Care Home: Pals Residential Home

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What the care home does well The service offers a warm, safe, clean and friendly environment for people to live. The people who use the service are well cared for. Their clothes are nicely laundered and their bedrooms are clean, well furnished and nicely decorated. Peoples` healthcare needs are monitored by the staff in the home and prompt action is taken when peoples needs change to ensure they receive the correct care.Pals Residential HomeDS0000018669.V377302.R01.S.docVersion 5.2People are offered a varied menu and are able to eat their meals in the dining room or the privacy of their bedroom. Staff respect peoples privacy and dignity at all times. People who use the service know who to speak to if they have any concerns and can be confident that they will be listened to. There is a very friendly and homely atmosphere and visitors are made very welcome by the staff. Staff are polite and friendly and are supported to improve their knowledge and skills through achieving National Vocational Qualifications in care. The home is well managed by an experienced owner, manager and deputy manager ensuring the home is run in the best interests of the people who use the service. What has improved since the last inspection? They have reviewed the format for the pre-admission assessment to ensure it considers all aspects of care needs. Pre-admission assessments are carried out by the service for all prospective people to ensure they are able to meet the person`s care needs. The format of the care records has been changed; they are easy to use and provide care staff with the information they need to ensure they meet each person`s care needs. There have been improvements seen in the services management of medication ensuring good outcomes for the people who use the service. Improvements have been made to the environment to make it brighter, more homely and safer for the people who use the service. Changes have been made to improve the overall management of infection control in the home to ensure people are not at risk of cross infection. Thorough and robust recruitment procedures are now in place to ensure suitable staff are employed by the home to care for people who use the service. The opinions of the people who use the service are being sought and the outcomes of these consultations are being used to develop and review their current practices to ensure they continue to improve the service.Pals Residential HomeDS0000018669.V377302.R01.S.docVersion 5.2 What the care home could do better: The storage of controlled medicines needs to be changed to ensure that it complies with current legislation. The medication policy needs to be further updated to ensure it contains clear information for staff about the receipt, handling, administration and disposal of medicines to ensure it is being appropriately managed at all times. Improvement is needed for medication records to ensure that there is safe control and handling of people`s medication. There needs to be a more `person centred approach` to health and social care to support the individual needs, choices and preferences of the people who use the service. People should be offered a key to lock their bedrooms when they are out of the room so that they are able to maintain the security and privacy of their possessions at all times. The induction programme for new recruited staff should be reviewed to ensure that it is in line with the Common Induction Standards that need to be met so that new workers know all they need to know to work safely and effectively. Training should be provided for staff about the Mental Capacity Act 2005 and the deprivation of liberty safeguards to ensure they understand their implications for day to day practice and care planning. Key inspection report CARE HOMES FOR OLDER PEOPLE Pals Residential Home 79 Ombersley Road Worcester Worcestershire WR3 7BT Lead Inspector Sandra Bromige Key Unannounced Inspection 4th August 2009 09:10 DS0000018669.V377302.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pals Residential Home Address 79 Ombersley Road Worcester Worcestershire WR3 7BT 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) 01905 612439 Mr Sharanjit Singh Purewal Mrs Eileen Nellie Jeynes Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14), Physical disability (14) of places Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 14 Physical disability (PD) 14 The maximum number of service users who can be accommodated is: 14 2nd September 2008 2. Date of last inspection Brief Description of the Service: Pals Residential Care Home is registered to provide personal care for up to fourteen older people who are frail, and who may have physical disabilities. The service is provided at an extended Victorian house in a residential area of Worcester approximately two miles from the city centre. The property has an established garden that is accessible to people who use the service. The stated aim of the service is to meet the individual needs of the people who use the service, by providing high quality accommodation and personal care. Up-to-date information relating to the fees is available on request from the service. A copy of this inspection report is available from our website www.cqc.org.uk Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This was an unannounced inspection. An inspector and a Pharmacist Inspector spent time at the home, talking to people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. We looked in detail at the care provided by the home for two people. This included observing the care they receive, discussing their care with staff, looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The manager and owner of the service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the comments have been included within this inspection report. We also received completed survey forms from eight people who use the service, three staff working at the home and one health professional who visits the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. Some of the comments from the surveys have been included within this inspection report. We have not received any complaints or safeguarding information about this service since the last inspection in September 2008. What the service does well: The service offers a warm, safe, clean and friendly environment for people to live. The people who use the service are well cared for. Their clothes are nicely laundered and their bedrooms are clean, well furnished and nicely decorated. Peoples healthcare needs are monitored by the staff in the home and prompt action is taken when peoples needs change to ensure they receive the correct care. Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 6 People are offered a varied menu and are able to eat their meals in the dining room or the privacy of their bedroom. Staff respect peoples privacy and dignity at all times. People who use the service know who to speak to if they have any concerns and can be confident that they will be listened to. There is a very friendly and homely atmosphere and visitors are made very welcome by the staff. Staff are polite and friendly and are supported to improve their knowledge and skills through achieving National Vocational Qualifications in care. The home is well managed by an experienced owner, manager and deputy manager ensuring the home is run in the best interests of the people who use the service. What has improved since the last inspection? They have reviewed the format for the pre-admission assessment to ensure it considers all aspects of care needs. Pre-admission assessments are carried out by the service for all prospective people to ensure they are able to meet the persons care needs. The format of the care records has been changed; they are easy to use and provide care staff with the information they need to ensure they meet each persons care needs. There have been improvements seen in the services management of medication ensuring good outcomes for the people who use the service. Improvements have been made to the environment to make it brighter, more homely and safer for the people who use the service. Changes have been made to improve the overall management of infection control in the home to ensure people are not at risk of cross infection. Thorough and robust recruitment procedures are now in place to ensure suitable staff are employed by the home to care for people who use the service. The opinions of the people who use the service are being sought and the outcomes of these consultations are being used to develop and review their current practices to ensure they continue to improve the service. Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 7 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 8 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 Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments are carried out by the service for all prospective people so that they are able to tell the service all about them, what they hope for and the support they need. The service does not provide intermediate care facilities EVIDENCE: We tracked the care of two people who have started using the service this year. The home has reviewed their pre-admission assessment format since the last inspection. We saw that staff from the home had carried out a preadmission assessment for each person before they were admitted to ensure they were able to meet the persons care needs. The home had also obtained summaries of care from the placing authority for each person. Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 10 The Annual Quality Assurance Assessment (AQAA) stated satisfactory assessment and admission procedures are in place at Pals. The manager undertakes a pre-admission assessment for all prospective service users may it be at their home or hospital. The pre-admission assessment then forms the basis of the care plan. The requirement from the last inspection report was met. The home does not provide intermediate care, although they do offer respite care subject to the availability of a vacant place. Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care provision and quality of the care records and management of medication for the people who use the service has improved ensuring peoples needs are met and the staff have the information they need to ensure they provide the correct level of care. EVIDENCE: We tracked the care of two people who had started using the service in the last five months and found good outcomes of care. For example, both people looked very well presented and they had both put on weight since admission. The home had arranged for one person to have new dentures fitted as they were not fitting correctly due to considerable weight loss. This person had seen a hearing specialist to have hearing aids provided to improve their hearing enabling them to have a better quality of life. One person had a pressure sore when they arrived but this has now healed. Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 12 One person whose care we tracked told us they are very happy here and they are looking after me well. They told us they are able to wash and dress themselves but the staff helps them to shower each Thursday. They also told us they are eating much better since they started using the service. Surveys completed by people who use the service told us they are happy with all aspects of care received. I always receive good care. For a small home I think the care and devotion we get is excellent. I think they look after me very well. Surveys were completed by eight people who use the service and they all said they receive the care and support they need. The format of the care plans has changed since the last inspection and the quality of the information provided is good. They are easy to understand, are reviewed regularly and at least once a month. A full review of each persons care is carried out each