Inspection on 23/08/06 for The Leonard Pulham

This inspection was carried out on 23rd August 2006.

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 24/01/06

The Leonard Pulham 19/09/05

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 Gill Wooldridge Unannounced Inspection 23rd August 2006 09:00 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 The Leonard Pulham DS0000019239.V302320.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. The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 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 Kim 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.V302320.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. General Nursing Care Including 1 respite bed. Date of last inspection 24th January 2006 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-three single rooms for long-term care. The home maintains five nominated RAF beds and three Masonic beds. The home has an established staff team supported by regular bank staff and has good links with local health professionals. 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 are well maintained and offer peaceful and secluded surroundings. The fees for the home are £ 750.00 per week. The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken on the 23rd August 2006 with a second day of the inspection carried out on the 25th August 2006. The manager was available throughout the inspection. On the first day of the inspection 7 hours were spent in the home with the second day of the inspection lasting approximately 3 hours. A tour of the home took place and the care of residents was tracked with a variety of records assessed which included, health and safety documentation, preadmission documents and medication records. Staff recruitment records, supervision systems; staff training records and the complaints procedure were also studied. The inspector assessed all the key standards of the National Minimum Standards for Older People. During the inspection residents were spoken to over and following lunch and during the tour of the home and whilst tracking individual residents care. Residents were complimentary of the service provided and the support they received from the staff team. Staff appeared un- phased by the inspection process. The Inspector would like to thank the residents, manager and staff team for the warm welcome and hospitality received. What the service does well: Pre-admission assessments take place before any admission to the home. Care plans are maintained to a satisfactory standard and reviewed regularly. The approach of the staff team is sensitive with all personal care is undertaken in a manner that protects the privacy and dignity of residents. Residents were generally complimentary of the care and support provided. There is a clear complaints procedure in place. The environment is pleasant and homely with an evident programme of redecoration in place. The homes designated housekeeping staff ensures a high standard of cleanliness is maintained with no evidence of offensive odours throughout the inspection. The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 6 The home has a well-maintained garden, which is accessible to residents. There is a programme of training which should ensure the professional development of all staff. Health and safety systems are in place which should ensure residents are protected from harm. The manager appears open and transparent; staff and residents generally 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: Details of all residents assessed needs should be supported by a care plan Some interrelation of care plans was noted however; this needs to be further developed especially in the case of residents with pressure wounds. Clear descriptions of all wounds need to be available to all staff. The level of assistance and support should be described more fully in the care plans. The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 7 The manager should try to ensure all care plans are signed by residents or their representative. It is acknowledged that residents sign the regular review of the care plans. Information needs to be included in care plans regarding advice from the dietician. Risk assessment training is advised for senior staff. The number of over written entries on Medication Administration Record (MAR) sheets was concerning, this was discussed with the manager who will address the issue. Due to her proactive approach a requirement is not set at this time. The systems in place include observing staffs practice and checking practice periodically and developing a more detailed audit system which is initiated by a daily audit and reminding staff of their accountability. A review of the homes Medication Administration Records sheets is strongly recommended to avoid any transcribing errors. It is strongly recommended that the manager purchase a further hoist. It is recommended that the manager encourage a residents committee. It is strongly recommended that the manager tries to be more visible to all residents. The manager is reminded that she must report under Regulation 37 any event that effects the well being of a resident. 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.V302320.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Pre-admission assessments are undertaken prior to admission which should ensure the staff team are able to meet the needs of residents. EVIDENCE: Within the Care plan 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 monthly or more frequently as need indicates. Care plans are reviewed regularly and nutritional and pressure wound assessments also take place as need indicates. The contract was discussed with the manager who confirmed the contents had been reviewed recently. Any concerns raised by relatives should be discussed with the Committee. It is recommended that the Committee/ accountant have a regular liaison with residents and relatives so that there is a forum to ask The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 10 questions that may be concerning them. The manager confirmed that residents sign the contract and maintain a copy. The manager confirmed that the home does not carry out intermediate care. The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. All residents have an individual plan of care, which is regularly reviewed, which should enable staff to provide the required care to residents. Medication Administration records are held in the home however, these were found to