Inspection on 14/01/08 for Ponsandane

This inspection was carried out on 14th January 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ponsandane 12/12/06

Ponsandane 11/10/05

Ponsandane 10/05/05

Ponsandane 09/02/05

Ponsandane 05/08/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

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

CARE HOMES FOR OLDER PEOPLE Ponsandane Chy-an-dour Penzance Cornwall TR18 3LT Lead Inspector Stephen Baber Expert By Experience Linda Wilson. Unannounced Inspection 10:00 14 January 2008 th 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 Ponsandane DS0000009091.V347939.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. Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ponsandane Address Chy-an-dour Penzance Cornwall TR18 3LT 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) 01736 330063 01736 332343 callerton@swallowcourt.com Swallowcourt Limited Miss Lisa Allen manager designate. Care Home 58 Category(ies) of Dementia - over 65 years of age (6), Learning registration, with number disability (9), Old age, not falling within any of places other category (58), Physical disability (18) Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Dementia over 65 years of age, excluding learning disability or mental disorder (DE(E)), maximum 6 Learning disability, over the age of 50 years with associated nursing needs (LD), maximum 9 The Home may accommodate up to 5 service users aged between 50 65 years for respite or permanent care. These service users may be across the registered categories, depending on need. 12th December 2006 Date of last inspection Brief Description of the Service: Ponsandane is a private care home providing personal care and accommodation for fifty-eight elderly people in need of residential and nursing care. The home is registered under the terms and conditions set out in the Care Standards Act 2000 and Care Homes Regulations 2001. The home is situated on the outskirts of Penzance town and is a short distance away from the main London to Penzance railway station. The bus route out of Penzance runs past the home and this makes reaching to the home easy if you haven’t got a car. There are panoramic views of St Michaels Mount and the bay from the front of the home. Some of the rooms have ensuite facilities and there is one shaft lift that serves ground to first and second floor as well as two chairlifts to aid the more dependent service users who find getting to their room difficult. The home provides spacious communal space and there are several rooms where people can meet with their visitors including their own rooms. The home has its own mini-bus, which is enjoyed by the service users especially when trips out are arranged. This service is free to the service users. Medical care is provided by several General Practitioners practices with the manager and staff working closely with all community professionals to provide a high quality nursing and residential care experience for the service users. The Managing Director who is the Responsible Individual for Swallowcourt company visits daily and offers support, guidance and supervision to service users, management and staff. As representative of the Company she writes a monthly report on the conduct of the home in line with her responsibilities under regulation 26 of the Care Standards Act 2000. Current weekly fees range from £393 to £700 per week. Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) have made changes to the way we inspect services. Known as Inspecting for Better Lives (IBL). We are now more proportionate when reporting our findings, and more focused on the experience of people using services. The purpose of the inspection was to ensure that resident’s needs are appropriately met, with good outcomes provided to them. This was the first inspection for the new manager who has submitted her application to the Commission to be registered under The Care Standards Act 2000. The Commission have introduced Experts By Experience. This project was developed to improve social care services by involving people we can use in our inspections. Areas covered by the expert included talking with the service users and staff, observations of daily life and relationships between staff and people who use services and a look around the premises. The expert spent over 4 hours in the home and gave very comprehensive feedback to management at the end of her visit. This was a key inspection, which was unannounced. It took place on 11th and 14th January 2008 and lasted for approximately 12 hours. The purpose of the inspection was to ensure that service users needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that service users placements in the home result in good outcomes for them. The inspection included interviews, some held privately in service users rooms and some in the communal area of the home, with service users and visiting relatives. Several members of staff were interviewed and there were opportunities to directly observe aspects of service users’ daily lives in the home and staff interaction with them. Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with the manager and managing director who were present throughout the inspection. The managing director explained that the company are making major improvements throughout so that service users receive quality care in a comfortable environment. The principle method of inspection was “case tracking”. This involves interviews with a select number of service users; staff caring for them and/or their representatives, and examination of records relating to their care. This provides a useful impression of how the home is working overall. At this inspection three service users and one learning disability service user were case-tracked, with particular reference to their individual and diverse needs Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 6 relating to their age, culture and ethnicity, religion, gender, sexual orientation and disabilities. The Expert By Experience submitted a report and we have dovetailed her observations into the main body of the report under specific headings. “A stately Georgian building set on the outskirts of the town surrounded by well kept gardens with neighbours peacocks parading in the grounds, is home to 53 residents at present and 60 staff. On entering it gave the impression of a hotel with the office of the manager to the left followed by a staircase and two rooms to the right of the entrance hall. On arrival we were told by posters on the door and by the manager