Inspection on 08/07/08 for Pymgate House

This inspection was carried out on 8th July 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Pymgate House 19/09/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Pymgate House 149 Styal Road Heald Green Stockport Cheshire SK8 3TG Lead Inspector Mrs Fiona Bryan Unannounced Inspection 8th July 2008 09:30 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.V367263.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.V367263.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 patfox@hotmail.co.uk 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 Mrs 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 (10), Old age, of places not falling within any other category (10) Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 10); Mental disorder, excluding learning disability or dementia, over the age of 65 - Code MD(E) (maximum number of places: 10). The maximum number of service users who can be accommodated is: 10 19th September 2007 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, including those who 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 £327 and £340 per week. A service user guide is available on request. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection, which included a site visit, took place on Tuesday 8th July 2008. The staff at the home did not know that this visit was going to take place. All the 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, the manager, visitors and other members of the staff team. Three people were looked at in detail, looking at their experience of the home from their admission to the present day. A selection of staff and care records was examined, including medication records, training records and staff duty rotas. Before the inspection, we asked for surveys to be sent out to residents, relatives and staff, asking what they thought about the care at the home. Seven relatives returned their surveys. Comments from these questionnaires are included in the report. We also asked the manager to provide us with some information prior to the inspection in a form called an Annual Quality Assurance Assessment (AQAA). This form ask for specific information about staff numbers, training, equipment in use, etc., but it also asks the provider to tell us what they have improved upon in the last 12 months, what they feel they do well, and what they are going to do to improve in the next 12 months. We used the information from this form in our planning of this inspection, and we have made use of the information provided throughout this 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. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 6 Residents and relatives said that staff were kind and that the atmosphere was homely. Comments included, “they look after us very well”, “(Staff) take care of my mother’s general needs extremely well, e.g., when she has not been feeling too well the doctor has been called and I have been informed immediately. All the staff are extremely caring and pleasant, nothing appears to be too much trouble”, “Everyone’s very helpful” and “They give continuous loving care”. 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. The meal seen on the day of the site visit looked appetising and tasty and residents seemed to enjoy it. Comments were mainly positive about the food provided at the home, although some residents found it a bit salty. Comments included “good food” and “my mother is of the opinion that all her meals are excellent and could not be better”. Visitors said they were made welcome at the home. We have received no complaints about this service since the last inspection. Relatives who returned surveys all said they knew how to make a complaint. Staffing levels at the home appeared to be suitable to meet the needs of people living there and it was reported that 66 had attained an NVQ qualification. It was reported that four staff had recently enrolled on a course for NVQ level 3. Residents expressed satisfaction with the care they received and said they could talk to the manager if they had any concerns. Residents looked at ease and generally well cared for. One resident said, “I am very happy” and a relative who returned a survey wrote, “If one day I have to go into residential care I would like to find somewhere like Pymgate House”. What has improved since the last inspection? Since the last inspection new armchairs have been bought for the lounge and some new curtains and bedding have been provided. Medicine administration records showed that medicines had been administered as prescribed. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 7 Recruitment procedures had been improved and no staff had started working at the home until the necessary checks had been done to make sure they were suitable to work there. Major improvements had not taken place, as many of the recommendations we made at the last inspection had not been taken forward. If the manager is to improve the outcomes to the people living at the home, she needs to address the requirements and recommendations as a priority. What they could do better: Pre-admission assessments were not recorded in a formal way and could not demonstrate that residents’ needs had been thoroughly assessed before they came into the home. Without a proper assessment staff will find it difficult to write care plans that address all the residents’ care needs. This could result in some needs not being identified and therefore not being met. Care plans were basic and lacked detail. Health care needs such as people’s nutrition and weight were not assessed and monitored consistently. This meant that staff could not tell if residents had lost or gained weight and were therefore unable to say if they required other treatment or advice, for example, from the dietician. The manager had just spoken to