CARE HOMES FOR OLDER PEOPLE
Pymgate House 149 Styal Road Heald Green Stockport SK8 3TG Lead Inspector
Kathleen Mcall Unannounced 6th May 2005 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 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 F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Pymgate House Address 149 Styal Road, Heald Green, Stockport, Cheshire SK8 3TG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 061 437 1960 NA NA Mr Brian Fox Mrs Patricia Fox Care Home 10 Category(ies) of OP - Old Age registration, with number MD(D) - Mental Disorder - over 65 - 1 of places Pymgate House F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: NA Date of last inspection 18th November 2004 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 1770’s, 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. 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. The Registered Persons 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 hands on approach with the service users. 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 F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over the course of 4 ½ hours. The registered manager Mrs Patricia Fox and two members of care staff accompanied the inspector during the inspection. Care plans, medication records and their storage were examined. The inspector spoke with nine of the ten service users resident in the home. The inspector also spent sometime talking to the care staff that were on duty regarding their training qualifications and about writing care plans for the service users. What the service does well:
A number of residents spoke positively about the quality of care that they received at the home and many said that they felt well cared for. One resident said that it ‘was really nice living at Pymgate House’ and that she wouldn’t want to live anywhere else. Another described living at Pymgate House as ‘home from home’ and that she had everything she needed. Residents told the inspector that they enjoyed the meals provided and that these were of a good quality. Residents were also very complimentary about the care staff at the home. The staff group was a stable one with many of the staff having worked at the home for ten years or more. The staff group was an experienced and well qualified group. The home does not have a structured activities programme and this appears to suit the residents living at the home. Trips out are arranged and one resident told the inspector that she and another resident had recently been on a trip to a local garden centre where they had tea and that there were plans for other residents to be taken out. A ‘mobile shop’ providing biscuits, sweets, and other gifts calls to the home once a fortnight and residents can make their own purchases. Pymgate House F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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 F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Pymgate House F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 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 standard(s) 1 and 4. Sufficient information was available to service users to enable them to make an informed choice about residing at the home. The home met service users care needs. EVIDENCE: Since the last inspection the home had put in place a Statement of Purpose. It is anticipated that new service users to the home will be provided with a copy of this document to assist and help them in deciding whether to live at the home. The home demonstrated that it was able to meet the needs of those service users resident at the home. Service users spoke positively about the quality of care that they received in the home, many said that they felt well cared for. Similarly service users spoke positively about the care staff, describing them as ‘lovely and very caring’. One service user described living at Pymgate House as ‘home from home’ and that she had every thing she needed. Staff interviewed confirmed that they had undertaken all mandatory training required to assist them in caring for the service users.
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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 standard(s) 7, 8, 9 and 10. Despite care plans being extremely poor, service users health and personal care needs were being met, staff demonstrated a clear understanding of each service users needs. The home had safe medication practices. EVIDENCE: Service users care plans were poor. Some were out of date and required reviewing and updating, others did not specify what a service users care needs were or how care staff met their needs. Care plans did not accurately reflect the care needs of the service users. Daily records tended to be completed on a weekly basis and in some instances on a monthly basis; this was not an acceptable arrangement. Significant changes in service users care needs can occur in a month and therefore these records would not accurately reflect a service users present situation. Service users had access to GP support, district nursing services and chiropody services when required. One service user told the inspector that she saw her doctor on a monthly basis when he visited the home and that she appreciated her health being monitored regularly. Pymgate House F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 Page 11 Medication systems in the home had improved significantly since the last inspection, the storage and administration of medication particular. Service users told the inspector that staff were caring and always treated them with respect. Pymgate House F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14 and 15. The day-to-day routine of the home was relaxed and informal and met the majority of service users needs. Mealtime arrangements were well managed and satisfied service users expectations. Service users were allowed plenty of opportunities to exercise control and choice over their lives. EVIDENCE: Service users told the inspector that the home did not have a formal activities programme, but that this suited them. One service user told the inspector that she and another resident had recently been on a trip to a local garden centre where they had tea and that there were plans for other service users to be taken out. During the inspection a ‘mobile shop’ providing biscuits, sweets, and other gifts called to the home. Service users said that the shop called fortnightly and they enjoyed the opportunity to purchase items with their own money, as they were unable to go out to local shops. One service user said that she would like to have the television in the lounge on more often. The day-to-day routine of the home was relaxed and flexible with some service users preferring to spend time in their rooms and others using the lounge facilities, although the majority of service users met for lunch and teatime meals. Service users told the inspector that they had a choice of when and
