Inspection on 03/05/06 for Pymgate House

This inspection was carried out on 3rd May 2006.

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 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 19/09/07

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 Kathleen Mcall Unannounced Inspection 3rd May 2006 11:00 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 Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 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.V290234.R01.S.doc Version 5.1 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 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. Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over the course of a day. The registered manager accompanied the inspector throughout the inspection process. Care plans, assessment documentation, and other records were examined. The inspector spoke with a number of residents and three members of staff who were on duty at the time of the site visit to the home. What the service does well: What has improved since the last inspection? Since the last inspection all residents now have a care plan The registered manager has made a number of changes to the way medication is administered and stored within the home. Printed medication administration records are now in place and the registered manager has purchased a fridge for the storage of some medications. All other medications is now stored in purpose built cabinets away from the kitchen area. Since the last inspection the registered manager has consulted residents about the type and frequency of activities provided at the home. Activities include quizzes; musical entertainers and Tai Chi. The majority of residents were satisfied with these arrangements. Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 6 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. Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 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 Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 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): 3 and 4. Quality in this outcome area is good. Service users care needs were fully assessed before admission and they are satisfied with the care provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One new service user had been admitted to the home since the last inspection. Information held on the service users file confirmed that the service user had been thoroughly assessed prior to their admission to the home. Assessments had been obtained from social workers and health professionals and the home had completed their own assessment documentation. Neither the service user nor their relatives were available for interview at the time of the site visit. The inspector met several services at the home. Service users told the inspector that they were happy with the way in which the home was meeting their needs. Several service users said they felt well cared for. Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 9 Care staff told the inspector that they regularly updated their moving and handling training and health and safety training. A high percentage of the staff group held an NVQ qualification in care. Staff said they familiarised them selves with service users care plans. The home operated the Key worker system and they felt this assisted their knowledge of specific service users. Care staff demonstrated a good understanding of service users care needs. Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. Care plans did not reflect how service users cares needs were met. Medication practices at the home remained unsatisfactory. Despite this service users health and care needs were met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection the home had been given a requirement in respect to service users care plans. The registered manager was required to review all service user care plans and to ensure that the service user care plan illustrated how the home was meeting service users needs in respect of their care and health needs. At the time of the site visit it was observed that all service users had a care plan. A new style care plan had been put in place, which was detailed and comprehensive, with the majority having been signed by the service users or a relative. Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 11 Care plans were not reviewed on a regular basis to reflect service users changing needs. Risk assessments were not reviewed on a regular basis and four service users were using bed rails at night to prevent falls. Risk assessments had been carried out for the use of these. Care plans still did not accurately reflect service users care needs. Two care plans did not reflect the deteriorations observed in service users health and care needs and from information supplied to the inspector at the time of the visit. The inspector had a discussion with care staff regarding their use of care plans, how they used the information held within the plan and how they familiarised themselves with the contents, and with any changes in the service users. Two members of staff said that they read the care plan and the daily records when they came on duty and had discussions with other members of staff, the registered manager and with the service users. At a previous inspection evidence of poor practice in the storage, recording and administration of medication was found and a number of requirements were issued. At the time of the site visit it was observed that the medication practices at the home had improved in a number of areas, ie storage arrangements and the introduction of printed medication records. However there was still evidence of some poor practice. Service users’ told the inspector that they were very satisfied with the way in which their health needs were met. All service users at the home were registered with one local GP, who called on a monthly basis and reviewed service users health needs. Service users’ told the inspector that staff treated them well and with respect at all times. Staff care practices were observed at the site visit. Care staff treated service users respectfully and spoke appropriately to them. Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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 day-to-day routine of the home was relaxed and informal. At a previous inspection the home had been given a requirement in respect of activities as some service users and a relative had complained that there was not enough going on in the home to occupy service users. Since the last inspection the registered manager had liaised with service users and several activities had been organised that included quizzes which took place twice per month. A musical entertainer called twice monthly. Weekly visits from local churches and the registered manager had arranged for service users to participate in Tai Chi exercise. The majority of service users’ said they were happy with these arrangements, however one service user complained that the home was too quiet and she would like more opportunity to watch TV and listen to the radio. Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 13 At the time of the site visit the inspector observed that the home still had a very quite environment with the majority of service users sitting in the lounge without TV or music. The inspector had a discussion with the registered manager who advised that that this was unusual that it wasn’t normally so quite. Visitors were welcome to the home and the home maintained contact with the local community ie church visits. Service users were able to see visitors in private. Service users or relatives of service users’ managed their finances. Service users’ were encouraged to make choices on a daily basis regarding what food they preferred to eat, and what activities they took part in. Service users’ expressed a high level of satisfaction about the meals and quality of food provided at the home. Lunch was a three-course meal served with fresh vegetables, the teatime meal was a light snack meal and breakfast was served in service users bedrooms. Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 14 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 and 18. Quality in this outcome area is adequate. Service users felt confident that their complaints would be taken seriously and acted upon. Not enough staff had undertaken training in adult protection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had been one anonymous complaint made directly to the commission since the last inspection, which was unsubstantiated. Service users told the inspector that they knew who to complain to and felt that their complaint would be dealt with in a suitable manner. Several service users’ told the inspector that they had nothing to complain about. The home had a procedure for responding to allegations of abuse and a number of care staff had undertaken appropriate training in adult protection as part of their National Vocational Qualification training. However at a previous inspection it was observed that not all staff had undertaken training in adult protection issues and the registered manager was required to ensure that all staff received such training. At the time of the site visit the registered manager was unable to provide evidence that remaining care staff had completed such training and thus the requirement remained outstanding. Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome area is good. The home was well maintained and provided comfortable living accommodation for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had no physical changes to the home environment since last inspection. Standards of hygiene and cleanliness throughout the home were good at the time of the site visit. The home provided comfortable accommodation and was free from any unpleasant odours. A number of service users rooms were seen, these were also furnished and equipped to a comfortable standard, many had been personalised by the occupants. Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 29. Quality in this outcome area is adequate. The home was sufficiently staffed to meet needs but the procedures for the recruitment of staff at the home did not provide adequate protection to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the site visit there were two senior carers on duty. The inspector spent some time talking with care staff about care plans, training and how they met the needs of service users. One member of staff said she had observed that service users were more dependent than previously and that sometimes laundry and cooking tasks took them away from time spent with service users. There were times during the day when the inspector observed that staff did appear to be very busy however staff managed these times well. 75 of the current staff group at the home continued to hold an NVQ qualification; there had been no change to this level since 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 moving and handling updates, food hygiene, fire training and the safe handling of medicines. Written evidence was not provided at the time of the site visit that confirmed the training had taken place. The registered manager was advised to make this evidence available at future site visits. Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 17 The staff group at the home was a stable one. Since the last inspection the registered manager had employed one new member of staff. The registered manager had not followed appropriate recruitment procedures with regard to the newly appointed staff member, who had commenced work without a Criminal Records Bureau check or POVA first check or written references being in place. This matter was dealt with in a separate letter sent to the registered manager. Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38. Quality in this outcome area is adequate. The home was well managed for service users; however staff were not appropriately supervised. The health and safety of staff and service users was safeguarded. 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. Previously it had observed that the home had made a start in monitoring the quality of service provided at the home. Service users questionnaires had been completed and the results analysed. At a previous inspection the registered manager was required to develop this further to include questionnaires being given to relatives, friends and significant stakeholders concerned with the home and that questionnaires must be anonymous. Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 19 At the time of the site visit it was observed that there had been no further progress with regard to developing the homes quality monitoring systems. The registered manager was advised that quality monitoring was an ongoing process with outcomes being reviewed on an annual basis. The home complied with the requirements of the fire authority. The home maintained records in respect of fire safety at the home. The registered manager had not responded to requirements regarding the supervision of staff within prescribed timescales. It has been a requirement since 19/08/2004 that the registered manager must provide formal supervision for all staff employed at the home. At the time of the site visit formal supervision arrangements had not been put in place. The inspector had a discussion wit the registered manager about ways in which this requirement could be met. Care staff told the inspector that there were good informal supervision arrangements in place at the home. Staff had the opportunity to discuss issues regarding service users and sometimes training arrangements on a daily basis at handover and with the registered manager. Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A 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 X 18 2 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 X 3 Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 21 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(1) Requirement The registered person must ensure that all service users have an up to date care plan. (Timescale of 07/12/05 not met) The registered person must review all service user care plans. (Timescale of 06/08/05 not met.) The registered person must ensure that the medicines policy is developed and expanded to reflect current guidance issued by the Royal Pharmaceutical Society and comply with the National Minimum Standards. (Timescale of 07/03/06 not met.) The registered person must ensure that the MAR charts used by the home are adequate for their purpose. They must indicate the date when the medication was started and the member of staff responsible for checking the medication brought into the home. Timescale for action 03/07/06 2. OP7 15(1) 03/08/06 3. OP9 13(2) 03/08/06 4. OP9 13(2) 13(4)(c) 03/08/06 Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 22 5. OP9 13(2) 13(4)(c) 6. OP9 13(2) 13(4)(c) 7. OP9 13 8. OP9 13(2) 18(1)(c)i 9. OP9 13 10. OP9 13 11. OP9 13 The registered person must ensure that medication provided to residents for use on leave is provided in appropriately labelled containers. (Not looked at on this site visit.) The registered person must ensure that residents who wish to manage their own medication are assessed as to their ability to do so, before medication is provided to them. Assessments must then be repeated on a regular basis. (Timescale of 10/01/06 not met.) The registered person must ensure that handwritten recordings on MAR charts are checked and signed by a second member of staff. The registered person must ensure that all staff members employed by the home, with responsibility for medication administration have received appropriate training. (Timescale of 07/02/06 not met.) The registered person must ensure that all medication is only administered to residents as prescribed. (Timescale of 13/12/05 not met.) The registered manager must ensure that staff use the correct codes when completing MAR charts and that all gaps are explained. The registered person must ensure that on occasions where a variable dose of medication is prescribed, for example, one or two tablets to be taken, an accurate record is made of the actual dosage of each medication administered. 03/08/06 03/06/06 03/08/06 03/08/06 03/05/06 03/05/06 03/05/06 Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 23 12. OP18 13(6) 13. OP29 Sch 2 14. OP33 24 15 OP36 18 The registered person must make arrangements for all staff to attend training in adult protection. (Timescale of 07/07/06 ongoing.) The registered provider must ensure that all records held in respect of persons working at the home as listed in Schedule 2 of the Care Homes Regulations 2001 are in place before a member of staff is employed at the home. The registered manager must ensure that feedback from service users is provided through the use of anonymous user questionnaires and that the views of family, relatives and significant stakeholders is sought. (Timescale of 06/05/05 not met.) The registered manager must ensure that persons working at the care home receive formal supervision at least six times a year. (Timescale of 19.08.04 not met). 07/07/06 03/05/06 03/08/06 03/08/06 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 OP9 Good Practice Recommendations The registered person should ensure that the home retains a list of staff members authorised to administer medicines, which includes a record of their signature and approved initials. The registered manager should provide written evidence of training that staff have completed and are undertaking. 2. OP30 Pymgate House DS0000008579.V290234.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD National Enquiry Line: 0845 015 0120 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.V290234.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!