Inspection on 28/06/07 for Puttenham Hill House

This inspection was carried out on 28th June 2007.

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

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

Other inspections for this house

Puttenham Hill House 28/11/05

Puttenham Hill House 23/06/05

Puttenham Hill House 15/11/04

Puttenham Hill House 30/06/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Puttenham Hill House Puttenham Hill Puttenham Guildford Surrey GU3 1AH Lead Inspector Mike Murphy Unannounced Inspection 28th June 2007 10:00 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 Puttenham Hill House DS0000017634.V339260.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. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Puttenham Hill House Address Puttenham Hill Puttenham Guildford Surrey GU3 1AH 01483 810628 01483 810 674 whitfica@bupa.com www.bupa.com BUPA Care Homes (BNH) Limited 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) Ms Carolyn Sarah Whitfield Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - (OP) The maximum number of service users to be accommodated is 36. Date of last inspection 28th November 2005 Brief Description of the Service: Puttenham Hill House is large property located in a rural setting just outside Guildford, off of the A31 road. The home provides nursing care and accommodation to up to 36 older people. It is owned and managed by BUPA Care Homes Ltd. The home has ample communal space including two lounges, a large dining room and an activities room which also incorporates hairdressing facilities. There are 28 single occupancy rooms and 4 double rooms, most of which have en-suite facilities. The bedrooms are arranged mostly on the ground floor with only 8 being located on the first floor. The home has adapted bathing and toilet facilities on both floors. The first floor can reached by passenger lift or stairs.The home has access to a vehicle for trips out and has ample parking to the front and side of the building. There are attractive enclosed gardens that are accessible to the service users. Fees at the time of this inspection were between £750 and £1200 per week Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector over the course of one day in late June 2007. The inspection methodology included discussions with managers, residents and staff, consideration of information supplied by the registered manager in advance of the inspection, consideration of CSCI survey forms completed by residents, relatives and healthcare professionals, and a walk around the building and grounds. The home is a comfortable building, in a rural setting, with pleasant landscaped grounds, just over five miles from Guilford. The accommodation is over two floors and all areas are accessible by wheelchair. The home was bright, tidy and clean and is large enough to accommodate a varying range of activities. Bedrooms vary in size, most having en-suite facilities. There is sufficient communal space on the ground floor to allow residents to spend time with others or to have time on their own as they wish. The home has good systems for assessing the needs of prospective residents and for drawing up a care plan to meet the needs of those who accept the offer of a place. From the evidence of this inspection the home liaises appropriately with other healthcare agencies in meeting residents needs and the overall standard of care is good. New menus have been introduced and there is a good level of satisfaction with the food. The home was recently awarded ‘five star’ status following a visit by an environmental health officer. At the time of this inspection the home had a vacancy for an activities co-ordinator but it was endeavouring to maintain a diverse programme of activities until an appointment to the post was made to. Staffing levels appear sufficient to meet the needs of residents. The home provides good opportunities for staff training and development. Mixed reports were given on the ethos of the home: some describing it as ‘like a family’, ‘centred on the needs of residents’ and a home which is ‘..safe and secure’; others reported ‘patchy’ communications between staff and indicated that staff were ‘under pressure’. While managers and staff will need to explore these matters together, there were no indications at the time of this inspection that they were affecting the quality of care to residents. Residents appeared settled and secure and expressed a good level of satisfaction with the care they received. Overall, this home is providing a valued service to residents and their families. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home needs to ensure that its practice in relation to the control, storage and administration of medicines conforms to current good practice in order to minimise the risk of errors in the administration of medicines to residents. The home should ensure that all nurses and care staff have access to regular formal supervision. This will support good standard of professional practice in providing care to residents. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 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 Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are thoroughly assessed prior to admission and the first few weeks of a person’s stay are considered a trial period. This process aims to ensure that the prospective resident is comfortable in accepting the offer of a place and that the home is able to meet the person’s needs. EVIDENCE: Enquiries and referral may either be made direct or through a local authority social services department. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 10 In the case of a local authority referral the registered manager (‘the manager’) will have access to the assessment of the prospective resident carried out by the referring social worker. In the case of a private or direct referral this information will be obtained by the manager from the prospective resident and their family. In both cases, where the prospective resident is in hospital, or perhaps in another home, the manager will acquire additional information from the nurse in charge of the ward or home. On receipt of the referral or enquiry, the manager will provide the prospective resident and their family with information on the home, invite them to visit the home and view its facilities, and arrange for an assessment of the person’s needs to be carried out. The assessment is usually carried out in the person’s present place of residence and is structured by the home’s own assessment form – ‘QUEST individual assessment’. The assessment is carried out by a registered nurse (usually the manager or deputy manager) and covers Communication, Lifestyle, Maintaining a safe environment, Mental state and cognition, Breathing, Eating and drinking, Elimination, Personal cleansing and dressing, Body temperature, Sleeping, Pain, Medication and End of life arrangements . The form also gathers information on medication, personal needs and expectations not covered in other sections, and the expectations of relatives. The outcome of the process enables the manager to decide if the home can meet the person’s assessed needs. Examination of the care records of some residents admitted since the start of 2007 and discussion with one resident and her family provided evidence of this in practice. In the case of one recently admitted resident there appeared to have been excellent liaison between the hospital and home. Where the referral progresses to an offer of a place and this is accepted, then a ‘trial admission’ is arranged. This enables the new resident to decide if they feel the home is right for them and for the home to decide whether it can meet the person’s needs. This period usually lasts around four weeks. At the end of this time a decision on permanent residence is made by both parties. The home does not offer intermediate care; therefore standard 6 does not apply. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 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. 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. Residents care plans are based on assessment of needs by registered nurses and support the provision of appropriate care. Liaison with healthcare agencies is good. Together, these ensure that residents’ healthcare needs are met. Arrangements for the control, storage and administration of medicines are generally satisfactory but greater attention is required in the control of medicines to minimise the risk of errors. EVIDENCE: A care plan is in place for each resident. Care plans (‘Personal Plans’) are based on assessments of need. As outlined in the previous section the first assessment takes place before the admission of the person to the home. This is reviewed and updated on admission. A further review and assessment is Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 12 carried out at four weeks from the date of admission or earlier if indicated. A third review and assessment is carried out at six months or earlier if indicated. Apart from the documentation associated with the QUEST system, care plans were also noted to include notes by other health care professionals (such as a physiotherapist), a print out of the notes made by a general practitioner, a ‘map of life’ (in which key events in the person’s life are recorded), a Waterlow pressure sore risk assessment, a manual handling assessment, ‘restraint’ assessment in relation to the use of bed rails, nutritional assessment, and risk assessments in relation to individuals. All of the care plans examined included a photograph of the resident. The quality of completed care plans varied. Care plans included references to ‘Cotsides’ when referring to bedrails. This term is inappropriate in an adult service. It is noted that some, but not all of the care plans examined included a falls risk assessment. In all of the care plans the weight of the resident was recorded but completion of the rest of the nutritional assessment varied. The quality of daily notes varied – some focussing mainly on the physical care given over the course of a shift while others included references to the person’s mood or social interaction. The present format of care plans is relatively new to the home and plans are in place for a sample to be audited by the nurse with lead responsibility. The results of this will be discussed between managers and staff and action agreed where required. All residents are registered with a GP and evidence of the involvement of other healthcare professionals, including physiotherapy, opticians, dentist, Audiology, and podiatry, was noted in care plans. The home was liaising with a specialist nurse in relation to the care of at least one resident. Medicines are prescribed by the resident’s GP and are dispensed by a local pharmacy. Medicines are checked by a registered nurse on receipt. The home has a contract with a specialist waste disposal company for the disposal of unused medicines. Records of medicines disposed of are maintained. Arrangements for the storage of medicines are satisfactory. There is sufficient space in metal cabinets, portable trolleys and a medicines refrigerator for current use. The supplying pharmacy does not carry out an audit of the home’s arrangements. It is thought that this may be because the home is a nursing home. A policy governing the administration of medicines is in place. ‘Homely Remedies’ are prescribed by the resident’s GP. Medicines are administered by a registered nurse. Medicines records include a copy of the prescription, a photograph of the resident and the medicines administration record (‘MAR chart’). Nurses are trained in BUPA systems. The