have a number of inconsistencies which have the potential to place residents at risk. Staffs practice is being reviewed to support the safety of residents. Staffs observed practice ensures residents privacy and respect is upheld. EVIDENCE: Four care plans were studied and the care of these residents tracked Care plans in place were generally found to be reflective of residents needs and generally easy to follow. Care plans are reviewed and evaluated monthly although this system was not easy to follow. Although most of the care plans were reflective of residents needs one care plan needed to be more specific regarding a residents psychological health, for example, can become agitated The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 12 and uncooperative, this was not detailed in the care plan regarding staffs approach. The deputy manager agreed to action this shortfall. The level of assistance and support needs to be described more clearly to support the care of any resident. The deputy manager has agreed to rectify this. Residents suffering with pressure wounds did not always have a clear description of the wound, this was an oversight and the deputy manager confirmed this would be addressed. The deputy manager was able to clearly describe the wound and the progress made in trying to heal the wound. Staff described gaining the support of the tissue viability nurse if the area was not healing or any deterioration. Some interrelation of care plans was noted however; this needs to be further developed especially in the case of residents with pressure wounds. One daily entry indicated that the home did not have the prescribed dressing for the resident’s pressure area, this was discussed with the deputy manager and manager who described a problem with receiving the dressing. This should not occur. It is acknowledged that two resident’ s care plans had clear descriptions of their wounds. Residents with a diagnosis of diabetes should have included in their care plan the normal range of blood sugar readings for each individual and signs and symptoms of hyper or hypo glycaemia should be recorded to support staff practice. Residents’ likes and dislikes were not evident in the care plans viewed. However, it is acknowledged that residents confirmed that staff and the cook are aware of any preferences. The care plans appeared a little de- personalised and the deputy manager confirmed that the team were in the process of developing a life history or pen picture to give any new staff an overview. Staff knowledge, both of carers and nurses was clear and this information could support the process of care planning. All reviews and referral information needs to be included in the care plan to ensure all staff are aware of all the information pertaining to a residents needs. Staff confirmed detailed handovers where they take notes however, some information may be lost in verbal exchanges and staff are reminded to record all details pertaining to residents care. It is acknowledged that staff hold a yearly formal review of residents care, this is noted as good practice. Turning charts support the care of residents and although practice in this area observed was sound, staff were not always recording their actions. This needs to be rectified. Nutritional and pressure wound assessments are regularly completed as are residents weights and blood pressures. However weights were difficult to track as the recording happens in two places. It is acknowledged that care plans regarding catheter care were detailed. Care plans include individual risk assessments, which support residents to live as independently and safely as possible. However, some residents sensory needs weren’t clearly reflected in the documentation and there should always The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 13 be a system for reducing any risk to the resident or staff. The risk assessment process should be supported by training for staff. At the previous inspection it was noted the pressure wound assessment did not provide a key to ascertain whether the scoring is a high, medium or low risk. This has been developed and a hard copy as well as information on the computer is available for staff. Some information was difficult to find on the computer. Staff described practice in convene care, they stated this was supported by training and regular competency checks. Residents described staff as generally helpful with lots of smiles, one resident described a small number of staff as having ‘off days’. This was discussed with the manager who stated that she was sometimes very busy with paper work. It is recommended that the manager tries to talk to residents daily and make herself more visible. It is acknowledged that staff stated that the manager regularly walks the floor and observes their practice, they described her as having high standards. One relative spoken with praised their mothers care by the staff team and described their mothers ‘carer’ as ‘exceptional.’ Staffs knowledge and observed practice was more than satisfactory during the inspection. A review of the homes Medication Administration Records sheets is strongly recommended to avoid any transcribing errors. All hand written entries or alterations should be supported by two staff signatures. The manager must support staff through refresher training and competency checks periodically, with records maintained. The manager must address any shortfalls in medication practice and remind the trained nurses of their personal accountability for maintaining records. Follow the Nursing and Midwifery Councils guidelines, the homes policy and the Royal Pharmaceutical Society’s guidelines. The manager need to develop further her audit system which it is acknowledged has significantly reduced the number of gaps noted. Staff practice was observed and following this a discussion took place with the trained nurse, their honesty was refreshing as was their willingness to address any practice issues, this needs to be supported by the manager to ensure all medication practice is ‘best practice’. Staff and the manager agreed to develop PRN management plans for residents prescribed any sedative type medication. On the second day of the inspection the manager had produced an action plan which included a detailed audit system, which included daily audit checks and a trained staff team meeting planned for the 30th August where staff would be reminded of their accountability and inform them that the manager would carry out spot checks