CARE HOMES FOR OLDER PEOPLE
Pytchley Court Nursing Home Northampton Road Brixworth Northants NN6 9DX Lead Inspector
Mrs Moira Mosley Unannounced Inspection 19th June 2006 10:00 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 Pytchley Court Nursing Home DS0000012634.V300627.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. Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Pytchley Court Nursing Home Address Northampton Road Brixworth Northants NN6 9DX 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) (01604) 882979 (01604) 882979 Southern Cross Healthcare Services Limited Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability over 65 years of age of places (40), Terminally ill over 65 years of age (40) Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th October 2005 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 Northampton 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 support 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. The fees are currently £450 per week for residential care and £550 for nursing care. Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a statutory unannounced inspection by one inspector. The inspection process included the collation of information and pre-inspection planning to gather information and then six hours were spent in the home. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for residents and their views of the service provided. This is achieved primarily through the process of ‘case tracking’ which involves reviewing the care of specific residents including looking at their records, talking to them and their families or representatives where possible and talking with the care staff who provide the personal care to those selected residents. The care of three residents was reviewed on this inspection to include care plans, risk assessments, medication and other records. In addition six residents were spoken to and several others met. Discussions were also held with two visitors in the home, three staff members and a period of observation undertaken. What the service does well: What has improved since the last inspection?
Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 6 Ten requirements were made at the last inspection these included providing training to staff about abuse and how to report any concerns, specific training to kitchen staff about the provision of liquidised diets, staffing levels, first aid cover and environmental repairs. These have all been addressed. The staffing levels have been monitored and both staff and residents spoken to stated they now had sufficient staff on duty to meet needs. Observations demonstrated that staff were available to interact with residents and residents were enjoying the attention given. The bathing facilities over both floor s has improved with a new shower and bath chairs having been fitted to ensure that all the bathrooms are accessible and suitable for the range of needs of the residents in the home. What they could do better:
Although the care plans were overall well written with direction for staff to meet assessed needs, these tended to focus on the physical health needs of the residents. Some residents need specific care to meet other areas for example social or psychological needs. One resident was displaying confused behaviours and she believed she could walk and therefore couldn’t see why some of the restrictions were in place, for example bed rails, her psychological needs were not identified anywhere in her care plans and there was a need to ensure these were documented and provide safeguards for staff who were being criticised. In addition none of the care plans seen were signed by either the residents or their relatives to show agreement to the plans in place. Medication procedures could be improved, the amount of medication coming into the home is being recorded, but errors appear to be made in the totals. There were some gaps in administration records and the totals of tablets did not add up to match the numbers recorded as being in the home. This prevents checks to ensure medication is being given as prescribed. A number of staff have not received updates on statutory training, including fire, food hygiene and manual handling. There is still a lack of staff with a first aid qualification. This training is required to ensure staff are able to do their jobs effectively, to meet resident needs and make the home safe. The kitchen extractor fan is still not working effectively and the kitchen was very hot, in addition there was a fridge that was not working within the safe temperature range. Fire records are being maintained however it was identified in April that the door seals that prevent the spread of fire needed replaced on a number of the
Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 7 doors. This has been noted on every weekly test and records state that new seals have been ordered. There was no evidence to show prompt action in this regard and no date for replacement was available. 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. Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s are being fully assessed to ensure their needs can be met prior to moving in to the home. EVIDENCE: Two residents whose care was tracked have moved in to the home over the past few weeks. Their pre admission assessment was detailed with good evidence of a thorough assessment by the manager of the home including a visit to the prospective person, liaison with the resident, their families and professionals involved in their care to ensure needs could be met. Residents spoke to confirmed they had been given information about the home and either they or their families had visited prior to admission, relatives spoken to stated they were very happy with the information they had received before accepting a place and liked the level of support the home had given to them in making a difficult decision. Areas of need were highlighted and a pre admission care plan was evident to ensure that the home had the necessary equipment and facilities in place to
Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 10 meet those needs and that staff had information to assist in a smooth transition into the home. NMS 6 is not applicable for this home, as they don’t provide intermediate care Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected 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. This judgement has been made using available evidence including a visit to this service. Care plans are not addressing psychological needs in sufficient detail and medication procedures are insufficient to ensure residents are receiving their medication as prescribed. EVIDENCE: The care plans for the three residents whose care was tracked were viewed; these contained comprehensive information and gave clear directions for staff to meet most needs. Of the two new admissions, one had a very comprehensive pre admission care plan and this had been updated into detailed care plans, however the second residents pre admission care plan did not address key issues including mobility and diabetes although very good plans had been developed for nutrition and pressure ulcer care. Care plans are regularly reviewed and updated and staff spoken to confirmed they use the plans as a working tool and are involved in their development and updating.
Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 12 Neither the residents spoken to nor the relatives were aware of the content of the care plans or had been asked to sign these. Another resident identified was displaying some behaviours, which were not identified in the care plans. This resident was confused about her level of ability and the need to protect her from harm and to protect staff from allegations, the physical needs were well documented but there is a lack of direction for staff in dealing with psychological needs. Healthcare needs are fully assessed including pressure ulcer and nutritional assessments. These are cross-referenced to care plans where needs are identified. There were also falls, fracture and manual handling assessments in place again with reference to care plans when indicated. There is evidence of input from a range of healthcare professionals including the GP, dental, optical and chiropody services. There are medication procedures in place for the safe ordering, storage, administration and disposal of medication. The medication administration records were cross-referenced to the medication stored for three residents and a spot check of all tablets in the monitored dosage system was undertaken. Medication is being signed into the home, however the balance did not always match the number of tablets. There were a few gaps in the medication administration records making it difficult to assess if medication has been given or omitted. The medication for the two residents, whose tablets were not in the monitored dosage system, had several discrepancies. The number of signatures on the medication administration records did not match the number of tablets remaining in the home, with more tablets evident than there should have been if they had been given. The acting manager agreed to investigate this further. Observations showed staff interacting positively with residents and showing care to maintain their privacy and dignity especially when involved in providing personal care needs. The residents spoken to stated that they liked living in this home and felt the staff were very nice to them and that they were treated with respect. Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 13 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. This judgement has been made using available evidence including a visit to this service. There is a good range of leisure activities available and family contact is supported to enable residents to lead full and active lives. EVIDENCE: There is an activity organiser employed in the home and a full programme of activities is available with the weekly plan displayed on notice boards around the home. The residents were observed to be offered to join the day’s arts and crafts and others received one to one chats, newspapers and interactions were encouraged. The residents spoke of the range of things to do and said they enjoyed the regular entertainers that visited the home. Visitors to the home stated they were always made welcome and were offered drinks and had the opportunity to purchase meals if they wished to eat with their relatives. Residents said they enjoyed contact with family and friends and some accessed the local community for shopping etcetera. Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 14 Resident said they were able to make choices about how they spent their days, one resident had chosen to have a lie in and staff were seen to be supportive in assisting him at a later time. The menus were available with daily choices and alternatives provided. The lunchtime meal was observed and the food looked nice. Residents said the food was good and staff were observed to be assisting residents as required. A number of residents have liquidised diets and the cook confirmed she had received training on the preparation and presentation of these meals. Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. There is an effective system for the home to respond appropriately to complaints made and residents are protected from abuse with their views listened to. EVIDENCE: The complaints procedure is available in communal areas and residents spoken to stated they would speak to the staff or the manager if they had any issues. There have been two complaints since the last inspection, one about fees and the other about care issues, both were fully documented and investigated with the outcomes clearly fed back to the complainant and all both have been fully resolved. Staff demonstrated a good understanding of abuse and training records demonstrated they have received training on how to recognise and report any concerns. There have been no allegations made since the last inspection. Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 16 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, 21 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents overall have a homely and safe place to live. EVIDENCE: The communal areas were seen on this inspection, the home was clean and welcoming and the residents spoken to said they were happy with the facilities. The environmental heath officer visited the home recently and there were no issues raised, the last fire officer visit was in 2004 with no concerns. Fire records have been maintained and the weekly checks are documented. However as addressed in National Minimum Standard 38 some action is required in relation to fire safety. A maintenance person is employed for the general upkeep of the building and records demonstrated adequate checks and routine maintenance. Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 17 The bathrooms have been improved since the last inspection and there are now bathing facilities on both floors with aids to assist residents in accessing them. Procedures are in place for ensuring the control of infection is well managed and staff spoken to were very clear about how they deal with clinical waste. Gloves and aprons are available in all areas and staff have been trained in infection control. Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 18 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): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitably qualified and trained staff are provided in adequate numbers to ensure resident needs can be met. EVIDENCE: Staff training records demonstrate that staff have received the training needed in order to perform effectively within their roles. There are a number of planned training events over the coming months and these are advertised on staff notice boards. Staff spoken to said that moral is currently quite good and staff were being supported in their roles. Staffing levels are maintained and both staff and residents spoken to said they felt there were sufficient care staff around to meet most needs. Some of the staff spoken to have achieved their National Vocational Qualifications (NVQ) at level 2 and they said that the manager was arranging for further people to commence this training. The recruitment procedures are good with evidence in staff files of a comprehensive system including references and Criminal record Bureau (CRB) checks prior to commencement of employment to ensure they are suitable to work in care.
Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 19 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): 31,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and safety of residents and staff is being compromised by the lack of statutory training and maintenance issues not being actioned in a timely manner. EVIDENCE: There had been three acting managers since January 2005 and this was causing problems in the home, however another acting manager has now been employed and it is intended she will apply for registration with the CSCI in the coming weeks. Both staff and residents spoken to stated the current acting manager was very approachable and positive changes have already begun. There is an effective system in place for the management of residents’ money with clear audit trails and balances available. The balances of residents money matched the records maintained, however it was advised that documented
Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 20 records are maintained of the audits, which should be carried out with the manager to ensure any discrepancies are quickly identified. There are regular meetings with residents, staff and relatives with the residents being supported and encouraged to be involved in the running of the home as far as possible. There is a Quality Assurance system including a monthly audit of all areas of the home with action plan identified for any shortcomings noted. There are questionnaires being sent out to families and friends of the home, these are then to be collated and a development plan developed for any issues identified. Policies and procedures are regularly updated and staff receive a company handbook outlining key policies. Staff training records showed that not all staff are up to date with statutory training, this includes a kitchen assistant who has not received food hygiene training. Of the 39 staff 8 have not had fire training and 5 have not had any manual handling training. The previous requirement for a member of staff to be available on all shifts with first aid training has only been partially met, with several shifts in the evenings and at night still not covered. The extractor fan in the kitchen was reported as still not working effectively despite several assessment visits from contractors, it was very hot in the kitchen with the thermometer recording 35 degrees. The fridge labelled number 2 has been recording a high temperature since the 8th June with no evidence of action taken. The door seals to a number of fire doors have been identified as needing replacing since April, notes state that new seals are being ordered but there was no evidence of a timely follow up to ensure this work is completed. Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 21 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 X 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 3 3 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 1 Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15 Requirement Care plans must be in place for all assessed needs, including psychological needs with clear guidance for staff. The totals of medication in the home must be accurately recorded. An investigation into the discrepancies between the totals of tablets in the home against the administration records must be made and outcome sent to the CSCI. All staff must be up to date with fire statutory training. A training plan must be submitted to the CSCI by All staff must be up to date with food hygiene statutory training. A training plan must be submitted to the CSCI by All staff must be up to date with statutory training in manual handling. A training plan must be submitted to the CSCI by The seals on fire door identified as being damaged must be replaced. Timescale for action 30/07/06 2. 3. OP9 OP9 13(2) 13(2) 30/07/06 30/07/06 4. OP38 23(4)(d) 30/07/06 5. OP38 13(4)(c) 16(j) 13(5) 30/07/06 6. OP38 30/07/06 7. OP38 23(4) 30/07/06 Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 23 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. 3. 4. 5. 6. Refer to Standard OP7 OP9 OP35 OP38 OP38 OP38 Good Practice Recommendations Residents or their representatives should be involved in the development and agreement to care plans. There should be no gaps in the medication administration records. The records should show regular balance checks of residents’ money by two people. The fridge no.2 should be repaired or replaced to ensure safe food storage temperatures. The temperature in the kitchen should be addressed to make it a safe working environment. There should be a member of staff with a first aid certificate on each shift. Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northamptonshire Area Office 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
© 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 Pytchley Court Nursing Home DS0000012634.V300627.R01.S.doc Version 5.2 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!