the district nurses about nutritional screening and had received some information and a tool for measuring nutritional status that she was planning to use for all the residents. Although efforts are made to provide some social and mental stimulation for residents, this could be improved and staff need to speak with residents to find out what sort of activities and events they would find interesting. Development of the key worker system may help staff to meet residents’ social care expectations in a way that is more individual to them. Some staff, although they had received training in the past, still seemed unsure as to how to recognise signs of abuse, and the policies and procedures for them regarding what action to take if they suspected abuse were not readily accessible or known to them. Whilst the percentage of staff who have received NVQ training exceeds the 50 we look for, we did identify that training in general has been extremely limited over the past year. Staff said they had received fire safety training but nothing else. Some of the staff have worked at the home for many years and need to have up to date training so they can develop their skills and deliver care in line with current knowledge about what constitutes good care for older people. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 8 The manager needs to start holding formal one to one sessions with all staff to identify their training needs and then needs to develop a training programme so they get the training they require. Some deficiencies were identified at the home during a recent inspection from Greater Manchester Fire and Rescue Service. These have not yet been addressed fully. The manager has been asked to produce an action plan with proposals as to how these shortfalls will be remedied. There was no proper quality assurance system in place. Without this, the manager will not be able to see what areas residents, staff and visitors feel need improving, plan how this will be achieved or measure the improvements made. Quality assurance systems must include opportunities for residents to give their views on the home. 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.V367263.R01.S.doc Version 5.2 Page 9 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.V367263.R01.S.doc Version 5.2 Page 10 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): Standards 1 and 3. Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Assessments are not properly undertaken before residents are admitted to the home, which leads to a risk that some of their needs will not be met. EVIDENCE: A statement of purpose and a service user guide are available in the home and copies are given to all new and prospective residents. Information contained in these documents appeared to be reflective of the services offered at the home. It was reported that prospective residents were encouraged to visit the home and when they were admitted it was on a trial basis for the first month. Three care files were examined. No detailed information, obtained as part of a comprehensive pre-admission assessment was available for any of them. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 11 It was reported that one resident had been admitted as a semi-emergency and the manager said they had been assessed within a few days of admission. A profile had been written, which contained good detail about the person’s family background and interests, but proper details about their abilities, and personal and health care needs were limited. Another resident had a care plan provided by Stockport Social Services but again the information in this was very basic and staff at the home had not undertaken an in-depth assessment of their own to ensure they had all the relevant information to plan the care that they would need to provide. A profile had been written for the resident that again contained some good information about their family relationships and previous interests but the records did not demonstrate that a thorough assessment had been completed. The third resident also had no detailed assessment but did have a profile completed. Staff said that the manager or the deputy manager went out to visit prospective residents before they came into the home and told them why they needed to be admitted and what care they needed. However, there was no formal documentation of any assessments that had taken place, other than general notes in an “enquiries” book stating the basic medical condition of prospective residents but with no further assessment of how they managed activities of daily living. Some of the files showed that basic risk assessments had been undertaken for either risk of falls or moving and handling but completion of risk assessments was not consistent. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 12 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. This judgement has been made using available evidence, including a visit to this service. Care plans and risk assessments are basic and lack detail. Systems for monitoring the healthcare needs of residents are not consistent. This presents a risk that residents’ personal, health care or social needs may not be met. EVIDENCE: Three residents were case tracked. All had care plans written of some type but most were lacking in detail and needed to be more person-centred. An improvement was seen from the last inspection in that it had been recorded that care plans had been reviewed more regularly, usually monthly. Information in the care plans was sometimes contradictory to the information that was available in the small amount of assessment paperwork provided, for example, the profile for one resident said that their religion was Methodist but their care plan said their religion was Church of England. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 13 Care plans did not always address effectively enough how health care needs were going to be managed and monitored. For example, one resident had a history of weight loss but the care plan for this only said to give the person supplementary drinks and offer small portions at mealtimes so they weren’t over-faced with too much food. No details were written as to how much weight the resident needed to gain or how this would be measured. The resident had been admitted to the home in April 2008 but not weighed until 16th June 2008. As the resident had not had a baseline weight recorded, it was impossible to know if they had lost further weight or gained weight since their admission. The recording of weights and the nutritional screening of residents were discussed with the manager, as this was an area that was highlighted as needing development at the last inspection. We were told that the manager had recently been given paperwork from the district nurses to complete nutritional risk assessments using the Malnutrition Universal Screening Tool (MUST). The resident discussed in the previous paragraph had been weighed in response to this and their weight recorded on the appropriate paperwork. Prior to this the manager said it had not been routine practice to weigh residents monthly but it was agreed that this would be undertaken in the future. Improvements in the detail of care plans and the monitoring of residents’ nutrition should have moved on more than they have as they were discussed at the last inspection. Records showed that residents had seen their GP, opticians and chiropodists. A very good system was in operation, whereby all the residents were reviewed by their GP about once every four-five weeks and the manager had a good relationship with the local surgery and liaised regularly with the GP there. However, the manager must make sure that staff are proactive in seeking advice when indicated, as one resident told us they had been in a lot of pain for three nights and had been unable to sleep. The night report for this resident confirmed that they had slept badly and that although they had been given painkillers they had not worked well. Staff were slow to follow this up, as the GP should have been asked if the resident needed stronger painkillers. A small number of medicine records were examined during this site visit and these were, in the main, satisfactory. A check of the controlled drugs showed that they had been administered and recorded accurately. Stock levels were kept to a minimum. Since the last inspection staff have started to sign the records to showing the amount of medicines received into the home. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 14 Relatives who returned surveys were positive about the care their family members received. Comments included “The care home takes care of my mother’s general needs extremely well, e.g., when she has not been feeling too well the doctor has been called and I have been informed immediately. All the staff are extremely caring and pleasant; nothing appears to be too much trouble” and “Everyone’s very helpful”. In answer to the question “What does the care home do well?” responses included “Looking after the residents. Nothing is too much trouble”, “They give continuous loving care. (There is) continuity in staff, atmosphere, etc. The manager lives on the premises, which I think enhances the ethos of the home. Residents can build relationships because of the continuity of staff”. Residents on the day of the site visit said staff were “very nice” and “very kind, lovely, they give us a cuddle”. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence, including a visit to this service. A lack of person-centred care planning means that people’s social and recreational expectations may not always be met. EVIDENCE: Residents said there was “nothing much going on” at the home, although when asked, they found it difficult to say what type of social activities they might enjoy. The manager said an entertainer was booked to visit the home once a fortnight who alternated between holding quizzes and exercise sessions and having sing-alongs with the residents. On the day of the site visit the entertainer was due and he ran an exercise session and a quiz, which the residents said they enjoyed. One member of staff thought it might be an idea to arrange a different entertainer so the residents “saw a different face”. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 16 It was reported that some residents received visitors and a couple went out with their visitors sometimes but few residents were enthusiastic about going out, even to the local shops or in the garden. Visitors said they were made welcome at the home and one visitor told us she had been recently invited for lunch and given a birthday present, which she had thought was very kind and a lovely surprise. One resident said she liked sport, especially football, and staff had ensured that she had been able to watch programmes on television such as Wimbledon. Although some good detail about residents’ social interests and background were provided in some of the files seen, the information had not been used to develop a person-centred care plan to meet individuals’ social care needs. Development of the key worker role could allow staff to spend time with individual residents finding out how they want to spend their time and facilitating this. The manager should access training for staff in providing activities for older people, as this would give staff new ideas about recreational pastimes they could try with the residents. Comments, in the main, were positive about the food provided at the home although several residents said the food could be too salty, especially the soup and the gravy. The manager said she would look into this and try to reduce the salt content of the food. A varied menu was available for