CARE HOMES FOR OLDER PEOPLE
Porthgwara Nursing Home LLP North Corner Coverack Helston Cornwall TR12 6TG Lead Inspector
Diana Martin Unannounced 21 June 2005 10:00 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 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. Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Porthgwara Nursing Home Address North Corner Coverack Helston Cornwall TR12 6TG 01326 280307 01326 281137 porthgwara@aol.com Porthgwara Nursing Home LLP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Marian Ozard Care Home with Nursing 32 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability (12), Terminally ill (6). of places Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 18/01/05 Brief Description of the Service: Porthgwara is a detached well maintained care home set in landscaped grounds in the village of Coverack, near the town of Helston. The home boasts a wonderful panoramic view of the sea from the front of the property, which is appreciated by residents, staff and visitors to the home. Porthgwara provides nursing and personal care for up to thirty-two elderly people. The registration also allows for people with a terminal illness or physical disability. Accommodation is provided on four floors and consists of the original house with modern day extensions. The most recent extension provides six rooms with en-suite facilities. There are spacious communal areas and adequate toilet and assisted bathing facilities. There are two shaft lifts to access the upper floors.The extensive gardens, lawn and very large patio are extremely well maintained. There are large tubs of colourful flowers on the patio. Access for residents is restricted in certain parts of the grounds for safety reasons. There is limited car parking space at the front of the home. Qualified nurses and care staff provide care in a relaxed friendly atmosphere. There is a flexible visiting policy and visitors are actively encouraged. A day-care service is provided by the home Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Porthgwara on the 21 June 2005 and spent the day at the home. This was an unannounced visit. On the day of inspection 29 service users were resident in the home. The inspector met with 6 service users and 2 visitors, a number of staff and the Registered Manager to gain their views on the service that Porthgwara provides. In addition the inspector examined records, policies and procedures and toured the building. This report summarises the findings of this inspection. What the service does well:
Prospective residents are assessed prior to being admitted to the home, this ensures that the home is able to meet their needs. Each resident has an individual care plan that includes health, personal and social care needs. Relevant risk assessments are undertaken for example to prevent pressure sores, to prevent the risk of falls and to ensure appropriate moving and handling. The plans are agreed with the resident or their representative and signed when possible, they are also reviewed every month and changes made as necessary. Daily records are kept for each resident that are informative. Work instruction books form part of the training for all staff and these are an excellent tool for staff. There are systems in place for respecting resident’s privacy and dignity and residents spoken with said there are no problems in this area. Activities are provided and an activities calendar is displayed. There is an activities co-ordinator employed who organises entertainment, trips out and daily activities for the residents. The residents are involved with choosing the type of activities they want and some were involved in the summer fete. Visitors said they are welcome in the home and residents said they could see their visitors in private if they wish. Residents can go out into the community and several attend local coffee mornings. Complaints are very few and there is a suitable complaints policy in the home with a method for recording the complaint, the action taken and the outcome. The home is situated in a beautiful setting, which is appreciated, by both residents and staff. The building is very well maintained and decorated to a high standard. Several rooms have recently been redecorated and refurbished and new furniture has been purchased. The grounds are lovely and kept tidy, the large patio overlooking the sea is a peaceful place to sit and is used for the fete and for visiting bands and singers. Everyone spoken with said there are enough staff at the home although residents felt the care staff are rushed at times, especially in the mornings. There is a nurse on duty at all times. Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 Page 6 The home’s recruitment procedure is robust and staff files contain the necessary documentation. Relevant police and adult protection checks are undertaken. The home is audited annually as part of the ISO 9001:2000 quality assessment audit and excellent administration systems are in place. The Registered Manager undertakes her own audits to maintain standards and quality in the home. An annual questionnaire is given to residents and their families, the survey results are positive and are available in the home. Staff meetings take place regularly and changes have been made following these meetings. There is an independant residents association that meet regularly, minutes are kept and the meetings are very well attended. Residents said they can air their views and things have improved as a result of their meetings. Residents control their money according to their wishes and capability. Money held on the residents behalf is stored securely in the safe with records kept of all transactions. Receipts are kept for all purchases. What has improved since the last inspection? What they could do better:
