CARE HOMES FOR OLDER PEOPLE
The Peele Walney Road Benchill Wythenshawe Manchester M22 9TP Lead Inspector
Ann Connolly Key Unannounced Inspection 1st June 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 The Peele DS0000066003.V297868.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 Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Peele Address Walney Road Benchill Wythenshawe Manchester M22 9TP 0161 4908057 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) Inspirit Care Limited Ms Susan Jane Clarke Care Home 108 Category(ies) of Old age, not falling within any other category registration, with number (108) of places The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home can accommodate a maximum of 108 service users requiring personal care only by reason of old age (OP) Date of last inspection Brief Description of the Service: The Peel is a newly build care home providing personal care for a maximum of one hundred and eight older people. The home was registered 8th February 2006. Although this is a large home, the emphasis is on providing small group living. The home is divided into three wings on three levels. Each level accommodates three units, making a total of nine units each providing accommodation for between 11 and 13 residents. Each unit has an individual shared living and activity space. All bedrooms lead off from the communal area. Units on the ground floor benefit from direct access into small cottage gardens, whilst the first and second floors lead out onto balcony areas. The ground floor provides a generous foyer area which includes a reception area, and a lounge/sitting areas which provides comfortable seating areas. The kitchens for the whole building are accommodated on the ground floor. The first and second floors provide additional facilities which include a library which overlooks the front gardens and provides large windows which project light into the building. Furnishing and fittings are of a high standard, and this room provides a pleasant multifunctional area for residents and their families to use. There is a large social room which is used for staff training and there are plans to fit it out as a cinema. The home is situated in the Wythenshawe area of Manchester, within easy reach of shops and community amenities. There are secure gardens around the building providing pleasant outdoor facilities and safe walkways for residents to enjoy in the warmer months. Beyond the garden areas there is parking for a large number of cars. The fees set for ninety six of the beds in the home are between £373.54 to £374.00, the remaining twelve of the beds are funded by the Primary Care Trust. Additional charges are made for hairdressing, newspapers, visitors meals and refreshments, and for telephone installations. A minimum charge is made for any Portable Appliance Testing (PAT).
The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report has been written using information held on the Commission for Social Care Inspection (CSCI) records, information provided by people who use the service, staff in the home and by the provider (i.e. the owner) of the home. A site visit was made to The Peele on 1st June 2006 without anyone being told about the visit beforehand. During this visit the inspectors had a look around the home and looked at paperwork that must be kept by the home to show that is it being run properly. Another way that was used to find out more about the home was by talking with some of the residents, visitors and staff who were in the home on the day of the visit. The manager was on annual leave at the time of this visit, and the support managers on duty during this visit were able to provide assistance and information to the inspectors. Residents in the home had been sent a care home survey questionnaire by CSCI asking them what he or she thought about the care in the home None of these were returned before the visit took place, however residents were able to express their views direct to the inspector. The care home questionnaire sent to the home was not returned to CSCI. All key standards were looked at during this visit. What the service does well:
This service has worked hard in ensuring that residents transferring to this home have received appropriate information and support to make the transition as smooth as possible. Residents spoken to during this visit to the home said that they had visited the home prior to moving in and that the mana,gement had consulted with them and listened to their views. All residents admitted to the home had a full assessment or review of their current care needs to ensure that staff had the appropriate information to support the residents living in the home. The home is a new building and is fitted with new high quality furnishing and fittings. The home was clean and tidy at the time of this visit providing residents with a well-maintained comfortable environment. The home has appointed activities organisers to ensure that residents are supported with recreational and leisure pursuits. There was evidence of a wide range of activities available for residents to access, and it was noted that residents had been consulted about their interests. The activities co-ordinator The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 6 had been proactive in involving relatives in meetings in an effort to develop the activities programme. Meals served in the home during this visit were well presented, and residents were offered a choice of meals. All residents spoken to spoke highly of the meals served in the home. It was good to note that residents could invite their friends or relatives to enjoy a meal in the home for a token payment. Residents were supported by a trained staff team, and residents spoke highly of the way in which staff supported them. One resident said, “ Staff are lovely here, they help you as much as they can”. All residents expressed confidence about raising any issue of concern to the management and staff, although it was noted that none of the residents had been provided with a Service User Guide. Since the home has opened it has carried out consultations with residents and relatives in the form of questionnaires and residents and relatives meetings. This provides evidence of a commitment to listening to the views of residents to assist in planning and developing the service. What has improved since the last inspection? What they could do better:
