Inspection on 22/09/05 for The Paddocks

This inspection was carried out on 22nd September 2005.

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

The inspector 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 08/01/09

The Paddocks 10/01/08

The Paddocks 26/04/06

The Paddocks 13/04/05

The Paddocks 20/09/04

The Paddocks 16/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Paddocks (The) Hilperton Road Trowbridge Wiltshire BA14 7JQ Lead Inspector Sally Walker Unannounced 22nd September 2005 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 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. Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Paddocks (The) Address Hiperton Road Trowbridge Wiltshire BA14 7JQ 01225 752018 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Orders of St John Care Trust Mrs Diane Bowden Jessica Ann Young Care Home 30 Category(ies) of DE(E) Dementia - over 65 (14) registration, with number MD(E) Mental Disorder - over 65 (14) of places OP Old Age (30) PD Physical Disability (1) Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 The maximum number of service users who may be accommodated in the home at any one time is 30 2 No more than 14 service users over the age of 65 years with either a mental disorder or dementia may be accommodated at any one time 3 Only the one named, male service user currently in residence under the age of 65 years with a physical disablement may be accommodated. Date of last inspection 13th April 2005 Brief Description of the Service: The home was originally built by the local authority as a home from people with a visual impairment in the 1970s. The home is situated on the outskirts of Trowbridge within a mile from the town centre. All the residents accommodation is to the ground floor and all single bedrooms. If any residents wish to share, the second bedroom would be set up as a sitting room. Small items of furniture may be accommodated if the bedroom allows. The home is divided into three units all leading off from a central area of sitting room, dining area, kitchen, bar, visitors room, administrative offices and laundry. Each of the units has its own small sitting area, bathroom and toilets. The home offers 1 respite bedroom and a 10 place day service. This day service operates from Monday to Friday and is separately staffed. Residents can join in with the activities and trips organised by the day service. There are plans to increase the accommodation and provide a separate day service facility. The care staffing rota provided a minimum of three care staff and a care leader during the mornings, 2 care staff and a care leader during the afternoons and evenings and 2 waking night staff with a member of staff sleeping in. In addition there are housekeepers, chefs, kitchen assistants, the handyman and the administrator. Miss Jessica Young was registered as manager in June 2005, having worked at the home for 5 and a half years, 3 years as a care leader. Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place between 9.30am and 1.10pm. Miss Young was present for the first part of the inspection but was dealing with a challenging situation, which needed her full attention, and the inspector gave her feedback via the telephone after the inspection. A tour of the building was made, 10 residents were spoken with, the care records, environmental risk assessments, rota and alarm point monitoring records were examined. What the service does well: What has improved since the last inspection? What they could do better: There must be an ongoing programme of training in mental health need if the home is to continue to provide this service for up to 14 residents. Care management assessments from social workers need to be up to date before any potential residents are considered for residence. The home must consider Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 6 whether they can continue to provide a service under the category of Mental Disorder given the recent events in the home, the situation that was occurring at the inspection and the lack of an ongoing programme of staff training in mental health. 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. Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 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 standard(s) 1 & 3 The home can provide evidence that they are able to provide a service to older people and older people with dementia. Lack of an ongoing programme of training in mental health cannot support the staff with meeting the needs of people with mental disorder. EVIDENCE: The home is registered for up to 14 places for people with dementia and 14 places for people with mental disorder. The home can show good evidence of its ability to care for people with dementia with access to training and an understanding of dementia care shown in the care plans and daily reports. However there is little evidence that the home can provide a specialist service for people with mental disorder with little training or understanding of what support is need for people with mental disorder and outdated care management assessments from social workers relating to other service provision. Discussions were held with Miss Young around the category of mental disorder and whether the home should continue to provide this category, given recent events in the home and the ongoing situation which was being resolved with specialist support. Miss Young was advised to review the category with her line manager to decide on the way forward. Miss Young was also advised that where care management assessments did not relate to a care Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 9 home provision that she either ask for a recent assessment or carry out her own assessment to determine whether the home can meet the prospective resident’s needs. Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 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 standard(s) 7, 8 & 10 The care planning process has improved to the extent that the home can now show that they are meeting residents’ physical, social and healthcare needs with positive outcomes for residents. Staff uphold residents right to privacy and dignity. EVIDENCE: The requirement that the care plans were reviewed and amended as residents care needs changed had been met in full with very good detail of residents current care needs, specific guidance to staff on how these needs are to be met and prompt review and revision if care needs changed or incidents occurred. The requirement that complex care needs of residents were detailed in their care plans together with clear guidance to staff on how those needs were to be met has been met. There was evidence that advice or directives from GPs or other healthcare professionals was acted upon. Assessments of residents’ risk of developing pressure sores had ceased in may pending the organisation implementing a new system and staff training. However as a matter of good practice, residents’ weights continued to be recorded regularly and those residents identified as at risk were monitored. Food and fluid intake was being monitored where indicated and any concerns referred to the GP. Food supplements were also available if necessary. Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 11 Moving and handling risk assessments were in place and related to the shortterm care plans. Other risks were assessed for each individual resident, for example, smoking self-medication, going out without staff and using a kettle in their room. The risk assessments were up to date with regular reviews. Staff were seen on many occasions to be working with residents in a friendly and professional manner. Public conversations were respectful. Staff who were dealing with the difficult situation were calm. Personal care was being provided behind closed doors. Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 12 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 standard(s) 12, 14 & 15 Residents are supported to follow their own routines and have a degree of control over their lives. The opportunities for developing their interests has improved. Residents were very satisfied with the range and choice of meals provided. Residents could choose where they ate their meals. EVIDENCE: Residents followed their own routines with some residents spending time in their rooms or in the sitting rooms as they wished. Some residents were having a lie in and others getting up at 6.30am whilst others were having a late breakfast. The requirement that the activities programme includes sessions suitable for the need of those residents with dementia and mental health problems had been actioned. Miss Young reported that activities staff from 4 other homes in the organisation were doing placements to provide activities. She went on to say that the range of activities now provided sessions to suit individual needs and that these were identified on the staffing rota and had been published with the monthly newsletter. One of the residents showed the inspector the newsletter which showed the improved activities provision. Some residents were taken shopping in Trowbridge, there was a beetle drive at another home in the organisation and there were trips to local garden centres. Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 13 Residents said that activities were available but most of those 10 spoken with did not join in preferring to spend time in their rooms or in the allocated smoking room. One resident said they had been on an activity holiday with other homes in the organisation. All of the residents spoken with said the meals were varied and tasty. They said the menus were on the tables and they would make their choice at each meal. Miss Young confirmed that the kitchen could provide this service as residents could see what the choices were at the point of delivery. One resident said there had been significant improvements in the quality of the food. Another said they had been to the meeting to discuss the menus. Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Policies and procedures are in place for residents and their relatives to complain about the service and for the appropriate reporting of any suspected abuse. EVIDENCE: The arrangements for making complaints was not considered in great detail. However those residents spoken with were asked about how they would bring issues up. Most of the residents said they would talk to their keyworker, their family and a small number mention Miss Young as the person to go to. Other residents said they could take issues to the regular meetings. One relative said they felt confident in discussing issues with Miss Young. Some residents could not respond due to capacity. The complaints procedure was displayed in the entrance hall. The training matrix showed that staff were being trained in the local procedure for the protection of vulnerable adults. Staff were familiar with the procedure and confident in referring any suspected abuse. Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 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 standard(s) 19, 21 & 26 Strategies were in place for ensuring a safe environment for residents. Miss Young has been able to secure funding for improvements which were a priority. The home was generally cleaned to a good standard and there were no unpleasant odours. Some areas required immediate attention. EVIDENCE: Each of the units had its own sitting area. A dining table had been put in these rooms to allow residents who did not want to eat with everyone else to have their meals in more privacy. The requirement that all of the toilet bowls were replaced in the current funding allocation with an action plan supplied to the commission had been met. The stained bowls which were difficult to keep visually clean had been replaced. Miss Young reported that she was awaiting confirmation from the organisation to replace the other older toilet bowls and stained baths. The home was cleaned to a good standard and no unpleasant odours were detected at any time during the inspection. However some attention needed to be given to the build up of lime scale on the underside of bath hoists and a plastic chair in one of the bathrooms. Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 16 The requirement that regular checks were carried out of the call alarm points to ensure that they are functioning and that the jack plugs were secured in their housings had been actioned with a record kept of weekly checks. It was noted that call alarms were being attended to quickly and staff respected. All of those residents visited in their bedrooms had their call bells within easy reach. Staff respected residents’ personal space by knocking on bedroom doors and waiting before being invited in. Some residents had keys to their room and all of the bedrooms could be locked from the inside without the use of a key; staff being able to gain access in an emergency with a master key. The requirement that the environmental risk assessments were revised and reviewed where necessary had been acitoned. The rear garden had been enclosed to protect residents from walking out of the home and onto the nearby main road. The front door had a numbered keypad and other exit doors were alarmed. Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 Staffing levels do not support all of the complex range of residents’ needs or the amount of management or administrative duties that care staff are required to complete. Staff have good access to training in most related subjects. EVIDENCE: The requirement that the allocation of staffing hours was reviewed with clarification of management and administrative responsibilities clarified is in progress. The Commission is to meet with the organisation to discuss its proposals for improved staffing levels throughout the home. Difficulties in covering some of the night shifts earlier in the year had been resolved. Miss Young reported that she was interviewing for 3 vacant night posts and the hours were being covered by permanent staff. Comments on the staffing levels from residents were varied with some saying they thought there were sufficient and some saying that staff did not have time to spend chatting. The situation which was occurring during the inspection would have had an impact on staff time. Miss Young said she was getting extra cover and one care leader had come in early to help with the situation. The requirement that an ongoing programme of specialist training for all staff in mental health and dementia care was in progress. The training matrix showed that most staff had had training in dementia care and Miss Young reported that the community psychiatric nurse was due to provide a session on mental health issues. Staff had attended a workshop on dementia and a video was provided. Most of the training is provided by the organisation and the home is limited by what is available. If the home is to continue with its Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 18 registration category of mental health, and given recent events in the home, a more varied programme of training in all aspects mental health should be regularly provided. Residents said that the staff were excellent and thoughtful. One residents said that the night staff were caring and responded promptly to call alarms often bringing a cup of tea. Staff were seen to respond naturally and well to residents with respect and appeared to have good relationships with residents. Staff were seen to be dealing with a particularly difficult situation with calm professionalism, ensuring that it had very little impact on other residents. Miss Young said she was meeting with staff to support then with a debrief on the situation. She has reported since the inspection that the matter is now resolved. As a matter of good practice it was noted that if agency staff worked they were inducted into the home. Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 38 The home is run in the best interests of the residents. Any cash held on residents’ behalf was being suitably managed. Strategies are in place to ensure that residents’ health and safety is protected. EVIDENCE: The requirement that Miss Young was inducted in to the role of manager and supported to gain NVQ Level 4 had been actioned. Miss Young reported that her award had been put back due to the assessor leaving but she was still doing reflective accounts on her practice pending a new appointment. She went on to say that her induction had included spending time with managers from other homes in the organisation and the care services manager. Miss Young was also due to have training in budget management the following week. She said the administrator had also familiarised her with some of the management systems and reports required by the organisation. One relative said that Miss Young had made significant changes in the home and that the atmosphere was better since she become the manager. They also Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 20 said that she was ‘hands on’ and would work with staff and was a visible manager who did not spend all their time in the office. Money held on residents’ behalf is managed by the administrator and Miss Young who are the only staff who have access to the safe. The money is small amounts for personal spending and relatives or a representative of the local authority are advised to manage residents’ finances if they cannot. The money was being satisfactorily managed with records of all transactions and receipts for purchases. The home does not hold any valuables on residents’ behalf. Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 3 x 3 x x x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x 3 x x 3 Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 22 yes Are there any outstanding requirements from the last inspection? 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 OP 30 Regulation 18(1)(c)(i ) Requirement Timescale for action 31st December 2005 2. OP 27 3. OP 1,2,4 & 8 The registered person must ensure that there is an ongoing programme of specialist training for all staff in mental health and dementia care. (In progress with some dementia training completed and a session in mental health planned with the community psychiatric nurse. The home is limited by what is provided by the organisation with no mental health training on their yearly programme.) 18(1)(a) The person registered must review the allocation of staffing hours to ensure that care needs are met. Management and administrative duties must be clarified. (The Commission is meeting with the organisation to discuss their staffing proposals). 14 & CSA The person registered must 2000 consider the ongoing provision of Section 15 a service for people with mental (1)(a) disorder. If the service is to continue then staffing levels should reflect this and there must be a suitable ongoing programme of training. Alternatively the home may apply to remove the category D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc 30th November 2005 31st January 2005. Paddocks (The) Version 1.40 Page 23 4. OP 4 14 from their registration. the Commission must be informed of any decision. The person registered must ensure that pre-admission assessments supplied by care managers or social workers are up to date and accurate 22nd September 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP 4 Good Practice Recommendations The person registered should consider carrying out their own pre-admission assessment, particularly when those supplied by the care manager or social worker are not up to date or accurate. Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 24 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB 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 Paddocks (The) D51_D01_S28296_Paddocks(The)_V247006_220905_Stage4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!