Inspection on 07/02/08 for Ponteland Manor

This inspection was carried out on 7th February 2008.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ponteland Manor 29/12/09

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Ponteland Manor Thornhill Road Ponteland Newcastle Upon Tyne NE20 9PZ Lead Inspector Janet Thompson Key Unannounced Inspection 7th February 2008 10:30 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 Ponteland Manor DS0000070543.V356914.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. Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ponteland Manor Address Thornhill Road Ponteland Newcastle Upon Tyne NE20 9PZ 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) 01661 821400 01661 821 402 Southern Cross OPCO Ltd Vacant Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (52) of places Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Old Age, not falling within any other category. Code OP - maximum number of places 52 The maximum number of service users who can be accommodated is: 52 7th September 2006 2. Date of last inspection Brief Description of the Service: Ponteland Manor is a two-storey purpose built home situated in the centre of Ponteland. The home is close to local shops and transport links. Access to local facilities is within walking distance. Ponteland Manor cares for elderly people, some of who require nursing care. The first floor of the home is mainly used for those requiring nursing care or a higher input of personal care. Access to the first floor is provided through a passenger lift. The fees for the home range from £495 to £660. Further information about the home can be found in the service users guide, the statement of purpose and previous inspection reports. These are readily available in the home. Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use the service experience good quality outcomes. The service has recently been taken over by a new owner and this is the first inspection since then. The commission considers that a newly owned service cannot be 3 stars at the first inspection. How the inspection was carried out: Before the visit we looked at: Information we have received since the last inspection visit. How the service dealt with any complaints or concerns since the last visit. Any changes to how the home is run. The manager’s views of how well they care for people. The views of people who use the service and their relatives or friends. This was given to us in the form of questionnaires. We received thirteen from residents and three from relatives. During the unannounced visit we: Talked with people who use the service and some of the staff. Looked at the information about people who use the service and how well their needs are met. Looked at other records the home is required to keep. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to make sure it was clean, comfortable and safe. Checked what improvements had been made since the last inspection visit. The owner of the home has recently changed and the manager has left. The deputy manager is now acting as manager. The acting manager was at the inspection. Feedback was given to her at the end of the visit. What the service does well: Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 6 Residents commented that they were happy at the home. They said, “staff do listen to us and try to help” and “al of the staff are really approachable”. One resident said she was pleased that she could choose how to live her life and was not pressurised to join in activities. Resident’s monies were well managed and easily accounted for. Staff were properly trained to meet the needs of residents. The home was clean and tidy. The outside grounds were attractive. 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. The summary of this inspection report can be made available in other formats on request. Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given enough information about the home before they decide to stay there. People have their needs and wishes assessed before they move into the home. EVIDENCE: Residents admitted to the home do have their needs assessed. Information from other professionals is included in this. The needs assessment forms part of the care planning. Three pre-admission assessments were examined. Good information was recorded and residents’ individual needs were clear. These included resident’ wishes regarding how they wish to be addressed and any gender preferences they express. The inspector spoke to one resident who said that she had visited several other homes and this one several times before she decided where to live. She said “I came for tea and on another day I had coffee in the morning, they made me very welcome and were patient while I made my big decision” Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 9 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): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of care planning is good and gives a good level of information to staff to support meeting residents needs. Care is planned with residents in a way they prefer and in a sensitive manner. Medication practice does not safeguard residents so they are potentially at risk. EVIDENCE: Five plans of care were examined. Two of the people whose care plans were seen were also spoken with and discussed with the staff. This is called case tracking. The care plans contained enough information about residents to enable staff to meet their needs. All care plans contained up to date information and had been regularly evaluated. Care plans that were case tracked showed a good reflection of the residents’ current needs. Care plans reflected the diverse range of residents’ abilities, likes, dislikes, social needs and aims as well as their physical needs. Residents had been asked how they wished to be addressed and about their preferences with regard to personal care. This was Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 10 clearly recorded. The staff are busy changing the care plans to the format provided by the new owner. The new format is comprehensive and clear. Residents looked clean and well cared for. All residents spoken to said they were well looked after. There was evidence in care plans that residents can see a doctor when they need to. Other health professionals such as psychologists, therapists, opticians and dentists had been involved in the care of residents. All residents who responded to the questionnaires said that they were well looked after. Residents said; “I’m always seen by the doctor if required”, “I moved here from hospital there was a poor outlook and my health fluctuated badly, the loving consistent care I have received here has helped me to gain more quality in my life”. A relative said “the nursing care has been so good for my father they have actually saved him from having a double amputation”. Medication administration records were examined on both floors. Medication management on the ground floor was satisfactory. All administration records were correctly filled in. The administration records on the first floor showed several gaps on two dates. This puts residents potentially at risk of a repeated dose been given in error. Two amounts of controlled drug were checked and found to be correct. Resident’s spoken to said that they were treated well in the home and they felt that staff treated them respectfully. One resident commented: “the staff work hard and are very nice, I am treated well”. Another resident said that “staff are always helpful and caring”. All residents said they could choose how to spend their day and could dictate their routines. One resident said she had chosen this home for that very reason as she would hate to be pressurised to join in with all activities. Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 11 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): 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in the home are encouraged to be as independent as they wish. They access social activities in the home and wider community. Choice and rights are promoted as well as healthy living. EVIDENCE: There are two activities organisers in the home. One works all day for five days per week and one works 4 hours for five days per week. This is very good provision. The part time organiser is responsible for carrying out one-toone activities and spending time with people on an individual basis. The activities on offer were varied and suitable to the resident group. In questionnaires residents said, “the activities are excellent” “we have films, games and guest speakers” “I am very happy, there is lots of outside space to walk in”. Relatives said the provision of activities was “generally excellent”. One resident told the inspector that she could come and go as she pleased, she said, “I am given my privacy and choice, I am not pressurised to do anything that I don’t want to do”. Relatives reported that they felt welcome in the home and where happy to come and go as they pleased. Visitors to the home were greeted in a friendly manner by staff. Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 12 Residents reported that the food was generally good. In questionnaires one resident said the food was “not like home and probably the weakest aspect of the home” but another resident said, “the chef tries very hard to make a good and varied menu and the food is lovely”. The new owners are introducing a new menu based on an independent healthy living format. The acting manager confirmed that residents are always consulted about the food. With such diverse tastes within the home it is the area hardest to achieve a level to please everyone. The dining areas were very well presented. Linen was clean and tables were set to restaurant standards. The food offered at the time of the inspection was very well presented and looked appetising. Menus were varied in content and there were choices of meals available. Regular consultation takes place between the kitchen staff, care staff and residents. Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 13 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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clear procedures are in place to protect residents from risk of harm and enable their concerns to be effectively dealt with. EVIDENCE: All residents spoken to said that they knew who to complain to. There have not been any complaints since the last inspection. Adult Protection procedures are available in the home. All staff have received training in adult protection. There was one issue referred to adult protection that was found to need no further action. Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 14 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): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The building is clean and generally well maintained. Good quality fittings have resulted in a comfortable setting for residents. EVIDENCE: The home was clean and well presented. Fixtures and fittings are of a good quality, giving residents a pleasant environment to live in. Repairs are carried out swiftly. The new owners and acting manager had already decided that parts of the home needed renewal and redecoration. This is particularly the case on the first floor. The acting manager has started the process of auditing what needs to be done and obtaining prices for the work. In questionnaires some relatives did comment on the work needing to be done. They said, “we could do with new towels and bed linen, upstairs could do with decorating and new carpets”. Residents did say the home was clean and one said, “the laundry is particularly good” Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 15 The inspector noted that everything was clean and tidy. There were no odours anywhere in the home. Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 16 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): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are supported through training and supervision to provide care to people in a way that meets their individual needs. Recruitment and selection practice does not fully protect residents. EVIDENCE: The staffing for the home is currently. 1 RGN and 5 carers on the first floor 1 senior care and 2 carers on the ground floor. 1 RGN and 3 carers throughout the home at night. These staff numbers were maintained at the time of inspection. Three staff recruitment files were examined. These were well organised and did contain all relevant information. All staff had a criminal records check and had provided evidence of their identity. One file did not contain any reference checks. This was in sharp contrast to the other files, which showed that robust procedures had been followed. Statutory staff training was up to date or planned in March 2008. Staff have an individual training file with their own training programme and personal development plan. 100 of the homes care staff are registered on an NVQ training course or have completed one. Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 17 Staff have received training in communication issues such as dealing with visual and hearing impairment, culture, challenging behaviour and confusion. Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run which benefits the people who live there. They are consulted about what goes on in the home through meetings and day-to-day contact. People living in the home and staff are protected through good health and safety procedures and checks. EVIDENCE: The home does not currently have a registered manager. The acting manager has been the deputy at the home for a number of years and is well known to residents. The acting manager is in the process of applying to CSCI for registration as the permanent manager. This means she will undergo an interview process to see if she is “fit” in the context of the law, to run the home. Residents are consulted about life in the home through meetings and quality questionnaires designed to seek their views. Meetings are also held with staff Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 19 and all heads of departments to ensure the smooth running of the home. Residents and relatives all said they were able to speak to the manager and were kept informed of events affecting them. A relative said, “we have free access to manager, they are usually available”. Monies are held for residents in individual accounts. All transactions are clearly recorded and receipts are kept. The amounts of money were not checked at this inspection. There were no issues found within the home that appeared to put residents at a health or safety risk. All areas were very clean. Fire exits were free from obstruction. There were no trip hazards. All hazardous substances were locked away. Health and safety checks and tests were up to date. Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 4 X 3 X X 3 Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Ensure that staff adhere to the procedure for the administration of medication. (OUTSTANDING SEPT 2006) 2. 3. OP31 OP29 8 19(1) Provide a registered manager. 01/05/08 Timescale for action 01/04/08 Ensure that staff recruitment and 01/04/08 selection procedures are followed. 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 OP19 Good Practice Recommendations Provide a plan of refurbishment. Make this available to CSCI and residents and relatives. Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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. Extracts may not be used or reproduced without the express permission of CSCI Ponteland Manor DS0000070543.V356914.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!