. Equipment is provided for moving and handling purposes and for the prevention of pressure sores. There is a medicines policy and staff receive training in the safe handling of medicines. Medication records are kept for each service user. A pharmacist visits the home regularly to check the systems in place and to offer training to staff. Ranges of activities including religious services take place regularly and service users were aware of what was on offer. Service users are able to maintain contact with their family and friends as they wish and I noted the constant flow of visitors on the day of the inspection. Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 Page 6 The food served is to a good standard with homemade cooking, fresh fruit and vegetables. At present Mrs Butland the registered manager consistently shows that she has full knowledge of the regulations and standards expected of her meet the needs of service users The home has a policy to protect service users from harm and abuse. Staffing levels meet the needs of service users and staff morale is good. The management run the home in the best interest of the service users. What has improved since the last inspection? What they could do better:
The manager is reviewing the care plans. The reviews that are carried out are not in line with the instructions and training given by the manager. The review sheet identifies outcomes and actions to be taken. Staff follows the assessment and care plan but do not complete the review in line with the directions detailed in the review sheet. The staff must not routinely write “None at present” and “None necessary” as their contribution to the reviews. Records must evidence that the changing needs and current objectives for health and personal care are reviewed and actioned.
Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 Page 7 The daily records should detail what actions staff have taken to offer reassurance and comfort to service users when they are experiencing difficulties. Comments such as “Service user in room and has began shouting to go to bed” should be expanded to evidence what action the staff have taken to resolve the matter. New staff applications should record the last ten years of employment on their application forms. A systematic review system should be set up to audit when reviews of service users records and policies and procedures takes place. 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. Polsloe House Ltd DS0000062250.V296681.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 Polsloe House Ltd DS0000062250.V296681.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Comprehensive needs assessments are carried out before service users move in to the home; this ensures that the needs of the service user can be meet. EVIDENCE: Three service users files were case tracked. Detailed assessments had been recorded for each service user. They were dated and signed, and contained sufficient detail on areas of need. There were detailed risk assessments and moving and handling assessments. I talked with the newest service users who moved from out of county to Cornwall. The service user felt that his admission had gone smoothly and that he was settling in well. He also said that his son assisted him throughout the admission and he thought the manager and staff involved him in all discussions and decisions that had to be made. Intermediate care is not provided at the home. Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 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 area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Each service user has an individual assessment/care plan setting out their health, personal and social care needs; these are detailed to guide and direct the staff providing care, however reviews do not record the outcomes and actions to be taken and reliance on stock phrases are being used. Service users have access to health care services as necessary to ensure their assessed needs are met. Risk assessments for moving and handling and the risk of falling are adequate to protect all service users. The home’s policies and procedures and practice on medicines protect service users. EVIDENCE: As detailed in “What they could do better” the manager is reviewing the assessments/care plans to inform and direct staff. The reason for this is that the manager wants to give much clearer guidelines for the staff providing care and when they review the service users. Currently the staff are failing to record what outcomes and actions they are providing for staff and have got themselves into bad practice by writing “None at Present” or “none necessary” as the sole entry in some cases on the review sheets Review are shared with the service users and the manager and staff are proactive in their dealings with the family and representatives of the service users. Environmental and
Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 Page 11 personal risk assessments are undertaken and reviewed and all service users have a moving and handling assessment. All service a user are registered with a doctor of their choosing and visits by them are made at the request of the manager and staff. The district nurse is currently visiting service users and their files are retained in the service users room. When the nurse visits she sees the service user in the privacy of their room. Aids and equipment are provided by the manager for the dependent service users and staff are provided with appropriate moving and handling equipment so that the dignity of the service users is paramount. A monitored dosage system is used and I observed the senior care assistant dispensing the medication correctly. A check of the medication system and Controlled Drugs book evidenced that everything was satisfactory and that the service users are protected by the homes medication policies and procedures. Staff receive training in the safe handling of medicines from Penwith College and the local pharmacist. All staff that dispenses medication to the service users have been trained in the safe handling of medication. . Records were well maintained for receipt, administration and disposal of medicines. Service users were confident that their healthcare needs were monitored and addressed and made positive comments about the qualities of the staff and the care that they received. Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 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 area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users could enjoy a lifestyle to suit their preferences, their social, recreational and religious needs were catered for. The home ensures that service users have ample opportunity to maintain contact with their family and friends as they wish. Service users dietary needs are well catered for with choices offered at all meal times. EVIDENCE: There is a very relaxed and warm atmosphere at the home. The service users can please themselves what they want to do when they want to do it. Activities including religious services are recorded on the white board in the main lounge and the day, date and year are filled in each day. Service users were aware of the activities and are working towards the Open fete day due to take place to raise money for the comforts of the service users. Some service users said they enjoy the activities but others were happy not to participate and this was respected. Service users said they were able to maintain contact with family and friends as they wished and I noted the constant flow of visitors on the day of the inspection. The relatives I spoke with said that they were very pleased with the manager and staff and were made to feel comfortable and were
Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 Page 13 offered hospitality when they visit. There is a visitor’s book, which all visitors to the home have to fill in. Service users said the meals are very good and there is plenty to eat. The lunchtime meal was nutritious and homemade. Fresh fruit and vegetables are included on the menu. Choice is offered to the service users at mealtimes. Likes and dislikes were recorded and available to staff. Food records are maintained in sufficient detail to evidence that the diet is well balanced. The dining room has been redecorated and looks very smart and clean and there is attention to detail in the dining room with tables that seat up to four people, good quality cutlery and crockery, table cloths and small vases of flowers. Jugs of squash are available throughout the communal rooms for service users. The Environmental Health Officer inspected the home in August 2006 and reported that everything was satisfactory. He left a folder titled ”Safe Food” for the home to use. The manager can also complete the training sheets to audit the catering arrangements of the home to demonstrate “due diligence” under The Food Safety Act 1990. Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 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 area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service Users complaints are taken seriously and acted upon with all service users and their representatives provided with clear information on the home’s formal complaints procedure so that they are aware of the options open to them if they are dissatisfied with any aspect of their care. There are systems in place to protect service users from harm and abuse with evidence that staff training in the protection of vulnerable adults to enable staff to protect service users from abuse takes place. EVIDENCE: Most of the service users who I talked with stated that they are satisfied with the care and services provided to them at the home. Some said that they had confidence in the home’s manager and staff team who were attentive to any concerns they had. All service users and their representatives are provided with written copies of the home’s complaints procedure and The Statement Of Purpose is on display in the front entrance along with the inspection report. Service Users I talked with at the time of the inspection said that they felt safe in the home. There are written procedures in place to guide staff on the action to take if they suspect abuse of a service user. The manager and some of the staff have undertaken multi-agency training on protecting vulnerable adults from abuse. The manager explained that she has put staff names forward for the next intake of training but the waiting list is very long.
Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 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): 19,26. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home and grounds are well maintained providing a safe environment for service users, staff and visitors. There is evidence throughout the home of investment in the redecoration, refurbishment and upgrading of the spacious grounds. The decoration and furnishings are to a good standard creating a comfortable home which is safe for service users. EVIDENCE: Since the company has taken over a year and a half ago there have been major improvements throughout the home both internally and externally with the result that the home is well maintained, decorated and furnished to a high standard. It was very clean, homely and comfortable. The grounds were very tidy and accessible. There are nice views of the front garden from the lounge and conservatory. Some said that having made difficult decisions to leave and sell their homes they were now very happy in their surroundings. There is a large lounge and a conservatory. There is a separate dining room, which has recently been redecorated. The service users said it was very light
Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 Page 16 and airy with tables that seat no more than four people. The home is nonsmoking but smokers can utilise the back conservatory, which was recently built by the providers. All staff have training in Infection Control and protective clothing and the staff uses disposable gloves. All personal and the homes laundry are laundered on the premises. I talked with the service users about their laundry service and the feedback given to me was that service users were satisfied with the way their clothing is laundered. Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 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 area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Staffing levels generally meet the needs of service users. The recruitment processes carried out for the most recent members of staff protected service users. The training policies and practice develop the knowledge, skills and competence of staff in all required areas. . Staffing ratios have been increased by day and night to meet the needs of the service users. EVIDENCE: The staff roster details the deployment of staff. Staff duty rota’s evidenced that there are two care assistants on duty throughout the twenty-four hour period. In addition there are two cooks and one domestic/handyman on duty. Two staff files were case tracked and evidenced that staff recruitment is conducted in line with the policies and procedures of the home. e.g. records contained an application form, references job description, equal opportunities declaration and a Criminal Records Bureau disclosure and POVA check. It is recommended that all prospective staff record the last ten years of employment. Staff records inspected evidenced that they had completed an induction complying with the ‘Skills for Care’ specification. 90 of the staff hold NVQ
Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 Page 18 level two and some hold NVQ level 3.The manager is arranging updating and ongoing training for staff in safe moving and handling, basic health and safety, first aid, food hygiene and adult protection. The service users told me that they are satisfied with the skills and competence of the staff who are responsive to their needs at all times. I observed the staff at meal times and throughout the day and I noted the good relationship they had with the service users. Staff called people by the name of their choosing and knocked on doors before entering. Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 Page 19 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): 31,33,35,36,38. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home is run in the best interest of the service users and they are safeguarded by the financial procedures employed. There are policies in place to safeguard service users. The records required by legislation are maintained and were found to be up to date. Appropriate training and safety checks are undertaken to ensure the health, safety and welfare of service users and staff. There is formal quality assurance and control system based on seeking the views of service users to ensure that the home is run in their best interests. Staff receive appropriate supervision to support them to work to the policies and procedures and meet the aims and objectives of the home EVIDENCE: Mrs Butland has many years’ experience of working in hospitals, nursing and residential homes. She works hands on with the staff offering them support,
Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 Page 20 supervision and guidance. The manager throughout the inspection demonstrated a good understanding of the legislation regarding health and safety. The manager has carried out an internal audit of quality assurance, which includes opinions from service users, staff, relatives and other interested stakeholders. As a result of the quality assurance audit an annual development plan for the home, based on a systematic cycle of planning, action, review, reflecting aims and outcomes for service users. Service users or family and representatives take responsibility for paying fees and managing their personal money. The manager only manages small amounts of personal money for a few service users. Records are maintained and signatures are obtained from service users when money is withdrawn. The staff stated they are reliably and well supported by the manager who is always available to offer advice and guidance when required. Staff meetings occur on a regular basis and the staff stated there was also positive mutual support amongst the staff group. Statutory documentation was in place that evidenced the various service documents and reports. The equipment and services at the home are regularly maintained and serviced and suitable arrangements are in place to promote the service users safety and well being in the event of a fire. The fire records were found to be up to date and in sufficient detail with staff receiving fire instruction at the recommended intervals Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 Page 21 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Each service user review should record the outcomes and actions to be taken and reliance on stock phrases should be discontinued. Application forms should detail the last ten years of staff employment details. 2 OP29 Polsloe House Ltd DS0000062250.V296681.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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