Inspection on 05/11/08 for Pytchley Court Nursing Home

This inspection was carried out on 5th November 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

Pytchley Court Nursing Home 18/05/07

Pytchley Court Nursing Home 19/06/06

Pytchley Court Nursing Home 26/10/05

Pytchley Court Nursing Home 14/04/05

Pytchley Court Nursing Home 06/12/04

Pytchley Court Nursing Home 03/08/04

Pytchley Court Nursing Home 18/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Pytchley Court Nursing Home 5A Northampton Road Brixworth Northampton Northamptonshire NN6 9DX Lead Inspector Irene Miller Unannounced Inspection 5th November 2008 08:30 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 Pytchley Court Nursing Home DS0000012634.V373963.R02.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.V373963.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pytchley Court Nursing Home Address 5A Northampton Road Brixworth Northampton Northamptonshire NN6 9DX 01604 882979 01604 882993 pytchleycourt@schealthcare.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) Southern Cross Healthcare Services Limited Manager post vacant Care Home 40 Category(ies) of Dementia (40), Old age, not falling within any registration, with number other category (40) of places Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Older Persons - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 40. 18th May 2007 2. Date of last inspection 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 following fees were provided by the manager as being current on 22 May 2007: Local Authorities who are funding residents are charged at a set rate of £288.45 to £331.60 depending on assessed needs. Those requiring nursing care are charged £344.78 plus any additional nursing contribution. Residents funded by the local authority will be asked for a ‘top up’ fee, which varies Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 5 according to their ability to pay. Privately funded residents are charged between £525 and £625, with those requiring nursing care charged up to £650 plus any additional nursing contributions. The actual fee is dependent on the resident’s assessed needs. The fees include personal care and where applicable nursing care, meals and accommodation. Chiropody, hairdressing services, and newspapers can be arranged and are charged separately. Other costs would include clothing and toiletries. Information about the services provided including the complaints procedure is displayed in the foyer of the home. This includes the statement of purpose, which as detailed in the body of this report is currently under review. A copy of the last inspection report was not on display at the time of inspection, however the inspector was informed that this is usually also available. Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 6 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. The ‘Key’ standards under the National Minimum Standards (NMS) were inspected during the course of this inspection. The Commission for Social Care Inspection (CSCI) focus on these standards as they are considered to be the standards, which have a particular impact on the health and welfare outcomes for people using the service. This was an unannounced inspection carried out by two regulation inspectors. Judgements reached within each of the outcome areas in the report were based on the drawing together of information from a range of sources such as, the reviewing of care plans, risk assessments, complaints records and safeguarding information about the service, written and verbal communications with the registered provider. We ‘case tracked’ four people using the service which involved sample checking care records (care plans) held at the service in relation to their health, safety and welfare, and were possible time was spent speaking with people to gain an insight into their experiences of using the service. In addition general observations of care practices and discussions took place with visitors, staff and the homes management. Staff files were sample checked to evaluate how the service ensures people are protected through their staff recruitment, training and support and development programmes. A random unannounced inspection took place on 6th August 2008 and some of the findings from this inspection are included within this report. We sent out some surveys to a sample of health professionals who visit the service, people who use the service, relatives and staff with the purpose of gather people’s views on the service provided. In May 2008 we received completed surveys from three members of staff, two health professionals and a relative. The information received provided us with people’s views at that time. We have considered the information received and where more recent information has been received we have included this also. We sent out some surveys to a sample of health professionals, people who use the service, relatives and staff to gather people’s views on the service Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 7 provided. In May 2008 we received completed surveys from three members of staff, two health professionals and a relative. The information received provided us with people’s views at that time. We have considered the information received and where more recent information has been received we have included this also. What the service does well: What has improved since the last inspection? What they could do better: We found discrepancies within the risk assessment documentation, although reviewed on a monthly basis they had not been accurately completed to reflect the changing needs of the person. Accurate assessment of the persons changing needs is pivotal in ensuring that the care plan is kept up to date. We found that the personal hygiene preferences of people using the service was not always being followed, for instance within one of the care plans there was instruction for the person to have a bath or shower weekly, the person Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 8 confirmed that they had not had a bath or a shower in a long time, the personal hygiene record within the care plan also reflected this. Details within the statement of purpose and service users guide need to reflect the homes aims and objectives, terms and conditions, services and facilities and be kept up to date. Details on pressure area sore and wound care treatment need to be recorded within the care plans and kept up to date as and when conditions change. Suitable scales need to be available to ensure that all people have the opportunity to have their weight gains and losses monitored. Professional guidance needs to be sought from a pharmacist and the general practitioner where medication