Although the home had an updated Service User Guide and Statement of Purpose, none of these documents were available in the reception area or office to give to any prospective users of the service. The receptionist was not familiar with these documents and said she would have nothing to give to anyone making an enquiry. It is important that the home has these document and information readily available so that prospective residents have access to this useful information which will help them to make important decisions about their future care arrangements. The pharmacist inspector examined medication systems ion the home. There were serious shortfalls in the way the home managed the medication systems in the home and there were systematic errors in the way medication was administered. These errors were discussed at the time of inspection and the pharmacist inspector has addressed all the shortfalls in a separate letter to the provider to enable them to put action plans in place to put the problems right. The home must address these concerns as a matter of urgency to ensure that residents in the home are safeguarded. Care plans required further development to ensure that all needs are clearly identified with specific instructions for staff to follow to meet individual needs.
The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 7 Overall privacy and dignity of residents was respected, however, there were two specific incidents when staff failed to follow good practice which compromised the privacy of residents. In one incident one member of staff who was assisting a resident with personal care in the privacy of her own room inappropriately agreed to a visitor to enter the room whilst performing personal care. In another incident, the cleaner entered into a resident’s room without knocking and interrupted private conversations with the resident, her family, and a visitor. All staff must follow the correct policies and procedures and follow good practice to ensure that residents are supported appropriately. The management had identified shortfalls in the staff understanding of Adult Protection, however, they have addressed this by arranging for staff to attend appropriate courses. It is essential that staff understanding of Adult Protection is monitored on an ongoing basis so as to ensure that residents are protected. Some of the bedrooms and communal areas lacked occasional furniture, and some personal items in bedrooms were inappropriately stored on window bottoms. It is recommended that furnishings in the home be audited so that occasional furniture can be provided where appropriate. Reviews carried out by social services care managers included a number of comments where residents had expressed concern about a lack of these facilities. Although the home provides useful and pleasant external garden facilities within a secure monitored parameter it was disappointing to note that there was no outdoor garden furniture which meant that residents were unable to use these pleasant facilities on warm days, especially since it was very warm on the day of this visit. The home must provide outdoor furniture so that residents can access all areas of the home. One relative said, “I thought they would have the outdoor furniture out, but they did say it was ordered”. Staff confirmed that they received support from the managers as and when required, however, from examination of records it was evident that some formal supervision sessions had fallen behind. It is essential that all staff receive ongoing formal supervision to reinforce good practice, to address training needs, and to ensure that residents benefit and are protected by a staff team that are well supported. Some of the residents and relatives visiting the home expressed some concern about how the staff were moved from unit to unit. The specific concerns related to a lack of continuity in care and that this might present problems in developing positive meaningful relationships. One relative said, “ When we were at the other home, you seemed to get to know the staff. I think it would be better if it was the same staff so we could get to know them and then we could talk to them”. She went on to say, “ I like the place, it’s lovely, but it should be more about the people not the place. I think the people should come first”. One resident said, “ Something is not quite right, I can’t put my finger on it, you don’t seem to get as much attention in this home”. One resident
The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 8 said, that staff were always moving about and went on to say, “ see what I mean, ( pointed at a staff member), she was upstairs yesterday, and now she is here”. It is essential that the manager listens to these views in order that the service can be developed in a way that meets the needs and preferences of the people using the services of this home. It was seen that the management had been monitoring the home, and reports were made available at the inspection. Residents in the home had not been provided with a Service User Guide, and the family of a resident admitted into the home on the day of this visit confirmed that they had not been given any information about the home. It is essential that existing and new residents are provided with this information to help them to understand the services they are receiving, and to be made aware of processes, e.g. complaints procedure, so that their best interest are protected. 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 Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 9 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 Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 10 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, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was no information available in the reception area to help prospective residents make an informed choice about their care arrangements and where to live. Residents were admitted to the home following a full assessment of needs. EVIDENCE: A number of residents from the four homes that closed were interviewed prior to the move to The Peele, and it was evident that they had been involved in consultations about the move and the transition itself had been handled sensitively by staff and residents. Residents spoken to said they had been involved in planning their move into the home and that this had involved visits to the home and meetings with the management to seek their views on how the move should be managed.
