Inspection on 19/09/07 for Pymgate House

This inspection was carried out on 19th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Pymgate House 08/07/08

Pymgate House 03/05/06

Pymgate House 07/12/05

Pymgate House 06/05/05

Pymgate House 18/11/04

Pymgate House 19/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Pymgate House 149 Styal Road Heald Green Stockport Cheshire SK8 3TG Lead Inspector Mrs Fiona Bryan Unannounced Inspection 10:00 19 September 2007 th 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 Pymgate House DS0000008579.V343907.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. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pymgate House Address 149 Styal Road Heald Green Stockport Cheshire SK8 3TG 0161 437 1960 0161 498 9645 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) Mr Brian Fox Ms Patricia Fox Mrs Patricia Fox Care Home 10 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (9) Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 9 OP and up to 1 MD (E). Date of last inspection 3rd May 2006 Brief Description of the Service: Pymgate House is situated in the Heald Green area of Stockport. It is a large detached house set in its own grounds. The property dates back to the 1770s, and much of its original character has been retained. Pymgate House is registered to provide accommodation for up to ten older people, one of whom may be suffering from a mental disorder. The registered providers of Pymgate House are Mr Brian Fox and Mrs Patricia Fox, who live on the premises. Mrs Fox is actively involved in the day to day running of the home and has a hands on approach with the service users. Accommodation includes six single bedrooms and two double bedrooms, one main lounge and a small sitting area off the main lounge and a separate dining room. There are two bathrooms, one on the ground floor, which has a bath hoist to assist service users and a shower. The bathroom on the first floor also has a shower facility. There is a stair lift to assist service users to their bedrooms on the first floor. The home operates a non-smoking policy for service users, visitors and staff. There is a large car park to the front of the house and extensive gardens with a decked area to the rear of the property. The home has three dogs and a parrot. Two of the dogs are registered as patdogs. Fees for accommodation and care at the home vary between £321 and £333 per week. A service user guide is available on request. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection, which included a site visit, took place on Wednesday, 19th September 2007. The manager was not told beforehand of the inspection visit. All key inspection standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with people who live at the home, visitors, the manager and other members of the staff team. Two people were looked at in detail, looking at their experience of the home from their admission to the present day. A tour of the building was conducted and a selection of staff and care records was examined, including medication records, employment records and staff duty rotas. Before the inspection, comment cards were sent out to residents and relatives asking what they thought about the care at the home. Information from these has also been used in the report. We also sent the manager a form before the inspection for her to complete and tell us what she thought they did well and what they need to improve on. Information from this has been used in the report. What the service does well: The internal and external appearance of the home provided a pleasant, comfortable environment for residents to live in. Residents liked their rooms and said that they were helped to keep them clean, tidy and free from smells. The garden was spacious and well kept; residents said they enjoyed spending time outdoors, weather permitting. Residents and relatives said that staff were hard working and very kind. Comments included, “I love it here” and “they (staff) are very kind and very caring – it is like a family. It is always the same and it stems from Pat (the owner/manager) who is very caring and staff are very caring indeed. The staff are very, very good – they respect the residents”. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 6 Staff were very knowledgeable about the residents’ day-to-day preferences and paid attention to small details that were important to the, such as making sure they were wearing their jewellery and perfume. This showed that they treated people as individuals and were considerate in taking into account their wishes and feelings. Two health care professionals who were visiting the home on the day of the site visit held positive opinions about the home, saying that residents always appeared well cared for and content, and that staff could be relied on to follow instructions and contact them if they had concerns about their condition. Relatives said the manager kept them informed about the residents’ conditions and that they were made very welcome when they visited. Residents and relatives expressed satisfaction with the manager, saying she was approachable and would sort out any problems for them. The manager operates an open door policy and is available most of the time, around and about the home. Well over 50 of care staff are trained to at least NVQ level 2, which means that staff have the skills and knowledge to deliver a high standard of care. The meal seen on the day of the site visit looked appetising and tasty and residents seemed to enjoy it. Menus were varied. What has improved since the last inspection? What they could do better: The majority of the shortfalls identified related to the poor standard of record keeping, which leads to a risk that staff may not know what care residents need or what systems are in place to monitor the effectiveness of the care. Pre-admission assessments need to be detailed. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 7 Residents’ care records need improving so that assessments and care plans are recorded every time for all individual care needs. This means that information about health and personal care and the residents’ personal wishes, likes and dislikes should also be included in the care plan. The manager had failed to follow appropriate recruitment procedures in respect of care staff employed at the home. The procedures used for the recruitment of staff at the home did not provide adequate protection to residents. A proper record of staff training, both planned and completed, was not available. This is necessary as evidence that staff have attended training to equip them with the skills and knowledge to deliver care and also so the manager can plan what training is required and when refresher courses are due. Quality assurance monitoring and auditing of the care services need improving so that continuous improvements are made in the home. As stated earlier, some medication practices are still unsatisfactory; if the manager had carried out audits to check that staff were adhering to the correct policies and procedures, it may have been identified that staff were administering some medication more often than was prescribed. 