CARE HOMES FOR OLDER PEOPLE
Pytchley Court Nursing Home Northampton Road Brixworth Northants NN6 9DX
Lead Inspector Moira Mosley Unannounced 14th April 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. Pytchley Court Nursing Home Version 1.10 Page 3 SERVICE INFORMATION
Name of service Pytchley Court Nursing Home Address Northampton Road Brixworth Northants NN6 9DX 01604 882979 01604 882993 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) Southern Cross Healthcare Services Limited Vacant Care Home with Nursing 40 Category(ies) of OP Old Age (40) registration, with number PD(E) Physical Disability - Over 65 (40) of places TI(E) Terminally Ill (40) Pytchley Court Nursing Home Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 6th December 2004 Brief Description of the Service: Pytchley Court is a purpose built home in the village of Brixworth. There are local facilities and amenities including shops and there is a bus service that runs through the village to the main towns of Northamton and Market Harborough. It provides accommodation for up to forty residents in need of nursing care; within this they are registered to provide personal care only for up to eight residents. The home provides care for people who are over the age of 65 and who require supprt due to old age, physical disability or terminal illness. Accommodation is provided over two floors with a passenger lift and staircase for access to the first floor. On the ground floor there is a large communal lounge and separate dining room, with a further lounge and dining facility on the first floor. Over the two floors there are 36 single and 2 shared bedrooms, all have ensuite toilet and wash hand basins. Pytchley Court Nursing Home Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place over 4.75 hours. The care of three residents was examined and this included looking at their care plans and records including medication. Discussions were held with those three residents and a further four residents of the home to find out how they felt about living here. In addition two visitors to the home and four members of staff gave comments included in this report. A tour of the communal areas on both floors, the kitchen and two resident bedrooms were seen as part of this inspection. The registered manager position has been vacant since January 2005 and an acting manager is in post until a new appointment is made. What the service does well: What has improved since the last inspection? What they could do better: Pytchley Court Nursing Home Version 1.10 Page 6 Training must be provided to ensure that residents needing liquidised diets are receiving a safe and nutritious diet. The numbers of staff on duty in the home must be in response to the level of dependency of the residents in order to ensure all care needs are provided for. A system to record all the medication that comes into the home is needed to ensure residents are receiving what’s prescribed for them. First aid qualified staff are required to ensure the home can respond effectively to any illness or accident. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Pytchley Court Nursing Home Version 1.10 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 Pytchley Court Nursing Home Version 1.10 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) 3 and 4 A good pre admission assessment is in place, which along with the staff training, and liaison with specialists ensures that the needs of the residents are identified and met. EVIDENCE: One resident’s assessment identified the need for pressure relieving equipment and treatment, her records and discussion with the resident confirmed these were in place at the point of admission. The staff spoken to confirmed they were given information about the residents and were provided with training in response to any specialist care needs. This has included infection control, diabetes, and managing aggression. Discussion with staff and residents along with documented evidence in care records showed that recent referrals to specialists have been made including audiology and dietetic services. Pytchley Court Nursing Home Version 1.10 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 A proactive management strategy is in place to address care plan and healthcare assessments. Further development of medication records is needed to provide a clear audit trail of medication in the home. EVIDENCE: An internal audit was evident to address the care plans that had insufficient detail about the action required to meet care needs. The care plans for areas of assessed risk were not supported by completed risk assessment documentation. There was a resident whose risk assessments for nutrition, incontinence, and manual handling were not completed and her pressure ulcer assessment was incorrectly calculated, although care plans for these areas were seen. The staff used the care plans for information and agency staff confirmed they were given information from care plans to direct their care when on the home. One of the residents spoke about her health and the input she was having from the staff and from the GP. She was very satisfied with the care she was receiving and felt clear about what was happening.
