Inspection on 24/01/06 for The Leonard Pulham

This inspection was carried out on 24th January 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Leonard Pulham 23/08/06

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 Barbara Mulligan Unannounced Inspection 24th January 2006 10:30 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 DS0000019239.V280414.R01.S.doc Version 5.1 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. DS0000019239.V280414.R01.S.doc Version 5.1 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 DS0000019239.V280414.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. General Nursing Care Incl 1 respite bed Date of last inspection 19th September 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. DS0000019239.V280414.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 24th January 2006 at 10.30am. The visit consisted of discussions with the registered manager and records, policies and procedures were examined. The inspection officer was Barbara Mulligan. The Registered Manager of the home is Kim Anwyl. The inspector assessed nineteen of the National Minimum Standards for Older People with seventeen of these fully met and two almost met. As a result of the inspection the home has received two requirements and two recommendations. The inspector would like to thank the service users, the staff team and the registered manager for their cooperation during the inspection. What the service does well: What has improved since the last inspection? Following the previous unannounced inspection that took place on 19th September 2006 a requirement was made to ensure all prescribed medications DS0000019239.V280414.R01.S.doc Version 5.1 Page 6 are administered to the person named on the prescription label. It is pleasing to note that this has been complied with. The environment is constantly being improved with prompt attention to repairs and a rolling programme of maintenance and decoration. The home have managed to maintain a good standard of care ensuring the personal, emotional and health care needs for service users continue to be met. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000019239.V280414.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000019239.V280414.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5 and 6. The homes Statement of Purpose and Service Users Guide are detailed and informative providing service users with details of the services that the agency provides. All service users have a written, individual service contract ensuring that there is an understanding of the homes terms and conditions. Service users receive care services from staff who have the skills and competencies to meet their care needs. Prospective service users have the opportunity to visit the home on an introductory basis, before making a decision to move there, ensuring that service users are able to make an informed choice about where they live. DS0000019239.V280414.R01.S.doc Version 5.1 Page 9 EVIDENCE: The Statement of Purpose contains all the necessary information as detailed in Schedule 1. The Service Users Guide is detailed and informative and contains all the necessary information detailed in Standard 1. All service users are given a contract that details the terms and conditions of occupancy. There is evidence from care notes that care-plans are working documents. The environment is designed to meet the requirements of service users who have physical needs and specialist equipment was observed around the home. The home employs eight registered nurses who are able to meet the health needs of service users. Prospective service users are invited to spend time at Leonard Pulham Nursing Home. The length and type of visit is individual to each potential service user, and may consist of an afternoon visit, a day visit or a weekend visit. If the visit is successful then an admission is planned. It is at this time that a key-worker is allocated. The potential service user has a review after the first four weeks to assess their stay in the home. Service users are not admitted for intermediate care. . DS0000019239.V280414.R01.S.doc Version 5.1 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): 11 There are good policies/procedures in place to ensure that the ageing, illness and death of a service user will be handled with respect and as the individual would wish. EVIDENCE: There are policies/procedure in place for the care of the dying and death of a service user. It includes procedures for the expected death of a service user, the unexpected death of a service user, Care of the Family and Organ donation. Every effort is made to ensure the service users stay in the home, and importance is placed upon the comfort and care of a service user who is dying. The home involves the service users and their families, if appropriate, when trying to ascertain an individuals wishes regarding dying and death This information is gathered as soon as is feasible. DS0000019239.V280414.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Systems in the home ensure that where appropriate service users are supported to exercise choice and control over their lives. Service users are able to receive visitors at the home and there are no restrictions imposed on visiting unless requested by the service user. Service users are encouraged to bring personal possessions in with them allowing personal space to reflect the character and interests of its occupant. The presentation and standard of food is good and meets the nutritional needs of service users. EVIDENCE: DS0000019239.V280414.R01.S.doc Version 5.1 Page 12 Care plans show routines of daily living and include bathing, rising and retiring times. Religious observance are recorded in care plans and service users interests are recorded in the initial assessment. The home employs a full time activities coordinator. She undertakes one to one activities in the mornings. On the day of inspection she was escorting one service user to the local garden centre. In the afternoons, group activities are organised and these are advertised within the home. There is a newsletter that also contains information about activities available. Service users are able to receive visitors in the privacy of their own rooms and are able to choose whom they see and do not see. There are no restrictions on visiting, and this is documented in the Service Users Guide. Involvement by local community groups includes the local church, regular visits by the hairdressers and barbers and various visiting entertainers. Service users and/or their families are encouraged to look after their own financial affairs whenever possible. If this is not practicable a chosen solicitor will be responsible for an individuals financial dealings. An invitation to bring in personal items of furniture and other belongings is included in the service users guide and this was evident during a tour of the premises. When questioned about service users having access to their personal records, the manager said that this could be facilitated if it was requested. The menu’s demonstrate a choice of main meal and is based on a four weekly rotating menu. These are changed every quarter. The main meal is served at lunchtime with a choice of main meal and sweet. The dining area is bright and spacious and meals are relaxed and unrushed. The inspector was informed that independent eating is encouraged for as long as possible. DS0000019239.V280414.R01.S.doc Version 5.1 Page 13 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): 17 and 18. The legal rights of service users are protected by the