Although there is a great deal of information in the care plans and other documents it is not easy to access as it is kept in different places. It may be easier to reference if all care documents for each resident were kept together. Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 Page 7 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. Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 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 standard(s) 3 Residents are only admitted to the home following an assessment of their needs that ensures the home can provide adequate care. EVIDENCE: The Registered Manager visits prospective residents whenever possible to assess their needs prior to admission. She also obtains any other assessments or information from Social Services, the hospital staff, Physiotherapists, and so on. Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 10 Individual care plans are generated for each resident that inform and direct the staff in their care provision. Systems are in place to ensure that residents are respected and their privacy is upheld at all times. EVIDENCE: Each resident has a care plan, which is reviewed monthly. Risk assessments included Waterlow scoring, nutrition, moving and handling, falls and Barthel scoring. Informative daily care records are maintained. The documentation is comprehensive and informative but would benefit from collating so that all care records for individuals are kept together. Work instruction books form part of the training for all staff and these are an excellent tool. The arrangements for ensuring privacy and dignity were specified in the statement of purpose. Staff were observed to respect residents privacy during the inspection. Suitable screening is provided in shared rooms and residents are addressed by their preferred name Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 13 The home provides a range of activities and aims to offer a lifestyle that meets individual residents needs. Links with family, friends and the community are good and allow residents the opportunity to socialise. EVIDENCE: The home has an activities co-ordinator who has undertaken several courses in the subject. Activities and entertainment are offered. These include singers, games, films, nail painting, Holy Communion and planting flower seeds. Trips out are also organised and a summer fete was imminent at the home. Records are kept of activities and those attending. There is a record of visitors to the home and there were visitors in the home during the inspection. Residents said they could receive visitors in private and at any time. Visitors spoken with said they are always made welcome in the home and can call in when they like. Residents said the telephone arrangements in the home are very good. Residents can go out in the community, for example, several go to local coffee mornings and one goes to the women’s institute. Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 Page 12 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 standard(s) 16 The home has a satisfactory complaints procedure that ensures complaints are listened to and acted upon. EVIDENCE: There is a suitable complaints policy in the home and a method for recording complaints, the action taken and the outcome. There has been one complaint in the last year, dealt with appropriately through the homes complaint procedure. Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 19 The home and grounds are extremely well maintained providing a very safe environment for residents, staff and visitors. EVIDENCE: Residents live in a safe well-maintained environment, which is well decorated, clean, homely and comfortable. The home has an ongoing maintenance programme and residents can be involved in the choice of decoration in the home. Several rooms have recently been redecorated and refurbished and new furniture has been purchased. Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Staffing levels meet the needs of the residents and staff morale is high. Recruitment procedures are robust and offer protection to the residents. EVIDENCE: The Registered Manager said the home incorporates a skill mix that meets the resident’s needs. The Department of Health’s Residential Forum calculations are used as a basis for working out the staffing levels. A nurse is on duty at all times. There is a robust recruitment procedure used and staff files inspected contained all of the relevant documents. Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 35 The home is run in the best interest of the residents and they benefit from the Quality Assurance systems in place. Resident’s money is managed well safeguarding their financial interests. EVIDENCE: Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 Page 16 The home is audited annually as part of the ISO 9001:2000 quality assessment audit and excellent administration systems are in place. A newsletter has been produced and it is hoped this will be a regular addition to aid communication in the home. Residents and their relatives complete a Quality Assurance survey annually; the results are sent to the Commission. The survey is to be extended to include external stakeholders, for example GPs and suppliers. The Registered Providers visit the home regularly and send a report to the Commission every month in accordance with Regulation 26. The Registered Manager undertakes her own audits, for example, suppliers, environment and kitchen cleaning. Staff meetings take place regularly and changes have been made following these meetings. There is an independant residents association that meet regularly, minutes are kept and the meetings are very well attended. Residents said they can air their views and things have improved as a result of their meetings. The Registered Manager said that residents could control their money for as long as possible. Appropriate records and receipts are kept. Money is held for residents in individual bags, securely in the safe. There is a policy in place for the control of personal possessions. Residents agree to the home dealing with their money, as it is included in the contract. Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 4 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 4 x 3 x x x Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 Page 18 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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 Good Practice Recommendations Porthgwara D52-D04 S56600 Porthgwara UI V233683 210605 Stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection 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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