The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 11 The files examined provided evidence that all residents admitted to the home had a full multidisciplinary assessment and preparation for the move included a visit from a representative from the home to carry out their own pre-admission assessment. There was evidence on files of an updated review for all those residents moving from the homes that had closed. The home had a Statement of Purpose and a Service User Guide, but these documents were not readily available to new and existing residents. The receptionist was unable to provide any documentation or information about the home to anyone enquiring about the service and the facilities on offer. Provision of these documents is necessary to help prospective residents to decide about their future care arrangements and to give them the information about the home. The documents must include recent copies of the inspection reports, which will provide residents, their visitors and families and staff in the home an overview on how the home is performing and whether or not it is meeting the National Minimum Standards. At the time of the inspection the home were not operating intermediate care services, however, an application to vary the condition to provide intermediate care has been received by the Commission. The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans did not provide full details of residents care needs and the interventions required to meet needs. Medication systems and procedures were not fully adhered to and the poor management of medication had the potential to place residents at risk. Overall residents were treated with respect and their right to privacy was upheld, however, two incidents of inappropriate intervention was noted during this inspection which did not ensure the privacy of residents. EVIDENCE: On Stoneyknolls house, the files of 3 residents were examined. Care plans were inconsistent in their contents and in the way in which they were written. Some of the documents were not signed or dated. Some reviews had taken place, however, these were insufficient in detail and did not include all
The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 13 apspects of the care plan. One care plan provided guidance for staff on how to meet a specific individual need, and indicated that the staff were to ‘observe half hourly’. Despite specific instructions, daily recording did not record that action had been carried out as detailed in the care plan. Notes on care plans provided evidence that residents had access to helathcare professionals. This was also confirmed by residents who said that they were able to see their General Practitioner on request. Another care plan stated that a resident required antibiotics for 7 days after which a review would be required. However, there was no evidence of this review taking place. Failure to continually monitor residents’ condition could potentially place them at risk. Some care plan recording contained inappropriate language, and it is essential that all staff receive appropriate supervision and guidance on how to use and record in care plans. Managers stated that only the senior care officers were allowed to use the communication book. This was discussed further as failing to involve care staff in all aspects of recording and care planning may prevent care assistants from developing their skills and limits their involvement. During the inspection observations were made of one resident being assisted to her room to use the en-suite. The carer supporting the resident managed this task with sensitivity and in an appropraite and discrete manner. The resident used the call system when she was ready to come out of her room. The member of staff knocked on door and waited to be asked in before entering .On most other occassions, staff were observed knocking on residents doors before entering, and were observed engaging in positve communication with residents using approprate and sensitive interventions. However, there were two incidents where the privacy and dignity of residents were not respected. One member of staff who was assisting a resident with personal care in the privacy of her own room inappropriately agreed to a visitor to enter the room whilst performing personal care. In another incident, the cleaner entered the a resident’s room without knocking and interrupted private conversations with the resident, her family, and a visitor. The manager must ensure that all staff in the home understand the principles of good care practice and ensure that all practices in the home ensures the privacy and dignity of residents is maintained at all times. The handling of medication in three of the four homes that transferred to The Peele care home was poor, and a number of significant shortfalls had been identified in the way in which staff handled and administered medication in the home. The Commission had highlighted these early concerns in a letter to the provider to assist the management in addressing the shortfalls and to eliminate bad practice at the early staged following the opening of the home. It was