the residents. Menus rotated over a fourweek period. Typical meals at lunchtime included casseroles, roasts, gammon, pies, cabbage and ribs and fish, whilst at teatime typical meals included salad, fish cakes, cheese and onion flan, cheese, eggs or sardines on toast and assorted sandwiches. At breakfast residents could choose cereals or have a cooked breakfast if they wished. Lunch was served at 12.30pm. Most of the residents sat at a large dining table, which they found sociable, as they could chat whilst they ate their meal. The table was laid with a cloth and napkins, although it was noted that no condiments were set out. Residents said they were not always offered accompaniments to meals, for example, mustard, if they were having beef and they said they would like this. Lunch on the day of the site visit was asparagus soup followed by fish in butter sauce, potatoes, cauliflower and beans and bread and butter pudding for dessert. Residents said the food was “lovely”, “food’s marvellous here” and “very nice”. All the residents ate well except one resident who only wanted a dessert, as she didn’t feel like eating the main meal. This resident was offered a sandwich instead but declined. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents felt their concerns would be listened to and acted on but a lack of staff awareness regarding safeguarding adults policies and procedures means that residents may not be protected from abuse. EVIDENCE: The complaints policy is available in the reception area of the home. However, although it was highlighted at the last inspection that it was out of date, as it still referred to the National Care Standards Commission, this has still not been updated. All the relatives who returned surveys said they knew how to make a complaint and felt they would be dealt with appropriately. It was reported in the AQAA that no complaints had been made to the manager and, consequently, no entries had been made in the complaints record. We have received no complaint or allegations about this service since the last inspection. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 18 Although some staff had attended training in safeguarding adults approximately a year ago, some staff appeared vague about how they might be alerted to signs of abuse. Some staff were not sure if the home had a copy of the Stockport Local Authority Inter-Agency Policy on Safeguarding Adults. The manager said she did have a copy but this was clearly not given a high profile and was not readily accessible for staff to refer to. Residents said they felt safe at the home. One resident said, “I have never seen anything where I’ve thought ‘I don’t think they should do that’”. Another resident said she felt very much at home and was not afraid to tell the manager if she had any concerns. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home was clean and pleasant for residents to live in but deficiencies in the arrangements for fire safety in the home put residents at risk. EVIDENCE: A partial tour of the home was undertaken. There were no physical changes to the home environment since the last inspection. The home was clean and smelled fresh. The manager said that maintenance personnel were contracted in to do work as it became necessary. The grounds of the home were well kept and attractive. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 20 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. Since the last inspection some new armchairs had been bought for the lounge and the manager reported on the AQAA that some new curtains and bedding had been purchased. 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. A Food Hygiene inspection was carried out on 5th June 2008, which identified some areas for action and the manager said that a second visit was carried out two weeks later, which she said was satisfactory. We did not see a report of the second visit. The Greater Manchester Fire and Rescue Service also inspected the home on 1st July 2008 and a copy of the letter sent to the home in respect of this visit was sent to us. The manager has been required to produce an action plan by 1st August 2008, for consultation with the Fire Service, proposing how she will remedy deficiencies found during their inspection. Some areas were quite minor whilst others were more serious, for example, the fire risk assessment for the home was not suitable or sufficient. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Although staff are experienced, they have not updated their skills and knowledge, so the care residents receive may not be based on current research or best practice. EVIDENCE: Examination of the staff duty rotas for the weeks commencing 23rd and 16th June 2008 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. These staffing levels were satisfactory. The AQAA said that 66 of the care staff employed at the home had achieved NVQ level 2 and the manager said that four staff had just started training for the NVQ level 3 in health and social care. Staff had attended fire safety training this year, but other than this, the manager said no other training had taken place. There were no proper training records and no system in place to identify staff training needs and plan a training programme for the year ahead. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 22 Some staff did not feel they needed any training as they had worked at the home for many years and felt that care was a matter of “common sense”. It was pointed out to the manager that ideas about what constitutes good care practice are constantly evolving and staff need to be up to date with what is considered best practice. Whilst residents looked well cared for and appeared, on the whole, quite content we felt that there was a wide scope for improvement in many areas of care from record keeping and monitoring health care needs to meeting social care needs and fostering independence and choice. Staff need the training and tools to be able to develop the service they provide. The personnel files for three staff members were examined. These showed that POVA First checks had been made and a CRB obtained. All relevant information about the applicants was generally on file and suitable references had been provided, in the main. The manager should make sure that all applicants provide a full history of employment; one of the application forms seen only provided an employment history for the previous five years. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The lack of quality assurance systems means that there is little evidence that residents’ views are taken into account and do not highlight the areas the manager needs to develop. 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.V367263.R01.S.doc Version 5.2 Page 24 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. Formal residents/relatives’ meetings were not held, as people could speak to the manager or make suggestions whenever they wanted to. 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. This was suggested at the last inspection but had not been taken forward. Staff said staff meetings were informal and no minutes were kept. As there was only a small staff team they were able to discuss issues regularly when they had “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 were kept in safekeeping for residents. Ledger books were maintained which itemised all transactions and receipts were kept. The system for the management of residents’ money was not examined during this site visit. Staff do not receive formal supervision from the manager. The manager should start to arrange supervision for all the staff, so their training needs can be discussed and so all staff can self-assess their performance and receive feedback on aspects of practice. Weekly checks had been made of the building and equipment in respect of fire prevention and health and safety. As stated in the section about the environment, the manager needs to respond to the Fire Service about how shortfalls found during their inspection will be addressed. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 25 The manager returned the AQAA to us within a few days of the expected date. All sections of the AQAA were completed but it was brief and gave us very little information about the service. The AQAA did not confirm if requirements from the last inspection had been complied with or if the recommendations had been considered and acted on. There was a lack of understanding of the purpose of the AQAA and as there were no formal quality assurance processes at the home the manager was unable to provide detailed information about how the home had progressed or plans for future development. Despite these management issues, residents did like living at the home and clearly held the manager and staff in affection. When asked what was good about the home, residents said, “Everything is done for you”, “I don’t have to wash up”, “You are among people” and “people are quite kind”. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 26 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 3 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 1 X 2 Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 23(4) Requirement The manager must ensure that action is taken to address the deficiencies highlighted during the visit from the fire service so that the home remains a safe environment for residents to live in. A staff training programme must be developed, which identifies staff training needs and ensures all staff are up to date with health and safety training and also receive training specific to their role, that builds on their skills and knowledge and ensures they are aware of current best practice ensuring that residents benefit from a well–trained staff group. Timescale for action 01/08/08 2 OP30 18 31/10/08 Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 28 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 OP7 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 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. Residents should be screened on admission to the home to determine their nutritional status and should subsequently be weighed regularly. Further consultation should take place with the residents to determine the type of social events and activities they would find enjoyable. The key worker role should be developed to enable staff to identify with individual residents recreational outlets that are meaningful to them. The manager should review and update the complaints policy. Some staff should have further training to ensure they are fully aware of the issues regarding adult protection. The policies and procedures for safeguarding adults should be given a high profile and made easily available for staff to read and use as a resource. The manager should ensure that candidates applying for work at the home provide full details of their employment history and any gaps are explored to ensure they are suitable to work at the home. 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. DS0000008579.V367263.R01.S.doc Version 5.2 Page 29 3 4 OP8 OP12 5 6 OP16 OP18 7 OP29 8 OP33 Pymgate House RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 9 Refer to Standard OP36 Good Practice Recommendations Staff should receive formal supervision at least six times a year, to discuss their training needs and ensure they are aware of the aims and objectives of the service. Pymgate House DS0000008579.V367263.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Area Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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.V367263.R01.S.doc Version 5.2 Page 31 - 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!