CARE HOMES FOR OLDER PEOPLE
Pytchley Court Nursing Home Northampton Road Brixworth Northants NN6 9DX Lead Inspector
Mrs Moira Mosley Unannounced Inspection 26th October 2005 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.V256683.R01.S.doc Version 5.0 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.V256683.R01.S.doc Version 5.0 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) 882993 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.V256683.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th April 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 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 DS0000012634.V256683.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a statutory unannounced inspection by one inspector, two hours were spent gathering information and planning for the inspection and 4 hours were spent in the home. The care of two residents was reviewed to include care plans, risk assessments, medication and other records. In addition discussions were held with six residents, three members of staff and two visitors to the home and a period of observation undertaken. The registered manager position has been vacant since January 2005 and an acting manager has been in post since May 2005, a registration application is required by the CSCI. What the service does well: What has improved since the last inspection?
The home is in the process of being redecorated and the residents spoke to were very pleased with the new décor in the communal areas. Pytchley Court Nursing Home DS0000012634.V256683.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Pytchley Court Nursing Home DS0000012634.V256683.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pytchley Court Nursing Home DS0000012634.V256683.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this inspection. EVIDENCE: Pytchley Court Nursing Home DS0000012634.V256683.R01.S.doc Version 5.0 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 the following standard(s): 8, 9 and 10 The lack of accessible bathing facilities is compromising the dignity and privacy of residents. EVIDENCE: Healthcare records show that residents are being fully assessed and there was evidence of input from other professionals, for example the GP, dietician, tissue viability nurse and chiropody services. The medication systems have been reviewed since the last inspection and regular audits are being undertaken, the audit trail required at the last inspection had been commenced, however the current Medication Administration Records (MAR) had not been fully completed to show the balance of medication in the home. There was one resident identified who had excessive amounts of stock, not being used in date order and it was not possible to ensure he has been receiving his medication as prescribed due to the lack of a clear audit trail. As identified within National Minimum Standard (NMS) 21 there are insufficient bathing facilities to meet resident needs. The dignity of the residents is being
Pytchley Court Nursing Home DS0000012634.V256683.R01.S.doc Version 5.0 Page 10 compromised as those on the first floor who cannot access the parker bath are either being strip washed or being transferred to the ground floor to use the shower room. For those residents who need hoisting, this involves being transferred in the lift, having been undressed and covered with towels due to the lack of space in the shower room. Pytchley Court Nursing Home DS0000012634.V256683.R01.S.doc Version 5.0 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 the following standard(s): 12 and 15 The production of food is well managed with the exception of specialised liquidised diets, which may compromise the nutrition for some residents. EVIDENCE: The requirement made at the last inspection for training in the provision of specialised liquidised diets has not been met although training has now been booked for November 2005.Theliquidised food prepared was in separate portions and staff did not blend it into a ‘mush’ as previously seen. The menus showed a good level of choice and the residents spoken to were very happy with the food provision. One resident stated, “couldn’t ask for better” and residents were observed to enjoy their lunchtime meal. The residents spoken to were very happy with the level of activity offered in the home and said there were daily activities including arts and crafts, bingo, outside entertainers and quizzes. Pytchley Court Nursing Home DS0000012634.V256683.R01.S.doc Version 5.0 Page 12 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): 18 The lack of staff awareness about abuse could compromise the protection of residents. EVIDENCE: The procedures for the reporting of any concerns raised about the treatment of the residents are in place and they have appropriately referred concerns to the Northants inter agency POVA (Protection of Vulnerable Adults) team. Staff spoken to were unsure of the procedures and although all were clear about what was acceptable behaviour, they were unsure of what would happen if they saw anything of concern. They had not received any training about abuse. Pytchley Court Nursing Home DS0000012634.V256683.R01.S.doc Version 5.0 Page 13 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. There are insufficient suitable bathing facilities to meet the needs of the residents. EVIDENCE: There has been a programme of redecoration and the residents were very pleased with the new décor. The Statement of Purpose states that there are three bathrooms and two shower rooms in the home, however there is only one shower room, located on the ground floor and one of the bathrooms on the first floor is not in use as the bath is too small and inaccessible for the use of hoists or other equipment needed to assist residents with bathing. One resident spoken to stated he was washed in bed by staff and he would love to be able to get into a bath or shower but there was none available that could accommodate him.