is required to be crushed for administration via PEG feed tube details need to be documented within the care plan. This is to ensure that all other administration methods e.g. liquids have been explored and that the medication is suitable to be crushed and given this way. Staff need to be fully aware of the special dietary requirements of people to ensure that meals are provided as identified in the care plan. Staff should only commence employment once all pre employment checks are carried out, however in emergency situations where a member of staff may start work pending a CRB clearance the service must be able to evidence that the member of staff works under strict supervisory arrangements and that they do not work unsupervised. Staff training needs to focus upon meeting the diverse needs of the people using the service. Although we did not evidence there were insufficient staff on the days of our inspection, this is clearly an issue that continues to be raised as a cause for concern. We have recommended that staffing levels should be reviewed and monitored in consultation with people who use the service to ensure that there are sufficient staff to meet people’s needs at all times. It is important that people’s views are sought on a regular basis to help identify particular times or days when people feel that they are not receiving care in a timely manner. 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. Pytchley Court Nursing Home DS0000012634.V373963.R02.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 Pytchley Court Nursing Home DS0000012634.V373963.R02.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): 1, 3 (Standard 6 is not applicable to this service) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Choice and the opportunity to exercise choice can only be achieved if people are provided with full information on the range of facilities and services available at the home. EVIDENCE: Information about the services provided is contained within a statement of purpose and a service user guide. These documents were available in the entrance hall with a copy of the most recent inspection report. We requested copies of the documents to enable us to review the information people are given to help them make decisions about their care. Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 11 We did not review these documents during our inspection in May 2007 as we were told that the manager was reviewing and updating them. An application had been submitted to the Commission for Social Care Inspection (CSCI) to vary the categories of admission just prior to the May 2007 inspection, to enable people with dementia to be admitted. Discussions had taken place about the content of the statement of purpose and it was an expectation as part of approval of this variation that detailed information about the care for people with dementia would be included. The only reference to dementia in the current statement of purpose is that it is a registered category of care. As there have been management changes since variation of categories in June 2007, it is not clear if the information was in place and has been removed or was not included at all. We would recommend that this issue is explored and more detailed information provided to help people understand what they can expect in relation to the range of needs that can be met and how the care will be provided. Some information within the statement of purpose and service user guide has been updated, however it has not been reviewed thoroughly. For example two different managers are referred to and there are two addresses for the Commission for Social Care Inspection. Regulation 5 of the Care Homes Regulations 2001 requires that the service user guide include details of the total fee payable and the arrangements for the payment of the fee. It must also include the arrangements in place for charging and paying for any services not included in the fee. There is information in the service user guide about the fees and what is included, however the actual amounts are not detailed. This is important to help prospective and current people who use the service and their families make informed decisions about their care. A sample check of people’s care files confirmed that an assessment of their needs is carried out prior to admission. The information gathered as part of the assessment, which also included information from the placing authority was sufficiently detailed about the persons needs to make this decision. This is important in helping to ensure that people’s needs are known and can be met, helping to avoid unnecessary moves for people. A pre-admission draft care plan had been developed based on the assessment of needs, providing staff with sufficient information to meet the person’s needs from admission. Pytchley Court does not provide intermediate care. Pytchley Court Nursing Home DS0000012634.V373963.R02.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 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Accurate recording within the assessment framework and care plan documentation is pivotal in ensuring that changing needs are identified and current needs are met. EVIDENCE: Review of the information we have received since the last inspection identifies that in May 2008 we received a completed survey from a relative of someone who has used the service for four years. They stated “--- needs have been well met at Pytchley Court”. They also told us that they are kept informed of General Practitioner visits and were informed immediately of a hospital admission. Positive comments were also received from two professionals in surveys received in May 2008. One commented that those people they were involved with all had their health needs met and that the General Practitioner or Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 13 hospital were always involved in a timely manner. Records reviewed during this inspection confirm that referrals are made to health professionals such as the General Practitioner and the speech and language therapist. During a random inspection on 6th August 2008 we spoke with people who were happy with the care they received and we also found evidence from a family that they had been ‘delighted’ with the way a persons end of life had been handled and the care that had been provided. We looked at a sample of care files and we spoke to people and the staff that care for them to see how people’s care is planned and their needs met. Care plans were in place, which were based on people’s assessed needs, in some plans there was some good information about people’s needs and preferences. For example one care plan detailed how the person liked to be dressed during the