with follow up sessions in supervision. The manager is The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 14 reminded to offer staff training and to record all competency checks. These measures should ensure the safety of residents. It was not evident that any resident is self-medicating. This should be explored. It is acknowledged that the GP reviews residents medication regularly and heath professionals support the care of residents, this was noted in records seen. Residents were able to describe the care they received and praised staff for their support and attitude. Privacy and dignity were observed to be respected during the time of the inspection. Sensitive practice was noted. Staff were seen to knock on residents doors and wait for a response before entering. Staff demonstrated an understanding of the needs of residents in their interactions and relationships with residents and in the detailed descriptions of the residents care. All residents were seen to have ready access via a call bell for any assistance they may need. The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The quality in this outcome area is good. This judgement has been made using available evidence including a site visit. Regular visitors to the home and positive comments received from comment cards from family members should ensure that residents are encouraged to maintain contact with friends and family. This was confirmed by residents. Residents described a range of activities which seem to meet their needs. EVIDENCE: Residents described a range of activities included quizzes, bingo, dominos, art classes, gentle exercises, a recent trip to Marlow. One resident described purchasing some flowers on a recent trip out. Many residents described the activity organiser as ‘wonderful’. A gentle exercise class took place on the afternoon of the inspection and after the class, tea was served along with a period of relaxation watching the television, ‘Countdown’ a great favourite. Exercise classes support residents in their physical health and mental stimulation. Several residents described a knitting group where up to 15 residents attend, knitting for a charity, jumpers and soft toys to support young children abroad. Residents were seen to enjoy reading and watching the television as well as knitting. Visitors to the home spoken to and who had sent comment cards to the Commission generally praised the service. The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 16 Staff did not appear phased by the inspection process, which added to the relaxed feel in the home. Care plans indicated that residents had been involved in the process, which should ensure that their choices and wishes are respected. One resident described wishing to set up a residents committee, with their permission this was raised with the manager who has agreed to facilitate this. The visitors’ book indicated that the home has frequent visitors and residents confirmed that their families visited frequently and kept in contact by phone as well. Committee members visit the residents. Breakfast was being served until around 10 am and there appeared to be an unhurried feel to the home. Breakfast is served in residents rooms on trays which adds to this unhurried feel. Staff described not rushing residents and encouraging their independence. Residents described the food as great and drinks were readily available throughout the home. The meal at lunchtime was turkey, roast potatoes and three vegetables accompanied by stuffing and bread sauce. Dessert was bread and butter pudding with lots of added fruit. One resident describe having a hot drink for supper and there being too much food. One resident said the food was average but overall residents praised the cook. The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 17 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 & 18 The quality in this outcome area is good. This judgement has been made using available evidence including a site visit. Consultation with residents and relatives in open discussions indicates that complaints and concerns would be appropriately actioned which should ensure that residents and relatives views are both listened and responded to. Staff and the manager appear aware of how abuse may manifest itself and are supported by the organisation’s policies and procedures. These measures should ensure residents are protected from abuse. EVIDENCE: Visitors to the home spoken to and who had sent comment cards to the Commission generally praised the service. Issues of concern raised by residents and visitors in their comment cards were discussed with the manager and are highlighted in other sections of the report or, were discussed with the manager directly. Staff and residents described that residents had occasional grumbles, the manager needs to develop a system to ensure these small concerns are recorded and actioned as appropriate. One resident described wishing to set up a residents committee, the manager stated that she would facilitate this. Residents generally described staff and the managers as approachable. One resident described that they felt that the manager was often busy and didn’t have a presence around the home however; staff confirmed that the manager The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 18 and deputy regularly walked the floor. The manager needs to be more visible to all residents to ensure their views are heard and actioned. The manager agreed that she is often busy with paper work and tries to talk to residents daily and will ensure she is more, visible. The manager shared one formal complaint received at the home this was investigated by the Committee who are reminded to keep the Commission informed, of any event that effects the well being of residents under Regulation 37. The outcomes appeared positive for residents. It is acknowledged that the manager stated she had reminded the Committee to do this. Staff clearly described how abuse may manifest itself and who they would report any potential or actual abuse to. Care Line was described by staff as advertised on the home’s notice board. Information seen supported this. It is recommended that the manager discuss adult protection in all staff meetings and reaffirm to bank staff the homes whistle blowing policy. Residents described that they did not hear staff raise their voices. Staff stated that they had not all completed adult protection training the manager confirmed that there are two sessions for staff in the coming weeks. Any staff that are not able to attend these sessions must have some further training in the coming weeks. Staff confirmed their knowledge base was as part of the NVQ process. The Leonard Pulham DS0000019239.V302320.