Care Home: Pantiles Residential Care Home

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What the care home does well The service provides a happy, friendly and welcoming environment. People and staff were observed to have good relationships and were seen spending time and interacting with each other. Each person has a detailed, comprehensive and accessible lifestyle and health action plan. The residents are actively supported to be fully involved in the completion of these plans. The plans are regularly reviewed and cover all areas of the person’s life. The residents are supported to maintain their independence, make decisions and choices in their daily lives and to participate in a range of activities. The service supports the residents to raise concerns and complaints and they have an accessible complaints procedure, which everybody knew about. People living in the service benefit from a stable staff team who know them well and receive lots of training. A family member of one of the residents expressed great satisfaction about the standard of care their relative receives at the home. What has improved since the last inspection? The service has complied with the one requirement made at the last inspection and hand towels are now available to prevent cross infection. In addition the home is undertaking a refurbishment of the central heating, which has resulted in the lifting of the floors throughout the home. The manager stated that once this is completed further refurbishment work which has been on hold will be started. What the care home could do better: No recommendations or requirements were made as a result of this site visit. The environment of the home will be enhanced by refurbishing the home, ensuring that appropriate furnishings are purchased in the communal rooms. The furniture must be designed and constructed to meet the needs of the residents. Key inspection report Care homes for older people Name: Address: Pantiles Residential Care Home 67 Harriots Lane Ashtead Surrey KT21 2QE The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kenneth Dunn Date: 0 9 0 9 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement They reflect the Care Homes for Older People Page 2 of 27 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. 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 Page 3 of 27 Internet address Care Homes for Older People Care Homes for Older People Page 4 of 27 Information about the care home Name of care home: Address: Pantiles Residential Care Home 67 Harriots Lane Ashtead Surrey KT21 2QE Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): The Pantiles Care Home Limited The registered provider is responsible for running the service care home 16 01372275310 01372279201 pantilescarehome@btconnect.com Type of registration: Number of places registered: Conditions of registration Category(ies): dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category 0 Number of places (if applicable): Under 65 2 Over 65 0 16 Additional conditions: The maximum number of service users to be accommodated is 16 Date of last inspection: Brief description of the care home: D D M M Y Y Y Y Pantiles care home is registered to provide care for 16 older people. The home is a large detached house set in a residential road, close to the village of Ashtead in Surrey. The home offers fourteen single bedrooms and one double. Nine bedrooms have ensuite facilities and there are ample bathrooms, showers and toilet facilities throughout the property, There is a range of communal areas including a lounge, conservatory and Care Homes for Older People Page 5 of 27 dining room. The garden is well maintained and secure for all the residents to access and use. Car parking is offered to the front of the house. The weekly fees range was from £440.00 to £550.00. Care Homes for Older People Page 6 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Two star good service. Our judgement for each outcome: Choice of home Individual needs & Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct and Management of the Home Poor Adequate Good Excellent How we did our inspection: This site visit was part of a key inspection. The visit was unannounced and we arrived at 10:00am and left at 14:00pm. The last key inspection was carried out on the 20th of September 2009. Information was provided to us by the service prior to this visit the service completed an Annual Quality Assurance Assessment (AQAA). This is a self assessment that focuses on how well outcomes are being met for people using the service. We received the AQAA by the expected date, which was clear and detailed and gave us all the information that we asked for. Reference is made to this assessment throughout this report. Care Homes for Older People Page 7 of 27 We received information from one family member of a resident. During this visit we also meet with people who live in the service. We met with the registered manager and staff. During this visit we looked at staff recruitment, staff training records, care plans, risk assessments, menus, Quality assurance systems, medication administration policies, health and safety records and policies and procedures. We also reviewed other information that we have received since our previous visit including notifications. Care Homes for Older People Page 8 of 27 What the care home does well: What has improved since the last inspection? 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. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: 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 are provided with appropriate information, which they need to know in order to make an informed choice about the suitability of the home as a place to live. People’s needs are assessed prior to admission to the home. Evidence: The home provides a statement of purpose and a service user’s guide. Both documents have been reviewed and updated regularly the most recent review was completed in June 2009. The registered manager stated that regular reviews have been undertaken and the review of the documents reflected this. Information supplied in the AQAA states that people referred to the service receive an assessment prior to admission to the home. The assessment policy has been reviewed and updated to ensure that it remains current and offers the potential resident security in their future placement. The policy was last reviewed and updated July 2009. This was confirmed by information seen on file of a random selection of three residents including the most recent person admitted to the home. The files fully cover the resident’s health, personal, emotional, social, participation and cultural needs. Other information had also been obtained from the care managers, health care professionals and family members. Care Homes for Older People Page 11 of 27 This service does not provide solely intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. This is what people staying in this care home experience: Judgement: 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 receive support from staff in the way they prefer and want to ensure that their physical and emotional needs are met. People are protected by the homes medication policies and practices. Evidence Each person has a plan of care in place. During this visit