Inspection on 29/11/05 for The Paddocks

This inspection was carried out on 29th November 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Paddocks 11/03/09

The Paddocks 22/08/07

The Paddocks 20/03/07

The Paddocks 26/09/06

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 Mrs Susan Golphin Unannounced Inspection 29th November 2005 09.30 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 The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 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 - over 65 years of age (24), Old age, registration, with number not falling within any other category (50) of places The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The unit known as Sandpiper to accommodate 24 (DE(E). The unit known as Kingfisher to accommodate 29 (OP). The unit known as Nightingale to accommodate 21 (OP). 3rd May 2005 Date of last inspection Brief Description of the Service: The Paddocks is a residential home providing care for 52 elderly people. It is situated on Cley Road, and is within walking distance of the town centre of Swaffham. There are two parts to the home, the older part 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 has 42 single rooms and 5 double rooms. 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 been extended to include a new 24 bedded unit for the elderly Mentally Frail, which is now open. The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection carried out between 9.30am and 4pm, by the lead inspector and the Pharmacist Inspector Mark Andrews. The registered manager, Elizabeth Keys and the heads of care for each of the designated units Mary-Ann Bushell, Sheila Watts and Margaret Hasler were present for parts of the inspection relevant to their areas of work. A significant number of changes have been instigated since the previous inspection in May 2005 and include -: • The appointment and registration of the manager of the resource Mrs Elizabeth Keys. • The new extension accommodating people with a mental frailty opened on 8 November 2005 and is fully operational. The unit has been named Sandpiper. • Work on the grounds and gardens and refurbishment of the original building (Kingfisher) has commenced and is in progress • The building work on the extension and upgrade of the kitchen and food preparation areas are also in progress. • A brief tour of the three units was undertaken and four residents and the heads of care and four staff were also spoken to. A small sample of resident’s care plans and staff records were seen during the course of the inspection. All the comments received have been incorporated into the report except where a specific or individual comment has been made and these have been passed to the management for their attention. Feedback was given to the manager and the heads of care throughout the day What the service does well: Residents and their relatives and representatives have access to information about the home in the service users guide and statement of purpose. Staff provide a good level of personal care and support to residents that promotes and protects their privacy and dignity. Residents spoken to on the day said the staff are kind and helpful and ‘do things for us without asking’ another said ‘I am well looked after and I am happy here’. Residents not able to take part in the inspection were observed being supported and cared for by the staff The new extension is furnished and equipped to a good standard with quality fabrics and furniture and providing a comfortable and pleasant environment. The training programmes for staff and care planning processes currently being brought into use are promoting the skills and knowledge of the care staff to meet the healthcare needs of residents with a mental frailty. The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 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.V269281.R01.S.doc Version 5.0 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): 2,3,4,5 Residents are issued with individual contracts on admission. There is a revised process in place for assessing the needs of all prospective residents. There are appropriate procedures in place to provide residents or their relatives with information about the service and facilities and contractual arrangements prior to admission. EVIDENCE: A new information pack about the home has been revised and re-issued, one resident said that they had a copy. All prospective residents are provided with a written contract on admission to the home, and a copy maintained in their files. A full assessment of need is completed prior to admission or before any placement is agreed. The assessment process has been reviewed recently, and changes made to the assessment format. The manager confirmed that the process is still being monitored. The information received is checked and reviewed to ensure it is accurate and reflects individual wishes and choices of the resident, especially for those residents diagnosed with dementia. (see recommendation) The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 9 Two residents spoken to on the day of the inspection confirmed that they had visited the home prior to admission and those that had not had been happy for a representative to do so on their behalf. The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, There is a clear care planning process being established which provides staff with the information they need to meet resident’s healthcare needs. There are policies and procedures in place to ensure the appropriate administration of medication. Personal support in the home is offered in such a way as to promote resident’s privacy and dignity, including end of life care and supporting relatives. EVIDENCE: The care planning process for residents with dementia has been under review and is currently being updated and implemented. A new format is in use and offers more detail and information about the needs and wishes and personality of the resident. Relatives and friends are also able to contribute to the planning process. Two of the staff spoken to on the day said that the history and details about the residents is clear and has helped them to establish how their care needs will be met. The head of care for Sandpiper is in the process of updating the information in the resident’s files and making sure that the agreed plan reflects assessed need. The care plans seen in Kingfisher are in need of review to reduce some of the out of date documentation held on file, and reduce the bulkiness of the file. It was agreed that the work on the documentation could The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 11 also include a comprehensive review to ensure the information in place is up to date and reflects current needs. (see recommendation) The inspection of Standard 9 was conducted