CARE HOMES FOR OLDER PEOPLE
Puttenham Hill House Puttenham Hill Puttenham Guildford Surrey GU3 1AH Lead Inspector
Mavis Clahar Unannounced Inspection 28th November 2005 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.V269618.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. Puttenham Hill House DS0000017634.V269618.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Puttenham Hill House Address Puttenham Hill Puttenham Guildford Surrey GU3 1AH 01483 810628 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) BUPA Care Homes Limited Mrs Jayne Louise Mannion Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Puttenham Hill House DS0000017634.V269618.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 36 beds providing nursing care for elderly people from the age of 60 years To include one bed for a person from the age of 48 years. The service may accommodate one named person over the age of 65 years who has dementia. 23rd June 2005 Date of last inspection Brief Description of the Service: Puttenham Hill House is a large property located in a rural setting just outside Guildford off the A31. The home is owned and managed by BUPA Care Homes Ltd and caters for 36 service users one of whom might require dementia care. There are 28 single occupancy bedrooms and four double bedrooms most of which have en-suite facilities. The majority of the bedrooms are situated on the ground floor with eight bedrooms on the first floor accessible by passenger lifts and stairs. The home has ample communal space including two lounge areas, a large dining room that incorporates an area for hair dressing facilities, and activities facilities. Adapted bathing and toilet facilities are conveniently situated on both floors. The home has its own vehicle, which is used for transporting service users to places of interest. There is ample parking for visitors and staff. The homes gardens are enclosed and are made accessible for service users in wheelchairs. Puttenham Hill House DS0000017634.V269618.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second inspection to be undertaken in the Commission for Social Care Inspection year March 2005 to April 2006. To obtain a full understanding of the homes performance for the year it is necessary to read both reports for the year. This is an unannounced inspection. This means that no one at the home had prior knowledge of the inspection. The home received an announced inspection on the 23rd June 2005. The first part of the inspection was spent reviewing the requirements from the last inspection, touring the home and grounds and speaking with service users and care staff. The second part of the inspection was spent reviewing a random sample of service users notes, care plans medication records and risk assessments. This was followed by review and assessments of the National minimum standards for older people. The last part of the inspection was spent giving feedback to the manager on the findings of the inspection. A number of repairs are needed to the home to ensure the safety and wellbeing of the service users. Requirements have been issued for these repairs to be carried out under the Environmental standards in the report. (Standards 19-26). What the service does well: What has improved since the last inspection? Puttenham Hill House DS0000017634.V269618.R01.S.doc Version 5.0 Page 6 Staffing levels have been improved with the appointment of five new permanent members of care staff, and the reduction in the use of agency staff. A relief Chef has now been employed to provide twenty hours of Chef time. The home has recently introduced candle lit suppers for service users to which they can invite their relatives and friends. Service users spoken to on the day of inspection have hailed this as a great success. The manager has relocated her office to what was the staff room, and the staff room is now situated in what was the manager’s office. The new office is now in a bigger room that allows for interviewing or speaking with service users or their relatives in more comfort as the office now contains a small table and chairs. The activity room has been redecorated. The participation to the staircase is now completed in line with the fire officer’s requirement. The home has purchased a new fridge for the servery. Three new profiling beds and four slide sheets for easy movement of service users have been purchased. A new fish tank and DVD player has been bought for the blue lounge. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Puttenham Hill House DS0000017634.V269618.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Puttenham Hill House DS0000017634.V269618.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 EVIDENCE: These standards were assessed on the last inspection. For further information on these standards please refer to the report of 23rd June 2005. Standard 6 does not apply to this home. Puttenham Hill House DS0000017634.V269618.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8 9. The health care needs of the service users are well met with evidence of staff training in place to meet the assessed care needs of the service users. EVIDENCE: One service user spoken to said “I have been here since before Christmas and the I am looked after very well by the permanent staff; agency staff is hit and miss as I have to explain what they have to do for me. I am much better now than when I came in. The only thing missing in my care is a shower, I would like a shower in my bathroom as I prefer a shower to a bath”. Another service user said, “My needs are met very well. You see I talk with the nurses and they do as I ask them. I am very satisfied with the care they give me”. The inspector reviewed training needs of carer in dementia care and found this was a need already identified and addressed by the manager and carer. No service user at this home is risk assessed as capable to self- medicate. All medication is administered by the Registered Nurse on duty under the guidelines of the Nurses and Midwifery Council guidelines on administration of medicines and the Medicines Act 1968.