a random sample of three peoples care plans was undertaken. The care plans were detailed and comprehensive and provided clear information and guidelines to staff about people’s health, personal, emotional, social needs and how they are to be supported. Information supplied in the AQAA states that care plans are reviewed six monthly and that a weekly meeting takes place between residents and staff. Daily diaries are maintained, which reflect people’s goals. It was clear that peoples likes, dislikes, choices and preferred routines are recorded and respected, such as their preferred times of going to bed and getting up. During this visit staff were observed to be caring and respectful to people, the manager stated that the staff are very aware and protective in ensuring that peoples privacy and dignity. Each persons care plan contained risk assessments ensuring that they are kept safe. People are supported by a range of health professionals including, General Practitioners, Community Nurses, Chiropody and Dentists. The manager stated that almost all of the residents have very close links with the Ashtead area at the time of the visit over 85 had moved into the home from the village. As a result of the Care Homes for Older People Page 13 of 27 localness of the residents they are all encouraged and supported to retain their existing GP’s. In the event of this not beingg possible the manager supplies detailed information about two surgeries in the area to allow the resident to make an informed choice about the GP’s the want to use. The ample of resident’s files demonstrated that the home retains detailed records of all health consultation visits. During this visit we looked at the homes medication administration policies. Medication was stored appropriately and systems are in place for the receipt and auditing of items. Medication is dispensed using the monitored dose system (MDS). Each person has a medication profile for identification and they were all signed. The medication policy was dated July 2009. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. This is what people staying in this care home experience: Judgement: People using the service good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activity programme meets the recreational needs of the residents. Spiritual needs are observed and promoted. The systems for autonomy and choice are good enabling residents to exercise choice and control over their lives. The standard of catering is good and offers residents a wholesome and varied diet. Evidence: The home has a limited activity programme in place that reflects individual needs and choice. The manager stated that the limitations on the activities programme was a result of the current resident group’s independence and wish to enjoy spontaneous events rather than a regimented programme of activities. The manager did state that the residents are encouraged to participate in activities but the experience of the home is that the majority prefer non structured activities. The activities offered at the home are however regularly reviewed by the manager, residents and the staff team to ensure the home is offering appropriate things for the residents. The manager stated that unfortunately these discussions are not regularly recorded so there is little or no evidence to support that the discussions take place. This was discussed with the manager during the site visit and it was agreed that in future they should be raised and placed on the minutes in the regular residents meetings in order to keep a clear record. There was evidence of garden activities being organised weather permitting and special events and birthdays are celebrated. The home held a summer garden party fund Care Homes for Older People Page 15 of 27 raiser for a national charity, as way of thanks after they supported one of the residents during a long illness, the event was opened to the local community as well as friends and families of the residents. There was documented evidence in the home of the success the charity garden party in the form of photographs and statements from those who were at the party, congratulating the home on a wonderful day. Family contact is maintained and relatives and visitors are welcome in the home at any reasonable time. Relatives are encouraged to contribute to the care planning process and to attend care reviews. They are also encouraged to participate in home events and functions. Spiritual needs are supported with weekly and monthly religious services being organised in the home. Visits from various clergy or lay persons are also arranged. Residents are given the opportunity to make choice regarding all aspects of their daily lives. They can choose when to get up and go to bed, when they wish to bath or shower, what clothing they wear, how they wish to spend their day, what activities if any they want to take part in. Menus are planned by staff with input from residents. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. This is what people staying in this care home experience: Judgement: 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 complaints and safeguarding procedures are in place to ensure that the residents are protected. Evidence: The home has a complaints procedure in place dated July 2009 and this forms part of the residents information guide. The registered manager stated that the policy is reviewed on a regular bases and there is clear evidence to support this, which was evidence during the site visit. The policy reviewed during the site however contained limited contact details of external agencies. This was discussed with the manager and it was agreed that the manager would undertake a further review and to ensure that all relevant contact details would be included in the new policy. Staff spoken to were aware of the complaints policy document and that any issues or concerns raised are managed before they get to the formal complaints process. Records confirmed that there has been four complaints made in the last 12 months and that they were appropriately managed within the stated time frames of the policy, there was documentary evidence that the final resolution for all 4 complaints were resolved to the satisfaction of the residents. There is a safeguarding procedure in place and it was confirmed that all staff have received appropriate training in order to ensure that they invoke the procedure if they felt abuse was taking place. The home also has a copy of Surrey’s multi agencies policies and procedures on safeguarding vulnerable adults in place. The staff have all attended external local authority training in these procedures. In addition the home has recently received a training DVD from Surrey County Council safeguarding team to reinforce the concept of safeguarding among the staff team. Care Homes for Older People Page 17 of 27 Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. This is what people staying in this care home experience: Judgement: 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. The home is suitable for its stated purpose. The residents live in a comfortable, homely environment, which meets their individual and collective needs. The home however should review the décor and the appropriateness of the furniture in the communal areas. The