The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 14 evident from the findings in this inspection that these shortfalls had not been addressed as the home continues to experience difficulties in managing the medication systems in the home. There was evidence that the manager had identified some of the shortfalls using their own internal audit systems and the home were receiving additional support from the learning directorate of the organisation to assist them in resolving the issues of concern and eliminate bad practice. The pharmacist inspector from the Commission carried out an inspection of medication during this visit, and all shortfalls have been highlighted in a separate letter sent to the provider. The home will be required to submit an action plan to the commission to address the shortfalls. A number of requirements have been made to relation to medication and these are listed at the back of this report. The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily routines in the home demonstrated that residents were encouraged to maintain control over their lives, and the appointment of activities coordinators assist in ensuring that social activities meet the expectations and preferences of residents in the home. Mealtimes in the home were a relaxing and social occasion and the food served was appealing and well balanced. EVIDENCE: One of the assistant managers said that the home was developing links with the local primary school next door to the home. She stated that the children participated in organised visits, and that it was envisaged that contact with the school would be increased. The assistant manager said that there had been a good response from residents and that there had been a positive response to this arrangement. There was evidence of a choice of menus. At the time of inspection there was a main meal choice of bacon ribs, cabbage and potatoes, or cheese flan,
The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 16 potatoes and vegetables. Both inspectors sampled the meals served on the day of the inspection. Both meals were a good standard and were attractively presented. Residents spoken to expressed satisfaction about the quality of meals served and confirmed that choices were offered daily, and that alternative meals were always made available. The catering manager stated that the menu choice list was made available to residents on a daily basis. Discussions took place with the catering manager and she confirmed that she was supported by three chefs and two catering staff. The catering staff were responsible for stocking the nine satellite kitchens on a daily basis. All meals are cooked in the main kitchen then transferred into the Bain Marie for each unit. Care staff on each unit then serve the meals. The support manager confirmed that all care staff had been given training in food handling and evidence of this training was seen in staff training portfolios. From discussions with the catering manager, it was evident that she had a good knowledge of special diets and was aware of the importance of presenting meals in attractive forms, e.g. soft diets. The catering manager demonstrated an awareness of the importance in maintaining communication links with the care staff team to ensure that the individual needs and preferences of residents were met in a realistic way. There was evidence from the minutes of resident/ relative meeting that the catering staff were involved in these meetings which provided residents with the opportunity of expressing their views and making special requests. It was noted that the home actively encouraged relatives to be involved in all aspects of residents lives, included important aspects such as sharing in a family meal. At the time of inspection, one of the care staff liaised with the kitchen staff to ensure that a visitor was able to participate in a lunchtime meal with their relative. A token charge of £1 is made for this arrangement. During the mealtime staff were observed to discreetly support residents when it was needed and the meal was unhurried and relaxed with full choice of drinks available such as tea, coffee, fruit juice and water. Serviettes were constantly made available due to the nature of the meal (ribs). Comments made by residents about the meal were , : This dinner is really good Bacon ribs - good Im a small eater - I leave what I dont want Meals are nice though. There was written minuted evidence that meeting had taken place with residents to discuss what kind of activities they would like to do. During the inspection discussions took place with one of the activities organisers. It was evident that she was aware of the importance of providing one to one activities and support to residents who find it difficult in being involved in large communal activities. The activities co-ordinator said that some activities were provided on the units, whilst others were provided for
The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 17 larger groups in the communal function rooms on the first floor.. The activities co-ordinator said that any involvement with residents on a 1:1 basis was recorded on individual files, but that general records were maintained to record which residents participated so that staff could monitor the effectiveness of the activities service. Some of the activities available to residents consisted of boat trips, shopping trips, bingo, health and beauty, armchair exercises. One of the support managers had been given specific responsibility for managing and co-ordinating the activities service to ensure that the service is developed in a way to maximise positive outcomes for residents in the home. Residents were positive about the contact they had with relatives and friends. One relative said that she always felt welcome, but had some concerns about the lack of contact with the managers who were now based centrally on the ground floor. She commented on how she missed ‘popping into the office’, but added that it was just a case of getting used to ‘the new set up’. The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Policies and procedures were in place to safeguard the interest of residents and most residents spoken to felt confident in expressing any concerns however, limited information was available to support residents and their families to make a complaint. Further to this some staff did not have a clear understanding of the adult protection policies and procedures and this could potentially place residents at risk if staff do not have the