Inspection on 19/09/05 for The Leonard Pulham

This inspection was carried out on 19th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

The Leonard Pulham 23/08/06

The Leonard Pulham 24/01/06

The Leonard Pulham 31/01/05

The Leonard Pulham 18/05/04

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Leonard Pulham Tring Road Halton Aylesbury Buckinghamshire HP225PN Lead Inspector Sue Smith Unannounced Inspection 19th September 2005 13:50 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 The Leonard Pulham DS0000019239.V252676.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. The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Leonard Pulham Address Tring Road Halton Aylesbury Buckinghamshire HP225PN 01296625188 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) Abbeyfield (buckinghamshire) Society Limited Mrs Kim Elizabeth Anwyl Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. General Nursing Care Incl 1 respite bed Date of last inspection 31st January 2005 Brief Description of the Service: The Leonard Pulham Home is a purpose built Nursing Home owned by The Abbeyfield Buckinghamshire Society, situated on the edge of the Chilterns just outside Wendover. The home maintains close links with the Royal Air Force and is adjacent to RAF Halton. The home provides thirty-two single rooms for long-term care and one of these is for respite care. The home maintains five nominated RAF beds and three Masonic beds. Leonard Pulham provides 24hr Nursing Care for older people. The home is a two-storey building and access to the upper floor is via a service lift. The home has several, tastefully decorated lounges and a light and spacious dining room, which overlooks the garden. Leonard Pulham is set within its own gardens that offer peaceful and secluded surroundings. The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken on the 19th September 2005. The home was visited by two inspectors due to a change in allocation, the previous inspector Barbara Mulligan attended with Sue Smith to provide support. The Manager was available throughout the inspection. The Inspection was carried out over 3 hours, a full environmental tour took place with a variety of records assessed which included, health and safety documentation, pre-admission documents, Careplans, Staff recruitment records, Supervision systems, Medication procedures, Staff training records and the complaints procedure. The inspectors assessed 19 of the national minimum standards for older people with 17 of these fully met and 2 almost met. As a result of the Inspection the Home has received 2 requirements and 2 recommendations. During the inspection Sue Smith spoke with a group of 8 Service Users in the downstairs lounge to gain their views. In addition Service Users seated in their bedrooms were spoken with during the environmental tour. Service Users were complimentary of the service provided and the dedication of the staff team. Staff were supportive of the inspection process. The Inspector would like to thank the Service Users, Manager and Staff team for the warm welcome they received. What the service does well: Pre-admission assessments take place before any admission to the Home. Careplans are maintained to a high standard to ensure the ongoing and changing needs of Service Users is met. The approach of the staff team is sensitive with all personal care undertaken in a manner that protects the privacy and dignity of Service Users. Service Users were complimentary of the care and support provided. There is a comprehensive complaints procedure in place with no formal complaints received at the home or directly to the Commission in the past 12 months. The environment is pleasant and homely with an evident programme of redecoration in place. The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 Page 6 The homes designated domestic staff ensures a high standard of cleanliness is maintained with no evidence of offensive odours throughout the inspection. The home has a well-maintained garden, which is accessible to Service Users. Regularly up-dated staff training is in place to ensure the professional development of all staff. Rigorous health and safety systems are in place to protect the Service Users and Staff from harm. The Manager is open and transparent; Staff and Service Users find her approachable and supportive. The staff team at the home are dedicated and committed to providing a professional and supportive service. What has improved since the last inspection? What they could do better: Medication procedures need to be further reviewed to ensure all prescribed medications are administered to the person named on the prescription label. This was only in relation to such medications as Lactulose, Movicol and Fibregel. A requirement is made in relation to this issue to ensure the home is able to fully meet standard 9 and Regulation 13 (2). The number of gaps in signatures on MAR (medication administration records) sheets, was high in number, this was discussed with the Manager who will The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 Page 7 address the issue, due to her proactive approach a requirement is not necessary at this time. The Home does not presently have a formal supervision procedure in place for Ancillary staff and are facing problems delivering regular formal supervisons to its night staff. A requirement is made for a system to be put in place that will ensure the home is able to meet standard 36 and Regulation 18 (2). A recommendation was made for the Pressure Wound management record to include the key used to assess high, medium and low risks for reference. A recommendation was made to support planned changes to the recruitment procedure, the home will need to ensure all files contain a copy of photo identification, for example a drivers licence or passport. 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 Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 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 The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 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 Pre-admission assessments are undertaken prior to admission ensuring the home are able to meet the needs of Service Users. EVIDENCE: Within the Careplan is documented evidence of a pre-admission assessment taking place; this is then updated on the day of admission to reflect any changes in need that may have occurred. Baseline observations are evident within this assessment tool, which includes clinical details, physical, behavioural, emotional and spiritual needs. The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 Page 10 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, 10. All Service Users have an individual plan of care, which is reflective of review, which enables staff to provide the required care to Service Users. Staff demonstrated an understanding of the needs of Service User and their interactions and relationships with them was positive, which enabled Service Users to express