day. However in several cases more information was required to ensure that people’s needs are fully met. Wound assessment records identified that someone was receiving treatment for a pressure ulcer, however there was no mention of any skin breakdown in the care plan. In this case the wound was improving, however as the purpose of care plans is to guide staff in the care to be provided there is a risk of peoples needs not being met. The use of care plans and communication about people’s changing care needs is an area, which requires review to ensure that people receive the care they need. A record showed that someone had a speech and language assessment two days before the inspection and advice was given that the person should have a mashable and moist diet and slightly thickened fluid. Prior to reading this we had seen the person being served an ordinary lunch and a drink, which was not thickened. As it happened the menu choice on that day fitted the criteria, but staff serving the meals had not been made aware of the changed needs. Records of pressure area risk assessments were viewed; the assessment uses a scoring system to determine the overall level of risk. We looked at the records of one person’s assessment which had a score of (21) this score indicated that they were assessed as being at ‘low risk’ of developing pressure sores. However this person had developed a grade 3 sore to their heel, there was documentation within the care plan that evidenced that the person was receiving treatment to the pressure sore and in discussion with the person they said that they had their heel dressed every other day by the nurse and it was getting better. The risk rating within this person’s pressure area assessment had remained the same since it was first implemented when they were admitted to the home six months earlier. The care of a person identified at very high risk of falls (score of 11) was looked at and within their care file a falls risk assessment was in place. The Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 14 documentation within the assessments asks a specific question (in the last month has there been any falls within a 24 hour period). We checked with the accident records and found that this person had sustained two falls within a 24-hour period over the past month, and this information had not been fed into the assessment documentation. The care plan is generated from the assessment and provides the yardstick for judging whether appropriate care is delivered, which will change as regular assessment of the person reveals their changing needs. As such accurate recording within the assessment is pivotal in ensuring that changing needs are identified within the care plan. Records for someone identified as being at nutritional risk stated that they could not be weighed due to there being no scales. We discussed this with the Acting Manager who confirmed that some hoist scales had been ordered. During the inspection we saw snack foods, which included crisps in the room of someone identified as a choking risk. The registered nurse advised us that the person’s family had insisted that these were given. We were concerned that there was no evidence of any discussion with the family or health professionals or proper consideration of the risks. The acting manager advised that he would discuss this with staff and the family as a matter of urgency. We looked at a sample of people’s medication and their medication administration records and a sample check of controlled drugs identified that safe medication systems were being followed in the administration, recording and storage of medication held at the home. Advice was given to seek urgent advice from the General Practitioner and the pharmacist about medication that was being administered via someone’s Percutaneous Endoscopic Gastrostomy (PEG) feeding tube. Crushing medication can alter the way a medication works so it is important that confirmation is received in respect of each medication to ensure it is safe and effective. We looked at how people are provided with individualised personal care within one care plan there was entries that the person preferred a bath or a shower once a week, however within the care plan ‘personal hygiene ’ documentation no record had been entered to confirm that this was taking place. We spoke with the person and they said that they have ‘a strip wash daily and had not had a bath or a shower in a long while’ the person put this down to having dressings which could not get wet. It is important that staff are fully informed on the personal hygiene preferences of people using the service and that this is detailed within the individual care plan. Within one care plan viewed the person had said that they preferred to have their hair washed weekly, again on checking the ‘personal hygiene’ Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 15 documentation over the two months prior to this inspection visit there was reference to this person having their hair washed twice, and of them declining to have their hair washed on one occasion. We did note that in someone’s care plan an entry had been made that they were to be washed whilst sitting on the commode. This is not considered to be very dignified and the acting manager was asked to look into staff practices in relation to preserving people’s dignity. People were observed to speak to and treat people with dignity and respect. We saw and were told that staff always knock before entering a room and speak to people in a confidential manner. Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 16 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. In general the lifestyle preferences and social needs of the people using the service are met. EVIDENCE: During our random inspection in August 2008 we witnessed an activities organiser working with small groups and individuals on meaningful activities to stimulate them. On the day of inspection an outside musician / singer was entertaining some of the people who use the service. People were observed to enjoy the entertainment and said how much they had enjoyed it; the staff participated in the activity by joining in with some dancing creating a lively atmosphere. In discussion with people comments received were in the main positive one person said they were ‘extremely happy at the home’, and went on to say that their only concern was having to wait for their meals, they said that they found their en-suite facility a little small, that they used a zimmer frame and find it difficult to manoeuvre in the confined space. Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 17 Within the care plans viewed there was records of individual activities that people had undertaken, one person had been busy knitting scarves to sell at a craft fair another person took enjoyment in feeding the birds in the garden and going for walks, there was records of people joining in social group activities such as Bingo sessions. One person said that they had good facilities in their room, that they had their own TV and telephone so that they could contact their family at any time they wished. A group of people were observed receiving the lunchtime meal the meal consisted of Lamb stew, mashed potatoes and green beans. We asked people about the quality of the meals provided and all said that they enjoyed the food at the home, one person had been provided with a salad, they said that they had salad most days and that this was their choice. Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 18 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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service and their representatives need to have up to date information on the contact details of persons they can address their concerns or complaints too. EVIDENCE: Information about the complaint procedure is detailed within the statement of purpose. Contact names and numbers are given for people to contact within Southern Cross in the event that someone is not satisfied with how a complaint is dealt with by the home manager. This information is important, however must be kept up to date. Details of the manager who left in July 2008 and an operations manager who left around the same time were included. Staff confirmed in surveys that they know what to do if people raise concerns about the home with them. The staff training matrix identifies that only 61 of staff have received training in safeguarding vulnerable adults. We spoke with the acting manager about recent complaints and concerns including those being investigated under safeguarding vulnerable adults procedures. Concerns raised have included concerns about staffing levels, staff training to meet people’s specific needs and health conditions, and response to call bells and the front door. The acting manager is cooperating with the local authority who are investigating the current concerns. Pytchley Court Nursing Home DS0000012634.V373963.R02.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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are provided with a clean, safe and pleasant home. EVIDENCE: We conducted a limited tour of the building and sample checked bedrooms, communal areas, bathrooms / WC’s and the kitchen and laundry facilities. One person had expressed a concern that they found their en-suite facility ‘a little tight to use with their zimmer frame and that the toilet seat was too low’ We look at the en suite facility for this person, there was grab rail and raised toilet seat available the en suite consists of a toilet and sink (no shower facility was available). The space was a little limited, as dressings were also stored within this area. Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 20 We noted that there had been a water leak in the ceiling near the main light, to ensure that the light switch was not used it had been taped on the off position. There was other lighting in the room in the form of a table lamp. In discussion with the staff it was confirmed that they were awaiting a contractor to attend to the ceiling. All bedroom viewed were individualised with personal items of small furniture, ornaments and pictures. There was a TV and telephone point available in some rooms. Within the bedrooms, bathrooms and WC’s there was personal protective clothing available such as disposable gloves and aprons and hand sanitizer was in use throughout the building to assist in reducing the risk of cross infection. Pytchley Court Nursing Home DS0000012634.V373963.R02.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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service have the right to be safe at all times and fully supported by staff that are appropriately trained and in sufficient numbers to meet their needs. EVIDENCE: A relative described the staff team as “attentive, cooperative, caring and courteous”. Three staff completed surveys in May 2008 of which two stated that there are ‘sometimes’ enough staff, while the third stated there were ‘usually’ enough staff. A comment was made that they are trying to get more staff without any luck, as the weekend pay rates are not very good. We asked ‘what could the service do better?’ One response was about the need for more staff to help ill people, as they need more time to feed and talk with them. Review of the complaint record indicated that this remains a matter of concern for people. We carried out a random inspection in August 2008 which was to look particularly at outcomes for people living at the home, the staffing levels and if care was being delivered in a timely and appropriate way. We found some discrepancies in the staff rota and a requirement was made about the need for Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 22 accuracy. On the day of the inspection we witnessed sufficient carers to meet the needs of people. We looked at the minutes of residents meeting held in October 2008 where concern was raised about people having to wait long periods to be taken to the toilet. The reason given was that there was not enough staff on duty; this is an ongoing cause for concern as the service provides care for people with high physical and emotional dependencies. One person in attendance at the meeting wished to express praise for one particular member of staff whom they said ‘goes that extra mile’. Although we did not evidence there were insufficient staff on the days of our inspection, this is clearly an issue that continues to be raised as a cause for concern. We have recommended that staffing levels should be reviewed and monitored in consultation with people who use the service to ensure that there are sufficient staff to meet people’s needs at all times. It is important that people’s views are sought on a regular basis to help identify particular times or days when people feel that they are not receiving care in a timely manner. We looked at the minutes of a staff meeting held in October 2008, seven staff only attended this meeting and in discussion with the acting manager he expressed his concern about this. Agenda items looked at improving customer care, health and safety and care plans. We looked at the recruitment files of two existing staff and two newly employed staff. In general all had the necessary documentation available to demonstrate that pre employment checks had been carried out, however two newly appointed staff had commenced employment prior to their Criminal Records Bureau (CRB) clearance