standard of cleanliness is good and procedures are in place minimise the spread of infection. Evidence: A partial tour of the premises was undertaken as part of the site visit including all communal area. On the day of the site visit the home was undergoing a refurbishment of the central heating system. This was part of the planned long term maintenance work on the home. Therefore areas of flooring and floor covering have been damaged during the refurbishment of the heating system. The manager stated that new floor covering would be fitted once the refurbishment of the heating has been completed. The home is relatively comfortable and homely. There is a large and bright entrance hall with some seating. The rear conservatory offers a pleasant area to sit and enjoy the garden. The dining room however was dark and the decoration was poor. In addition the furniture in the dining room is not suitable for the residents. The tables are of a light pedestal construction and the chairs are a mix of several designs and styles and not designed for people with poor mobility and balance. Again the sitting room decoration is old and required to be updated the furniture is mainly high backed wing chairs however the majority were stained and some had rips to the fabric covering. Care Homes for Older People Page 19 of 27 During the site visit it was not possible to enter occupied bedrooms as people were either in the rooms or unavailable to give permission to undertake the visit. The AQAA provides information that all bedrooms are now used only as single occupancy. The manager stated that the residents can bring items of furniture and personal possessions with them into the home to help personalise their rooms and make it feel homely. Toilets and bathrooms have been adapted to meet the mobility needs of the residents. There is a stair lift to access the first floor and ramps access to the garden. The standard of cleanliness is good. There is an infection control policy in place and all staff undertake training in this policy. Disposable aprons and gloves are provided and staff were observed to wash their hands frequently. Arrangements are in place for the collection of clinical waste. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. This is what people staying in this care home experience: Judgement: 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. Staffing arrangements are sufficient ensuring that resident’s needs are being met. Staff training and development is ongoing providing a competent staff team to care for the residents living in the home. The recruitment and vetting of staff is good promoting the welfare and safety of the residents however documentation must be maintained to ensure that all appropriate checks are undertaken. Evidence: The staff duty rota was seen and there was sufficient staff on duty at all times to meet the needs of the residents. Feedback received from a family member of a resident stated that the standard of care was very good and that the residents are well cared for. The manager stated that there are times when the home is busy but that there were always enough people on duty to support the residents and other staff members. Staff training is ongoing and evidence of this was seen in individual files. All staff undertakes induction training. Mandatory training is in place and includes fire safety, manual handling, food hygiene, health and safety and medication awareness. National Vocational Qualification (NVQ) records evidenced that the home has a commitment to staff to undertake an NVQ in care, in order to improve the support offered to the residents. There is detailed evidence that formal supervision is in place. There is a recruitment policy in place, which was reviewed by the manager during July 2009. Care Homes for Older People Page 21 of 27 Three staff employment files were randomly sampled during the site visit. In two files gaps were highlighted in the employment histories of the staff members, this was discussed with the registered manager. The manager stated that the home was aware of the nature of the gaps in the employment histories and that they have been discussed fully with the individuals concerned; regrettably there is no documentary evidence to support this. The manager made an undertaking that all gaps would be documented in the staff files and an audit of all files would be completed by the manager. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. This is what people staying in this care home experience: Judgement: 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 arrangements for the day-to-day management of the home are good. The systems in place for monitoring the quality of the service should be reviewed to ensure that they fully represent the best interests of the residents. Robust policies and procedures are in place ensuring the safety of the residents and staff. The health and safety of the residents and staff are promoted and protected. Evidence: The home is well managed by the registered manager who is fully qualified to undertake this role. The registered manager has several years’ experiences in the provision of care for older people and demonstrated strong leadership skills. The registered manager is supported by the registered provider. One family member of a resident who contacted the commission stated that “the home was well run” and “I can always talk to the manager”. The home has a comprehensive set of policies and procedures to ensure that the residents and staff are safeguarded. The policies and procedures are continually reviewed and updated in order to ensure that they accurately reflect current legislation. Systems are in place to manage random quality assurance (QA). Questionnaires are distributed to residents and their feedback is analysed and acted upon. The service has recently undertaken a QA but at the time of the site visit it had not been fully analysed. The questionnaire undertaken in June 2008 was available for the purpose of this visit; the information provided by the QA highlighted a high level of satisfaction throughout Care Homes for Older People Page 23 of 27 the home. Care plans are reviewed monthly and audits of medication are also undertaken monthly. Health and safety audits and maintenance check are undertaken weekly. The health safety and welfare of the residents and staff are observed and promoted. All staff are familiar with the health and safety policy and have undertaken training in its operation and procedures. Risk assessments are in place for all identified risks and to promote safe working practices. The inspector observed that COSHH (Control of Substances Hazardous to Health) procedures are adhered to. Fire safety is observed and there is a contract in place for the maintenance of fire fighting equipment. All staff have regular training in fire and safety awareness. The AQAA indicated that all the required safety certificates are in place and renewed as required. The inspector noted that home kept records of all accidents and incidents and these are reported accordingly. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes No Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: 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). 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