Puttenham Hill House DS0000017634.V269618.R01.S.doc Version 5.0 Page 10 Puttenham Hill House DS0000017634.V269618.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 14 Service users are encouraged and enabled to make choices in their daily lives and to form links with the community. This helps to enrich and support service users social and spiritual life EVIDENCE: Service users informed the inspector that they have good contact with their relatives and now that the home has started this candle light suppers, their relatives are able spend longer time with them as they can order their supper here at the home. One service user said, “This is one of the best idea the home has had. The atmosphere in the dining room is not unlike being at a good restaurant with your family”. Service users informed the inspector that they are enabled to make daily choices in their clothing, their meals, where they would like to have their meals, and which activities they will participate in. One service user said she can arrange to change rooms if she was not happy in her room and a room was available. The inspector formed the opinion that service users saw the home as their own house and was very proud of their home. Puttenham Hill House DS0000017634.V269618.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Service users spoken to were knowledgeable about whom they would complain to if they were not happy about anything, and they felt their views would be dealt with promptly. EVIDENCE: The home had five complaints from service users recorded, one from the operations manager and one from a relative of a service user. All complaints have been partially upheld and have now been resolved; within the homes complaints time scale. Puttenham Hill House DS0000017634.V269618.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 21 25 The overall quality of the maintenance of the home is poor and in some places potentially dangerous, placing service users and visitors at risk of injury or harm EVIDENCE: The home has a programme of routine maintenance in place but this is not followed, consequently there is a lot of repair work to be done. The requirements issued at the last inspection under standard 19 were carried out, but the standard of work is very poor and most of this work needs to be re done again. A number of requirements have been issued under standard 19. Please see requirements for greater details. The toilet situated opposite bedroom 36 on the first floor has no hand washing facilities and as a consequence of reducing the risk of cross infection this toilet was closed immediately under health and safety regulations. Puttenham Hill House DS0000017634.V269618.R01.S.doc Version 5.0 Page 14 The bathroom opposite Bedroom 31 is in need of urgent redecoration to remove the broken plastic beside the toilet, cover the exposed lamp and replace the broken tile that has some form of white substance stuffed in the hole of the tile. Requirement was issued on this standard. Puttenham Hill House DS0000017634.V269618.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 29 30 The home now has a more constant and permanent staffing levels and this is reflected in the comments made to the inspector by service users. EVIDENCE: The home has recently employed five new members of staff who has completed their induction training and is currently undergoing the five core courses. Service users spoken to say they could see a difference in the care given by the permanent staff as compared to the agency staff. The homes recruitment policy was reviewed and it was demonstrated that the home is operating within their employment policy, which incorporates the equal opportunity policy of the home. Speaking with care workers and service users and a review of a the homes training records all demonstrated that care workers are trained and supported in performing the duties expected of them. Puttenham Hill House DS0000017634.V269618.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): 33 The needs of the service users in this home is the base on which the home is pivoted. EVIDENCE: Service users informed the inspector that they have regular contact with the manager and that they felt able and comfortable in discussing any issue that might be causing them concerns, knowing it will be dealt with in a sympathetic and private way. The manager informed the inspector that regular daily meetings are held with heads of departments to plan each day, and care meeting with care staff is held the first Tuesday in every month. Service users are asked for their comments to be discussed at this meeting. The homes Quality Audit has just been completed and will be sent off to the researchers for analysis and reporting early next year.
Puttenham Hill House DS0000017634.V269618.R01.S.doc Version 5.0 Page 17 The inspector observed good interaction between service users and the manage, between the manager and all grades of staff. Puttenham Hill House DS0000017634.V269618.R01.S.doc Version 5.0 Page 18 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 1 X 2 X X X 2 X STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X X Puttenham Hill House DS0000017634.V269618.R01.S.doc Version 5.0 Page 19 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 OP19 Regulation 23 Requirement The bathroom opposite bedroom 6 to have some form of ventilation installed. The piping must be boxed in to protect service users and staff from possible burns. The showerhead is to be kept in the upright position prevent the occurrence of legionnaire. Repair the holes in the wall of the bathroom Replace the wash hand basin that is broken in the bedroom next to the activities room In the activities room, repair the end of the counter supporting the sink, replace the broken tiles and plaster board to the wall beside the sink. Redecorate the toilet between the dining room and the activities room. Sluice opposite the drapery, the floor must be replaced. Bathroom with the parker bath next to bedroom 29, the pipes are to be boxed in to prevent accidental burns. Replace the wash hand basin in the bathroom of bedroom 33. It
DS0000017634.V269618.R01.S.doc Timescale for action 26/02/05 2 3 OP19 OP19 23 23 26/02/06 26/02/06 4 5 6 OP19 OP19 OP19 23 23 23 26/02/06 26/02/06 26/02/06 7 OP19 23 26/02/06 Puttenham Hill House Version 5.0 Page 20 8 OP21 13 9 10 OP19 OP25 23 23 is cracked in many places The toilet opposite bedroom 36 has no hand washing facilities. An immediate closure order was issued to avoid the possibility of cross infection. Replace the damaged vanity unit in bedroom 23. In the bathroom opposite bedroom 31, remove the broken plastic fitting beside the toilet, cover the exposed lamp, and replace the damaged tile that has some form of white material stuffed in the hole in the tile. Generally redecorate the bathroom. 28/11/05 26/02/06 26/02/06 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 37 Good Practice Recommendations Pre assessment records of service users should be kept with service users notes. Puttenham Hill House DS0000017634.V269618.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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