their thoughts, feelings and needs. Medication Administration records are held in the Home, however these were found to have a large amount of gaps leaving the Service Users at risk. All medication is stored and disposed of in a satisfactory manner; ensuring Service Users are protected by the systems in place. The administration of such medications as lactulose, fibregel and movicol will need to be readdressed to ensure all administrations are in line with current pharmaceutical guidance, thus ensuring Service Users continue to be protected by the systems in place. Staff practice in giving and assisting with such elements as personal care and arrangements for medical examinations ensure the privacy and dignity of Service Users. The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 Page 11 EVIDENCE: Careplans in place were found to be maintained to a high standard. Each service User has an individual plan of care, which is reviewed, on a monthly basis, with additions made as and when required to reflect a change in needs. Careplans include individual risk assessments, which support Service Users to live as independently and safely as possible. All Careplans include manual handling assessments; pressure wound assessments, falls risk assessment with interventions page and a nutritional assessment. These were all found to be reflective of the current needs of Service Users with regular reviews taking place. The inspector did note the Pressure Wound assessment does not provide a key to ascertain whether the scoring is a high, medium or low risk, on discussion it was confirmed that this key is available when inputting the data on the computer, however the printed version held in the Careplan file does not provide this information. Due to the high number of differing assessment tools that are commonly used to assess skin integrity the Inspector recommends this vital information is added to the printed copy to ensure Agency, bank or newer nursing staff are aware of the assessed and scored risk categories. Qualified nurses administer medication, generally the systems in place were robust and in line with the homes current medication policy, however on inspection of the MAR (medication administration records) sheets there were 10 signature gaps in one month. The Manager has addressed this area of practice with staff previous to this inspection with improvements made to the recording. The inspector has advised the Manager to again address this as a practice issue with the nursing team to ensure future recording practice is improved. A requirement has not been made at this time due to the proactive approach of the Manager to resolve this issue. The home ensures all medication is stored appropriately in lockable facilities. A new disposal system (in line with recent changes to disposal arrangements) has been organised with the clinical waste contractors for the home, which will soon be implemented. Medication administration is generally in line with current codes of practice and pharmaceutical guidance, however it was noted such medications as Lactulose, Fibregel and Movicol are administered from one bottle due to a lack of space in the medication cupboards. This is in breach of current pharmaceutical guidance due to these being obtained on individual named prescriptions. The home will need to address this issue and obtain further storage facilities, which will enable staff to administer these medications appropriately. Discussion took place with the Manager to problem solve this issue, the Manager was proactive in her approach to resolving this issue of concern and will ensure The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 Page 12 alternative storage space and a change in administration procedures will be put in place. The Inspector will need to reflect this as a requirement of the Home to ensure an audit trail is maintained for these medications. Staff were observed throughout the inspection communicating and assisting Service Users. At all times the approach of the staff team was sensitive with all care undertaken in a manner that protects the privacy and dignity of Service Users. Service Users spoken with at the time of inspection were complimentary of the support received by staff and were happy with the way in which care is implemented. There were no verbal complaints received from Service Users during the inspection. The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 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): x EVIDENCE: The activities provided in the home were not assessed during this visit, however throughout the inspection Service Users were observed enjoying a variety of planned and spontaneous activities. Service Users spoken with at the time of inspection were complimentary of the activities and social opportunities offered to them. This standard will be fully assessed during the course of the next inspection. The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 Page 14 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. The home has a comprehensive complaints procedure, with records of complains and investigations open to inspection. The complaints procedure is made available to Service Users and significant others, which ensures all relevant persons, are able to make a formal complaint appropriately. EVIDENCE: There have been no formal complaints made to the home or directly to the Commission in the past 12 months. The homes Manager ensures she is available to Service Users and visitors when issues of concern arise, this proactive approach ensures all minor concerns are dealt with before they become an issue for complaint. The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 Page 15 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, 20, 21, 22, 23, 24, 25, 26. The Home is well maintained with an evident programme of redecoration in place. Comfy furnishings, ornaments, fixtures and fittings are supplied in communal areas making the environment homely for Service Users. Suitable single sleeping accommodation is provided with evidence of personal possessions to make these more homely for Service Users. The Home has designated cleaners, which ensure the home is clean, hygienic and free from offensive odours. Sufficient numbers of toilets and bathrooms are available to ensure the needs of Service Users are met. The Home is situated in pleasant gardens, which are accessible to Service Users. EVIDENCE: The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 Page 16 The home is registered to provide services for 32 Service Users; all bedroom accommodation is single occupancy. Within this registration is 1 designated respite bed. The home provides suitable communal space to meet the needs of Service Users. Lounge space is scattered throughout the floors of the building, these are pleasantly decorated with comfy furnishings and are reflective of a homely environment. The dining area on the lower ground floor is pleasantly decorated with sufficient numbers of chairs and tables to meet