knowledge to manage an allegation of abuse. EVIDENCE: The home maintained a detailed and comprehensive record of all complaints made to the home. There have been fifteen complaints made direct to the home. Thirteen of the complaints had been addressed by the homes own internal investigation procedures and the complainants had been informed of the outcome. Two complaints were currently in the process of being investigated, and the home had notified the Commission of circumstances surrounding the complaint allegations. The Commission has not received any complaints about this service. Several residents were spoken to about making complaints. All residents spoken to expressed confidence in raising any issue of concerns to the management or staff in the home. However, none of the residents in the home had any information about how to make a complaint. And none of the residents
The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 19 had been given a service user guide or statement of purpose, which should contain information about how to make a complaint. Relatives spoken to during the inspection also said they felt confident about raising concerns, however, relatives of a resident admitted on the day of inspection had not been provided with any information about the home in the form of a Statement of Purpose or Service User Guide, which should include information about terms and conditions and how to make a complaint. Policies were in place for the protection of Vulnerable Adults from Abuse and the home used the Manchester local authority Multi Agency policies and procedures. Two staff spoken to during the inspection said they had received training in adult protection. However, following discussion with these staff, it was evident that they had a good understanding of issues surrounding abuse, however, they were not fully familiar with the adult protection procedures and were not aware of any procedures beyond reporting any incident/allegation to the manager. The management had identified shortfalls in the knowledge base of staff in the home. In an attempt to address the shortfalls, the home had developed links with the social services department to organise training in adult protection procedures. The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and tidy providing residents with a comfortable environment, which was well maintained. EVIDENCE: Standards of cleanliness and hygiene throughout the building were of a good standard. The home was clean, tidy, and no offensive odours were present. Residents in the home expressed satisfaction about the home and felt that it was a lovely home. One resident, you cant fault it here, its lovely. Entrance to all units in the home is via a large reception lounge area. This area provides additional seating and pleasant lounge facilities for residents and their relatives/guests to access. A large notice board was located in this area, however, although the dates of relatives/residents meetings were posted, and minutes from previous meeting, the board provided very little information about the home. The large reception area appeared well equipped but did not
The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 21 contain any information, Statement of Purpose or Service User Guide. When a request was made for information, the receptionist was unable to provide any information which an existing or prospective resident might require about the home. The home is on three levels with three units on each level. All units were provided with a range of different bathing facilities to suit varying preferences of service users. All rooms are fitted with en suite shower facilities. The support manager said that most residents had taken advantage of private bathing facilities, and used these in preference to the communal bathing facilities. Toilet facilities were provided with paper towels/warm air-drying and liquid soap, which aid in preventing cross infection. The first floor provides a multifunction room and library/lounge which is accessible for all residents in the home. The multifunction room is booked out in a diary system and is used fro residents activities, and training purposes. The library provides a relaxing comfortable environment with large windows overlooking the large garden areas. This facility can be used by all residents in the home for a variety of uses. The room is equipped with relaxing seating arrangements, and tables and chairs. The home was equipped and furnished to a high standard. It was noted that personal touches throughout the home varied. The support manager were aware that additional occasional furniture, personal items and pictures were required to provided homely touches. The management felt that providing the homely touches was something that evolved through consultation with residents and getting to know tastes, preferences of individual residents in the home. Some of the bedrooms lacked occasional furniture. For example, some residents had sound systems stored inappropriately on windowsill. Other rooms housed items e.g books and ornaments, and there was an absence of occasional furniture/ bookshelves to accommodate such items. It is recommended that furnishing in rooms is audited so that occasional furniture is provided where appropriate. It was noted that in some rooms, empty suitcases were stored on the top of wardrobes. It was recommended that suitable alternative storage is provided for these type of items. Toiletries in bathrooms were stored in baskets, and although bathroom space was generous, there appeared to be lack of storage space. This was also evident in the bedroom space. The home’s own service user survey had also picked up on similar concerns expressed by residents and their relatives. It is understood from the management that plans are in place to address these concerns.
