CARE HOMES FOR OLDER PEOPLE
Porthgwara Nursing Home LLP Porthgwara Nursing Home North Corner Coverack Helston TR12 6TG Lead Inspector
Diana Penrose Announced Inspection 6th December 2005 09:40 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 Porthgwara Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 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. Porthgwara Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Porthgwara Nursing Home LLP Address Porthgwara Nursing Home North Corner Coverack Helston TR12 6TG 01326 280307 01326 281137 porthgwara@aol.com porthgwaranursinghome.co.uk Porthgwara LLP 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) Mrs Marian Ann Ozard Care Home 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 Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st June 2005 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 plant tubs on the patio. Access for residents is restricted in certain parts of the grounds for safety reasons. A quiet area of the garden has been set aside for visitors and staff to utilise. 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 Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Porthgwara Nursing Home on the 06 December 2005 and spent five hours and fifty minutes at the home. This was an announced visit. The purpose of the inspection was to undertake a statutory inspection. The inspector focused on the following key areas of care: choice of home, care planning, medication, adult protection, some of the environment and training. On the day of inspection 26 residents were living in the home. The methods used to undertake the inspection were to meet a number of residents, staff, the registered manager and registered providers to gain their views on the services offered by Porthgwara. Records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. What the service does well:
The home provides nursing and personal care to a high standard. Efforts are made throughout the home to continually improve the service for both residents and staff. There is a very open style of management and this along with residents meetings, staff meetings and a quality assurance system allow everyone to have a say. The home gives relevant information to prospective residents and their family making sure they have the information they need when choosing where to live. 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 reviewed every month and changes made as necessary. Daily records are kept for each resident that are informative. Residents health needs are met by involving the GP’s, specialist nurses and other healthcare professionals when required. Moving and handling and pressure releiving equipment is provided along with special beds if necessary. There is a suitable system for the storage, administration and disposal of medicines and relevant guidelines are available for the staff. Residents said they exercise control over their lives and choices are available to them. There are choices on the menu and residents said they can have what they like to eat, one resident said “it’s like beiing in a top class hotel”. Homemade food is provided with plenty of fresh fruit and vegetables. There is a poloicy for the protection of vulnerable adults and staff are attending courses on this subject. The local authority guidelines are available to staff. Residents live in a safe well-maintained home that is decorated to a high standard. It is very clean, homely and comfortable. The home is situated in a beautiful setting, which is appreciated by residents, staff and visitors. The
Porthgwara Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 Page 6 grounds are lovely and kept very tidy, the large patio overlooking the sea is a peaceful place to sit and is utilised for the annual fete and for visiting bands and singers. Residents were out walking on the patio during the inspection. Laundry is all dealt with in the home and sufficient equipment is provided. There is a training co-ordinator employed to ensure that training needs are met and the staff’s knowledge and skills are up to date. There is a month’s induction programme for new staff and 55 of the care staff have undertaken the NVQ level 3 course in care, others are on the course or booked to start in January 2006. The registered providers endeavour to ensure that working practices are safe, all staff attend statutory training and all equipment and services are checked regularly. What has improved since the last inspection? What they could do better:
The medicines policy requires reviewing and updating to be a more comprehensive guide for staff. Medicines labelled for an individual resident must not be given to other residents, for example Lactulose syrup which tends to be prescribed in large bottles. Consent should be gained for the use of any form of restraint such as cot-sides on a bed. Porthgwara Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 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 Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Porthgwara Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Prospective service users are given information about the home enabling them to make an informed decision. EVIDENCE: There is a statement of purpose, service users guide and brochure in use and available in the home. The registered manager said these documents are given to prospective residents or their representatives. Some minor additions were discussed and agreed with the registered provider. Porthgwara Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 Individual care plans are generated for each service user that inform and direct the staff in their care provision. 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; a review of the home’s policy and procedures will further ensure service users safety. EVIDENCE: Each resident has a care plan that is compiled with the resident or his or her representative, dated and signed. The plans are reviewed monthly. There are separate care plans for the care staff to use. Profiles are written for each resident that include social and religious preferences. Risk assessments include Waterlow scoring, nutrition, moving and handling, falls and Barthel scoring. Daily records are maintained. The care documentation is comprehensive and informative. There should be written consent gained for any form of restraint used, for example, cot-sides. Residents are registered with a GP, other healthcare professionals are involved when required to ensure that needs are met. The home has sufficient equipment for moving and handling purposes and pressure relief. There are 14 electric beds provided for residents. The home provides an escort service for