simultaneously by Pharmacist Inspector Mr M Andrews. The inspector found that whilst medication management practice is overall satisfactory, there were inadequacies in the storage of medicines awaiting disposal of medicines, the storage of some refrigerated medicines, failings in the recording of the receipt of some medicines, non-administration of medicines and MAR chart records for some medicines against which they are to be safely administered. In addition, on conducting a small sample of audits, the inspector found a number of situations where medicines were unaccounted for. These incidents must be investigated by the registered persons. The inspector was satisfied that members of care staff authorised to handle and administer medicines have undergone general medication-related training, are regularly re-assessed to ensure they remain competent to undertake such tasks and there is medication policy and procedural guidance available for reference. As, however, there was found to be no clear evidence to confirm that staff administering insulin by injection have received specialist training, appropriate steps are now required to resolve this and ensure proper training has been provided in all aspects of the management of diabetes. The inspector also made several recommendations in order to assist the home make enhancements in its current medication practice. A copy of the full pharmacy report has been sent to the registered providers alongside this report and is available subject to request. (see requirements) The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 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 the following standard(s): 12,13,14,15, Residents are able to socialise with others as they choose and maintain contact with family and friends. Residents are encouraged and expected to be involved in the process of daily living and decisions about their lifestyle. There is programme of social and recreational activities in place which residents can access. There is a need to review the way in which information about the menu and meal options is made available to residents so that an informed choice can be made each day. EVIDENCE: Recent changes to the way in which the home is managed has provided each of the heads of care with the opportunity to review the social activities and recreational stimulation for residents, and develop appropriate programmes to promote more individuality and interest. There is a designated activities organiser in the home and regular group sessions are in place. This standard was the subject of a requirement at the last inspection and is acknowledged as work in progress and will be taken forward to the next inspection (see requirement) The heads of care and the manager said that residents are asked for their views and opinions about their care and encouraged to remain part of the planning process and decision-making about what they wish to do. During the The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 13 discussions the staff said that if they have to act or make a decision for a resident because of their frailty they try to do so on an individual basis. Two residents said that their families visit regularly and are made welcome in the home. One resident said that they do as they wish within their own health limitations, and whilst it ‘isn’t like being in one’s own home it is a safe alternative’. The main meal of the day is displayed on a chalkboard in each of the designated units. Catering staff also visit residents to discuss their meal choices, however on the day of the inspection the menu was not displayed and the resident group did not know what was for lunch. The inspector was able to discuss the meal planning process with the chef and whilst it is evident that the chef has an extensive knowledge of individual resident’s likes and dislikes and special needs in respect of their diets the residents do not seem to have any knowledge or awareness of the process. The chef was able to give good examples of special meal preparation and devices used to encourage people to eat based on his knowledge of their preferences, and it was agreed that there is a need to review the way in which the menu is both displayed and made available to residents on a daily basis. It was also agreed that the chef and manager should review the way in which food consumed at each meal is recorded as a way of monitoring intake and levels of nutrition. Residents said that the meals are very good and ‘very tasty’. One resident said that she did not mind not knowing what was for lunch it was always a nice surprise. The head of care confirmed that they remind residents about the menu and the options available on a daily basis. Staff were observed assisting people to eat and drink in a discreet and sensitive way. (see requirement) The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected on this occasion EVIDENCE: Not inspected on this occasion The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The standard of environment in this home has improved and provides the residents with a comfortable and homely place to live. Specialist equipment to aid and promote independence and mobility is in place and accessible to residents. There is an infection control policy in place with clinical advice and guidance for staff to follow. EVIDENCE: The home now has three designated care units, the newly commissioned building Sandpiper is equipped, decorated and furnished to a good standard. Resident’s rooms seen on the day are attractively laid out and some have small personal items of furniture giving the rooms a sense of individuality. Only two of the resident’s rooms in the Nightingale unit were seen both were well maintained. Some areas of the home would benefit from redecoration and minor works. The drawers and work units/surface in the small buttery kitchen are in need of repair or replacement. The display board used for the menu information is also showing signs of wear and tear and should be replaced. The The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 16 manager confirmed that the carpets in some of the resident’s rooms and communal areas are earmarked for replacement soon. (see requirement) The original building Kingfisher is still subject to extensive building work especially at the front of the premises and main kitchen. It is to the credit of the staff and management that the areas being used by the resident’s was clean and tidy and free from any hazard associated with the major works. On the day of the inspection the head of care was in the process of re-establishing a separate dining room and sitting room. Both rooms were furnished and equipped appropriately improved the choice and range of communal space for residents. The CSCI acknowledge that the improvements to the