Pymgate House F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 Page 13 where they had their breakfast. One service user liked to have her breakfast early in bed and then after remain in bed relaxing before staff helped her dress. Visitors were made welcome at the home and service users kept in touch with family and friends. Service users told the inspector that they enjoyed the meals provided at the home; lunch was always a three-course meal with fresh vegetables. Pymgate House F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 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 standard(s) 16. Procedures for dealing with complaints were in place, however this had not been tested in practice since the last inspection. EVIDENCE: The home had a complaints policy and procedure; there had been no complaints since the last inspection. 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. One service users told the inspector that she had lived at the home for two years, she was very happy and had no complaints. Pymgate House F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 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 standard(s) 19 and 26. Service users lived in clean and comfortable accommodation. The registered manager failed to maintain records held in respect of fire safety for the home. EVIDENCE: The home provided comfortable accommodation throughout. The grounds of the home were well kept and attractive. The home was clean, tidy, bright and airy throughout and was free from any unpleasant odours. The home failed to maintain records held in respect of fire safety, a separate letter has been sent to the home concerning this matter. Pymgate House F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29. The home was sufficiently staffed; with a staff group that was skilled and suitably trained to meet service users care needs. Staff personnel files were not completed as required. EVIDENCE: At the time of the inspection the home was adequately staffed that were trained to meet the assessed needs of service users living there. The staff group at Pymgate House was a stable one, a significantly high number of staff held an NVQ level 2 qualification and a further three members of staff were completing NVQ level 3. There had been no new members of staff had been employed at the home since the last inspection, so it is difficult to comment on the homes recruitment procedures. There is an outstanding requirement in relation to employment files at the home and staff photographs are still required. The registered manager had not responded to requirements regarding the recruitment of staff within prescribed timescales. Pymgate House F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35, 36 and 38. The home was well managed for service users; however there was no evidence of staff supervision. The registered manager and she did not maintain fire safety records to an acceptable standard. EVIDENCE: The registered manager does not hold a relevant qualification in care, however she is an experienced carer and has held the post of manager at Pymgate House since 1986. The registered manager had a ‘hands on ‘ approach, which was popular with service users. The home had made a good start in developing a quality assurance and monitoring system. Service users questionnaires had been completed and the results analysed. Further questionnaires need to be undertaken with family, friends and significant stakeholders concerned with the home. Questionnaires need to be anonymous.
Pymgate House F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 Page 18 The home failed to maintain records held in respect of fire safety, a separate letter has been sent to the home concerning this matter. Service users handle their own finances, as was seen on the day of the inspection when several service users had their own purses and purchased items from a local tradesperson. The registered manager had not put in place regular supervision for staff. Two members of staff had completed an annual appraisal. Staff told the inspector that informal supervision took place on a daily basis at handover between staff. There is an outstanding requirement in respect of staff supervision from two previous inspections. The registered manager had not responded to requirements regarding the supervision of staff within prescribed timescales. Pymgate House F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 4 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 2 x 3 2 x 2 Pymgate House F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 Page 20 Are there any outstanding requirements from the last inspection? 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 OP 7 Regulation 15(1) Requirement Timescale for action 6th August 2005. 2. OP 29 3. OP 33 4. OP 36 5. OP 38 The registered manager must review all service user care plans and must ensure that the service user care plan illustrates how the service users needs in respect of health and welfare are met . Schedule The registered manager must 2 ensure that staff files contain a current photograph of each employee. (Previous timescale of 18.01.05 not met). 24(1)(3) The registered manager must ensure that feedback from service uers is provided through the use of anonymous user questionnaires and that the views of family, relatives and significant stakeholders is sought. 18(2) 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). 23(4)(c)(v The registered manager must ) ensure that records held in respect of fire safety are maintained on a regular basis. 6th June 2005 6th May 2006 6th July 2005. 6th May 2005. Pymgate House F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 Page 21 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 OP 7 Good Practice Recommendations The registered manager should maintain daily observation records in respect of service users no less than on a weekly basis. Pymgate House F54-F04 s8579 Pymgate House v226445 060505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 2nd Floor, Heritage Wharf Portland Place Ashton-under-Lyne OL7 0QD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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