Porthgwara Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 Page 11 hospital visits. Residents are encouraged to exercise by walking and joining in games with skittles, hoops and balls. The home has a policy for the administration of medicines, which requires some reviewing. The policy and a copy of ‘The Royal Pharmaceutical guidelines for the administration of medicines in care homes’ is available for staff. Medicines are supplied from the GP surgery and GP’s review the medicines annually. Patient Information Leaflets (PIL) are maintained. Medicines records are all satisfactory. Medicines prescribed for an individual resident must not be given to anyone else, for example, Lactulose syrup. Porthgwara Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 15 Service users are helped to maintain control over their lives and staff respect their individual preferences and choice. Dietary needs of service users are well catered for with a varied selection of food available that aims to meet their taste and preference. EVIDENCE: Service users said they are encouraged to exercise choice and control over their lives, this is evidenced in care plans and daily records. Resident’s rooms are personalised with their own belongings. Three residents control their own finances. Choices are available on the menu and residents said they have what they like to eat. All residents spoken with said they enjoy the food provided. They said there was little disruption while the new kitchen was fitted. Fresh fruit and vegetables are always on the four-week menu. Relatives said the staff are very hospitable with refreshments always on offer. It was a resident’s birthday on the day of inspection and a special cake was made. Appropriate assistance is given at mealtimes and special crockery and cutlery are provided if required. Porthgwara Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Arrangements are in place for the protection of service users safeguarding them from harm or abuse. EVIDENCE: The home has an adult protection policy and a copy of the local multi-agency code of practice. The policy has been updated following recent ‘No Secrets’ training. More staff are booked to attend this training. Porthgwara Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The home and grounds are extremely well maintained providing a very safe environment for residents, staff and visitors. The home is clean and free from offensive odours making it a pleasant place to live in. 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 are involved in the choice of decoration in the home. Several rooms have been redecorated and new furniture has been purchased. There are no allocated changing facilities or lockers for staff. The registered provider said that lockers have been discussed with staff but they are happy with the present arrangements. All laundry is dealt with in house and the laundry person has a good system in place. There are two washers and one drier. COSHH data sheets are available in the laundry. Porthgwara Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 30 Service users are in safe hands and benefit from the number of care staff that have an NVQ qualification. The home provides appropriate training for staff to help them be more competent in their roles. EVIDENCE: There is a training co-ordinator who has compiled a training matrix for each area and records of training are maintained. 55 of care staff are qualified to NVQ level 3 and others are on the course or starting soon. Staff receive statutory training as required and there are other courses available, some in house and some external. There is a month’s induction programme for new staff that is extended as necessary. Training needs are identified during supervision and appraisal, staff meetings and general conversation. Training includes palliative care, dementia, infection control and adult protection. Eleven staff will be attending fire warden training in January 2006. Porthgwara Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 Appropriate training and safety checks are undertaken to ensure the health safety and welfare of service users and staff. EVIDENCE: The management endeavour to ensure that working practices are safe. Relevant service checks take place when required. Staff receive statutory training regularly and records are kept. There is a person trained in first aid on duty at all times. The kitchen staff have all received food hygiene training. Accident reporting complies with data protection and the Registered Manager audits accidents in the home informally, there is no tool used. Health and safety risk assessments have been undertaken. Porthgwara Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Porthgwara Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 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 OP9 Regulation 13(2) Requirement Medicines prescribed for an individual resident must not be given to anyone else, for example, Lactulose syrup The medicines policy must be reviewed Timescale for action 06/12/05 2 OP9 13(2) 01/02/06 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 OP8 Good Practice Recommendations There should be written consent gained for any form of restraint used, for example, cot-sides Porthgwara Nursing Home LLP DS0000056600.V258826.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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