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The quality in this outcome area is good. This judgement has been made using available evidence including a site visit. The home is warm, well furnished and well maintained and provides a comfortable environment for residents with a range of needs and abilities. EVIDENCE: The home is registered to provide services for 32 Service Users; all bedroom accommodation is single occupancy. The home provides suitable communal space to meet the needs of residents. 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 residents. The manager stated that there are plans to replace the lighting in the home in the coming months along with a programme of redecoration in some communal areas. The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 20 Bedrooms have been updated with the fitting of new wardrobes and vanity units; these are modern and are of a high standard. All bedrooms are adequate in size and reflective of personal possessions. Residents discussed being satisfied and pleased with their rooms and enjoyed watching the birds from their bedroom windows or from the communal areas. Residents confirmed that there are regular tests of the fire alarms. Adequate bedside lighting, sockets and additional adaptors to support the residents have been provided. It is strongly recommended a new hoist is purchased to support the care of residents. The bathrooms at Leonard Pulham have been individually decorated to provide a pleasant and relaxing environment, these are maintained to a good standard providing specialist baths and equipment to further support the residents. The home employs designated housekeeping 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 had been discussed at previous inspections. 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 residents during the summer months, garden furniture is provided to further support the use of this area. This area is private and well maintained. The Leonard Pulham DS0000019239.V302320.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The quality in this outcome area is good. This judgement has been made using available evidence including a site visit. Staff spoken to were knowledgeable about the care of residents this should ensure residents needs are met. Staffing levels need to be kept under review to ensure all residents needs are fully met. The home has a clear recruitments procedures which should ensure residents are protected from the risk of abuse. A continuous programme of training for staff should further ensures that residents needs are met. EVIDENCE: Four recruitment files were assessed during this inspection. These contained all relevant required checks such as written references, CRB disclosures and POVA checks. Verification of identification has been sought and included photographic identification. It is strongly recommended that the manager formally checks the authenticity of all references authenticity which needs to be supported by a telephone conversation with records maintained. There is a rolling programme of training. The manager stated that any gaps in training will be addressed in the coming months. In addition NVQ training is provided and staff having completed their NVQ 2 are encouraged to do their NVQ Level 3. Information gained from the pre inspection questionnaire The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 22 indicates that 50 of staff have gained an NVQ award. All nursing staff holds a first aid certificate which ensures a first aider is on duty at all times. Nursing staff spoken to were clear about their line of accountability and not to undertake tasks that they had not been trained in for example, taking blood and male catheterisation. The Manager and Deputy Manager have completed their NVQ 4 Registered Managers Award. Following individual discussion with care and nursing staff it is apparent that staff are skilled to support the care of residents they were thoughtful in their answers and described clearly their actions in given scenarios. Staff discussed the approach and support they offered to residents and this was observed as thoughtful and sensitive. Residents spoken to confirmed that staff work as a team and there are lots of smiles. Staff were able to clearly describe good communication as the key to teamwork and an acknowledgement of individual staff members skills. Staff felt supported by nurses and the managers. Rotas viewed indicate that there are generally nine staff on duty in the morning reducing to six in the afternoons. This was discussed fully with the manager who stated that she would always increase staffing if residents needs increase. Staffing levels are generally reflective of need. A formal system of assessing residents needs is in place this needs to correlate with other information to ensure staff are deployed appropriately. The manager stated that she is in the process of recruiting two RGN’s and the deputy manager confirmed that level 2 nurses always hand over to a level 1 nurse. Staffing levels observed during the inspection indicate that residents needs are generally met. This was supported by the rotas seen at the inspection. Residents raised concerns such as having to wait for staff, to assist them in personal care, for what seems long periods of times. Staff confirmed that sometimes residents have to wait, the call bell system records the response time that residents wait. The manager needs to check the system to ensure residents are not waiting too long. It is acknowledged that the manager stated that the home has just purchased a new hoist which should solve the problem described above, if the manager finds that this is not the case then she should purchase a further hoist. A wall planner indicates the future staff training, this needs to be supported by a training matrix. The manager has agreed to send a copy to the Commission. The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 23 Supervision of staff needs to be ongoing and night staff may need particular support this should be facilitated by the appointment of a new night sister. Staff spoken to confirmed that there is a formal process of supervision, which is supported, by a more informal process. The manager described a flexible approach to night staff training to ensure night staff receive all the appropriate training. The Leonard Pulham DS0000019239.V302320.