CARE HOMES FOR OLDER PEOPLE
Puddavine Court Ashburton Road Dartington Totnes Devon TQ9 6EU Lead Inspector
Judy Cooper Unannounced Inspection 17th January 2006 9.30am 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 Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 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. Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Puddavine Court Address Ashburton Road Dartington Totnes Devon TQ9 6EU 01803 866366 01803 866366 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) Manor Collection Ltd Mrs Valerie Hilda Austin Care Home 38 Category(ies) of Dementia - over 65 years of age (38), Old age, registration, with number not falling within any other category (38), of places Physical disability (38), Physical disability over 65 years of age (38) Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. PD Category is from age 55 yrs only Date of last inspection 20th April 2005 Brief Description of the Service: Puddavine Court is a large detached house on the edge of Totnes, substantially extended a few years ago. Accommodation is provided over three floors and there are thirty-six single rooms (the majority of which are en-suite) and one double en-suite room. There are two lounges and the main dining room on the ground floor, and also lounge and dining areas on the other two floors. All floors are accessed via a shaft passenger lift. The garden is large, accessible and attractive. There is ample car parking space. The home is registered to care for people aged sixty-five years and over, who may or may not be, suffering from dementia. The home also provides care for service users from the age of fifty-five years who have some form of physical disability. Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on a Tuesday morning/afternoon. The inspector, allocated to the home, as well as the inspector’s line manager, undertook this inspection. Opportunity was taken to tour the premises, examine some records and policies and talk with the owner (who was present at the beginning of the inspection), the home’s registered manager (who was present throughout), many residents, some staff members as well as a visiting District Nurse. Staff on duty were also observed, whilst in the course of undertaking their daily duties. The majority of required core standards were inspected at the last inspection in April 2005. Those inspected on this occasion concentrated on resident welfare on a day to day basis, some general environmental standards, those in relation to staff recruitment and staffing levels as well as two core standards that were not inspected on the last occasion. What the service does well: What has improved since the last inspection?
Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 6 The owner stated that all radiators, that are accessible to residents, have now been covered to ensure residents are protected from the risk of sustaining a burn from an unprotected surface. The owner stated that window restrictors have now been installed to all necessary windows, to further protect residents. The owner also stated that all hot water outlets which provide hot water to residents’ facilities, including residents’ hand wash basins have now been provided with water regulation to 43 degrees Centigrade to ensure residents’ safety is further upheld. Updated and more efficient laundry equipment has also been provided to ensure that residents’ laundry needs can be fully met. The Court Group have also recently identified a health and safety officer, from within the current staff team, who will take on responsibility for ensuring that all matters of health and safety are both undertaken and maintained as required across the Court Group homes including Puddavine Court. A monthly inspection is to be undertaken and a report issued with any shortfalls noted, so that the responsible person/manager of each home can ensure that residents’ health and safety is maintained at all times. Staff training has continued with the manager now having completed her NVQ level 4 in care and management along with the home’s head of care having already been successful in obtaining the same awards in November 2005. Other staff training has been/is being made available, which includes NVQ training to ensure that virtually all other care staff are qualified to NVQ level 2/3 in care. This allows residents to receive care from a trained and aware staff group, which was reflected in the positive comments received overall, from the residents spoken with, regarding the good care they felt they received at the home. What they could do better:
Residents’ daily care records and subsequent risk assessment reviews need to clearly identify any incidents/accidents that may have taken place involving the resident and any change needed to the care to be provided. This is to ensure that all staff are aware of, and provide for, these needs. Residents’ pre-admission assessments, care plans and care plan reviews should be agreed and signed for by the residents or their advocate, at the time
Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 7 they are drawn up/undertaken, to ensure that residents or their chosen representative are involved at all times, and agree with, the intended care to be provided. To ensure that all residents health and safety is protected at all times, as far as is possible, any supplementary heaters being used within residents’ rooms must be fixed within the resident’s room and risk assessed to ensure that any identified risks, associated with the use of the heaters, are minimised. (The manager did confirm, that the day after this inspection, the responsible person had authorised immediate remedial action to ensure the heaters in question were both fixed to a wall and that a full risk assessment was carried and documented in relation to the use of the heaters). The responsible person/registered manager must ensure that residents are fully protected by the appointment of suitable staff. To this end, the registered manager must apply for, and receive back, two written references in respect of each member of staff working at the home, which should, if possible, include the staff member’s last employer. A Criminal Record Bureau enhanced disclosure must be also be applied for any staff member that has previously worked at the home, and after a period of absence has again returned to work within the home. 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. Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 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 Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 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): 3 The admission process is appropriately managed with residents’ needs explored and known prior to admission to the home. EVIDENCE: By randomly selecting the records for a resident, who had been admitted to the home since the last inspection, it was noted that a full and detailed admission procedure was undertaken which had ensured that Puddavine Court was considered an appropriate home for the resident. (It was however noted that the pre-admission assessment undertaken by the home’s manager, in conjunction with the resident and their next of kin had not been signed by either party to confirm their involvement or agreement). The resident, was able to fully confirm that they had been made to feel comfortable, both on admission and since, and that they felt their very specific needs were both known and met, as far as possible, by the staff. The resident stated that they felt that “Puddavine Court was a lovely place”. Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 10 The care manager for this resident continues to have regular contact with the resident and the manager confirmed that the care manager was also very happy with the care the resident was receiving. The home does not provide for intermediate care. Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10 Although residents’ health and personal care needs are well known by the home’s staff, residents could be at risk by staff not fully documenting all incidents/accidents appertaining to residents. Confirmation that residents are involved in their care planning processes was not always available. Residents’ rights to dignity, respect, individuality and independence continue to be maintained. EVIDENCE: The care plan was inspected which related to the resident whose admission procedure was previously inspected. The care plan was concise and contained relevant information appertaining to providing for the individual resident’s care, including any medical needs of the resident, as well as any visits made by any health professionals. The care plan had not yet been signed by the resident to confirm the fact that they agreed with the plan of care or whether, or not, they wished to be involved in the monthly review of the plan.
Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 12 It was also noted that the individual resident’s daily records did not fully detail a recent fall that the resident had sustained, or the action that had been taken at the time of, and following, the fall. The resident’s risk assessment had not been fully updated with the details of this fall. This could place the resident at risk as staff may not be fully aware of any changes/ heightened risks associated with this resident and so consequently hinder them in providing the appropriate care. Another care plan inspected indicated that originally the resident concerned had chosen to be involved in the review process, but was now too frail to do so. Consequently the resident’s next of kin was now involved in this process on her behalf. However this change had not been recorded within the resident’s care plan. The manager and staff liaise with other professionals as required and, during this inspection a District Nurse was asked for feedback and was able to say that she felt the staff cared appropriately for the patients she had contact with at the home and that she felt confident that the staff did all they could to follow any clinical instructions she may give. Resident feedback was also very positive about the care received, with residents saying that they felt well looked after and that the staff treated them well and were very kind to them. Staff on duty were noted as treating the residents with respect and with an understanding of their individual needs. All residents were seen as being dressed very nicely and presented very well. Again specific praise was made in relation to the home’s head of care, in respect of her awareness of the residents’ needs and her ability to meet these needs appropriately and effectively. Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Residents continue to enjoy a varied life at the home, with visitors encouraged and welcomed. Links are also encouraged and maintained with the local community. Residents continue to enjoy a programme of various informal daily activities and social outings. EVIDENCE: On the day of inspection several residents took the opportunity to go on a mini bus trip to Dartmoor. Residents confirmed that they felt happy at the home, with such comments received as: “they look after us well, we enjoy our trips out”, “couldn’t be better”, and “10 out of 10 for care”. The home continues to operate an open visiting policy and the visitor’s book clearly showed that the residents had many visitors at varying times throughout the day. The routines within the home remain flexible to ensure that residents can choose how they spend their time with one resident noted as being facilitated to be able to have a quiet day in bed at their own choice, whilst others either were enjoying being in their own room or spending time in the communal areas of the home. Although standard 15 was not inspected in full, it was noted that the manager has employed a new chef, who was spoken with during the inspection. It was
Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 14 noted that he was enthusiastic and was generally trying to introduce a variety into the day to day menu. Positive comments were received regarding the meal served on the day of inspection, which was beef stew and dumplings, followed by a fruit tart and custard. Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected on this occasion. EVIDENCE: Although none of these standards were inspected, it should be noted that the CSCI has not received any formal complaints in respect of Puddavine, since the last inspection undertaken in April last year. A current investigation, is currently being conducted by the police, in relation to the death of a resident in June last year, which involved the resident falling from a first floor window of the home. This has yet to be concluded. Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,26 Puddavine Court continues to provide a very comfortable, clean, pleasant, well maintained and warm environment. EVIDENCE: The home again presented as very comfortable, homely and welcoming. Bedrooms remain personalised as desired and residents can bring in personal items with them if they wish to. A few bedrooms were noted as having been provided with an additional free standing heater. Residents who had them valued the additional warmth they provided. The day after this inspection the Court Group’s health and safety officer ensured the heaters were fixed to the residents’ walls and enlarged the risk assessments in relation to the continued use of the same to ensure residents’ health and safety is not unnecessarily compromised. The home was noted as being very clean and during the inspection a domestic member of staff was spoken with and it was clear that she took obvious pride in her work.
Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 17 The laundering needs of the residents are met appropriately with new improved laundry equipment having been recently provided to ensure that the residents’ laundry requirements can be undertaken as effectively as possible. The Court Group have recently identified a health and safety officer, from within the current staff team, who is responsible for ensuring that all matters of health and safety, including fire safety, are both undertaken and maintained as required across the Court Group homes including Puddavine Court. This member of staff now undertakes a monthly inspection of each home, and the report in relation to the inspection of Puddavine was available. Three new door guards have been identified as being required within Puddavine to ensure that the practice of propping/wedging fire doors open is discontinued and therefore residents are not unnecessarily placed at risk in the event of a fire occurring within the home. The local Environmental Health Department undertook an inspection of the home at the end of December 2005 and the report was available. The two identified shortfalls within the report have now been rectified which ensures residents’ meals are being prepared in a satisfactory and safe environment. Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 Staff at the home are well trained and presented well in both appearance and manner. They continue to be employed in sufficient numbers to meet the current resident groups’ needs. The homes’ recruitment polices do not always fully protect the residents. EVIDENCE: The home is currently at its considered full occupancy of thirty-six residents. Staffing levels were seen to be in sufficient numbers to ensure that residents’ needs could be met during the day and night. The manager is currently employing a trainee member of staff who is seventeen years of age. During a discussion with her she confirmed that she is fully aware of the restrictions on her not providing personal care, but it is to the home’s credit that they are currently enrolling her in the NVQ level 2 training in care to allow her to be ready and able to offer personal care when she is eighteen. The trainee was able to say that she fully enjoyed her job and felt that caring was the career that she wished to pursue The NVQ assessor was due in the home on the afternoon of the inspection. Residents spoken to stated that they felt well looked after and that staff were always available if needed. During the inspection it was noted that staff had sufficient time to spend with the residents, attending to their personal needs whilst the two staff members spoken with (one being the home’s senior care manager) confirmed that they felt the staffing levels were sufficient to meet
Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 19 the residents’ needs and an extra staff member would be put on duty if required at any time. Training continues to be very well planned and supports the staff in providing for the varied needs of the residents. The majority of the staff, within the home, hold an NVQ training award (level 2,3 or 4) whilst a couple are currently in the process of obtaining an NVQ qualification. Their training, experience and awareness was reflected in some of the positive comments received from residents and the visiting District Nurse in relation to the good care provided. The staff files for the last two staff to be employed at the home were inspected. It was noted that the staff files were incomplete. A fully completed application form was not available for this staff member neither were there were any references in relation to the staff member. A CRB disclosure had been requested and the manager later was able to confirm that it had actually been received back at the Organisation’s head office the day before the inspection. However it had not yet been passed to the manager for inspection prior to this inspection and consequently the inspector could not view it. The other staff member’s file only contained one reference and because this member of staff was known to the home as she had previously worked at the home when a previous CRB had been undertaken, it had been considered unnecessary to undertake a new one. However it is a requirement that a further enhanced CRB disclosure be obtained by any organisation if a staff member does have any time away from the work place. This is to ensure that residents are at all times protected by suitable staff only providing personal care. Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,38 The home is managed appropriately. Routine health and safety issues have been maintained as required and new measures introduced to ensure residents’ health and safety continues to be upheld. EVIDENCE: Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 21 The registered manager has been in post for several years. She is therefore well acquainted with the day to day running of Puddavine Court. She has just completed her NVQ level 4 in care and management and is now awaiting verification of her work. The home continues to operate thorough internal quality monitoring systems with residents’ feedback invited as part of the overall process. A representative from the management of the Court Group undertakes a monthly, in depth, quality audit visit where all aspects of the running of the home are examined and reported on, including consultations with the residents. On the day of inspection the representative was also due to undertake the monthly inspection/audit. The manger, in conjunction with the newly appointed health and safety representative, undertakes all required routine health and safety management including fire awareness. The owner and manager stated that all hot water outlets to residents’ hand washbasins have now been regulated throughout the building to prevent residents sustaining a scald, all hot surfaces protected throughout the home to protect residents from sustaining a burn, whilst window openings that have been identified as being a risk factor have been fitted with restrictors to further protect residents. Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 4 x x x x x x 4 STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x x x x Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP25 Regulation 13 Requirement Any portable heater used within a resident’s bedroom to provide supplementary heating must be fixed within the resident’s room and risk assessed to ensure that any identified risks, associated with the use of the heaters, are minimised. The registered manager must ensure that an enhanced disclosure from the Criminal Records Bureau is obtained in respect of any staff member that returns to work at the home, following a break in service. To ensure residents are at all times protected, a robust recruitment procedure must be adhered to. This must include a detailed application form being completed by any prospective staff member and two written references being requested and obtained by the responsible person/registered manager. Timescale for action 17/02/06 2 OP29 18 17/02/06 Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 24 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 Residents’ daily records, and residents’ risk assessments, should contain up to date current information and analysis regarding any incidents, accidents or required changes to the care that may need to be provided. Residents’ pre-admission assessments, care plans and the care plan reviews should be agreed and signed for by the residents, or their advocate, to ensure that they are in agreement with the intended care to be provided. Puddavine Court DS0000003783.V276086.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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