the needs of Service Users; this again has been decorated to a high standard and is reflective of a pleasant and relaxing environment. Bedrooms have recently been updated with the fitting of new wardrobes and vanity units; these are modern and are of a high standard. Six rooms are still awaiting the fitting of these new facilities. All bedrooms are large in size and reflective of personal possessions. Adequate bedside lighting, sockets and additional adaptations to support the Service User have been provided. The bathrooms at Leonard Pulham have been individually decorated to provide a pleasant and relaxing environment, these are maintained to a high standard providing specialist baths and equipment to further support the Service Users. The home employs designated cleaning staff to ensure the home is maintained to a high level of cleanliness and ensuring all infection control measures are in place. The Inspector noted during the environmental tour the limited storage space available for such things as laundry bins used by staff throughout the day. Suggestions for where these could be stored after the morning rush were shared with the Manager to ensure further measures to limit the spread of infection can be put in place whilst also taking into the consideration the need for staff to be able to access these quickly and efficiently. At the time of inspection the home was found to be clean and tidy with no offensive odours evident. The home has a large and well-maintained garden, which is regularly accessed by Service Users during the summer months, comfy garden furniture is provided to further support the use of this area. The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 Page 17 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): 29, 30. The home has a full recruitment procedure in place, which is in line with Schedule 2 and Standard 29, ensuring Service Users are protected from the risk of abuse. Staff receive training to support them in their role, which further ensures the protection of Service Users. EVIDENCE: Six staff recruitment files were assessed during this inspection. These contained all relevant security checks such as written references, CRB disclosures and POVA checks. Verification of identification has been sought in all cases, however this does not include photo identification. On discussion with the Manager it was ascertained that they are presently formulating changes to their procedures to include photo identification. At this time a recommendation is made to ensure all new recruitment files contain photo identification, for example driver’s licence or passport to verify identity. This standard will be further assessed during the next inspection to ensure this work has been carried out. Staff receive mandatory training with records of training undertaken held in individual files. In addition NVQ training is provided through the Fremantle Trust. At this time the Manager and Deputy Manager has completed their NVQ 4, four Care staff have completed NVQ 2 and one has completed NVQ 3. The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 Page 18 The home has contracted the services of a training facilitator to further improve the systems in place. At this time the trainer comes to the home three hours per week to ensure staff receive appropriate and necessary training. The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 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, 36, 38. The Manager of the Home has the necessary skills and training for her role to ensures practice in the home is in the best interests of Service Users. Staff supervision is not taking place at regular intervals, which leaves staff limited in their options to discuss practice issues. The home has rigorous systems in place, which ensures the protection of the health and safety of Service Users and Staff. EVIDENCE: The Manager is open and transparent in her practice; staff find her approachable and available to discuss issues of concern. The Manager undertakes regular training to support her practice development. The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 Page 20 At this time there is no formal supervision process in place for Ancillary Staff, in addition the Manager reports that she is experiencing difficulty ensuring the night staff receive regular supervisions. This does limit the options available for discussion of practice issues or the professional development of individuals. The home will need to put a system in place, which will provide a formal documented supervision record for each staff member. A requirement is made to this effect. The home has a computerised audit system of all health and safety requirements, this programme ensure the Manager is regularly reviewing on a daily basis systems in place. For example on any given day the Manager is asked to answer a question on a recording form to ensure a chosen system is up-to-date. The Inspectors assessed records held for fire safety with the last fire drill taking place on 26/6/05. The home has a fire policy in place with the last Fire Authority inspection taking place on 17/3/05. In addition fire fighting equipment was last serviced on 9/5/05. There is a daily recorded inspection of fire escape routes and weekly recorded fire alarm/emergency lighting testing undertaken. C.O.S.H.H. risk assessments and data sheets are in place and made available to relevant staff. PAT testing was last undertaken in May 2005. Hot water temperature monitoring is undertaken on a monthly basis with an Annual Legionella audit, in addition a chlorination test was undertaken on the 9/9/04. Health and Safety training is in place for relevant staff with all staff undertaking mandatory fire and manual handling training which is regularly updated. The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 x 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x 2 x 3 The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 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 9 Regulation 13 (2) Requirement All medication must be administered from the designated and named prescription bottle e.g. lactulose, fibregel, movicol with additional medication storage facilities purchased to aid staff to administer medications within current pharmaceutical guidance. All Staff must receive regular formal supervisions. Timescale for action 15/11/05 2 36 18 (2) 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 7 29 Good Practice Recommendations The Pressure Wound management record held in the Careplan includes the key to assessing high, medium and low risks for reference. A photocopy of a photo identification document such as drivers licence or passport, is to be held on each recruitment file. DS0000019239.V252676.R01.S.doc Version 5.0 Page 23 The Leonard Pulham The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 The Leonard Pulham DS0000019239.V252676.R01.S.doc Version 5.0 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. 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