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The quality in this outcome area is good. This judgement has been made using available evidence including a site visit. The manager of the home has the necessary skills and experience for her role to ensures good practice in the home. Further developments in the homes quality audit systems will benefit the service delivery. Residents financial affairs need further developments to ensure there is no perceived impropriety. The home has systems in place, which should ensure the health and safety of residents is generally safeguarded. The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 25 EVIDENCE: The manager appears open and transparent in her practice; staff find her approachable and available to discuss issues of concern. The manager described undertaking regular training to support her practice development. A formal supervision process is now in place for ancillary staff, and night staff the manager described this as work in progress. Staff spoken to confirmed that there is a formal process of supervision, which is supported, by a more informal process. The manager described a flexible approach to night staff training to ensure night staff receive all the appropriate training. Small amounts of residents’ money are kept in the home safely. However, on checking the amount of money held with the records there was an anomaly. The accountant and manager must investigate this and send their finding to the Commission. It is strongly recommended that the manager and accountant find an account for residents where they can receive interest on the money held. Quality assurance systems were discussed fully with the home having some systems in place which involve residents. Outcomes and action pans need to be developed from the findings. Care plan audit system needs to include following through all a residents care needs. Audits should have an overall impact on the quality of all paper work. The Inspector assessed health sand safety records by spot-checking several records, information given by the manager and deputy confirmed recent checks with regard to fire procedures and other health and safety records. The home has a computerised audit system of all health and safety checks however some systems showed some inconsistencies. Residents stated that the fire alarm is tested weekly although records seen indicated that these checks were not always undertaken. The manager must ensure that staff understand their health and safety responsibilities and that this is described along with the task in the appropriate folder. A recent Environmental Health Officers report indicated no requirement or recommendations. Hot water temperature monitoring is undertaken on a monthly basis and staff record the water temperature every time a bath is run in a book. Records seen confirmed that the home had a contractor carry out a chlorination test on the 22/8/06. Lift and hoist records were seen to be undertaken in March and April 06. The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 26 Accident records viewed showed some good recording, although this was not always consistent. The manager described presenting her findings on accidents to the Committee on a regular basis. She needs to formalise her audit system and ensure risk assessments are updated following a residents fall and that risk management reviews take place with records maintained. It is recommended that senior staff undertake risk assessment training. The manager is reminded that she must report under Regulation 37 any event that effects the well being of a resident. The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action 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 OP7 OP7 Good Practice Recommendations It is strongly recommended that the manager reminds staff that all residents assessed needs should be supported by a more detailed care plan. It is strongly recommended that the manager reminds staff that all care plans should interrelate with each other especially in the case of residents with pressure wounds. Clear descriptions of all wounds need to be available to all staff. It is strongly recommended that the manager reminds staff that the level of assistance and support should be described more fully in the care plans. It is strongly recommended that the manager ensures that the care plans for residents with diabetes include there normal blood sugar reading, and that the staff a have written guidelines regarding hypo and hyperglycaemia signs and symptoms. An audit system will support an overall standard of care DS0000019239.V302320.R02.S.doc Version 5.2 Page 29 3 4 OP7 OP7 5 OP7 The Leonard Pulham 6 7 8 9 10 11 12 13 OP9 OP9 OP9 OP14 OP16 OP16 OP27 OP29 14 15 16 17 OP35 OP37 OP38 OP38 planning. It is strongly recommended that the manager reviews the process of transcribing medication onto the Medication Administration Records sheets. It is strongly recommended that the manager ensures that two staff sign any hand written entry. It is strongly recommended that the manager develop PRN management plans for any medication perceived as having a sedative effect. It is strongly recommended that the manager facilitates a residents Committee. It is strongly recommended that the manager tries to be more visible to all residents. It is strongly recommended that the manager records any residents concerns a ensuring their are written outcomes. It is strongly recommended that the manager correlate residents dependency levels with other information to ensure staff are deployed appropriately. It is strongly recommended that the manager formally checks all references authenticity which needs to be supported by a telephone conversation with records maintained. It is strongly recommended that the manager explores bank accounts that give residents interest. The manager and responsible individual is reminded to report any event that effects the well being of a resident. It is strongly recommended that staff undertake training in risk assessments. It is strongly recommended that the manager formalises the audit system for accidents and ensures that risk assessments and risk management plans as appropriate are in place and reviewed. The Leonard Pulham DS0000019239.V302320.R02.S.doc Version 5.2 Page 30 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.V302320.R02.S.doc Version 5.2 Page 31 - 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!