CARE HOMES FOR OLDER PEOPLE
Polventon House High Street St Keverne Helston Cornwall TR12 6NS Lead Inspector
Stephen Baber Key Unannounced Inspection 28th September 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 Polventon House DS0000066615.V303481.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. Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Polventon House Address High Street St Keverne Helston Cornwall TR12 6NS 01837 849029 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) Melita Care Homes Ltd Mrs Christine Stewart Care Home 19 Category(ies) of Dementia - over 65 years of age (5), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (19), Physical disability (1) Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection First Inspection. Brief Description of the Service: Melita Care Homes Ltd trading, as Polventon is a private residential care home providing personal care and accommodation to 19 older people some of whom may have a dementia or other mental health problems. The home is a detached house with a modern extension in the village of St Keverne approximately eleven miles from Helston town. The home provides respite and day care facilities. All bedroom accommodation is single with the one registered double currently being used as a single. Polventon does not have rooms with ensuite facilities but bathrooms and toilets are spread out throughout the home. There are facilities for disabled service users to access the home and there is a shaft lift that serves ground to first floor in the main building. All accommodation is on one level in the extension. The home is privately owned and the registered providers are closely involved in the day-to-day management and administration. The home also has a manager registered with the Commission, a team of care staff, ancillary staff and a maintenance man employed to assist in the smooth running of the home. There is communal space available throughout the home for service users to have quiet or listen to music. There are ample, very well maintained and safe grounds for service users to enjoy. The health centre provides medical cover, which is next to the home. Fees range from £385 to £480 per week. I asked the manager to explain the philosophy of the home under the new providers? She said that the home is committed to continuous improvement, quality services, support, accommodation and facilities which ensure a good quality of life and health for service users. Polventon House DS0000066615.V303481.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. This was an annual key inspection, which took place over one day and was unannounced. It lasted for 71/2 hours. The Commission received information about the home in the form of the pre inspection questionnaire and this was taken into account when planning the inspection. The purpose of the inspection was to ensure that service users’ needs are appropriately met in the home, with particular regard for ensuring good outcomes for them. This involved discussion with service users and observation of the daily life and care provided. There was an inspection of the home’s premises and of written documents concerning the care and protection of the service users and the ongoing management of the home. I talked with staff and observed them in relation to their care practices. I also had open and honest discussion with the home’s manager. The principle method used was case tracking. This involves examining the care notes and documents for a select number of service users and following this through with interviews with them and/or their relatives and staff working with them. This provides a useful, in-depth insight as to how service users needs are being met in the home. At this inspection, three of the service users were case tracked. This was the first inspection for the new owners. The manager Mrs Stewart transferred over with the new owners. What the service does well:
A great deal of the documentation that was used previously has been reviewed and updated and the new owners have continued to use the formats that were previously successful. Service users are assessed prior to being admitted to the home so that they can be sure it will be suitable for them. They are encouraged to contribute their own views to the assessment process so that their care can be better tailored to their preferences.
Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 6 The systems for managing service users’ medication has changed but the new system is very effective and safe to ensure that service users are generally well protected from medication errors. Service users interviewed at the time of the inspection said that the manager and staff look after them well and that they are very pleased with the new owners. Staff were observed to treat service users with respect at all times during the inspection and records suggest that they are appropriately consulted about matters relating to their privacy and dignity and autonomy and choices afforded them. The home aims to ensure that service users have good outcomes and enjoy a good quality of life. The atmosphere in the home was very warm and relaxed and service users were doing what they wanted to and staff were very supportive. Every afternnon there are activities and on the day of the inspection a quiz took place. Those people who wished to participate did and those who wished to come to the bottom lounge to observe did. At the end of the activities the manager always goes around the service users and encourages them to raise any issues that are bothering them. The quality assurance exercise has been completed and other interested stakeholders views were sought. Two district nurses and case coordinator replied to the questionnaires and other professionals did not have the courtesy to respond. The feedback was very positive from service users and their relatives. All of the service users expressed satisfaction with the food provided to them and I noted the attention to detail on the dining tables which made for a pleasant dining experience for the service users. There is a choice of foods at each meal and plenty of variety in the menus. Service users’ dietary needs and preferences are considered as part of the assessment and care planning process so that their nutritional needs can be properly met. Service users interviewed stated that they feel safe and are well cared and that the manager and staff were helpful and kind. The home is very much part of the community and the local village is actively involved in the home. There is an open door policy to visiting and people are given hospitality when they arrive. There has been a significant improvement in the number of staff that have NVQ level 2 and 3. Service users can be confident of the competence and skills of people working with them. The home is well and competently managed for the benefit of service users. The manager is very experienced, a qualified nurse and has care and management qualifications. She leads by example and supports, guides and supervises staff on a daily basis. The registered providers are also actively involved in the day-to-day management of the home and are readily available to staff and service users. The company complete a monthly regulation 26 report on the conduct of the home. Copies of the reports are retained in the home.The manager appreciates their contribution and support. Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 7 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. Polventon House DS0000066615.V303481.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 Polventon House DS0000066615.V303481.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): 1,3,6(n/a) 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 provides a Statement Of Purpose that clearly sets out the objectives and philosophy of the service supported by a Service User Guide that summarises the Statement Of Purpose and provides clear information about the home. The guide is precise in what the prospective service user can expect and gives a good detailed account of the quality of the accommodation, qualifications and experience of the staff, how to make a complaint, recent CSCI report. All service users are given a copy of the Guide. New service users are admitted on the basis of an assessment of their needs. This ensures that service users and their representatives can be fully confident that the home is suitable for them. EVIDENCE: The home’s statement of purpose provides clear information on the admission procedure, which is on the basis of an assessment of a prospective service user’s needs, to ensure they can be met. There are written assessments on
Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 10 service users’ personal files, which cover all their personal, health and social care needs, including needs relating to their religion. Service users are invited to contribute to the assessment process and the files case tracked evidenced their participation. Service users interviewed indicated that they were assessed prior to admission to ensure that the home was suitable to meet their needs. All three records evidenced consideration of risks, which included personal. Environmental and situational risks. The home does not have dedicated facilities for intermediate treatment although the statement of purpose provides information to assist service users wishing to be admitted for short periods of respite care. There is an accurate description of the facilities the home can provide in the Statement Of Purpose. Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected 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. The home ensures that service users are regularly and individually consulted about their satisfaction with their involvement in both the development and review of the plan. Service users receive clear feedback on all decisions and actions that effect the placement and their individual care. Practice is supported by policies and procedures and practice guidance. The home works to an efficient medication policy supported by procedures and practice guidance. EVIDENCE: Service users have detailed written care plans, which address all their personal, health and social care needs, including needs relating to their religion, culture and ethnicity. Their care plans state the aims and objectives of their placements in the home, which is particularly important for service users undergoing short-term or respite stays with a view to returning home. There is evidence that service users are consulted on key aspects of their care planning, which directly affect them. Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 12 The home has reverted to the Boots Monitored Dosage system. Medication is administered by staff that are trained and competent members of staff. Storage, administration, recording and disposal of medication satisfy the guidance stipulated by legislation and regulation. The pharmacist inspects the medication system and gives training to staff. Service users interviewed confirmed that they are well cared for and staff treat them respectfully. The records evidenced that service users are consulted on important matters relating to their care, privacy autonomy, choices and dignity. Observations made by me showed that people are called by the name of their choosing and staff knocked on doors before entering. Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected 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. Family and friends are welcome and know they can visit the home at any time. Staff always make time to talk to visitors and share information with the agreement of the service users. The layout of the home provides seating areas within the communal areas of the home where service users can entertain visitors, in addition to the privacy of their own rooms. It is clear that the home encourages individual and groups from the community to visit the home. Food and mealtimes are treated as an occasion and something to be looked forward to. An experienced cook is responsible for providing quality nutritional meals that meet the cultural and dietary needs of the service users. EVIDENCE: The manager visits all service users each morning. This she says is the special time she has with them where they can discuss anything with her. With regard to the daily activities there is a notice board, listing activities available to service users on a daily basis. Service users’ assessment and care records indicate their social and recreational interests, which they are encouraged to pursue following admission. There are no restrictions on visitors and service users are able to go out with relatives whenever they wish. Service users confirmed that they are able to choose whether or not to join in with activities and some chose to remain in their rooms rather than go to the
Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 14 party. All those interviewed stated that they are satisfied with the care and services provided to them at the home. There are records on their personal files relating to important decisions about their care, which they have been consulted on. The Environmental Health Officer recently inspected the home and found everything satisfactory. The home’s menu plans indicates that there is a choice of home-prepared meals at every mealtime and there is plenty of variety in the food served. Staff are available to provide service users them with assistance if necessary. Their individual care plans indicate their dietary needs and preferences. All of the service users interviewed stated that they are very satisfied with the food provided to them The dining room is bright and airy and small tables seat up to four people. The attention to detail in the dining room and on the table makes for a pleasant dining experience. Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 15 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. Polventon has an up to date complaints procedure, which is very clearly written and is easy to understand. The policies and procedures regarding Adult Protection of service users are very detailed and are reviewed and up dated. The manager is clear when incidents need external input and who to refer the incident to. EVIDENCE: There have been no complaints. The home has a very detailed complaints procedure that explains the types of complaints that can be made and the timescales for the resolution of complaints. The home has written policies and procedures to guide staff on how to recognise and prevent abuse of vulnerable adults. The manager and deputy are going on local multi-agency training and will cascade their knowledge onto staff working in the home. Recruitment procedures demonstrate how staff should be recruited on the basis that they are safe to work with vulnerable adults. Service users said to me that they feel safe and protected in the home and that all the staff are kind. Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 16 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 has a well-maintained environment, which provides aids and equipment to meet the care needs of the service users. It is very pleasant and a safe place to live with service users encourage to personalise their rooms with treasured mementos from home. EVIDENCE: The home was warm and kepted clean, tidy, well maintained and comfortable at the time of the unannounced inspection. Service users’ rooms and communal areas are well furnished and equipment to make the home safer for them is available. There are written risk assessments of the home’s environment and in respect of fire safety, which are regularly reviewed. The home is Systems are in place to control the spread of infection, in accordance with relevant legislation and published professional guidance.
Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 17 All personal and the homes laundry are laundered on the premises. The new owners have purchased a new commercial dryer since taking over the home. Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 18 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. Service users have confidence in the staff that care for them. Rotas show well thought out ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the service users. The providers and manager encourage staff members to undertake qualifications and recognise the benefits of a skilled, trained workforce. The service clearly defines the roles and responsibilities of staff through accurate job descriptions and person specifications. Service users report that staff working with them are very skilled in their role, and are consistently able to meet their needs. EVIDENCE: There is a significant increase in the staff that holds NVQ level 2 and 3. Nine of the thirteen staff has a nationally recognised certificate. Polventon enjoys a very stable group of staff that have worked at the home for many years. There is a clear, written recruitment policy and recruitment documents provide evidence that this is adhered to in practice. There is a comprehensive policy to ensure that staff are recruited on the basis of equal opportunities. Interview records are retained and there is evidence that staff have undergone necessary checks to determine their suitability to work with vulnerable older people. Records of staff attendance at training courses are maintained on their files. All new staff undergoes detailed induction training, (Skills for Care). There is a reliance on in-house training and this is down to
Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 19 the cost and time to pursue external courses. Courses are conducted in house and through local colleges and independent training providers. The manager also organises in-house training courses for staff and often cascades the knowledge gained to all levels of staff. Two new members of said that they are pleased to have a recognised national qualification, which evidences that they are trained to do the job. Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 20 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 manager and providers have the required qualifications/experience and are competent to run the home. They work to continuously improve and provide and increased quality of life for the service users. There is a strong ethos of being open and transparent in all areas of running the home. The management team are service user focused and lead and support a strong staff team who have been recruited and trained to a good standard. The management team are aware of developments nationally and by CSCI and plans the service accordingly. EVIDENCE: The home’s manager is registered with the Commission as a fit person to be in charge of the home. The company representatives are also in regular contact with the home. All were present at the time of the inspection. The manager
Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 21 runs the home very well for the benefit of the service users and discharges her responsibilities fully. The yearly quality assurance exercise has been completed for the home. The results have been consolidated but this should be further developed to have an action plan based on a systematic cycle of planning-action and review, reflecting the aims and outcomes for the service users. The staff at the home said they were well supported by the managers and informal advice and guidance was readily available when this was required. In each unit the managers have established regular opportunities for staff to be formally supervised about their work and each staff member has an annual appraisal. Family members or service users manage their financial affairs. The manager manages one service users account. The record sheet was looked at and the good practice of the service users signing for when withdrawals took place was in place. Suitable policies and procedures are in place to promote safe working practises and provide a safe environment for service user and staff. The new providers have given each member of staff a staff handbook, which clearly sets out what is expected of them. The equipment and services at the home are regularly serviced and maintained and appropriate fire precaution and fire safety measures are in place. Service users and staff said they were confident that every reasonable effort was made to provide a healthy and safe environment. Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X 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 3 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 4 x 3 X 3 3 X 3 Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 23 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 2 3 Refer to Standard OP7 OP33 OP37 Good Practice Recommendations Review sheets should be placed at the back of the care plans and reviews record when they take place. An action plan should be drawn up based on a systematic cycle of planning-action-review, reflecting the outcomes for service users. The Equal Opportunities policy should be developed further to incorporate diversity in the areas of race, belief, gender identity and disability. Polventon House DS0000066615.V303481.R01.S.doc Version 5.2 Page 24 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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