deputy manager said that competence is assessed by indirect observation of practice. This has not Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 13 included night staff to date. It would be advisable for the home to consider structuring the assessment (through the use of a checklist based on good practice for example) and to include all nurses in the process. At the time of this inspection no resident was administering their own medication. There are lockable facilities in resident’s bedrooms should any wish to do so (subject to the home’s policy and procedures). Examination of records and storage found that practice is generally satisfactory but there did appear to be some weaknesses which indicate a need to strengthen management controls over this aspect of the home’s work. There also appeared to be some matters which the home may wish to take up with its supplying pharmacy. A stock of Fentanyl patches which were no longer in use were still stored in the controlled drugs (CD) cupboard. The days of one MDS (monitored dosage system) cassette did not correspond with the actual days of administration. Other issues discussed at the time with the deputy manager concerned the use of lactulose (shared stock), storage of suppositories in a refrigerator (did not appear harmful but may not be necessary unless stated on the package – the home may wish to seek the advice of a pharmacist on this matter) and an unsigned cancellation of a prescription. It was noted that handwritten entries on the MAR chart, transcription of a prescription or of medicines supplied by a hospital, had not been countersigned. The deputy manager said that the home’s policy is that only entries relating to new prescriptions are countersigned by two nurses. Arrangements for maintaining the privacy and dignity of residents appear satisfactory. Personal care is given in residents’ own bedrooms or bathroom, medical examinations take place in the resident’s bedroom, there are a number of locations around the home where residents may talk to visitors in private, and staff were observed to treat residents with courtesy. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. Residents’ well being and quality of life is maintained through the home’s diverse programme of activities, contact with the local community, and the choice and quality of food. EVIDENCE: Residents wishes in respect of how they wish to spend their time is respected and they are not obliged to participate in activities. Residents may receive visitors at any time. Over the course of this inspection visit, at varying times in the day, some residents seemed content watching TV or reading in their own rooms, others participated in an organised activity, some received visitors, while others spent time in the lounge in the company of fellow residents. The home comfortably accommodated these varying levels of activity. The home had a vacancy for a full-time activities organiser and in the meantime the post was being covered one day a week by an activities coPuttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 15 ordinator from another BUPA home. The vacancy was noted by residents and relatives who responded to a CSCI survey in advance of the inspection. These included comments such as: “The home is without an activities person at the moment, so the residents are left a lot of the time to their own devices, which is a shame. When someone is with them they all seem a lot happier”; “Activities co-ordinator has resigned due to illness”; “No activities personnel at present”; “(Must) employ an activities person to keep the residents entertained”; and “Would like more activities at weekends”. The manager was hopeful that an appointment to this key post would be made soon. The activities organiser who was covering the post was keen to emphasise the importance of activity and its role in improving the quality of life for individuals and that of life within the home as a whole. It facilitated interaction between people (involving care staff and relatives in activities on occasions as well), increased stimulation, reduced boredom, maintained skills, and encouraged physical activity. She encouraged discussions on articles in newspapers, crosswords, board games, art classes, crafts and exercises. In addition to the work of the activities organiser the home also organises outings, book readings, visits by pets, and music performances. The programme for July included ‘Pets as Therapy’, bingo, a book reading of ‘The Moon’s a Balloon’ (David Niven’s memoirs), a number of films, a handbell concert, a guitar recital, a song recital, and trips out to the Basingstoke Canal Visitors Centre, Boxhill and to Claremont Lake in Esher. Breakfast is served between 7:30 and 9:30 am. The menu includes cereals, yoghurt, bread and preserves, fruit, fruit juice, hot breakfast if desired, and hot beverages. Lunch is served to residents requiring assistance at 12:00 noon. Lunch for other residents is served at 12:30. Lunch is the main meal of the day and consists of three courses; soup or starter, choice of main course with vegetables, and choice of dessert. The menu operates over a four week cycle. Starter lunch choices in week 1 may include: Mushroom & Sherry soup or Melon & Ginger (Mon), Carrot & Coriander soup or Prawn & Lemon mayonnaise (Thu), or, Vegetable soup or Trio of Melon (Sun). Main course choices in the same week may include: Fillet of Salmon with Lemon & Parsley Butter or Pork Escalopes and Mustard Sauce (Mon), Gammon Steak & Parsley sauce or Chicken with Tomato and Basil sauce (Thu), or, Roast Turkey or Roast Lamb (Sun). A salad alternative is available every day. Desserts may include: Bread & Butter pudding and Cream or Fresh Fruit Salad (Mon), Cheesecake or Chocolate Mousse (Thu), or, Treacle Tart or Coffee Mousse (Sun). Tea and cakes are served at 3:00 pm. Supper