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. Pymgate House DS0000008579.V343907.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 Pymgate House DS0000008579.V343907.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. Standard 6 is not applicable. Quality in this outcome area is adequate. Assessments are undertaken but they do not always consider all the potential care needs of prospective residents, which leads to a risk that the home will not be able to meet some needs. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Two visitors said that they had to come to look round the home before their relatives had decided to live there; one resident said they had also been and had lunch and stayed for a few hours. Everyone spoken to said they felt the information they had been given about the services the home could provide had been accurate and honest. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 10 Staff said that before new residents were admitted to the home either the manager or the deputy manager went to assess their needs, and staff were then informed about the care new residents needed when they were admitted. Two residents were case tracked; however, their records did not demonstrate that thorough assessments had been undertaken. Risk assessments for the risk of falls, pressure ulcers, moving and handling and nutrition had not been undertaken. Many of the residents have some degree of independence and do not have complicated medical or health care issues, and residents and relatives felt that their needs were being met. However, if assessments are not fully completed there is a risk that some care needs will not be identified and a further risk that people’s needs will change and this will not be recognised and acted upon. Pymgate House DS0000008579.V343907.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 adequate. Records are basic and lack detail. This is acceptable for residents who have a low level of needs but presents a risk that more complex needs will not be monitored properly because the staff do not have enough information about how to do this. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Two residents were case tracked. Care plans were available but they did not contain a lot of detail and the reader could not determine from the plans exactly what the residents could do for themselves and what care staff needed to provide. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 12 For example, one person’s care plan to address their hygiene needs said that the service to be provided was “help with washing and dressing”, and the objective was to “offer any assistance required”. This did not give any real insight into the abilities and needs of the resident. Another resident had mental health problems but there was no detail about how this manifested, or how the staff could manage and monitor this. As stated in the previous section, risk assessments had not been undertaken. One resident had lost weight but had no care plan for how to address this. The records showed that the resident was to be weighed weekly but this had not been done. The manager said that residents were not routinely weighed but were weighed when the GP requested it. The manager said that she thought the district nurse was weighing the resident and a weight for the resident had been recorded in the diary but not in their care plan. Better systems are needed to ensure that residents’ health needs are monitored effectively and to ensure that where other health care professionals are involved it is clear who has what responsibilities towards the resident. Despite the haphazard recordkeeping, residents looked well cared for and said they received good care. Relatives said that when they visited, the residents always looked smart and tidy. One visitor said that staff knew her relative liked to wear earrings, jewellery and perfume and they made sure she looked really nice when she went out to her house, knowing that her looks and appearance were important to her and she wouldn’t “feel right” without them. Staff were knowledgeable about the residents and were able to offer far more information about their likes and dislikes and preferred daily routines than was written in their care plans. This indicated that whilst the records were not as good as they should be, staff do, in the main, know what they need to do for each resident. There was evidence that residents or their representatives had been involved in planning their care and a very good system was in operation, whereby all the residents were reviewed by their GP about once every four-five weeks. The GP visited on the day of the site visit and spent time with all of the residents and the manager, reviewing their medicines and treatment. In this way, it was probably unlikely that residents would suffer any major deterioration without it being recognised, despite the records not meeting their intended purpose. Relatives said that they were kept informed about changes to the residents’ condition and one relative said that staff were observant and had noticed when their relative was unwell and had been prompt in calling out the doctor. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 13 The GP and the district nurse who visit the home both said that either the manager or the deputy manager were available when they called and staff followed any advice or instructions that they asked to be carried out. Both these professionals also said that they had observed staff attitudes towards the residents to be respectful and helpful. Residents said the staff were kind and polite and one visitor said staff were very caring indeed. This person said that she felt staff treated residents “like a family” and went on to say “It is always the same and it stems from Pat (the owner/manager) who is very caring and staff are very caring indeed. The staff are very, very good – they respect the residents”. Since the last inspection a new fridge has been purchased for the storage of medicines that require refrigeration. There continue to be some areas within the procedures for managing medicines that need improving. The procedure for recording dose changes could lead to confusion. One entry was seen where the new dose had been changed alongside the original preprinted instruction. The date of the change was not recorded and it seemed from the number of tablets left that some staff had been giving the old dose and some the new dose. Some medicines had not been counted and signed for on receipt into the home. This means that there is no clear audit trail for some medicines coming in, being administered and leaving the home. One resident had been given eye drops three times a day for several days when the prescription stated that they were required twice a day. Some eye drops for this resident were required eight times a day but had only been signed as having been given four times a day. Photographs were available to assist in the positive identification of residents when administering medication and specimens of staff signatures were provided to clarify which staff member had administered medicines on any given day. Pymgate House DS0000008579.V343907.