The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 22 The home provides pleasant external garden facilities within a secure and monitored parameter. All ground floor units open onto pleasant cottage garden areas. The remaining six unit have balconies which overlook the garden areas. The support manager confirmed that all areas were risk assessed. It was disappointing to note, that although the weather had improved and it was warm there had been no attempt however, to furnish the garden areas appropriately or to encourage residents and relatives to use these areas. During the inspection, relatives were overheard commenting on the failure of the home to provide outdoor garden furniture. Initially, following discussion with one of the support managers, she said that this furniture had been ordered. When the home were asked to provide evidence of this, it became apparent that furniture hadnt been ordered. However, at the time of inspection, one of the support manager was able confirm with head office that external furnishings had been prioritised as a matter of urgency. Some of the recent reviews carried out by social services care managers, highlighted that residents had expressed their disappointment about not being able to access the outdoor facilities due to lack of outdoor seating areas. The laundry room was located on the first floor. All laundry was delivered to the laundry via a central shoot system which meant that laundry was not transported through the building improving infection control throughout the building. All laundry was colour coded and items were washed separately as required and necessary. Three laundry assistants managed laundry for the whole building. All three staff confirmed that they were in receipt of supervision and that they found the management approachable. One of the staff said, we have good team work, good systems and we all work together .Staff confirmed that they had received full training on how to operate the machinery and had just been updated on COSHH training. The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefited from a staff team who were trained, supervised and supported by management. EVIDENCE: Four staff files were examined and all files contained documentation as required by this standard and associated regulations. This included job application forms, interview notes, two written references, evidence of job consultations and training plans. There was documentary evidence that CRB checks had been completed. Staff spoken to during the inspection confirmed that they had received ongoing supervision both formal and informal. Prior to the move to the Peele staff from all four homes had received orientation training, and had received appropriate line management supervision to support them through the transition. The support manager agreed that some supervision sessions had fallen behind, but that all staff files were currently in the process of being audited to ensure that all staff were brought into line with the home’s policies and guidelines for supervision. Staff were observed supporting residents in a sensitive respectful caring manner. Staff were observed engaging in meaningful conversations with
The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 24 residents in the home. The numbers of staff on duty during this visit were sufficient in numbers to meet the needs of residents in the home. Staff training records provided evidence of a wide range of skills and experience and showed that the home placed emphasis on ongoing training and development. The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 25 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,,33,35,37,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Deployment of staff in the building does not always enable staff to meet individual needs of residents which could potentially place residents at risk. EVIDENCE: The manager was on holiday leave at the time of inspection. The inspectors of the site visit were assisted by the support managers. During this visit information was provided about the relative and resident satisfaction surveys, and this confirmed that the home was monitoring all aspects of the service and where necessary developing action plans to address any shortfalls. One of the staff said that a number of relatives had got together to form a relatives/resident committee. Management in the home had assisted relatives
The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 26 by encouraging them to use the support of the activities organiser to coordinate meetings and to arrange for letters to be sent out to relatives of all resident in the home. The notice board in the reception area provided dates of forthcoming meetings and also the minutes from previous meetings. It was evident from this information that residents and relatives were being consulted about their views on the home. One relative who was spoken to said that she had recently filed out a questionnaire. She said that the questionnaire asked questions about the move to the new home and for opinions on how the home could be made better. A sample of the questionnaire was seen during the inspection. Since sending out the questionnaire, management of the organisation have analysed the data received and report of the findings has been supplied to the CSCI. The report provides evidence that the home is committed to listening to the views of the people