having been obtained. There was evidence that the home had carried out checks with the Protection of Vulnerable Adults register prior to the staff starting work at the home. In discussion with the acting manager they stated that new members of staff who start employment pending their CRB clearance work under the supervision of the team leaders. We looked at the staff rota to establish how the supervision is managed, there was a lack of clarity on the rota and it was not possible to establish which team leader had undertaken the responsibility for overseeing the induction period of the new member of staff. Responses received from three staff in the surveys confirmed that their employer carried out checks such as criminal record checks and obtained references before they started work. The staff surveys state that staff feel that they have training appropriate to their role, however two of the three people state that they have not had training which helps them keep up to date with new ways of working and to understand and meet the individual needs of people. They were asked to think Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 23 about needs relating to disability, gender, race and ethnicity, faith and sexual orientation when answering the question. Responses to a question about knowledge in this area suggest that this is an area where further training is required to ensure that people’s needs can be met. The staff training matrix identifies that more training is required to ensure that staff have the necessary knowledge and skills to meet people’s needs and to carry out their role safely helping to safeguard people who use the service. One area of particular concern is dementia training with the matrix identifying that only 3 of staff have had completed basic dementia awareness training and none of the staff had completed the ‘Yesterday, today and tomorrow’ training course which is run by the Alzheimer’s society and used by Southern Cross in their dementia care homes. Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 24 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 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of people would be further protected through having care plans in place that are based upon people’s current assessment of needs. EVIDENCE: Standard 31 relates specifically to the registered manager and their experience and qualifications. There was no registered manager in post at the time of this inspection in October 2008. However this standard is considered from the perspective of the adequacy of the management arrangements, as this is considered a key aspect of ensuring that residents receive appropriate care. Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 25 The registered manager left in July 2008. Since that time there have been two acting managers in post. The most recent has been in post for just seven weeks. The Care Standards Act 2000 requires that anyone managing a care home apply for registration. The expectation of the Commission for Social Care Inspection is that an application for registration of a manager is made in a timely manner. Southern Cross Healthcare has a range of quality assurance tools and audits to help measure the quality of care. We looked at a recent medication audit carried out by the Operations Manager. The operations manager carries out monthly unannounced visits to look at the quality of care provided. We found the audit had identified appropriate areas for improvement and the acting manager was clear about the actions to be taken to address the shortfalls. No health and safety concerns were identified during a sample check of the premises. Some of the training identified through review of the training matrix, and referred to in the staffing section, identifies the need for updated training for some staff. This includes areas, which affect the health and safety of residents such as movement and handling, health and safety and infection control. Pytchley Court Nursing Home DS0000012634.V373963.R02.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 1 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Pytchley Court Nursing Home DS0000012634.V373963.R02.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 OP1 Regulation 4 Schedule 1 5 Requirement The statement of purpose must be kept up to date to fully reflect the homes aims and objectives, terms and conditions, services and facilities. The service user guide must contain all information detailed in Regulation 5, including clear information about all charges. This would help prospective and current people who use the service and their families make informed decisions. Risk assessments must be accurately completed to ensure that the changing needs of people using the service are identified, and appropriate care provided. The incidence of pressure sores, their treatment and outcome must be recorded within the care plan and reviewed at least one a month. Scales suitable to ensure that all people have the opportunity to have their weight gains and losses monitored must be available. DS0000012634.V373963.R02.S.doc Timescale for action 06/03/09 2. OP1 06/03/09 3. OP8 13 (4) (c) 06/03/09 4. OP8 15 06/03/09 5. OP8 12 (1) (a) (b) 06/03/09 Pytchley Court Nursing Home Version 5.2 Page 28 6. OP9 7. OP7 8. OP15 9. OP29 10. OP30 In respect of medication that is crushed for administration via PEG feed tube professional guidance must be sought from a pharmacist and the prescriber and the details documented within the care plan. 15 The personal hygiene preferences of people using the service as detailed in their care plan must be followed 12 Dietary requirements specified by health professionals must be adhered to. This is to reduce risks including that of choking. 19 A system must be in place to evidence the day-to-day supervision arrangements for new staff that commence employment at the home prior to a CRB clearance. This is to protect people using the service. 18 (1) (c ) Staff must receive training (i) appropriate to their role and the assessed needs of people who use the service to ensure that they have the necessary knowledge and skills to fulfil their responsibilities and meet people’s needs. This must include dementia care training. 13 (2) 06/03/09 06/03/09 06/03/09 06/03/09 06/03/09 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 OP27 Good Practice Recommendations Staffing levels should be reviewed and monitored in consultation with people who use the service to ensure that there are sufficient staff to meet people’s needs at all times. Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Pytchley Court Nursing Home DS0000012634.V373963.R02.S.doc Version 5.2 Page 30 - 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!