Inspection on 22/08/07 for The Paddocks

This inspection was carried out on 22nd August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Paddocks 11/03/09

The Paddocks 20/03/07

The Paddocks 26/09/06

The Paddocks 29/11/05

The Paddocks 03/05/05

The Paddocks 01/11/04

The Paddocks 15/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Paddocks 45 Cley Road Swaffham Norfolk PE37 7NP Lead Inspector Kim Patience Unannounced Inspection 22nd August 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Paddocks DS0000027321.V349317.R01.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 Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Paddocks Address 45 Cley Road Swaffham Norfolk PE37 7NP 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) 01760 723416 01760 722420 lincolncare1@aol.com Lincoln Care Homes Limited Mrs Elizabeth Keys Care Home 74 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (23), Old age, not falling within any other of places category (50) The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The unit known as Sandpiper to accommodate 23 (DE(E) and 1 DE. The unit known as Kingfisher to accommodate 29 (OP). The unit known as Nightingale to accommodate 21 (OP). 20th March 2007 Date of last inspection Brief Description of the Service: The Paddocks is a residential home providing care for 74 elderly people. It is situated on Cley Road, and is within walking distance of the town centre of Swaffham. There are three parts to the home, the original building which has a new extension and an adjacent new wing. In addition to the main building there is a separate building which houses the administrative offices and laundry. The home is set in mature and attractive grounds. There is car parking at the rear of the home. Medical and nursing services are provided via the local G.P. service. The home has now been extended to provide care to 24 residents with dementia type illness. The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took approximately 7 hours to complete and comprises of information provided by the home, information provided by stakeholders with an interest in the service, a site visit when records relating to residents, staff and the running of the service were inspected and interviews with staff and people who use the service. Two regulation inspectors completed the site visit and the Commissions pharmacist inspector inspected the homes medication arrangements. What the service does well: What has improved since the last inspection? What they could do better: The home has plans to continue to develop care plans and this is still needed particularly in the area of social care. Some reorganisation of records is also needed so that relevant information is easier to access. The homes medication management system is still of concern and must be addressed before the quality rating of the service can be good. The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 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 The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good as the home can demonstrate that people who wish to use the service are only admitted to the home once an assessment has been completed to determine that their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a policy and procedure on new admissions to the home. All prospective residents have their needs assessed prior to coming to live at the home and are given information about the services provided so they can make an informed decision as to whether the home is suitable. Prospective residents and their relatives are invited to view the accommodation as part of the decision making process. People coming to the home for short-term respite also have their needs assessed in the same way. The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Quality in this outcome area is adequate as people who use the service can now be assured that their health and care needs will be properly assessed and met. However, there are still concerns about the homes management of medication and this must be resolved before this outcome area can be rated as good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A total of six residents care plans were inspected in Sandpiper, Nightingale and Kingfisher. Overall improvement can be seen, care plans contained good detailed information relating to each resident and person centred information has now been added. Records had been reviewed regularly and there was evidence that resident’s and their relatives had been involved in the process. There are still some difficulties in easily extracting relevant information from resident’s files but this has improved since the last inspection. Further The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 Page 10 improvements are still to be made and the home is to introduce a new care plan format, which should facilitate this. See recommendations. Assessments and records relating to health care needs were good and there was evidence that people’s health needs were being adequately assessed and appropriate action was being taken. Several residents were spoken with during the visit and all said they were very happy with their care. The inspection of the medication standard was conducted at the same time by the Commissions pharmacist inspector Mr M Andrews (Sandpiper and Nightingale units only). The inspection follows two previous pharmacy inspections when concerns relating to the homes medication practices were found. During this inspection the inspector found that the home has made some improvements to its medicine administration system but during the lunchtime medicine round unsafe medicine administration practices were again observed. The home now records reasons why medicines of a psychoactive (and potentially sedative) nature prescribed for discretionary administration by staff are given. However, when auditing records for a resident, it was found that haloperidol was being given at times when the resident was vocal to varying degrees. By this, it remains of concern that the use of these medicines may not be adequately justified. The inspector found omissions in records of medicine administration and again a significant number of discrepancies where medicines could not be accounted for. This included warfarin prescribed for a resident for anti-coagulant treatment where it could not be determined from records if it had been given correctly as prescribed. The inspector found that medicines requiring refrigeration in Nightingale unit had been stored at temperatures significantly below the accepted range and so may not be safe for use. A detailed report of the inspectors findings has been sent to the provider separately and is available subject to request. The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good as people can be assured that they are provided with life experiences based on their choices, preferences and previous experience of living. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an activities coordinator who was seen in all three wings of the home engaging with residents throughout the inspection. There continues to be a regular plan of activities and this is good. In addition, during the inspection, one to one activity was seen. Improvements are still needed to social care plans to ensure that people are provided with meaningful activities, but progress has been made here since the last inspection. For instance, the home has a social needs assessment that sets out people’s ability to engage in the activities on offer and what assistance and support they may need. See recommendations. Residents spoken with during the inspection said that they were provided with activity such as sing along, quiz games, card games and one to one chats. Records relating to some residents showed that there were frequent trips out of the home with relatives and friends and this is good. During the inspection The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 Page 12 visitors were seen and spoken with. One relative said they visited regularly and always found it to be a positive experience. In Sandpiper, the wing for people with dementia type needs, people were observed to engage in the routines of daily living such as setting the tables for lunch. The mealtime experience was observed in Sandpiper and Kingfisher. People appeared to find the experience positive and notable improvements could be seen in Sandpiper. Menus were on display, there was a choice of two meal options and picture menus have been introduced to ensure that a meaningful choice of food is offered. The picture menus were said by the manager to be working well and people made positive choices from the pictures seen. This is also used as an opportunity for staff to engage in activity with residents and that’s good. The way that meals were prepared and delivered was much more efficient and people had meals presented in a way that met their individual needs. Staff were seen to support people with their meals in a sensitive and caring manner and this is an improvement on what has been observed previously. Staff were also seen to offer people choices of drinks and places to sit and this good. Finger foods such as fruit, sausage rolls and cheese straws are now available in between main meals and this is said to be popular with residents, which is good. Those residents spoken with said they enjoyed the meals provided and observations on the day showed that people enjoyed the meal and on the whole ate well. Records of dietary intake are maintained and nutritional needs assessments are carried out to ensure that people are maintaining a good nutritional intake. The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good as people who use the service can be assured that complaints are handled appropriately and that systems are in place to protect vulnerable people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure that is well publicised. Complaints are handled effectively and all of the nine resident surveys indicated that people know who to speak to if they wish to raise concerns and complaints. The home also has policies and procedures in place for the protection of vulnerable people and all staff are provided with adult protection training. The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good as people can be assured that the home provides good accommodation and facilities with an ongoing plan of improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was conducted and all areas were found to be clean and tidy. Work is still in progress in Nightingale, but the home has made efforts to keep the disruption to a minimum. Two lounge areas and a small dining room have been created to ensure people have a choice of sufficient communal space whilst the building work is being completed. Residents spoken with appeared to be satisfied with the temporary arrangements in place and no one expressed any concern on the day. The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 Page 15 Work to refurbish Kingfisher has been completed and the environment in this part of the home is now much better, the décor is nice and the communal areas are comfortable and homely. In Sandpiper, residents now have access to a small quiet lounge, which offers people more choice in terms of where they wish to sit and social engagement and this is good. The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good as people who use the service can now be assured their needs will be met by sufficient numbers of trained and competent staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the number of staff has been increased and this is good. In addition each wing of the home has designated senior staff and this helps to achieve continuity and consistency. As far as possible, the home aims to have designated staff working in each wing, however, this is subject to availability. Six members of staff were spoken with during the inspection. Senior staff now have clear roles and responsibilities, some tasks such as the supervision of care staff have been delegated to them and supervision is now up to date. Regular training, such as Moving and handling, fire safety updates, infection control and dementia awareness is being offered to care staff and the home has a training plan in place. Two staff files relating to new staff were inspected and found to be in good order. Each contained an application form and the necessary pre-employment checks. New staff are provided with an induction that meets the common induction standards and this is good. The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good, as people can be assured that the home is well managed and in a way that promotes their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home has increased the number of management hours allocated to the heads of care in each of the units and this has been instrumental in achieving the significant improvements reported at this inspection. The heads of care now have 3 days management time per week and each have designated senior staff to support them. The heads of care stated that the additional hours have enabled them to achieve the goals of the organisation much more effectively and efficiently and have been able to make some positive changes. The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 Page 18 The overall management is much improved with clear lines of accountability and clearer roles and responsibilities, which is good. However, there are still issues about the overall management of medicines in this home, which give rise to concern. The managers need to ensure that they have robust systems for ensuring that policies and procedures are adhered to. The home has a good quality assurance system in place that includes consultation with major stakeholders. Regulation 26 visits are also conducted on a regular basis. However, as reported at the previous inspection, the quality of these internal self-audits needs to be improved so that deficits are identified and dealt with. Staff supervision is now in place, however, supervision should apply to all staff and heads of care reported that they were not receiving one to one formal supervision. They did however report that they received lots of informal supervision and the manager was very supportive. See recommendations. There were no issues about health and safety during the site visit and the home has systems in place to ensure good health and safety is maintained. The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 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 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 3 2 X 3 The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement People who use the service must be assured that the home has a safe system for the storage, handling, recording and administration of medication. The home must comply with the requirements made on the pharmacy inspection report. Timescale for action 14/09/07 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. 3. Refer to Standard OP7 OP12 OP36 Good Practice Recommendations Relevant information relating to people who use the service should be easy to access. People who use the service would benefit from improved social care plans so that the home can provide activities that are based on their preferences and choices. Heads of care should be given the opportunity to have formal one to one supervision. The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Paddocks DS0000027321.V349317.R01.S.doc Version 5.2 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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