premises both internally and externally are still taking place that the standard has only been inspected from an observational aspect, and will be reviewed again at the next inspection when the work is complete. The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30 Improvements in the staff group’s expertise and skills continues to be made and consolidated, to meet the healthcare needs of the residents. Arrangements are in place to offer relevant training and clinical guidance to all staff. EVIDENCE: The manager is continuing to review the staffing levels and also reviewing dayto-day practice and work routines to ensure that the expertise of the staff is directed and applied in the best way. Each unit has a head of care and work is in progress to establish a managerial structure for each unit and allocate a senior carer for each shift. Care staff already working at the home and who meet the person specification will be offered posts and the manager is working on a ‘grow your own policy’ for promoting staff. Standard 27 was not inspected in any detail other than to establish that there sufficient numbers of staff on duty to meet resident needs. It was agreed that the standard will be looked at in more detail at the next inspection and when the management team have had time to review the staffing levels and monitor the new systems in place. Three staff were spoken to, and confirmed that they have completed their induction training and receive supervision from the head of care. Two newly appointed staff talked positively about their work and gave a confident account of their work and practice. Currently, staff are working between all three units, to gain experience of all three care units. Training in dementia care is taking place in-house. The course covers understanding dementia; dealing with The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 18 difficult behaviour; life in the home: including values and attitudes, activities and everyday life and supporting personal care; communication and team building. Each of the course participants must undertake a small test to measure their evidence of learning and understanding. This course is offered to all staff working within the company. The management are to be commended for their proactive approach and input to this training. Three of the staff files and corresponding training information were seen on the day. NVQ opportunities are being made available to staff as well as specialist training and managerial training for the heads of care. The manager is also looking at ways in which the staff who will undertake staff supervision can access appropriate training. (see recommendation) The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35, Arrangements are in place to monitor and safeguard residents financial interests. Arrangements are in place for the management and supervision of the home. EVIDENCE: The manager Elizabeth Keys was appointed to her post in September 2005 and registered with the CSCI in November. Mrs keys is a qualified nurse with a range of experiences in caring for older people, and is clear about the direction of the home and its immediate future. The manager has been assessing and identifying areas of change and promoting new initiatives as part of the long term plan and development to promote best practice and improve the expertise and knowledge of the staff. The CSCI acknowledges the ongoing changes and work in progress at the home and has given consideration to the timescales set for the requirements made in this report. The management group includes an administrator who has responsibility for managing and maintaining records. Three staff files and the financial records The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 20 for two residents were seen. Each person’s financial records and monies are maintained separately. The records showed an up to date credit and debit balance. The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 2 x x x x x x 3 STAFFING Standard No Score 27 x 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 x x x The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 3 Regulation 14 Requirement Timescale for action 31/03/06 2 9 13.2 and 18.1c The registered providers and heads of care must continue to carry out and complete the review of assessed needs of all residents as part of the review of the service. Repeated requirement 31/01/06 The registered persons must take steps to ensure medicines are safely stored and that safe record-keeping practice is upheld at all times. Registered persons must take steps to ensure adequate training is provided for members of staff in all aspects of the management of diabetes The registered providers and the heads of care must continue to review and revise the social and recreational needs and wishes of residents to promote individual as well as group activities Repeated requirement The registered providers and management must review the way in which information about meals and menus is shared with DS0000027321.V269281.R01.S.doc 3 12 16m&n 31/03/06 4 15 16 31/03/06 The Paddocks Version 5.0 Page 23 5 19 23 residents. Residents should receive information about meals in a format that suits them. The registered providers must implement a programme of maintenance and repair and replacement for Nightingale to include replacement of carpets and redecoration and repair where indicated 31/03/06 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 Refer to Standard 3 Good Practice Recommendations It is recommended that the heads of care and the manager continue with the review of the assessed needs of the residents to ensure assessed health care needs are being met. and also the care planning process and also review the content of the files to ensure that the information maintained is up to date and current. The management team should also establish a protocol for archiving information from resident’s files which is more than 12 months old. It is recommended that the heads of care and the manager continue with the review of the care planning process and also review the content of the files to ensure that the information maintained is up to date and current. The management team should also establish a protocol for archiving information from resident’s files which is more than 12 months old. It is recommended that the registered persons and the management team continue to promote and provide training opportunities at all levels including NVQ training. Training for heads of care who will be undertaking managerial tasks and supervision responsibilities should also be offered training in the areas they are expected to manage. 2 7 3 28 and 30 The Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Paddocks DS0000027321.V269281.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!