month by the key worker and daily records are maintained. Care staff told us the care plans are well set out and easy to read. They check the care plans for any changes and write in the daily reports for each shift. Staff spoken with had a good knowledge of the care needs of the people whose care we tracked. The care plans do not currently provide a person centred approach to care and people who use the service need to be consulted about their individual plans of care. The service are already aware they need to improve in this area as the AQAA under the section what we could do better said, we need to offer a more person centred approach to delivery of care. This will be achieved by better care plan structure, involving the service user, family or friends. The pharmacist inspector visited the home on 4th August 2009 as part of the key inspection to check the management and control of medicines within the home. A previous inspection had found that medication was stored in the laundry room. At this inspection we saw that medication had been moved to a locked room upstairs. The temperature of the room was recorded daily and was within the correct storage temperature for medication. This means that medication was stored securely and within the recommended temperature ranges. The manager informed us that care staff who handle medication had undergone medication training in 2008. We were not shown certificates; however a member of staff informed us that her certificate was kept at home. This means that staff who administer medication have been trained to do so and ensure the safety of the people who use the service. Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 13 We were shown a medication policy, which was dated 8th April 2009 and had been updated. The policy included a procedure for administration; however other procedures for safe medication handling were not available. For example, there was no written procedure for the receipt or disposal of medication. This means that due to a lack of written procedures care workers may not follow safe and best practice. We looked at the current records for the receipt, administration and disposal of medication for people living in the home. The medication administration record (MAR) charts were documented by the care staff either with a signature for administration or a code was documented with a reason why medication was not given. However, the receipt of medication was not always documented. For example, two people had recently been admitted for a short respite stay. The records for the receipt of their medication were incomplete and had not been documented. We also found that a painkiller had not been documented onto one of the MAR charts and therefore there was no record to show if it had been given. This means that the home failed to keep accurate records of medicines held in the home particularly for people staying for respite care which may place people at risk of harm to their health and well being. We saw that the home kept a record of any medication changes or reviews made by a GP. This record was kept next to the MAR charts. This was acknowledged as good practice and ensured that any medication changes were immediately available for care staff to check. Risk assessments for the self administration of medication were available. We spoke to one person who was looking after and taking their own medicines which was stored in their bedroom. They were happy looking after their own medicines and allowed them their independence. We looked at the risk assessment dated May 2009, which identified any hazards and the checks that were made to ensure that the person was safe. We saw staff knock on doors before they entered the room. People we spoke to told us their privacy and dignity is respected and the staff knock the door before they come into their room. We saw staff speaking to people with respect. Considerable improvements have been made since the last inspection. Six requirements from the last inspection report relating to health and personal care have been met. Two requirements relating to the storage of controlled medicines and the homes written policy and procedures for the management of medication have been partly met. These requirements remain with the same timescales. We will monitor the homes compliance with these requirements within two months from the date of this inspection. Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 , 14 & 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People would benefit from a person centred approach to social care to ensure they are supported to continue to enjoy their individual hobbies and interests in the home and outside in the local community. People are able to keep in touch with their family and friends and have healthy, well-presented meals and snacks at a time and place to suit them. EVIDENCE: We saw information in the care plans about peoples hobbies and interests for the two people we tracked. We saw that staff are recording activities that take place in the home in a separate book, but there is no information to show who is joining in with the activities. This is not being recorded in the individual care plans and is not being promoted in a person centred approach to the provision of social care. The care staff on duty provide activities in the afternoons. On the day of the inspection we saw staff spending time with people in the lounge during the Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 15 afternoon. There was music playing and some people were singing along to the music. One person was doing a jigsaw with a carer and another person was playing cards with large print cards for people who have sight problems. One person whose care we tracked told us they preferred to spend most of the time in their room. They enjoy watching the television or their videos or DVDs. They told us the staff collect a daily paper for them from the shop over the road and they attend the monthly communion service in the