Pytchley Court Nursing Home Version 1.10 Page 10 There was no clear evidence of the amounts of medication entering the home however there was a clear procedure in place for the storage, administration, and disposal of medication. All of the residents spoken to said that the staff treat them well and respect their privacy, staff were observed to knock doors before entering bedrooms and dealt with personal issues in a considerate manner. Pytchley Court Nursing Home Version 1.10 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 Social interactions are well managed to provide daily interests and activities for the residents. The production of food is well managed with the exception of specialised liquidised diets, which may compromise the nutrition for some residents. EVIDENCE: There is a good range of daily activities offered and the residents spoke highly about these. Several residents especially enjoyed the arts and craft sessions. One resident spoken to said she was supported in making choices about how she spent her day. The social assessments in care plans and discussions with staff and residents supported the encouragement of resident choice. There were two visitors in the home who said they were always welcome in the home and residents all spoke about their friends and family visiting. The lunchtime meal was homemade, with fresh vegetables used. There were two options and portions were good. The residents said the meal was fine and they were generally happy with the menus. The kitchen has had a recent good environmental health visit and required records are well maintained. Pytchley Court Nursing Home Version 1.10 Page 12 A visitor in the home raised concerns about the quality of food provided, that food was not freshly prepared, there was too much pre-packaged food, and over use of frozen vegetables. There was no evidence seen to substantiate the issues raised and the cook confirmed that most of the menu is homemade and fresh vegetables used. The residents spoken to said they were given choices and overall they said it was satisfactory, with choices offered. Fresh fruit was not generally available or encouraged and the acting manager stated she would review this. The cook has had no training in the preparation of liquidised meals to provide a balanced and safe meal for residents with swallowing difficulties. The care staff were seen to mix the meals together into a bland ‘mush’ when feeding residents. Pytchley Court Nursing Home Version 1.10 Page 13 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 There is an effective system for the home to respond appropriately to complaints made. EVIDENCE: The complaints procedure was evident on notice boards. The residents spoken to said they felt able to raise any concerns and worries with the staff or manager in the home, this was confirmed by one of the visitors in the home. The acting manager was aware of the complaints procedures and demonstrated a commitment to responding to any issues raised. Pytchley Court Nursing Home Version 1.10 Page 14 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 22 and 24 Proactive action is being taken to ensure that the provision of specialist equipment is available. Residents are provided with safe and comfortable surroundings suitable for their needs. EVIDENCE: The communal lounges and dining areas were clean and tidy with no hazards evident. The residents spoken to said they were happy with the facilities and furnishings available. There is a maintenance person on site every day to ensure routine maintenance is kept up to date. Resident bedrooms were personalised and the residents said they had everything they needed to make them feel comfortable. One resident and their relative raised concern that they felt a nursing bed would help this resident in getting in and out of bed. The acting manager agreed to review this as part of the ongoing issues about moving and handling.
Pytchley Court Nursing Home Version 1.10 Page 15 Pytchley Court Nursing Home Version 1.10 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 Staffing levels are insufficient to meet more than the basic care needs of the residents. EVIDENCE: The visitors and the residents all spoke very highly about the staff team in the home. They were described as caring, hard working, friendly and helpful. Comments from visitors and residents indicated that they felt there was insufficient staff time to spend interacting with the residents and to meet more than basic care needs. Observations confirmed that whilst staff were very friendly and interacted with residents this was during the provision of drinks, meals and toileting activities. There were periods of time when residents sat in lounge areas with no staff evident. There was no evidence of a calculation of staffing levels based on the current dependency levels of the residents and their level of care needs. Pytchley Court Nursing Home Version 1.10 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 and 38 There is an effective strategy in place for the management of the home and this provides staff with leadership and support. Residents’ health and safety is compromised in the event of an accident or illness because there are no qualified first aid staff. EVIDENCE: The Registered Manager position is currently vacant and a recruitment process is underway. The deputy manager is acting up providing management cover in the interim period and there is a management strategy in place to provide support and guidance. There was no trained first aider on duty and the acting manager confirmed that first aid training had not been provided to the staff team.
Pytchley Court Nursing Home Version 1.10 Page 18 Manual handling, infection control, food hygiene and fire training is provided to all staff. There were systems in place to monitor and maintain the health and safety of residents and staff. Pytchley Court Nursing Home Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2
COMPLAINTS AND PROTECTION 3 x x 3 x 3 x x STAFFING Standard No Score 27 1 28 x 29 x 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 x x x x x x 2 Pytchley Court Nursing Home Version 1.10 Page 20 no 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 9 Regulation 13(2)(17( 1)(a) and schedule 3(3)(i) 12(1)(a)( b) and 16(2)(i) 18(1)(a) Requirement A clear audit trail of all medication in the home must be available. Ttraining must be provided for the provision of specialised liquidised diets. Dependency levels of residents must form the basis of calculating staffing levels. A copy of the calculation to be submitted to the Commission for Social Care inspection. There must be a qualified first aider on duty at all times. Timescale for action 10/6/05 2. 3. 15 27 10/6/05 10/6/05 4. 38 13(4) 30/6/05 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 Good Practice Recommendations Pytchley Court Nursing Home Version 1.10 Page 21 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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