it serves, and to using the information to develop the service. Some of the residents, relatives and staff expressed concerns about the deployment of staff in the home. Residents were aware that staff moved around from unit to unit, one resident expressed concerns about this. Staff commented on the fact that at the start of their duty there were never sure which unit they would be working on and they also noted that this upset some of the residents. It is essential that the management listen to their concerns about how staff are deployed throughout the building and there worries about lack of continuity in staffing structures which may potentially upset residents and give rise to difficulties in staff and residents in establishing positive meaningful relationships. In an effort to improve performance throughout the home, all three support managers have lead responsibility in key areas which include Health and safety, medication and rosters. Management had identified shortfalls in the fire procedures in respect of evacuation of the building. As a result, increased fire training had been commissioned by the home, and consultations with fire training agencies were taking place with managers at the time of this visit. There was evidence on this inspection to confirm that Regulation 26 visits had taken place and one of the managers stated that a formal document had been developed to record regulation 26 visits. There was evidence that these visit records were accompanied by a separate letter which was sent to the manager enabling her to address key issues of concern. All health and safety policies were in place and had been examined as part of the recent registration process. The support manager said that resident finances were in the process of changing and that the home were working with social services to arrange appropriate management of residents’ finances and to ensure that monies for
The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 27 residents were being held in an interest bearing account. Resident finances will be examined in more detail at the next inspection/ site visit. The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 28 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 The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 29 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 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 2 X 3 X 3 3 The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? N/a 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 OP1 Regulation 4 &5 Requirement All existing and prospective users of the service must be provided with information about the home in the form of a Statement of Purpose or Service User Guide. Care plans must clearly identify all care needs with details of the interventions required to meet the needs. Staff must follow good practice and ensure that the privacy and dignity of residents is maintained at all times. All staff must receive training in Adult Protection. The registered provider must provide suitable outdoor furniture to enable residents to access all parts of the home both internally and externally. The management must review the deployment of staff in the home to ensure that all parts of the home are staffed appropriately and in a manner that meets the needs of the residents. Timescale for action 30/06/06 2 OP7 15 30/06/06 3 OP10 12 30/06/06 4 5 OP18 OP19 13 23 30/06/06 30/06/06 6 OP33 24 30/06/06 The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 31 7 8 OP36 18 13(2) OP9 9 OP9 13(2) 10 OP9 13(2) 11 OP9 13(2) 12 13 14 OP9 OP9 OP9 13(2) 13(2) 13(2) 15 OP9 13(2) The registered manager must ensure all staff receive formal supervision. The registered person must ensure that medication is stored within manufacturers’ recommended temperatures and that staff are aware of what action to take in the event of medication being stored incorrectly The registered person must ensure that a risk assessment is made on the storage of controlled drugs/ fridge lines and the provision for their transport across the floors. The registered person must ensure that medication is stored securely at all times. Medication must only be stored in residents room if they are risk assessed as capable of self administering. A lockable facility must be provided for medicines storage. The registered person must ensure that accurate records and an audit trail are kept for all prescribed medication. The registered person must ensure that a robust ordering procedure is in place. The registered person must ensure that all medication is accounted for at all times. The registered person must ensure that care staff receive appropriate training to enable them to administer medication safely. The registered person must ensure that medication is administered as prescribed by the GP. 30/06/06 01/06/06 01/06/06 01/06/06 01/06/06 01/06/06 01/06/06 01/06/06 01/06/06 The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 32 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 OP24 OP9 Good Practice Recommendations Bedrooms to be audited, and provision of occasional furniture to be provided as required. It is recommended that when a new entry is made by hand that the person making the entry signs it and a second person checks it for accuracy and counter signs it. The Peele DS0000066003.V297868.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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