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. The day-to-day routine of the home, including mealtimes, was relaxed and informal and met service users’ needs. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The arrangements for social activities and stimulation suit the majority of residents. The home is only small and all the residents know each other, get on well together and like to spend time chatting and relaxing in the lounge. One resident said she got up early but this was generally her choice – she was, however, unsure if she would be able to have a lie-in if she wanted to. Most residents liked to get dressed and then come into the lounge, as they preferred company to spending time alone. One resident who preferred to spend time in her own room was able to do this and staff called in regularly to check she was alright and see if she needed anything. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 15 Visitors said they were made to feel very welcome and when they came there were sometimes activities and social events taking place, such as quizzes and exercise sessions. All residents also have the opportunity to take weekly communion if they wish and the hairdresser visits weekly. Some residents mentioned a trip they had recently been on to Llandudno, which they had enjoyed. The owner has several dogs and a parrot, and some residents had chosen to live at the home on the strength of that because they liked animals. Residents enjoyed having the animals around and it added to the homely atmosphere. Examination of the menus showed that a nutritious and varied diet was provided by the home. Residents had a choice of cereals, porridge, prunes and cooked options, such as egg or tomato on toast, for breakfast. Typical food for the main meal of the day included roast dinners, meat and potato pie, fish pie, braised steak and onion, plaice, liver and sausage, cabbage and ribs, gammon, chicken casserole and cod. Lighter teas included food such as sardines on toast, Welsh rarebit, poached egg on toast, burgers, sandwiches and salads, omelettes, mackerel, fish cakes and pancakes. One resident said she had Special K and All Bran with prunes and a slice of toast, butter and marmalade for breakfast, which was what she had preferred when she had lived in her own home. Another resident said she liked to have breakfast in bed and always had tea and toast. Residents said that there was more choice at teatime but if they did not like the main meal on offer, they could request something else. Lunch on the day of the site visit was asparagus soup, followed by roast beef and Yorkshire puddings, roast and mashed potatoes, sprouts, carrots, and home made apple crumble and custard. A sample of the soup was tasty and appetising. Residents were complimentary about the food provided by the home. One resident said the puddings were “delicious”. Several residents mentioned their favourite dishes, such as fish cakes and corned beef hash. One resident said the staff were “all good cooks”. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 16 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 and 18 Quality in this outcome area is good. Residents felt confident that their complaints would be taken seriously and acted upon. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The complaints policy is available in the reception area of the home. However, it was out of date, as it still referred to the National Care Standards Commission, which stopped operating in 2003! Residents and relatives spoken to said that if they had any concerns, the manager or the deputy manager were around the home nearly all the time and they would speak to them. Pymgate House is a small home and the manager enjoys a very good rapport with all the residents and their representatives; any concerns are therefore dealt with immediately and in an informal way. No formal written complaints have been received since the last inspection. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 17 The manager said that the majority of staff have undertaken training in safeguarding adults, although no records were available to confirm this. Staff were aware of the procedures to follow if they suspected abuse. Residents said they felt happy at the home and relatives had confidence that the residents were safe. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 18 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. The home was well maintained and provided comfortable living accommodation for residents. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: There were no physical changes to the home environment since the last inspection. The manager said that maintenance personnel were contracted in to do work as it became necessary. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 19 The grounds of the home were well kept and attractive. The lounge and dining room were an open plan design that facilitated residents chatting and socialising together. An additional small sitting area was available for residents to entertain visitors or sit quietly if they wished. A number of residents’ rooms were seen. These were homely and personalised with ornaments, furniture and mementos. Six bedrooms were single rooms whilst two were double rooms. Aids such as raised toilet seats and grab rails were provided. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 20 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): 27, 28, 29 and 30 Quality in this outcome area is adequate. The home was sufficiently staffed to meet residents’ needs but the procedures for the recruitment of staff at the home did not protect them from potential abuse. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Examination of the staff duty rotas showed that there were usually two carers plus the manager or the deputy manager on duty throughout the day and one carer on duty at night with the owner sleeping-in on the premises. The deputy manager also spends two supernumerary days per week undertaking administrative work. These staffing levels were satisfactory, although there had recently been some debate between staff and management, as carers did also have to attend to cooking and housekeeping duties, as well as providing care, and they felt that they did not always have as much time as they would like to spend with residents, as the days were very busy. However, residents and relatives felt that there were enough staff and said, “Someone is always around”. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 21 The personnel file for one new staff member who had been employed since the last inspection was examined. This showed that although a CRB had been applied for and a POVA First check made, the POVA First result had been received after the person had started working at the home. Additionally, no suitable references were available. One pre-written testimony was in evidence but this did not state what the relationship was of the person who wrote it and it had not been written by either of the people whom the employee had put forward as referees. The manager said that she had phoned both referees and had verbal assurances that the person was suitable to be employed in a care home but there was no record of the conversations she had. Poor recruitment practices were highlighted at the last inspection. Care staff on duty at the time of the inspection said that they had undertaken further training to assist them in their role as carers, which included food hygiene, the safe handling of medicines, emergency first aid and health and safety. Certificates were available to confirm that staff had undertaken first aid training and the manager and deputy manager had certificates for first aid in work place and the safe handling of medicines. However, apart from these, no written evidence was provided at the time of the site visit to confirm that other training had taken place. The manager said there were no proper training records but dates may be entered in the diary when staff had attended training. This disorganised system does not allow the manager to properly monitor what training staff have received and determine when refresher training is due. Of 13 care staff, ten had successfully obtained NVQ level 2. This equates to 77 of care staff being trained. The manager had just arranged for staff to attend moving and handling training in October 2007. Relatives said that they thought staff were well trained and equipped with the right skills to look after the residents. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 22 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, 33, 35, 37 and 38 Quality in this outcome area is adequate. The home was well managed for residents; however poor auditing systems are not highlighting the areas the manager needs to develop. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The registered manager does not hold a relevant qualification in care. She is an experienced carer and has held the post of manager at Pymgate House since 1986. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 23 Since the last inspection the manager has attended training in emergency first aid in the workplace and the safe handling of medicines. The manager operates an open door policy and is very actively involved in the care of the residents. It was clear from observing her interactions with residents and visitors that they all knew her very well and vice versa. One visitor said that he saw the manager “all the time” and that he was regularly updated about his relative’s progress. Formal residents/relatives’ meetings are not held, as people can speak to the manager or make suggestions whenever they want to. Similarly, the manager said she had not undertaken any satisfaction surveys for some time, as she speaks to everyone personally. However, the manager should consider documenting some of these discussions to provide a record of how she takes the views of residents into account when making decisions about the running and organisation of the home. This would also be useful for her as part of an annual quality assurance assessment, for reflecting on areas that were identified as needing development and improvements that have been made as a result. Staff said they had attended a staff meeting about three weeks previously but these were not regular events; again the small staff team see each other regularly and chat over issues as they arise when they have “handover” sessions at the beginning of each shift. The manager does not undertake any formal audits to check that staff are complying with the home’s policies and procedures in areas such as care planning and medicine administration. If audits were undertaken, this might highlight more readily to the manager the shortfalls in, for example, record keeping. Only small amounts of money are kept in safekeeping for residents. Ledger books are maintained which itemise all transactions and receipts are kept. One visitor said she was satisfied with the arrangements at the home for handling her relative’s money. Weekly checks had been made of the building and equipment in respect of fire prevention and health and safety. Staff were seen to be using safe working practices. Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 24 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 2 3 Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 Requirement The manager must have in place detailed care plans, which reflect the changing needs of service users and the up to date action required. This includes assessments and care plans for pressure area care, moving and handling and nutrition. (Timescale of 30/11/06 not met). The manager must ensure that medicines are administered as prescribed. The manager must ensure that if a person is required to start working at the home before their CRB has been returned a POVA First check is obtained before they commence employment. The manager must also ensure that two appropriate written references are obtained before the person starts working at the home. (Timescale of 30/11/06 not met). Timescale for action 31/10/07 2 3 OP9 OP29 13 19 31/10/07 31/10/07 Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 26 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 OP3 OP8 Good Practice Recommendations The manager should ensure that detailed written assessments are in place for each resident, which clearly identify their abilities and care needs. The manager should ensure that when other health care professionals are involved in a resident’s care, it is clear who is carrying out the different aspects of care and information is properly shared and recorded. The manager should ensure that medicines are counted and signed for on receipt into the home so an audit trail can be maintained of medicines in the home. The manager should ensure that when the dose of a medicine is changed, this is written and dated on a separate line on the medicine record so it is clear when the new dose commenced. The manager should review and update the complaints policy. The registered manager should provide written evidence of training that staff have completed and are undertaking. The manager should develop a proper quality assurance system to demonstrate how the home listens to and acts on residents’ views and to assist in identifying areas for improvement. Part of the quality assurance system should also include the manager’s own audits assessing the care practices of staff and ensuring records meet the required standards and are suitable for purpose. 3 4 OP9 OP9 5 6 7 OP16 OP30 OP33 Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Old Trafford, Manchester M16 9HU 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. Extracts may not be used or reproduced without the express permission of CSCI Pymgate House DS0000008579.V343907.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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