home. They were aware that there are some activities provided in the home but they chose not to join in. There was a mixed response from the eight people who completed the surveys about the activities in the home. We asked if the home arranges activities they can take part in and the response we received was, one person said always, two usually and four people said sometimes. Comments also included; like the activities. Would like to sit outside more. A comment in a staff survey said, residents could perhaps have more say about what activities they would like to participate in. Maybe ask for suggestions. We saw a book case in the lounge with a selection of books of varied topics suitable for both genders. There was only one large print book available for people with sight difficulties. Staff when asked told us they did not have any audio books available in the home. The AQAA stated, the practices at Pals enable residents who are able to exercise choice and control over their lives, however more frequent service user consultation will help to promote a more service user friendly home, leading to a development of person centred approach to the delivery of care. Thus the home have already identified this is an area where improvement is needed. We saw visitors coming into the home and they were made welcomed by the owner, manager and staff. The AQAA stated they had received the following comments from visitors, they are always made welcome and a tray of tea is always provided when we visit. The care plan for one person we tracked mentioned ensuring the person had a choice of where they spent time with their visitors and to ensure they were offered refreshments. When we arrived at the home people were having breakfast of their choice. Their preferences for breakfast were stated in the care records seen. One person told us they have breakfast and lunch in the dining room and supper in their room. We saw staff serving people with morning drinks and biscuits and afternoon tea and cake. The menu for lunch was displayed on the notice board in the dining room. Lunch was faggots, mashed potato, peas and fresh carrots with a dessert of lemon sponge and custard. One person was vegetarian and was served vegetable quiche at lunchtime. Peoples food likes and dislikes were recorded in the care records. The menu for a two week period was seen and this showed the home offers a varied menu; there is no choice on the menu of main course or dessert for lunch and supper. The AQAA states, choice given at mealtimes, special diets are catered for. We Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 16 observed one person we tracked had chosen the vegetarian option being served that day instead of the faggots. We asked people who completed a survey if they liked the meals and five said always, one usually and two sometimes. We saw the minutes from a recent meeting with the people who use the service. They had requested staff provide early morning tea whilst they are in their rooms. Staff told us this had been implemented. Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures are in place to address any complaints so people can be confident complaints are taken seriously. Staff are aware of safeguarding issues and know how to respond to any concerns. Recruitment procedures are thorough to protect the people who use the service from any potential abuse. EVIDENCE: The homes complaints procedure is on display in the home. The owner stated it is currently being reviewed. We saw information informing people who use or visit the service telling them of the change of details of the services regulatory body (Care Quality Commission) and a visitor showed us a letter they had been given informing them of the new contact details. The AQAA states all our service users, their family and staff are aware of our complaints procedure. We havent received any complaints in the last twelve months. All our staff are aware that if they are concerned about any of the service users they would report it to management. We looked at the homes complaints record and the last complaint recorded was received in 2007. All eight surveys from people who use the service told us there is someone they Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 18 can speak to at the home if they are not happy. Staff surveys told us they knew what to do if they received a complaint. We have not received any complaints about this service since the last inspection in September 2008. One of the inspectors who were not known by the owner was asked for their identification before they invited them into the home. The AQAA states Pals has a policy and procedure on adult protection. All new staff have a POVAfirst done before employment commences. The AQAA states a response in a recent questionnaire sent out to people who use the service stated I feel very safe and secure living at the home. Staff spoken with were aware of what action they would take if they suspected any abuse in the home. The owner has arranged for all staff to receive refresher training next month about safeguarding people from an external training organisation. We looked at the recruitment records for two staff employed in March and April 2009. Criminal Records Bureau checks had been completed before they started work in the home. Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People stay in a safe and well-maintained home that is homely, clean, pleasant and comfortable. Improvement has been made to the homes practices for the management of infection control to ensure people are not placed at risk of cross infection. EVIDENCE: We looked at the parts of the home used by the people whose care we tracked. These areas were clean, tidy, and well maintained. Their rooms were nicely furnished and decorated and they had personalised them with their own furniture, electrical items, photographs, pictures and ornaments. There were approved locks on the bedroom doors to promote privacy, although keys were not provided to enable them to lock their bedroom doors. Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 20 The AQAA states the environment has improved in the last 12 months as they have replaced the flooring throughout the communal areas on the ground floor and these areas and the first floor corridors have been redecorated. Six bedrooms and two bathrooms have been redecorated. Two bedrooms have new carpet. A new handrail has been fitted to the front entrance. All fire doors have been fitted with Dorguards to enable them to be held open so people can walk through easily but they will close automatically if the fire alarm system is activated. A new shower installed in the wet room. A new hot water boiler has been installed in the kitchen so water is now heated on demand. The manager told us the temperature of the water is set at the boiler. The eight surveys we received from people who use the service told us the home is fresh and clean. Comments received said, the home is clean and tidy and Im very happy and grateful for the room I have been given and the nice view from the window. A comment in a staff survey said the environment is nice and clean. The AQAA identifies we need to improve the visual setting of the garden area. There is a small paved area at the rear of the house with patio furniture available for use. The minutes from a recent meeting with the people who use the service shows they requested some tubs of flowers for this area. Staff told us this had been implemented. We saw some tubs of flowers on the patio area of the home. The home have improved their practices and procedures since the last inspection as communal flannels are now used for peoples face and disposal cloths have been provided for washing other areas of the body. The manager confirmed communal towels and flannels and any soiled laundry is washed above 65 degrees Celsius as bacteria is destroyed at these temperatures. The AQAA states they have procedures in place for the management of infection control and all staff have received training in this subject. The owner has arranged for all staff to receive refresher training next month about infection control from an external training organisation. The three requirements relating to the environment from the last inspection report have been met. Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. EVIDENCE: On the morning of the inspection the manager and two care staff were on duty with ancillary support from one domestic and a cook. In the afternoon there were three care staff on duty. The owner was in the home all day and was acting in a managerial capacity during the afternoon. We looked at the staff rota for a two week period. These showed the manager or deputy is on duty each day Monday to Sunday, when the deputy manager is on duty she provides managerial cover to five oclock in the afternoon when she is replaced by another care assistant. There are two care staff on duty each shift in addition to the manager or deputy. One cleaner works Monday to Friday each morning. A cook is on duty for fours hours each day. There are two waking night staff. These staff launder the clothes during the night and carry out other cleaning duties, such as cleaning communal rooms. The owner is actively involved in the management of the home. Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 22 Staff told us there is enough staff on duty in the home. We asked eight people who use the service in surveys if there is staff available when needed and they responded; three said always, two usually and three sometimes. Comments stated we find staff helpful and friendly most of the time. Comments from staff in surveys said there is good communication between staff. People who use the service told us the staff are very nice and very helpful. They home currently employ female staff from a multi-cultural background. The AQAA states there is sufficient staff on duty to meet the needs of the service users. All staff who has achieved NVQ 2 is now completing Level 3. The manager told us they have three staff who has achieved NVQ 2; four staff has NVQ 2 and 3. Two staff are currently undertaking NVQ 3 and one undertaking NVQ 2. The owner told us he has recently purchased training from an external trainer to cover updates for all the mandatory training for staff, for example moving and handling, health and safety, infection control. This training will commence in September 2009. We looked at the recruitment files for the two most recently employed staff. All information required through regulation was seen including Criminal Records Bureau checks in place before they started work in the home. We saw induction records for both of these staff. The induction programme used for these two staff is not in line with the Common Induction Standards (CIS). We saw an induction file which contained an induction programme template. The owner said this programme will be used for all new staff. The home need to review this programme before it is put into use to ensure it is in line with the CIS which have been developed by Skills for Care as these set down minimum expectations about the learning outcomes that need to be met so that new workers know all they need to know to work safely and effectively. The AQAA states the service do not have a policy for the Induction of staff. This needs to be put into place. Staff told us in completed surveys the home had carried out pre-employment checks before they started work at the home. They were asked if their induction covered everything they needed to know and the response we received was one said very well, one partly and one mostly. The two requirements relating to staffing in the last inspection report have been met. Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because it is run and managed appropriately. Peoples opinions are sought so that the home develops and reviews their practice and make sure they continue to improve the service. The environment is safe for people and staff because health and safety practices are carried out. EVIDENCE: The AQAA states the care manager has been in charge of Pals for more than 11 years, is now assisted by a deputy care manager who is working towards her managers qualification. The manager told us she has not attended any training about the Mental Capacity Act 2005 or the deprivation of liberty Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 24 safeguards. The manager told us the deputy manager has started her NVQ 4 and hopes to complete this in the next six months. The owner has also started NVQ level 4 training since the last inspection. A comment in a staff survey told us, we always have support and information from the manager. A comment in a survey from a health professional told us it is a very well run home. We were told the service does not hold or manage any monies belonging to people who use the service. The AQAA states a quality assurance system is being set up to ensure that the home is run in the best interests of the service users who live at Pals. More frequent meetings are planned to achieve these goals. Most of the policies and procedures are being updated. The numerical information in the AQAA showed there are a number of policies which the service does not have in place. This was discussed with the manager at the inspection and most have now been put into place with the exception of a policy for the induction of staff and racial harassment. Questionnaires have recently been given to people who use the service as part of their internal quality monitoring programme. A meeting has been held with people who use the service and suggestions from them have all been implemented. Information provided by the owner confirms all of the homes equipment has been serviced in the last 12 months. We looked at the records for window restrictor checks and saw they were recorded each month as being checked. We looked at the management of Legionella and water temperatures. We saw radiators with covers to prevent people burning themselves. The owner told us they have had a new gas boiler fitted and the water is heated on demand. They do not have water storage tanks in the home. Thermostatic valves are fitted to all en-suite baths to maintain the water at a maximum temperature. The owner told us he checks the water temperatures at the hot water outlets each month. He does not record the individual temperatures, only if they are outside the acceptable range. Shower heads are chlorinated every month and a water sample is sent for testing annually. We did not see any thermometers in the wet room to test the temperature of the water. The manager told us the temperature is set at the boiler. Staff told us they check the temperature of the water with their hand before the shower is used. The home has had two inspections by Worcestershire County Council in June 2009. One from the Environmental Health Officer, who awarded them a four star rating and a health and safety inspection. The outcome of this inspection stated no contraventions in health and safety management by the service. We saw accident records being completed for one person we tracked following a number of falls. These forms need to be removed from the accident book and placed in the individual care records so that they comply with the Data Protection Act 1998. Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X N/A X X 3 Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Timescale for action To make arrangements to ensure 04/08/09 that controlled drugs are stored securely in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with the guidelines from the Royal Pharmaceutical Society of Great Britain. (This requirement has not been met; the date given is the date of the inspection). The policy and procedure for the 04/08/09 storage, handling and administration of medication must be reviewed and action taken to ensure medication is being appropriately managed. (This requirement has not been met; the date given is the date of the inspection). To make arrangements to ensure 04/09/09 that records are kept of all medicines received, administered and leaving the home or disposed of to ensure that there is safe control and handling of peoples medication. DS0000018669.V377302.R01.S.doc Version 5.2 Page 27 Requirement 2. OP9 13(2) 3. OP9 13(2) Pals Residential Home 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 OP9 OP12 Good Practice Recommendations The pages of the controlled drug register should state the name and strength of the medication that is being recorded to ensure accuracy. People should be consulted about their hobbies and interests and this information recorded and used to formulate a social care plan. People should be supported to continue to enjoy their hobbies and interests in and outside of the service, which suit their needs, preferences and capabilities. Particular consideration should be given to people with visual, hearing or dual sensory impairments and those with physical disabilities. This is so that people have access to social stimulation suited to their needs and expectations and which support them to retain their mental and physical capacity. People should be offered the choice of a key to lock their bedroom doors to ensure they are able to maintain the security of their bedroom. The induction programme should be reviewed to ensure it is in line with the Common Induction Standards which have been developed by Skills for Care as these set down minimum expectations about the learning outcomes that need to be met so that new workers know all they need to know to work safely and effectively. The staff should undertake training about the Mental Capacity Act 2005 and the deprivation of liberty safeguards to ensure they understand their implications for day to day practice and care planning. 3. 4. OP19 OP30 5. OP38 Pals Residential Home DS0000018669.V377302.R01.S.doc Version 5.2 Page 28 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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