there had been two cases of “D and V” and so after the lead inspector had conferred with me and the manager it was decided that the inspection go ahead and some rooms and staircase where the infection was located were areas to be avoided. Visitors were also asked to refrain from going to this area for fear of spreading the infection. I was shown around the home by the managing director (The Swallowcourt Group bought the building in 1996.) and several residents kindly spoke to me in their rooms and in the dining room. What the service does well: Service Users are only admitted following a thorough assessment to ensure the home can meet their needs. Prospective service users and their family are invited to visit the home prior to any decisions being made to live there. One resident said that the manager visited her prior to admission and told her all about the home. The home pays great attention to keeping families involved with a person’s care. Service users said their healthcare needs are met and specialist healthcare professionals visit the home when required. Appropriate equipment is provided for pressure relief and moving and handling purposes. There is a suitable system for medications. There are several risk assessments undertaken to enhance the service users care. All service users spoken with said the care is to a high standard and they are very happy living in the home. They said they are treated with respect and dignity and their privacy is upheld at all times. They also said their individual preferences are respected and they can choose what they do each day. There is an open visiting policy and visitors said they are always made welcome and can visit when they like. Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 7 Social activities take place each day and are organised by a co-ordinator. There are posters to inform service users of what’s on and when; records of attendance are kept. Time is spent on one to one sessions when staff and service users get to know each other. Life histories are on file to help staff interact with residents. Service users talked about activities such as trips out, shopping, keep fit and the art class. This is a small example of the activities carried out. Staff training continues to receive a high priority with the company establishing a corporate approach to policies and procedures throughout its homes. Staff felt well supported in their roles and enjoyed the opportunities they are offered regarding training. The manager is pro-active in maintaining and promoting self-audit procedures in an effort to improve standards. Team work is given high priority with the manager explaining that she applies the principles of equality and diversity to the service users and staff. One example of this was a person from another country came to work at the home and she was not happy with some issues that she felt was not being managed. We established from her that she is now very happy with the current manager and the way things have been resolved to everyone’s satisfaction. The service provides a well maintained home set in large tidy grounds. It is clean, warm and comfortable with good measures in place for the prevention of infection. There is a nutritious menu and service users said the food is good. Fresh fruit and vegetables are included. All service users spoken with said they enjoy the food and it is of a very good standard. A glass of wine or juice is on offer with meals and the menu card is on the tables with choice recorded. There is a robust recruitment policy and procedure. There are suitable staffing levels with a skill mix that meets service users needs. Service users said the staff are very kind and caring. One said, “The staff are wonderful, I am very well looked after”. What has improved since the last inspection? Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 8 The company continue to invest in the home and since the last inspection redecoration and refurbishment of some parts of the home and individual rooms has taken place. The manager along with the managing director have reviewed the home’s staffing and feel that a more structured system is now in place. On the day of the inspection there were 10 care assistants, three nurses as well as domestics, administration, maintenance and chefs and kitchen staff on duty. The company have introduced new comprehensive policies and procedures and are about to install a computer in the nursing office with direct links to the main registered office. The care documentation has had a complete review and new assessment forms are in use. The care plans are being compiled in more detail to inform and direct staff in the care provision. The fire risk assessment has been re-written in more depth. Overall standards have been maintained and in some cases improved upon. Management and staff are working hard to achieve the best possible care for those who use the service. What they could do better: We gave very comprehensive feedback to the manager and managing director. The care documentation is being upgraded and will inform and direct the staff when completed for all service users. The Expert by Experience said to the manager that overall the feedback from the service users was very positive about the care and comfort they receive. However two service users said that there are occasions when they ring their bell and seem to be waiting a long time for staff to help them. The manager was receptive to this and said that she will look into the matter. The commitment to training is excellent and staff receives comprehensive training. However staff are not put on Skills For Care Induction until they commence their NVQ training. This is incorrect and all staff must commence this induction training from appointment. Whilst staff receive regular monthly supervision the records evidenced that the supervision was mainly task orientated. Supervision is also an opportunity for Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 9 staff to discuss career developments, care issues and any matters that they wish to share with the supervisor. When reviews take place for service users with a learning disability it would be helpful if the social worker and family representatives were invited to the review. The challenge for the manager is to improve on the high standards already set. She said that she is looking forward to the challenge ahead of her. 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. The summary of this inspection report can be made available in other formats on request. Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 10 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 Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 was assessed. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are only admitted to the home following an assessment of their needs to ensure the home can provide suitable care. Views expressed by a number of service users & relatives showed that they had made a positive choice by selecting Ponsandane and that the home had sought sufficient information before a placement. EVIDENCE: The manager visits prospective service users to gain essential information from all those concerned with their care. Family and friends are fully involved and the views are sought from the manager. This forms the basis of an immediate care plan on admission, which is then reviewed as the service user settles. The care plan is updated as needed at regular intervals. Service users and their relatives are encouraged to visit prior to taking up residence. The service users I spoke with said that they appreciated the time Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 12 the manager extended them to try to find out their likes and dislikes before admission. They also said to me that it helped them to know about the home prior to admission. The Expert By Experience in her report said: “Some of the residents were unable to walk without help and two of these told me that they had to wait to be taken to the toilet when pressing the buzzer. One lady explained that she would get “frantic” while waiting. The same lady, who used to be a nurse, also said that the home was perfect otherwise and “amazingly clean.” The subject of cleanliness was echoed throughout the visit.” Both of these residents were satisfied with their care otherwise. Only two of the residents interviewed in their rooms wished to venture downstairs to the dining room or lounge and had been on trips to the supermarket and garden centre. The Home has their own bus, which is fully adapted. The other residents said they were happy to stay in their room and had their meals delivered to them. As I walked along the rooms staff were taking cups of beverages and biscuits to residents in their rooms and there was also cleaning and tidying being carried out”. ” The Company have said in their AQAA that their plans for improvement in the next twelve months are: “To be constantly investing in the structure and refurbishment of the home. To constantly invest in staff training and development. To look for new innovations and equipment so that our care homes are at the forefront using modern equipment and up-to-date methods. To address any areas of concern that arise quickly and efficiently. To address any areas arising from inspections or visits from CSCI”. Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care plans are generated for each service user, they are all being reviewed and updated to fully inform and direct staff in the care provision. The standard of care planning set is high and is being maintained. Service users have access to health care services as necessary to ensure their assessed needs are met. There are systems and policies in place for dealing with service users medicines that assure service users safety. The homes policies, procedures and culture ensure that service users are respected and their privacy and dignity is upheld at all times. EVIDENCE: The home maintains a comprehensive system of care planning. Service users are assessed at regular intervals. The care plan includes a photograph of the service user, physical and mental health assessments, GP and external health / social care professional visits and a daily record, which includes social activities Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 14 and visits from friends and relatives. All service users are registered with a GP at the local practice. Chiropody and dentistry is available on a domiciliary basis. There was evidence that care plans are reviewed monthly and the service user and their representative are invited to that review. It is recommended that six monthly reviews take place for the service users with a learning disability and the social worker and representatives being invited to that review. A new style care plan is being introduced that is in line with standard 3.3 and contains more detail to inform and direct the care staff. The manager is going to introduce the new style care plan for all new service users. The files case tracked evidenced that there was a lot of relevant information in the service users files including life histories, records of health professional’s visits and relevant risk assessments. The care plans and risk assessments are reviewed monthly. The home has a medication policy. Medication was appropriately stored in a locked medication room. MAR sheets were signed and dated appropriately. The Controlled Drugs register is appropriately maintained. All medication issues remain the responsibility of the trained staff with the home continuing its policy of minimal medication for service users as far as possible There are no service users self-medicating at the present time. Service users said to me that they were treated with due respect and dignity”. The home employs it’s own recreational assistant who actively seeks out the interests and hobbies of the service users. There were good individual records of all activities undertaken in groups and individual one to one sessions. We spoke with the service users who said their health care needs are met very well and they have access to a doctor or other health professionals when required. The manager said that links with specialist healthcare professionals is very good and was confirmed by the nurses on duty. The company employ inhouse trainers who are responsible for moving and handling training and there is appropriate equipment provided. There are appropriate mattresses and cushions provided for pressure relief. Care practice was observed to be appropriate during the inspection and carried out in a calm, efficient manner. Service users said their personal care is carried out as they wish it to be and with respect for their privacy and dignity. Staff were observed to uphold service users privacy during the inspection and knocked on doors before entering and conversations that involved the care to be given were fully explained to the service user. The Expert By Experience in her report said: “” Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 15 The Company have said in their AQAA that their plans for improvement in the next twelve months are: “To maintain the high standard of care provided at the home. To improve the facilities further with more wet rooms and specialist equipment.” Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13, 14 and 15 were assessed. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users take part in appropriate activities and are encouraged to maintain their independence and individuality. Links with the local community are excellent and allow service users the opportunity to socialise. Service users have appropriate contact with family and friends according to their wishes. Service users rights and individual choices and preferences are respected. Dietary needs of residents are well catered for with a varied selection of food available to meet their taste and preference. The standards in the dining room are conducive to a pleasant dining experience. EVIDENCE: The aim of the home is to provide the service users with a qualitative experience and to empower them to have the opportunity for informed choice to maximise a fulfilled and satisfying life. I talked with the new recreational coordinator and service users about this service. Outings are arranged on an individual and group basis with the Mini bus available at all times. The recreational coordinator was able to fully explain that she takes into account a wide variation in preferences and capacity with the result that every Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 17 opportunity is made to meet individual needs. Detailed records are maintained to evidence what individual service users like to do. I observed the staff welcoming family and friends and every hospitality was given. Some family members can eat with the service users. Service users can entertain visitors in their own rooms or the communal rooms. Service users said that the arrangements for visiting were good. The staff with whom the inspector spoke showed a good knowledge of people’s individual needs and circumstances so they were able not only to respond appropriately but were aware of a service user’s previous life or experiences and could thereby share conversations that sometimes seemed muddled. Ponsandane offers a waiting service at meal times. The first class service to the service users was noted and hot and cold drinks of all sorts were available with dinner. The service users made consistently positive comments about the quality and content of the food and the standard of catering. The menu records a varied and wholesome diet. Overall the standards are very high making for a very enjoyable dining experience. The dining room is spacious and furnished to a high standard with small tables that seat up to four and tables have clean linen tablecloths and napkins. The variety of meals was well presented and appetising with a menu card displayed on the table. The service users said they enjoy their meals. The service users were unrushed and waiting staff provided appropriate individual attention with the care assistants offering help to service users who required more assistance. Nutritional needs are assessed and special diets are catered for. Meals can be taken in the dining room; other service users prefer to eat in their own rooms. A chef is employed and he said he has reviewed the menu again taking into consideration the servicec user likes and dislikes. At the moment the menu is written in a diary and typed up for display each day. Fresh fruit and vegetables are included and cakes are homemade. Food records are maintained. Service users and staff spoke highly of the chef and all said the food is very good. The kitchen has been refurbished with stainless steel fittings. The Expert By Experience in her report said: “I was introduced to the activities coordinator and at least two of the residents said she had been very helpful. If a resident is unable or does not want to go on a trip she will sit in their room and read a book to them. There is a religious service carried out by members of a local church on a Thursday when some residents take communion and sing hymns in the lounge. There are jugs of fruit juices available for residents in the sitting areas. And Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 18 there is a lounge where residents may take their visitors. Tea and coffee making facilities are in the room together with a TV and also a large table where people can sit around. I was invited to stay for lunch and had a pleasant meal in a dining room, which would not have been out of place in a good hotel. There were fresh flowers on each table (some with two seats and some with four) and a menu offering varied meals. Special diets were being adhered to sensitively according to the care plan of each resident”. ” The Company have said in their AQAA that their plans for improvement in the next twelve months are: “The combination of internal audits, quality assurance audits will continue to enable us to meet and surpass our residents’ needs. ” Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a comprehensive complaints procedure that ensures complaints are listened to and acted upon. Robust arrangements are in place for the protection of residents safeguarding them from harm or abuse. EVIDENCE: The home has a comprehensive complaints procedure that ensures complaints are listened to and acted upon. The service users who spoke to the inspector were very satisfied with the service and none had felt the need to make a complaint. Arrangements are in place for the protection of service users safeguarding them from harm or abuse. The home’s policy and procedure on the prevention of abuse complies in general with the standard. Reference needs to refer to the revised Local MultiAgency Code of Practice for the Protection of Vulnerable Adults. It is recommended that the provider obtain a copy of the code of practice from the Department for Adult Social Care. We discussed the training needs of all the staff with the training manager and internal trainers who fully explained what they did. Comprehensive training is in the protection of vulnerable adults Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 20 during induction. The manager has completed the multi-agency ‘alerter’s training’ and is scheduled to attend the follow up course in the next few weeks. New systems have been set up regarding service users personal money. Money is kept in a non-interest account and can be used for personal comforts as and when service users require money. An inventory is kept of service users’ personal belongings and furniture. All records are stored securely and confidentially. Valuables are kept in the safe The Expert By Experience in her report said: The Company have said in their AQAA that their plans for improvement in the next twelve months are: “To carry out research into the topic of restraint which affects some residents who have dementia. To monitor each area of restraint such as medication, cot sides and reclining chairs. To train staff to be aware of the freedom of liberty, at which point we need to be considering the Bournewood principles for which there is a draft code of practice available, formally due for implementation in Autumn 2008. To continue to have consent from G.P, relatives and friends for residents who lack capacity. To always evidence this in our care plan.” Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides a high standard of accommodation and the grounds are well maintained providing a safe environment for residents, staff and visitors. The home is comfortable, clean and service users said they are comfortable and well cared for. EVIDENCE: Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 22 Ponsandane presents as a comfortable, warm, homely and clean. There is evidence to show that the commitment to improving the environment continues. Discussion took place with most of the service users and visiting relatives about the individual rooms and accommodation. We were given feedback, which said that Ponsandane provides a high standard of accommodation, décor and furnishings. A group of maintenance men have a continuous redecoration and maintenance programme which includes maintaining the grounds. This is to ensure that that all parts of the home are presented and maintained to a high standard. The property has extensive landscaped gardens, which overlook St Michaels Mount. Access to the gardens has been made easier for service users with ramped areas. Some service users spoke about going out into the grounds in the better weather and seeing the wildlife. The laundry facilities are suitable with washing machines and large driers. There is a sluice on each floor with washer disinfectors. Protective clothing is supplied for staff and they were seen wearing aprons and gloves. Hand washing facilities for staff are suitable and alcohol hand cleansing gel is provided. There are relevant policies in place for infection control. The Expert By Experience in her report said: “The rooms were light and cosy having residents personal belongings on show. There were magnificent views from all the windows in the rooms. One gentleman resident did not like his arch shaped window, as he could not get curtains or coverings to fit. And one of the chest or drawers had seen better days and was a bit shabby. The resident said the drawers were sticking and she found them difficult to open and close”. The Company have said in their AQAA that their plans for improvement in the next twelve months are: “We run a continuous programme of refurbishment. When bedrooms become vacant they are redecorated and new carpets provided as required. Evidenced throughout is the commitment to providing high standards of accommodation which matches individual preferences and needs.” Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 were assessed. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The suitability of staff and their training needs is afforded a high priority. Procedures are in place to provide a good staff balance in all disciplines so that service users’ needs are met both by number and skill mix. Staffing levels meet the needs of service users and staff morale is good. Service users benefit from the care staff that are well trained or in the process of training to at least NVQ level 2 in care. Recruitment procedures are robust and offer protection to the service users. EVIDENCE: There is a recorded roster, which detail the staff’s planned work. As observed there were three nurses and ten care assistants on duty during the morning. This means that service users can have special time set-aside for them. Care staff are in sufficient numbers to meet the needs of the service users. The training manager and internal trainers said that they aim to provide welltrained staff. Ponsandane exceeds the 50 level of N.V.Q level two qualifications with several staff attaining level 3. One senior carer said she would like to undertake level 4 and the company looked favourably upon this. The following example whilst not being exhaustive is an example of some of the training provided by the company: Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 24 Courses undertaken by care staff are the principles of care, moving and handling, fire prevention, food hygiene, first aid, health and safety, No Secrets, Safeguarding Adults from abuse, death dying and bereavement, infection control and role of the care worker. There is also a training matrix compiled by the training manager with courses recorded for the coming year. We discussed with the internal trainers the structured induction given to all staff. Records of partially completed induction training were on file, with completed sections appropriately signed and dated. All staff have individual training records which include ‘Performance and Development Reviews”. There is a summary training plan, which details the training that staff have received and the ones inspected were up to date. A staff member interviewed at the time of the inspection reported that they are provided with good access and support to undertake training to develop their knowledge and skills for the benefit of service users. There is a recruitment policy and the home operates an equal opportunities policy. There is overseas staff employed. One said she is very happy working in the home and all staff are treated equally. Staff files inspected contained the documents required by legislation and included interview records. Staff are issued with terms and conditions of employment and an appropriate job description. Relevant employment checks are made. The Expert By Experience in her report said: “The staff were friendly and pleasant and waved to the residents when passing their rooms. One staff member had been employed for 7 years and said it was a comfortable place to work in and there was respect for the residents and staff alike. Training is carried out in house by specialist and experienced trainers. There is also a comprehensive induction period with mentoring afterwards. There are regular staff meetings and resident meetings” The Company have said in their AQAA that their plans for improvement in the next twelve months are: “It has been identified that some staff are working long shifts which are tiring and not necessarily productive. Ponsandane will be recruiting sufficient staff and have the ability to draw from the Swallowcourt bank to enable this practise to be eradicated. The company value its staff and the contributions they make.” Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,32, 33,35,36 and 38 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The prospective manager is of good character and fit to run the home. The prospective manager is committed to achieving a very good standard of open management and administration, which will benefit service users, staff and relatives. The home handles service users money in an appropriate manner and ensures their financial interests are safeguarded. Appropriate training and safety checks are undertaken to ensure the health, safety and welfare of service users, visitors and staff. EVIDENCE: Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 26 The new manager has been in post since the 18th December 2007. Staff and service users said that even at this early stage she has managed to create a good atmosphere within the home. Since taking over the manager has implemented more regular staff meetings and communication is taking place. We asked the manager about her management style and she said that she is open, honest and in all her dealings with relatives, staff and service users the processes of managing and running the home will be open and transparent. The Responsible Individual, Mrs Allerton provides the Commission with a monthly Regulation 26 report about the services and facilities provided. A Quality Assurance questionnaire has been circulated to service users and their families this month. A report will be compiled on completion of the surveys and a copy will be made avialable to the Commission. We disussed the drawing of an action plan as a result of this exercise and the manager said that she will create a pictographic diagram that will identify the areas for improvement. Staff meetings and service users meetings are held with minutes maintained. Appropriate arrangements are in place for the safekeeping of service users money. Service users can control their own money for as long as they wish and are able to do so if they want. Money held for service users is stored individually and securely, records are maintained and receipts are kept. The administrator and manager deal with service users money and all transactions are signed for. Staff appraisals and supervision have been established and take place regularly. However the supervision is mainly task orientated and does not cover any issues that staff may wish to discuss. It is recommended that supervision sessions include an opportunity for staff to discuss any issues that they may wish to share with the manager and trainers. The head of maintenance maintains a database of required maintenance and safety checks. The company are going to set up a central server that feeds each home. The managers are going to be linked into this and are going to have computers in their offices. The company’s ‘Health and Safety Policy’ sets out the responsibilities of the employer and employees, and the arrangements for managing health and safety. There are hazard analyses and risk assessments for a range of activities and equipment. Records detail regular required checks on fire systems. Accidents records were appropriately completed and comply with the Data Protection Act 1998. All records inspected were up to date and in sufficient detail. Staff felt that the company paid good attention to health and safety matters. Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 27 The Expert By Experience in her report said: “After talking to the residents and staff we gathered in the managers office and discussed the issues raised such as long waiting time for residents when they called for assistance. The manager said this would be looked into and it had probably happened at their peak times I.e. meals and in the morning. She also explained that some patients are on medication, which means they need the toilet sometimes five times in a short space of time. A possible graph showing the time taken to answer the buzzer was discussed. On the subject of the arch window this may be rectified with certain modifications which are due to take place in the home and the managing director said the chest of drawers will be replaced as over the time they are hoping to replace all the “old” furnishings. I also noted the bedspreads, which had been replaced after they had been considered “not cosy”in the previous report. They are attractive and fresh looking. There is a pleasant ambience surrounding the home and the residents interviewed were happy with the service. There seems to be a lot of attention to detail to make the home comfortable and resembling a home environment for the residents. The manager who has only been in post since 18th December 2007 seems very approachable and open with plans for the future development of the home”. The Company have said in their AQAA that their plans for improvement in the next twelve months are: “To continuously update the company policies and procedures introducing legislative training. To work closely with the Health and Safety company that advises Swallowcourt and Ponsandane and provides the policies in this important area.” Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 28 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 4 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 4 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 x 3 2 X 3 Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 29 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 The registered person should encourage whenever the involvement of the social worker and representatives of the service users to the six monthly reviews to evidence that agreement has been reached on the care to be given. The registered person should draw up an action plan as a result of the Quality Assurrance and present it as a pictographic diagram that will identify the areas for further development based on a systematic cycle of planningaction-review reflecting aims and outcomes for service users. The registered person should create opportunities for staff to discuss any issues they may wish to share with the supervisors at supervision. 2. OP33 3. OP36 Ponsandane DS0000009091.V347939.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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