Inspection on 09/05/07 for The Peele

This inspection was carried out on 9th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 Peele 13/08/08

The Peele 29/08/07

The Peele 30/01/07

The Peele 01/06/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Peele Walney Road Benchill Wythenshawe Manchester M22 9TP Lead Inspector John Oliver Unannounced Inspection 9 May 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Peele DS0000066003.V334619.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.V334619.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Peele Address Walney Road Benchill Wythenshawe Manchester M22 9TP 0161 490 8057 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 Under Application Care Home 108 Category(ies) of Old age, not falling within any other category registration, with number (108), Physical disability (12) of places The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home can accommodate a maximum of 108 service users. Up to 108 service users may require care by reason of old age. A maximum of twelve (12) beds on a specified unit can be used for Intermediate Nursing Care for service users who are 50 years and over. Of these twelve (12) beds, two may be used to accommodate people who are over 18 years of age. 30th January 2007 Date of last inspection Brief Description of the Service: The Peele is a purpose built care home providing personal care for a maximum of one hundred and eight older people. The home was registered on 8th February 2006. Although this is a large home, the emphasis is on providing group living. The home is divided into three wings on three levels. Each level accommodates three units, making a total of nine units, each of which provides 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 has a large foyer area, which includes a reception area, and a lounge/sitting area with comfortable seating. The kitchens for the whole building are accommodated on the ground floor. The first and second floors provide additional facilities. This includes 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 also 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 £378.84 to £450.00; the Primary Care Trust funds the remaining twelve of the beds. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 5 Additional charges are made for hairdressing, newspapers, visitors’ meals and refreshments, and for telephone installations. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the last inspection visit to The Peele in January 2007. A visit took place on 9 May 2007 over a total period of 9.5 hours and the home was not told about the visit beforehand. During this visit the inspector had a look around the home and looked at paperwork that must be kept by the home to show that it is being run properly. Another way that was used to find out more about the home was by talking with some of the people and staff who were in the home on the day of the visit. Some of the people living in the home were unable to express their views directly, so time was spent watching how staff talked to and supported them. Some changes had taken place to the management team in the home since the last visit by the CSCI. For the last nine weeks the home has had the support of a new home manager and, for the last four weeks, the support of a new deputy manager and a new assistant manager. Following the last inspection visit in January 2007 there were a number of particular concerns about how medication was being dealt with in the home and because of this a Statutory Requirement Notice was served on the organisation who is responsible for managing The Peele. The main focus of this inspection was to understand how the home was meeting the needs of the people living in the home and how well the staff were themselves supported by the management of the home to make sure that they had the skills, training and support to meet the needs of those people and if the management of the home had addressed those issues identified in the Statutory Requirement Notice. As there was a need to check a lot of information during the visit, a second inspector and a Pharmacist inspector also took part in the visit. The Pharmacist inspector checked whether the requirements made in the Statutory Requirement Notice had been met or not. What the service does well: The home is a fairly new building and has a good standard of furniture and fittings which provides people living in the home with comfortable surroundings. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 7 Meals served in the home during this visit were well presented, and people were offered a choice of meals. Comments from people living in the home included: “The meals are always good here” and, “You can have what you want – within reason”. What has improved since the last inspection? What they could do better: The way information is given to people living in the home and for those people considering coming to live in the home could be improved. Although a Service User Guide and Statement of Purpose were available much of the information was out of date or incorrect and this could confuse people. It is important that the home has these documents readily available with the right information to help people make important decisions about their future care arrangements. Care plans, risk assessments and other important information used to deliver care to people living in the home could be better recorded. Information was not always correct and did not clearly inform staff how it was sometimes best to assist a person living in the home. This could place a person living in the home at risk. Although there had been a recent review of staffing levels in the home there was still some concern that the rotas were not being planned in the best interest of the people living in the home and this could place people at risk. Some of the people living in the home and a number of relatives expressed concern (via resident/relative surveys) about how the staff were moved from unit to unit and comments included: The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 8 “I do think though that the carers allocated to the one unit should not be moved about, as my mother just got used to the staff when they were moved and other staff came in their place….it confuses old people when there is change”. “Staff has recently been reduced – I am not sure why…”. “Due to so many staff and management changes over the past year..” “You have to accept that with so many changes of staff and staff rotas you are not really aware of who could be keeping you informed…”. Some of the bedrooms and communal areas lacked ‘homely touches’ and did not reflect the characters of the people living in the home. It would be good if people living in the home were given opportunities to participate in making decisions about furnishings in their own rooms as well as the communal areas. It was also recommended that further information be sought into dementiafriendly design to ensure that people living in the home that suffer with memory loss can develop more independence in surroundings that meet their specific needs. Being able to take part in social and leisure activities and other such events can play an important part in everyone’s life. Although the home had 3 designated activities organisers the home was found to be failing in this area by a lack of meaningful social and leisure activities being made available. Staff commented that they were kept busy carrying out tasks such as giving out laundry and other such duties, which gave them very little time to actually spend with residents in socialising or getting to know individual residents better. This was also commented upon in a number of the surveys returned to the CSCI by relatives of people living in The Peele. Although the management of the home were providing staff with various opportunities to attend training courses, no training had been arranged to give staff the opportunity to gain skills and knowledge when supporting people who may have a degree of dementia. The manager and staff responsible for administering medicines in the home must make sure that residents are given their medicines as prescribed by the doctor. The manager and staff responsible for administering medicines in the home must also account for all prescribed medicines and make sure that all records about medicines are clear and accurate. It is essential that the manager and staff responsible for administering medicines in the home make sure that medicines do not run out so that residents living at the home have continuity of treatment. Please contact the provider for advice of actions taken in response to this The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 9 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 10 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.V334619.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are only admitted into the home following a full assessment of their needs although more information needs to be made available to help them make an informed choice about the care being offered by the service. EVIDENCE: A copy of the latest information provided to prospective residents was made available during this visit. This information is in the form of a Service User Guide and a Statement of Purpose. Some changes had recently taken place within the staffing structure of the home and this was not reflected in this information. It is recommended that the Service User’s Guide be reviewed and updated with the correct information and in a format that it can be easily read and understood. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 12 From a sample of residents’ files that were seen there was evidence of Care Managements and Nursing assessments and Care Plans that had been carried out by the purchasing authority before the person came to live in the home. In addition to this, staff in the home confirmed that they would visit any potential new resident to find out more information and confirm that they could meet the prospective resident’s assessed needs. The home has the facility on one particular unit to offer an intermediate care service to people requiring support during their transition from a stay in hospital and returning home. One person on this unit was spoken to during this visit and was very clear about the service being offered and what they could expect from that service. They were also very clear that no charges would be made for this service. A care plan was in place and was based on goal planning/achieving and the person discussed her participation in this process. Evidence was seen of assessments that had been carried out regarding the individuals’ abilities at managing their own personal care and an assessment that took place in her own home to assess her ability at managing the environment such as accessing the bathroom and kitchen before returning home on a permanent basis. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans were poor and the standard of medicines management within the home must improve to ensure the safety of the residents who live there. EVIDENCE: Care plans did not clearly define health and personal social care needs and were found to be inconsistent in their contents and in the way in which they had been written. One particular care plan consisted of 9 separate sheets of information which was hard to follow and the photocopying of the individual sheets was poor which made them difficult to read and link with any risk assessments. This could place the health and safety of an individual resident at risk. Discussion with the manager about this confirmed that all care planning documentation was in the process of being reviewed by the organisation in order to find a more suitable/appropriate format. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 14 Again, because of the poor standard of care planning it was difficult to assess if regular reviews had been carried out of individual care plans and whether the care plans accurately reflected residents changing needs. There was some evidence that moving and handling assessments had been reviewed in March 07. A number of surveys returned to the Commission by relatives of people living in the home also included comments such as: “…both patients and staff would benefit if assessments were carried out on a more regular basis…” and, “..I find I have to check out some basics like false teeth (cleaned), care of clothes – the appearance of your relative can vary again from carer to carer”. One resident who has vascular dementia needed particular support with this. Examination of the care plan did not demonstrate that any particular part addressed this issue or gave staff any guidance on management strategies to support the individual person, placing them at risk of their needs not being appropriately met. It is recommended that the manager undertakes a review of care planning in the home and considers providing person-centred care plan training for the staff. A nutritional assessment had been carried out for this individual and had been consistent for the past four months with an outcome of ‘low risk’. A mealtime was observed and it was seen that this particular person chose to have a ‘turkey’ dinner. The meal was placed in front of them and left. This person did not attempt to eat the meal but held the knife and fork in her hands. A carer came and stood over the person, took the knife and fork and proceeded to cut the meat and then handed the knife and fork to the person and then walked away. No communication took place. There was no information in the nutritional assessment or within a care plan that indicated that this person may require help at meal times or could be at risk of not eating or becoming malnourished if not assisted. It is recommended that research is undertaken into providing staff with relevant information about how to support people at risk from malnutrition. People living in the home are at potential risk from staff not understanding individual residents’ nutritional needs, or not making sure that residents are eating. Observation on a number of the units during the inspection demonstrated that there was a high ratio of people living in the home with varying degrees of dementia that required more time to be given to them individually by carers. Observation of staff highlighted that they seemed unaware of how to meet or deal with the varying needs of people with forms of dementia. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 15 One member of staff spoken to said that they felt they needed training in ‘challenging behaviour and dementia’. In relation to residents’ health and healthcare, a record was kept of all input from healthcare agencies and professionals such as District Nurses and G.P’s. At this inspection, medication in four units of the home was looked at together with the medication records. The way in which medication is administered and recorded on the intermediate care unit had vastly improved and the manager on this unit had made significant changes to the way medicines are handled. Residents on this unit now receive their medicines as prescribed by the doctor and the records demonstrated that medicines are given properly and are accounted for. A new system of ordering medication had been put in place to make sure that residents always have enough medicines in the home to ensure continuity of treatment. Following the last inspection site visit to the home in January 2007 a Statutory Requirement Notice was served on the home regarding poor medication practice. Five requirements were made to make sure that residents were kept safe from harm. During this inspection site visit it was found that although some improvements had been made there was still four of the five requirements not being met and residents’ health and safety was at potential risk from harm. Examples of the findings include: Medication was still not being administered to residents exactly as the doctor had prescribed it. One resident was prescribed a controlled drug, a strong pain-relieving patch to be applied every 72 hours. It was found that this particular resident had been without pain relief for varying periods of time on nine occasions since the beginning of March 07, the longest time being 72 hours late. Another resident had been prescribed some antibiotic capsules to be taken four times daily for seven days. For three of those seven days, the resident was only given the capsules three times daily; this could harm the residents’ health. At the time of this visit it was day three of a new monthly cycle of medication. However, the manager could not account for all prescribed medication. The records for one resident showed that an analgesic (pain relief) had been prescribed and that a count of tablets on the day of this visit showed that the remaining balance of this medication was incorrect and that 12 tablets were unaccounted for. When medicines are not accounted for resident’s health could be at risk. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 16 It was also found that some records were inaccurate and, on the day of this visit, a carer had signed that a tablet had been administered to a resident. On checking the remaining medication it was found that the tablet had not been administered. The health of this resident may be placed at potential risk from harm. It was seen that a resident was potentially at risk from harm from being given the incorrect dose of Warfarin (blood thinning medication) because a higher strength of tablet was also being stored in the trolley alongside the medication that was currently prescribed for the resident. On the day of this visit staff spoken with were unsure if a resident was still prescribed a particular medication or whether the stock had run out. This was a more serious concern as the residents’ health was potentially at risk from harm. Despite the evidence of all the training the care staff had been given it was found that some residents’ health was put at risk by the poor way in which medication was administered, handled and recorded. Although the management team of the home had put in place ‘tools’ to monitor medication practice in the home, it is also of serious concern that this had failed to identify or to prevent further poor practice with medication and resulted in some residents’ health still being placed at potential risk from serious harm. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home do not appear to have much choice and control over their preferred lifestyle and were not provided with many social and leisure opportunities potentially leading to boredom and apathy. EVIDENCE: It was confirmed that the home had three designated activities organisers who arranged regular activities to take place in the home. Activities advertised on the notice boards on each unit included: Bingo, Church, Shop and reading group. On the day of the inspection visit the activity was ‘Shop’ and when asked what this involved was told that a trolley is taken around the lounge areas and residents can buy things such as sweets and toiletries etc. The outcomes and experiences of people participating in any activities should be recorded on an individual basis in a person’s care plan. This information could then be considered during the reviews of a person’s wellbeing and to assess if people are achieving their personal goals. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 18 Televisions were on in most lounge areas but many of the residents were just sat around with very little interaction happening. One resident spoken to said, “I’m fed up – not a lot goes on here”. Many residents were observed sat in chairs with little or no communication taking place and when anyone did move staff tended to shout “sit down…” or “where’re you going…?” This restricted people’s choice and freedom to move around the units and most people sat back down. Some staff spoken to during the visit also spoke about residents with “challenging behaviour” and “dementia” and at times, appeared unsure of how to support people who may have more complex needs. Before the inspection visit took place a number of relatives were sent survey questionnaires by the Commission for Social Care Inspection and those returned included the following responses: * “More could be done to encourage more daily activities for the residents”. However, another one stated: * “Provides activities for…i.e. trips, bingo, religious service, mobile library”. During the inspection site visit, apart from when lunch was being served, whenever the inspectors were around the communal areas on the different units they did not see any member of the staff just spending time and socialising with the residents. The staff were seen to be actively involved in undertaking various tasks such as putting away laundry and providing residents with personal care. A lot of visitors were seen to come and go throughout the day and evening and the visitor’s book demonstrated that visitors frequented the home on a very regular basis. There was evidence of a choice of menu and residents are asked on a daily basis what they would like. The meal served on the day of the inspection site visit was nicely presented and residents spoken to said that they enjoyed the meal. Comments included: “good roast dinner”, “the meals are always good here” and, “you can have what you want – within reason”. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The welfare and safety of people living in the home is afforded protection by the policies and procedures in place. EVIDENCE: The home has a detailed complaints procedure in place, which was readily available. Since the last inspection site visit in January 2007 there has been a significant improvement in the way in which complaints are managed. Seven complaints had been received by the home since that last visit and all had been investigated and concluded by the manager with written evidence kept on file. The Commission for Social Care Inspection had received one complaint and this had been passed to the manager of the home to investigate. Evidence was available to show that this had been satisfactorily concluded. Discussion with one visitor confirmed that a complaint they had made to the management of the home had been dealt with appropriately. One resident spoken to said if they had a complaint they would speak to a member of staff and expect “something to be done about it”. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 20 Discussion with the manager confirmed that no allegations had been made or referred under the Protection of Vulnerable Adults (POVA) procedure since the last inspection visit to the home. It was confirmed that all staff had received POVA training and that this would be ongoing for any new staff. The manager of the intermediate care unit was very clear about the process to follow should an allegation of abuse be made. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The environment is generally clean and well maintained but would benefit from being made more homely for the residents. EVIDENCE: Cleanliness and hygiene throughout the building were generally of a good standard although there were a number of areas on the day of the site visit that did need further work to bring up an acceptable standard and these were pointed out to the managers at the time. Residents in the home expressed satisfaction about the home and one resident said, “My room is good, nice and clean – what more can you ask for?”. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 22 Corridors leading to each unit were very ‘stark’ and lacked any homely touches such as pictures. A number of bedrooms were seen and all were very similar in layout but again (and unless by choice) lacked any personalisation. No pictures had been hung on the walls and no particular homely touches were apparent. Rooms did not reflect the individual character of the person whose room it was. The manager said that a directive from ‘head office’ had said that things such as pictures around the home were ‘not allowed’. This could prevent an individual resident from expressing choice about how they choose to live and from having things around them that are important to them. However, following the inspection visit, the Responsible Individual informed the Commission for Social Care Inspection that there had been a miscommunication of information between head office and the new manager on this particular issue and that efforts would be made to increase the homliness of the environment. It was evident that a number of residents needed specific support due to dementia and it is recommended that research is undertaken into dementia friendly designs that provide enabling environments for people to have greater independence. Information on this subject can be accessed from The Dementia Services Development Centre at Stirling University www.dementia.stir.org.uk and The Alzheimer’s Society www.alzheimers.org.uk Carpets in a number of areas would benefit from deep cleaning and, on the units where smoking is allowed would benefit from replacement where covered in cigarette burns. The manager should also consult the environmental health officer regarding the smoking regulations that are due to come into force from July 2007. The laundry room was situated on the first floor and soiled linen/laundry items were delivered to the laundry via a central shoot system which meant that laundry was not transported through the building. All laundry was colour coded and items are washed separately as required and necessary. Staff working in the laundry confirmed that they had received the following training, Infection Control, Moving and Handling, COSHH and Basic Life Support. They did say however, that the laundry area gets extremely hot in warmer weather even with the windows open and the extractor fans on. The Peele DS0000066003.V334619.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staff’s lack of knowledge and skills regarding caring for people with dementia has the potential for residents needs not to be fully met. EVIDENCE: Discussion with the management team confirmed that no new staff had been employed in the home since the last inspection site visit carried out in January 2007. The staff file of one of the new managers was examined and was found to contain all the required and relevant documentation including an enhanced Criminal Record Bureau check. A recent review of staffing levels throughout the organisation had taken place and new rotas had been developed following this consultation. Discussion with the manager indicated that it was considered enough staff were available to meet resident needs throughout the day. Problems arose should a member of the staff team not be available for duty at short notice or should a resident require a hospital escort. The manager had put a further proposal to the Board of Directors requesting a further increase in staffing hours to meet such shortfalls. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 24 As stated elsewhere in this report, there are a number of residents with varying degrees of dementia. Staff have not received any training in this particular subject and appeared unsure of how to deal with certain behaviours that may be presented by an individual resident. This can put both the resident and member of staff at risk. At previous inspections concerns had been raised by residents, relatives and staff about the frequency of staff being moved around from unit to unit causing distress to some residents and creating a lack of continuity of carers on the units. A number of comments were received from relatives prior to this inspection site visit taking place (via survey), and these included: * * “You have to accept that with so many changes of staff and staff rotas you are not really aware of who could be keeping you informed..” “I do think though that the carers allocated to the one unit should not be moved about, as my mother just got used to the staff when they were moved and other staff came in their place, and mum then had to get to know them, it confuses old people when there is change..” “Staff has recently been reduced – I am not sure why..” “Lack of staff can’t cope with different service levels for individuals” * * However, another quote stated that: * “Due to so many staff and management changes over the past year generally – (the home has provided adequate care)”. Discussion with the manager indicated that now new rotas were in place greater consistency of staffing on each unit would be maintained. Staff training records provided evidence of ongoing training being arranged for each staff member such as Moving and Handling, Basic Food Hygiene and First Aid. However, as stated elsewhere in this report staff were unable to demonstrate a clear understanding of supporting people with varying degrees of dementia and therefore, must receive relevant training in this subject to support them in the job they do. The Peele DS0000066003.V334619.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home benefits from a new management team although further work is required to ensure that the home is run in the best interest of the people living there. EVIDENCE: The home’s previous manager had left since the last inspection site visit in January 2007 and a new manager and management team had been put in place that consists of a home manager, deputy manager and assistant manager. All posts are full time and the home manager was in the process of registering with the Commission for Social Care Inspection (CSCI) at the time of this inspection site visit. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 26 A number of important issues had arisen during the last inspection site visit that resulted in the CSCI issuing the home with a Statutory Requirement Notice (SRN) due to concerns that the previous manager of the home was not ensuring that medication was being administered to people living in the home safely. Although at this site visit the Pharmacist inspector still found a number of concerns that had been identified in the SRN regarding medication practice in the home, there had been some overall improvements, especially on the intermediate care unit. The last quality audit of the service had been carried out in May 2006 and information contained within this audit also included the findings from a survey carried out in March 2006. This survey was detailed and comprehensive. Where management dealt with the personal allowances for individual residents a record of balances was kept with receipts in place. It is recommended that two staff witness and sign all transactions carried out on behalf of individual residents. Staff spoken to during this visit confirmed that supervision was taking place. Comments also included: * * * * * “The manager is very approachable”. “All (managers) very approachable – all come onto the floor to monitor what is going on – they check residents and staff”. “It’s better now there is a manager on each floor”. “We get our one to one supervision”. “Recently done Moving and Handling training”. It was confirmed within the written information provided by the manager prior to the inspection visit taking place that all routine maintenance and servicing of equipment used in the home is carried out. A random selection of reports was checked to confirm this. The fire alarm system is tested on a regular basis and staff spoken to confirmed this. The last fire drill recorded was carried out on 26/03/07 and the staff taking part signed the record. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 27 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 2 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 3 The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (a) Requirement Care plans must clearly identify all assessed needs of the individual resident and demonstrate how those needs are to be met. All care plans must be reviewed (and be updated where required) on a regular basis. Timescale for action 27/07/07 15 (b) (Previous timescale of 05/03/07 not met). 2 OP8 13 (4) (b) and (c) Risk assessments must be in 27/07/07 place for all risks identified for an individual resident with details of how the risk(s) are to be managed. The registered person must 09/05/07 ensure that medication is administered as prescribed by the doctor. (Previous timescales of 01/06/06, 02/01/07 and 05/03/07 not met) DS0000066003.V334619.R01.S.doc Version 5.2 Page 29 3. OP9 13 (2) The Peele 4. OP9 13 (2) The registered person must ensure that all medication is accounted for at all times. (Previous timescale of 05/03/07 not met) 09/05/07 5. OP9 13 (2) The registered person must ensure that accurate records and an audit trail are kept for all prescribed medication. (Previous timescale 05/03/07 not met) 09/05/07 6. OP9 13 (2) The registered person must ensure that residents have a sufficient quantity of medication in the home to ensure continuity of treatment. Residents must be provided with a structured programme of activities that reflects their interests and social and leisure needs. Residents must be supported and encouraged to make meaningful and valued choices in relation to their day-to-day routines and decisions that affect them. To support residents changing needs and goals the home must make sure that the individual staff members have the skills and receive the appropriate training to support them carry out their job. 09/05/07 7. OP12 16 (2)(m)(n) 27/07/07 8. OP14 12 (2) 27/07/07 9. OP30 18 (1) 31/08/07 The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 30 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 OP1 Good Practice Recommendations It is recommended that the Service User’s Guide and Statement of Purpose be reviewed and updated in order to provide prospective residents and/or their representatives with the right information about the service being offered by the home. Copies should then be submitted to the Commission for Social Care Inspection. The registered person should consider training in personcentred care planning for staff working in the home. Adopting this approach will ensure that individuals are placed at the forefront of the service they receive. The registered person should undertake research into providing staff with information about how to support people at risk from malnutrition. The manager should ensure that the outcomes and experiences of people engaged in activities in the home and in the community are recorded. It is strongly recommended that consideration be given in consulting residents and improving the communal and personal space by adding ‘homely touches’ such as pictures and personal effects. The registered person should undertake research into dementia-friendly design that enables people suffering from dementia have greater independence within the home. It is strongly recommended that consideration is given to replacing those carpets covered in cigarette burns as a matter of priority as part of the rolling programme of maintenance. The registered person should consult their environmental health officer about the restrictions that need to be applied in the home when the smoking regulations come into force in July 2007. It is strongly recommended that an audit of all carpets be undertaken and deep cleaning arranged where required. It is recommended that an assessment of the laundry be carried out and consideration given to supplying further ventilation for the comfort of staff working in that area. DS0000066003.V334619.R01.S.doc Version 5.2 Page 31 2. OP7 3. 4. 5. OP7 OP12 OP19 6. OP19 7. OP19 8. OP19 9. 10. OP26 OP26 The Peele 11. 12. OP27 OP35 It is strongly recommended that staff are deployed throughout the home in a manner that provides consistency for residents. It is strongly recommended that where managers deal with the personal allowance on behalf of individual residents all transactions be recorded with two signatures. The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North West Regional Office 11th Floor West Point 501 Chester Road Old Trafford M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Peele DS0000066003.V334619.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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