is served at 5:30 pm – around 5:00 pm for residents requiring assistance. Supper is a three course meal. Choices from the same week’s menu include a soup starter (Tomato, Pea & Ham, and, Broccoli & Stilton), a Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 16 main course (Welsh Rarebit & Salad, Omelettes & grilled tomatoes, and, Sandwiches), and dessert (Yoghurt, Crème Caramel, or, Trifle). Fresh fruit and cheese and biscuits are available every day on request. A ‘Night Bite Menu’ is available on request between 6:30 pm and 6:30 am. This includes Fresh Fruit, and snacks such as Beans on Toast, Sandwiches, Cakes and Biscuits, and toast with ‘spreads, jam or marmalade’. The chef has been in post for two and a half years. New menus have been introduced since the last inspection. The chef said that he likes to have feedback from residents and families on the food provided. The kitchen had been inspected by an Environmental Health Practitioner in March 2007. A copy of the report of that inspection was made available for this inspection. It is noted that the concluding paragraphs include the sentence ‘Based on the outcome of this inspection, your premises have been awarded a food hygiene rating of 5 stars: excellent’. Residents views on the food were generally favourable. One stated ‘Dietary needs now being met’; another said ‘Sometimes the food is awful: Much of is fattening’. However, the most common response to the question ‘Do you like the meals at the home?’ in CSCI survey forms was ‘Usually’. No one selected a response below this. A few respondents ticked ‘Always’. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 17 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, 17 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good systems for investigating complaints and good procedures with regard to the protection of vulnerable adults. Together, these aim to ensure that complaints are thoroughly investigated and to protect residents from abuse. EVIDENCE: The home has a complaints policy and a summary of this is included in the folder provided to each resident. The policy outlines a three-stage process and includes the information that a complainant may complain to CSCI at any stage in the process. Examination of one file discussed during the course of this inspection provided evidence of the home’s conformance to the procedure including the involvement of senior managers at appropriate levels in the process. Comments on the complaints procedure from respondents to this inspection included “I would speak to my family” (rather than use the procedure), “What is the good of complaining”, and “(The home) listens to any queries or complaints and tries to rectify then in an obliging manner”. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 18 The manager said that all residents are registered to vote. BUPA has a policy on the protection of vulnerable adults (POVA) and on whistleblowing. The manager had a copy of the current Surrey joint agency policy on the protection of vulnerable adults. According to the staff training summary provided to this inspection four staff had completed training on ‘abuse awareness’ and five staff had completed training on ‘Protecting Vulnerable Adults’ in 2006. Further training sessions are planned for July and October 2007. The home’s arrangements for the recruitment of staff aim to protect vulnerable adults through appropriate background checks on applicants and the requirement for an Enhanced CRB certificate. The subject is included in the list of topics to be covered by staff in their individual portfolios and a self-assessment DVD is available to staff as a resource. Staff spoken to during the course of the inspection visit said that they had never witnessed abuse in the home and felt that residents were safe from abuse. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 19 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 home provides an accessible, clean and well maintained environment which provides residents with a comfortable and safe place to live. EVIDENCE: The home is located on the outskirts of the village of Puttenham (which is just off the A31 road), just over five miles from Guilford. The nearest rail station is Guilford. It is a large detached house, with a purpose built extension, set in large landscaped gardens. There is an area for parking to the front and side of the home. The home has its own minibus which is used for outings. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 20 The accommodation is arranged over two floors. There are 28 single occupancy rooms and 4 double rooms. Eight bedrooms are on the first floor. Most, but not all, bedrooms have en-suite accommodation. The first floor is accessible by stairs or lift. Bedrooms vary in size. There are sufficient communal areas for the present number of residents. There are two lounges, a good sized dining room and an activities room. A number of improvements have been made to the home environment since the last inspection in November 2005. All the requirements of that inspection a large number of which were concerned with improvements to bathrooms and hand basins - have been acted on, a new ‘wet room’ has been installed, new carpets have been laid in the ground floor, and a water feature has been removed from one of the lounges. The manager said that there are plans for continuing refurbishment over the next year, to include redecoration of bedrooms. There are sufficient bathrooms and WCs for current use and sufficient aids to mobility and care are in place to assist residents as required. There are attractive enclosed gardens that are accessible to residents. The gardens include large areas of lawn, flower beds, mature shrubs and trees. All areas of the home were tidy, clean and free of untoward odours. The kitchen and laundry were well managed, clean and tidy. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels appear satisfactory and the home provides training and staff development across a range of subjects. This helps to ensure that there are sufficient numbers of appropriately trained and supported staff to meet residents’ needs. EVIDENCE: The home’s staffing include the manager, a deputy manager, registered general nurses (RGNs), care assistants, an administrator, receptionist, activities co-ordinator, chef, housekeeping staff, domestic assistants, and a handyman. The present staff establishment provides for 2 RGNs and 5 or 6 care staff in the morning, 1 or 2 RGNs and 4 care staff in the afternoon and evening, and 1 RGN and 3 care staff at night. Nurses and care staff are supported by housekeeping, domestic and other staff in providing care to residents. The manager said that the home was close to being fully staffed around the time of this inspection although some staff who had worked in the home for some years were due to move on to new jobs in the near future. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 22 In terms of National Vocational Qualifications (NVQs) the home has not quite achieved the standard to have 50 of care staff (excluding the manager and registered nurses) trained to NVQ 2 and above. Four more care staff were due to start such training during the next quarter year and on completion the home should then meet this standard. The recruitment of new staff in the UK is managed by the home. The recruitment of staff from overseas is managed by the overseas department of BUPA. The staffing of the overseas department includes three home managers. Vacancies are advertised in local newspapers. Applicants are required to complete an application form, provide two references, complete a health questionnaire and attend for interview. Successful candidates are required to provide an enhanced CRB (Criminal Records Bureau) certificate. The registration status of RGNs is checked with the NMC (Nursing and Midwifery Council) by the manager and held on a database which is maintained by the administrator. All staff are provided with a copy of the GSCC (General Social Care Council) codes of practice on starting. New staff may be appointed on a ‘POVA First’ basis, working under supervision until the enhanced CRB is received. The records of four staff appointed since the last inspection were examined and all were found to be in order. All nurses and care staff are provided with a learning portfolio. An internal summary report, by subject, of training completed by staff up to May 2007 and estimates of the numbers still to attend was provided for the inspection. The home’s position was discussed with the RGN who has a lead responsibility for the co-ordination of training. This internal report should inform the home’s plans for staff training over the next 12 to 18 months. New staff undergo a two day induction to the home. The ‘Skills for Care’ induction standards are completed within four months of appointment. A record is maintained in the BUPA learning portfolio. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements for the home are satisfactory and arrangements are in place for consulting residents and other stakeholders. Residents should benefit by having their views taken account of by managers and by having some influence on the quality of the service provided. Arrangements for health and safety are satisfactory and aim to ensure that residents, staff and visitors are safe. EVIDENCE: Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 24 The registered manager is a registered nurse and is currently pursuing the Registered Manager’s Award (RMA). She aims to complete the RMA by November 2007. The manager has been in post since September 2006 and before her current post was acting manager in another care home. The manager is therefore, suitably qualified and experienced for her position. The manager is not responsible for any other service. She is accountable to the Regional Manager. All staff in the home are accountable to the manager. Some concerns were expressed about an apparent change in the ethos of the home. References to this were included in comments on a change in ‘style’ of management, apparent communication problems between staff - and on occasions between staff and residents, concerns about its potential effect on the quality of care (e.g. through a lack of attention to detail or a sense in which some staff might appear less committed to their work), a wish for better team work, and a couple of reports that staff appeared to be working under increased pressure. At the same time, others reported the overall ethos of the home to be ‘very caring’’, ‘like a family’, and a home which is ‘centred on the needs of residents’. This mixed picture was reflected in the comments of some respondents to the CSCI survey. These included: ‘communications between staff patchy on occasions’; ‘Information not shared with staff’; ‘staff and management may have some issues’; ‘staff under pressure …..; ‘ The staff are always changing. Some of those who stay are very kind and helpful’; ‘ Some staff are much better than others’; and, ‘At present there is a changeover of staff and home manager, so new ways of communicating with relatives are being put in place’. At the same time comments also included: ‘I feel safe and secure – the service is very personal’; ‘Friendly atmosphere’; ‘Staff work hard and are very caring’; and, ‘(The home) listens to any queries or complaints and tries to rectify them in an obliging manner’. It was difficult to come to any firm conclusion on this by the end of this inspection. While concerns were expressed that potentially the situation might have an adverse affect on the quality of care, there was no evidence to suggest that it had done so to date. The overall impression was of a home that was undergoing change and that this was having a varying effect on people. Both sets of views were communicated by people with a genuine interest in the welfare of residents. The home carries out a number of quality assurance related activities. These include a stakeholder survey, meetings with residents, care plan audit, Regulation 26 visits, and checks on the environment. The reports of a resident satisfaction survey and a staff survey carried out in 2006 were seen. The next stakeholder survey is to be carried out in September 2007 using a form which has been adapted for use by the home. Survey reports include an action plan which is submitted to senior managers in the organisation. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 25 The home aims to have meetings with residents on a quarterly basis. The manager said that the meetings are run by the residents with support from one member of staff – to date this has been the activity organiser, but from the next meeting onwards will be the administrator. The manager and other care staff attend the meeting to talk to particular items on the agenda. The QUEST care plans were introduced into this home in January 2007 and were fully in place by the end of March 2007. One nurse has a lead role in relation to their implementation (a ‘champion’) and there are plans to carry out an audit of a sample of care plans in the near future. An auditor has been trained to lead the exercise. The outcome should address any weaknesses in the implementation of the system to date. The area manager does regular Regulation 26 visits. Notes are taken and copies were seen during the course of the inspection visit. The records include action notes where required. The organisation offers training in equality and diversity and the home has held events to celebrate cultural occasions. The home’s maintenance man and the estates manager do a walk around to check the state of the environment every six months. All of the work in the environment listed in the report of the last inspection has been completed. The manager said that meal times had been moved back half an hour or so following consultation with residents and relatives. The home does not act in any capacity in relation to the financial affairs of residents. Each bedroom has a lockable space for residents use and there is a safe for the storage of valuable in the office. The home does not undertake cash transactions on behalf of residents. A mixed impression was obtained on the implementation of formal supervision in the home. The manager said that all nurses and care staff receive six supervision sessions a year. The manager acknowledged that these may not be happening at regular intervals but points out that the national minimum standards do not specify a frequency, only a minimum number per year (standard 36.2). Records confirm that supervision does take place for some staff but at an uneven frequency. Records confirm a structure for the process and that supervision notes are signed by the supervisor and supervisee. Discussions with staff appeared to reflect an uneven picture of practice in the home. Some staff could not recall having ever had one to one formal supervision with their line manager. There was not a clear or consistent view of what formal supervision was about or of what would normally take place during the course of a supervision session. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 26 Supervision is important in maintaining and developing good standards of practice. Given the diversity of views on this matter there does appear to be a need for a reappraisal of the current position of formal supervision in the home. BUPA has a policy governing this matter and this should guide management and staff practice. Staff are required to have an annual appraisal. These are held in the summer or winter depending on the anniversary of the date the person commenced employment. ‘Group Supervision’ may be held on an ad hoc basis. The discussion is likely to be focussed on a specific topic – an example given was a discussion on the completion of accident forms. There is a health and safety policy and a health and safety operational manual in place. The maintenance man has a lead responsibility for health and safety matters in the home. This includes fire safety training, routine checks of fire safety procedures, ensuring that contractors maintain fire safety equipment, that portable appliance testing (‘PAT tests’) of electrical equipment and testing of gas appliances by CORGI engineers is carried out, and ensuring that hot stored water is appropriately treated in order to prevent the development of Legionella. The home had recently received a visit from the local environmental health department and had been awarded five stars for its excellent practice in food hygiene. A contract is in place for the removal of clinical waste and sharps and unused medicines. Systems are in place for recording accidents and for reporting on a quarterly basis to senior managers. Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 3 Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP9 Good Practice Recommendations The registered manager should ensure that staff cease to use the term ‘Cotsides’ which is inappropriate in an adult service The registered manager should ensure that the control, storage and administration of medicines conforms to good practice as advised by the relevant professional bodies and the home’s own polices and procedures The registered manager should ensure that all nurses and care staff have a clear understanding of the purpose and process of formal supervision and that supervision meetings are held at regular intervals. 3 OP36 Puttenham Hill House DS0000017634.V339260.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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