Pytchley Court Nursing Home DS0000012634.V256683.R01.S.doc Version 5.0 Page 14 The staff confirmed that a few of the residents were unable to access the parker bath on the first floor and if they needed to shower a resident would transfer them via the lift to the ground floor. As discussed in NMS 10 this is compromising their dignity. 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.V256683.R01.S.doc Version 5.0 Page 15 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, 29 and 30. Staffing levels are insufficient to meet more than the basic care needs of the residents. EVIDENCE: Both residents and visitors spoken to commented about the lack of staff to do more than meet basic needs. Observations confirmed that whilst staff were very friendly and interacted positively with the residents, they had limited time to spend with them. The lounge on the first floor was generally unstaffed throughout the inspection and staff confirmed that there were two care staff and a nurse on duty for the 16 residents on the first floor, several of the residents required two staff to meet their care needs and the nurse was undertaking nursing tasks and so unavailable for general observations and interactions. The residents were assisted to sit at the dining tables from 12 although lunch did not arrive until 1pm. This was in order to ensure that residents could be toileted and changed etcetera prior to lunch but meant a lengthy wait for several of them. Those residents needing assistance with their meal had to wait until 1.15 when staff were able to sit and help them, as the two staff were busy serving those in the dining room and those who were eating in their bedrooms. Within the home the rotas showed that there were 5 care staff and 2 nurses on duty for the 33 residents. The requirement made at the last inspection was for
Pytchley Court Nursing Home DS0000012634.V256683.R01.S.doc Version 5.0 Page 16 the dependency level calculations to be submitted to the CSCI this has not been met. The numbers of staff on duty need to show evidence of the hours hat the registered nurses actually work in direct resident contact and a clear assessment of the dependency levels of the residents in order to demonstrate adequate staffing to met needs. Staff files showed a detailed recruitment procedure which included the uptake of references and Criminal Record Bureau (CRB) checks prior to employment. Staff spoke to confirmed they have received a range of training including all statutory training with regular updates. Training notices are displayed on notice bards around the home and staff said they felt supported to access training to help them meet resident needs. Pytchley Court Nursing Home DS0000012634.V256683.R01.S.doc Version 5.0 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 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, 32, 33, 35 and 38. The lack of clear management in the home is negatively affecting the care of the residents. Shortfalls in the maintenance of a safe environment are compromising the health and safety of the residents and staff. EVIDENCE: The registered manger position has been vacant since January 2005 and the lack of a consistent management strategy is adversely affecting staff and the care being provided to the residents. Staff spoke about inconsistencies in care due to the different approaches by three acting managers since January 2005. Staff were generally unsettled and unsure about their futures and felt issues raised were not being addressed. The current acting manager was not available at the time of the inspection and staff were unsure of any quality assurance system. It was evident that some questionnaires have been sent to residents but there was no evidence of any
Pytchley Court Nursing Home DS0000012634.V256683.R01.S.doc Version 5.0 Page 18 collation of findings or action plan to address identified needs. There are regular staff and resident meetings with a relatives meeting arranged for December. Resident monies are securely stored and all monies given to the home for safekeeping is fully documented and receipted. The balance of money in the safe was cross-referenced to records for the two residents whose care was tracked and the accounting system was well managed with regular audits. The large bins for the home were positioned blocking the view from the dining room on the ground floor, staff explained that they had to move them on the day of collection due to the unsafe paving and the bin collection service won’t pull the bins over this area. The paving slabs to the side and front of the building are uneven and loose and present a potential trip hazard. Quotes have been received for the repair of this area. The kitchen extractor fan has broken and the temperature recordings are showing excessive heat in this area. Quotes have been made for its repair. The fire exit to the rear of the building was partially obstructed due to the storage of wheelchairs and furniture. This was due to the recent refurbishment programme and a skip is on order to remove the unwanted items. The door was cleared at the time of the inspection. The requirement for a qualified first aider to be on duty at all times has not been met although a training date in November for 12 staff to obtain the appointed persons certificate has been booked. Pytchley Court Nursing Home DS0000012634.V256683.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X 2 X X X X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 X X 2 Pytchley Court Nursing Home DS0000012634.V256683.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP15 Regulation 16(2)(i) Requirement Training must be provided for the provision of specialised liquidised diets.Previous timescale of 10/6/05 not met. 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.Previous timescale of 10/6/05 not met. There must be a qualified first aider on duty at all times.Previous timescale of 30/6/05 not met. Medication stocks must be fully audited and effectively managed to minimise over stocking. Staff must be trained in abuse and the reporting of protection of vulnerable adult concerns. Suitable bathing facilities must be provided for all residents identified needs. An action plan identifying how this will be achieved must be submitted to the CSCI. An application for the
DS0000012634.V256683.R01.S.doc Timescale for action 30/11/05 2 OP27 18(1)(a) 30/11/05 3 OP38 13(4) 30/11/05 4 5 6 OP9 OP18 OP21 13(2) 13(6) 23(j) 30/11/05 30/12/05 30/11/05 7 OP31 8 30/11/05
Page 21 Pytchley Court Nursing Home Version 5.0 8 9 10 OP33 OP38 OP38 24 23(2) 16(g) registration of a Manager at the home must be submitted to the CSCI. A quality assurance system must be established and maintained. The external paving must be made safe. The extractor fan in the kitchen must be repaired to provide a safe working environment. 30/12/05 30/11/05 30/11/05 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 2 Refer to Standard OP10 OP32 Good Practice Recommendations Arrangements should be made for bathing of residents in a manner, which respects their dignity Staff should be supported to feel able to raise concerns about the home and feel their views are valued. Pytchley Court Nursing Home DS0000012634.V256683.R01.S.doc Version 5.0 Page 22 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.V256683.R01.S.doc Version 5.0 Page 23 - 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!