homes policies, procedures and protocols. Policies and procedures to protect service users from abuse are in place, but there is a lack of POVA training for care workers, leaving service users at risk of abuse and harm and their rights to be safe are not protected. EVIDENCE: Voting can be facilitated for any service user that requests to do so. Postal votes are arranged and individuals can be taken to the polling stations by car if they wish to vote that way. The manager is aware of the POVA register and stated that she would submit staff for inclusion if it became necessary. Policies for whistle blowing and adult abuse are in place and observed to be reviewed regularly. Copies of both policies are kept in the nurse’s office for all staff to have access to. The inspector was unable to find any evidence if POVA training in staff files looked at. However the manager stated that staff have undertaken POVA training. The registered manager is required to ensure that all staff undertake POVA training and this is updated on a regular basis. The inspector also looked at a policy regarding aggression towards staff from service users and was informed that this is covered during TOPPS induction. DS0000019239.V280414.R01.S.doc Version 5.1 Page 14 DS0000019239.V280414.R01.S.doc Version 5.1 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): These standards were not assessed during this inspection. EVIDENCE: DS0000019239.V280414.R01.S.doc Version 5.1 Page 16 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 and 28. Staffing numbers are sufficient to ensure that the assessed needs of the service users are met. Service users benefit from a staff team who are up to date with their training, to ensure that staff are competent to do their jobs. EVIDENCE: The duty rotas for the home were looked at. A mixture of full time permanent and regular relief registered nurses are employed in the home during the day and night. This does not include the registered manager. There are approximately twenty-three care staff and fourteen ancillary staff employed by the home. The morning shift consist of two to three RGN`S and six to seven care workers. The afternoon shift consists of one or two RGN’s and four to five care workers. The night shift consists of one RGN`S and two care assistants. Following the previous unannounced inspection it was recommended that staff files contain photo identification. This was not evident during an inspection of staff files. The registered manager stated that staff photos are stored on the homes computer but not in staff files. It was agreed that these will be printed and maintained in staff files. It is recommended that in addition to photos of staff, the registered manager will obtain further proof of an individuals identity i.e. copy of passport or driving license and these will be kept in personal files. DS0000019239.V280414.R01.S.doc Version 5.1 Page 17 All new staff receive the TOPPS training within the first six weeks of appointment. There is evidence in staff files to demonstrate that all staff undertake mandatory training. However, it was difficult to assess all staff regarding the training they had undertaken because certificates are held in individual files. It is recommended that the home implement a training matrix making it easier to assess what training staff have completed and when training needs to be updated. Progress is being made with NVQ training with care staff undertaking this training following the completion of the TOPPS Training. All staff receive a minimum of three paid days training per year. DS0000019239.V280414.R01.S.doc Version 5.1 Page 18 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): 32, 33, 34, 35, 36 and 37. The management approach of the home creates an open, positive and inclusive atmosphere. Various methods of measuring quality assurance are in place ensuring that the quality standards that apply to service provision are maintained to a prescribed standard and, in relation to service users requirements, are not compromised. There are clear and consistent policies in place to ensure the money and property of services users is protected. Staff supervision is not taking place at regular intervals, which leaves staff limited in their options to discuss the practice issues. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. DS0000019239.V280414.R01.S.doc Version 5.1 Page 19 EVIDENCE: The home operates regular staff meetings for all staff. The manager tries to meet and talk to all service users on a daily basis. There is an equal opportunities policy in place and this was looked at during the inspection. The home operates an open door policy where staff and service users and relatives can approach some one to talk to at any time. There are clear lines of accountability and the processes of managing and running the home are open and transparent. The registered manager stated that a service users satisfaction questionnaire is sent out on a regular basis although these were not examined during the inspection. Service users and their representatives are always invited to reviews if that is the wish of the service user. Accidents, pressure sores and complaints are monitored regularly and there is evidence of this. Following the homes previous unannounced inspection it was identified that no formal supervision process was in place for Ancillary staff, and in addition the registered manager stated that she was experiencing difficulty ensuring the night staff receive regular supervisions. A requirement was made that all staff must receive regular formal supervisions. This has not been complied with at the time of the inspection and the registered manager has requested a longer timescale. This was agreed at the inspection and will be a requirement of this report. The homes policies and procedures files are extensive and evidence was seen of policies being updated. Insurance certificates for the home are on display in the main reception area. Service users are encouraged to look after their own financial affairs where at all possible. An administrator employed by the home undertakes all financial transactions. The manager does not undertake the role of appointee for any service users. Secure facilities are available for the safekeeping of valuables if required. The records maintained for health and safety are in good order. The homes policies and procedures are comprehensive and cover a wide range of issues. All confidential information is kept in secure areas of the home. DS0000019239.V280414.R01.S.doc Version 5.1 Page 20 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 3 3 X 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 2 X X X X X X X X STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 3 3 2 3 x DS0000019239.V280414.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard 18 36 Regulation 13(6) 18(2) Requirement The registered manager is required to ensure all staff receive up to date Pova training. The registered manager is required to ensure that all staff receive formal supervisions. (Previous timescale of 15/11/05 not met.) Timescale for action 30/06/06 30/05/06 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 Schedule 2 30 Good Practice Recommendations It is recommended that proof of staff identification be maintained in all staff files. It is recommended that the home implements a training matrix. DS0000019239.V280414.R01.S.doc Version 5.1 Page 22 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 DS0000019239.V280414.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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