Care Home: Partridge House Nursing And Residential Care Home

What the care home does well The home provides nursing care for people with a mental health illness of the older person and for older people with general mental health conditions. The home is clean, comfortable and well maintained with residents being able to have free access to the garden and most parts of the home. The standard of catering provided is good, with choices of menu available at all meals. Food is well presented and registered nurses preside over the serving of meals and therefore are aware of the nutritional intake of the residents. It was seen that all grades of staff know each resident by name and were aware of the preferences of the individual residents, and residents were seen to be treated with patience and understanding with good interaction between staff and residents apparent. Visitors to the home were spoken with and were very positive about the home, the care of their relatives or friends who live at the home and the friendliness and helpfulness of the staff. What has improved since the last inspection? There have been many improvements since the last inspection. Change of management within the home and the employment of a deputy manager have resulted in the recruitment and retention of permanent staff. On previous inspections the home has appeared chaotic and rushed, during this inspection the home was calm and unhurried, staff were spending time with residents and there was a pleasant and orderly atmosphere. Staff spoken with said ` we now have enough staff on duty, agency staff are rarely used`: ` There has been 100% improvement in the home, it`s a nice place to work now`: ` Management is approachable and understands that we need sufficient staff to give the residents the care they need. Some areas in the home have had new carpets, the maintenance in the home is now receiving regular attention and there were no unpleasant odours in any area of the home. The quality of the food and the choices offered on the menu has improved and the kitchen was clean. The home was recently awarded five stars in the ` scores on doors` initiated by the Environmental Health Authority. An activities co-ordinator is in place and a `reminiscence` area has been set up in the ground floor lounge. This resembles a sitting room of the 1940`s-1950`s era and has objects commonly used in homes at this time. Residents were seen taking themselves in there and sitting contentedly. A new format of care planning, which was commenced last year, is now in place and the majority of the care plans seen reflected the current and changing needs of the residents. Records relating to complaints were complete and reflected the actions that were had taken place to address the complaint and to prevent reoccurrence of the concern. The home has complied with seven out of the eight requirements made at the last inspection. Efforts have been made towards compliance with the eighth requirement, which is regarding activities, and although much has been done, more input is required. There have been improvements noted in all areas of the home and it is hoped that this level of improvement will now be sustained. What the care home could do better: Whilst the majority of care plans were reviewed on a regular basis, some parts of the care plans, such as individual risk assessments, have not always been reviewed regularly. The manager should ensure that registered nurses are aware of their responsibility in the reviewing of care planning and involving residents or their representatives in this process. The manager must ensure that systems are in place to ensure that care plans are kept up to date in the absence of key workers. Anchor has made a decision to stop keeping daily care records in the care plans; these have been replaced by daily care sheets, which have not always been completed by the care staff. If the home is ever in a position to have to evidence that daily care has been given to a specific resident it would be difficult to prove that they are fulfilling their duty of care. There is scope for the variety and frequency of activities to be increased to ensure that residents admitted under this category of registration have an activities programme, which fulfils the need for stimulation and holistic care. Whilst there is evidence that the company quality-monitoring programme takes place, there was no evidence that the views of relatives and residents have been obtained. The area manager has given assurances that this would be commenced. The Statement of purpose kept in reception requires amending to show current management arrangements and the manager should ensure that allprospective residents have written confirmation regarding the home`s ability to meet their needs. Assurances were given that this would be commenced. Not all new residents are receiving the homes terms and conditions in a timely manner. The CSCI expects the home to address those areas that still require improvement, as identified in the main body of the report. Requirements have not been made over all the areas discussed as assurances were received from the area manager that action would be taken. These will be examined at the next inspection. CARE HOMES FOR OLDER PEOPLE Partridge House Nursing And Residential Care Home Leybourne Road Off Heath Hill Avenue Bevendean Brighton East Sussex BN2 4LS Lead Inspector Elizabeth Dudley Unannounced Inspection 24th April 2008 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Partridge House Nursing And Residential Care Home DS0000014021.V361060.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. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Partridge House Nursing And Residential Care Home Leybourne Road Off Heath Hill Avenue Bevendean Brighton East Sussex BN2 4LS 01273-674499 01273 693332 cliff.parker@anchor.org.uk www.anchor.org.uk Anchor Trust Address 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) Vacant Care Home 38 Category(ies) of Dementia (38), Mental disorder, excluding registration, with number learning disability or dementia (38) of places Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is thirtyeight (38) Service users must be aged sixty (60) years or over on admission Date of last inspection 1st May 2007 Brief Description of the Service: Partridge House is a purpose built home that was developed in partnership between Anchor Trust, ARDIS and Brighton and Hove Social Services to provide care for 24 older service users with mental health problems. Fourteen new rooms were added bringing the number of service users able to be accommodated to 38. This now provides 30 nursing beds, 6 for residential care and 2 for respite care. A conservatory has been added to the building. All of the accommodation provided is in single rooms, which have en-suite facilities, and the home is divided into four units. The gardens are well maintained and accessible to all service users, a shaft lift gives access to all parts of the building. Anchor Trust is a not for profit organisation and ARDIS is a local charity providing services for people with dementia. Partridge House is situated in a residential area, local transport links are poor, but there are good car parking facilities. The current fees as of the 1st May 2008 are £730:32p per week. Additional charges are payable for chiropody, hairdressing and other items. Details of these are available from the home. Partridge House Nursing And Residential Care Home DS0000014021.V361060.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 2 stars. This means the people who use this service experience good quality outcomes. This unannounced inspection took place on the 24th April 2008 over a period of eight hours. The appointed manager was not present at the inspection and the administrator and registered nurses on duty facilitated it. The results of the inspection were discussed with the manager of another Anchor home on the instructions of the area manager. A pharmacy inspector from the CSCI accompanied the lead inspector and undertook a thorough audit of medications administered in the home. Results of this are discussed in the main body of the report and a recommendation made. Methods used to collect information about the home included examination of documentation in the home, observation of staff working with residents, the serving of breakfast and lunches and conversations with residents, staff and visitors to the home. Most residents were seen or spoken with during the inspection, and four residents were spoken with in depth and gave their views on life in the home. Documentation examined included care plans, personnel files, staff training and supervision records, catering records and health and safety files. Prior to the inspection questionnaires were sent out to relatives and residents. Of these thirteen were returned from relatives and visitors to the home and two from residents. These gave information about the daily life in the home and helped to inform the judgements made in this report. Thanks are extended to those people who responded. The surveys returned were generally positive and a small selection of comments from them are as follows: ‘I have nothing but praise for Partridge House, my father is lucky to be there’: ‘ They have splendid parties and eh food is wonderful’: ‘Staff are always friendly and co-operative’: ‘All the residents appear contented, comfortable and clean’: ‘ I think it would be good if the staff wore name badges, it would help relatives and residents’. ‘ I do have to ask for information about my mother, it is not always volunteered’: ‘ an occasional interview with the manager or a senior nurse to discuss my relatives progress would be appreciated’. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 6 The Annual Quality Assurance Assessment, required by the CSCI, which gives an overview of what has been achieved in the home and issues to be addressed, was received by the CSCI prior to the inspection. This accurately reflected the current status of the home. This was used as part of the inspection process. What the service does well: What has improved since the last inspection? There have been many improvements since the last inspection. Change of management within the home and the employment of a deputy manager have resulted in the recruitment and retention of permanent staff. On previous inspections the home has appeared chaotic and rushed, during this inspection the home was calm and unhurried, staff were spending time with residents and there was a pleasant and orderly atmosphere. Staff spoken with said ‘ we now have enough staff on duty, agency staff are rarely used’: ‘ There has been 100 improvement in the home, it’s a nice place to work now’: ‘ Management is approachable and understands that we need sufficient staff to give the residents the care they need. Some areas in the home have had new carpets, the maintenance in the home is now receiving regular attention and there were no unpleasant odours in any area of the home. The quality of the food and the choices offered on the menu has improved and the kitchen was clean. The home was recently awarded five stars in the ‘ scores on doors’ initiated by the Environmental Health Authority. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 7 An activities co-ordinator is in place and a ‘reminiscence’ area has been set up in the ground floor lounge. This resembles a sitting room of the 1940’s-1950’s era and has objects commonly used in homes at this time. Residents were seen taking themselves in there and sitting contentedly. A new format of care planning, which was commenced last year, is now in place and the majority of the care plans seen reflected the current and changing needs of the residents. Records relating to complaints were complete and reflected the actions that were had taken place to address the complaint and to prevent reoccurrence of the concern. The home has complied with seven out of the eight requirements made at the last inspection. Efforts have been made towards compliance with the eighth requirement, which is regarding activities, and although much has been done, more input is required. There have been improvements noted in all areas of the home and it is hoped that this level of improvement will now be sustained. What they could do better: Whilst the majority of care plans were reviewed on a regular basis, some parts of the care plans, such as individual risk assessments, have not always been reviewed regularly. The manager should ensure that registered nurses are aware of their responsibility in the reviewing of care planning and involving residents or their representatives in this process. The manager must ensure that systems are in place to ensure that care plans are kept up to date in the absence of key workers. Anchor has made a decision to stop keeping daily care records in the care plans; these have been replaced by daily care sheets, which have not always been completed by the care staff. If the home is ever in a position to have to evidence that daily care has been given to a specific resident it would be difficult to prove that they are fulfilling their duty of care. There is scope for the variety and frequency of activities to be increased to ensure that residents admitted under this category of registration have an activities programme, which fulfils the need for stimulation and holistic care. Whilst there is evidence that the company quality-monitoring programme takes place, there was no evidence that the views of relatives and residents have been obtained. The area manager has given assurances that this would be commenced. The Statement of purpose kept in reception requires amending to show current management arrangements and the manager should ensure that all Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 8 prospective residents have written confirmation regarding the home’s ability to meet their needs. Assurances were given that this would be commenced. Not all new residents are receiving the homes terms and conditions in a timely manner. The CSCI expects the home to address those areas that still require improvement, as identified in the main body of the report. Requirements have not been made over all the areas discussed as assurances were received from the area manager that action would be taken. These will be examined at the next inspection. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6. People who use the service experience good quality outcomes in this area. Prospective residents receive sufficient information about the home before deciding whether they wish to live there. Preadmission assessments are comprehensive and contain sufficient information to inform the home and the prospective residents of whether the home can meet the health and social care needs of the prospective residents, but currently the home does not advise the prospective resident or their representatives of this in writing. Not all recently admitted residents have received a statement of “Terms and Conditions of Residence”. This judgement has been made using available evidence including a visit to this service. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 11 EVIDENCE: The Service User Guide and Statement of Purpose are produced in a format that is able to be easily read by the residents living in the home and includes the information as required by regulation. All residents have received a copy of these documents. Not all copies of the Statement of Purpose had been amended to show the current manager, and the administrator gave assurances that this would be addressed. Prospective residents also receive a brochure. Surveys from representatives of residents stated that generally they were satisfied with the amount of preadmission information they received. Not all recently admitted residents have a copy of the terms and conditions of residence, and this should be made a priority. Prospective residents are assessed by the manager prior to admission to the home, three preadmission assessments were examined; these were comprehensive and included sufficient information to inform the care planning process. Visits to the home by the prospective resident and their representatives are encouraged. No written confirmation is sent to prospective residents to inform them of whether the home can admit them. The area manager gave assurances that these would be commenced. The home employs some registered mental health nurses and some registered general nurses. The majority of staff working at the home have undertaken a “Dementia Care” course. All the residents are admitted under the local authority contracted beds scheme; therefore any application for admission will be referred by the local authority. People are admitted to the home for respite care but the home does not admit people for intermediate care. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. People who use the service experience good quality outcomes in this area The standard of care planning has improved and generally identifies care to be given to meet the residents current and changing needs. Residents are treated with dignity and empathy and good interaction between staff and residents takes place. The standard of medication administration safeguards the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the course of the inspection ten care plans across the units were examined, these showed a general improvement in the standard of care planning in the home, although generally care plans in the ground floor units were more comprehensive than those on the first floor. The majority of care plans showed the current and changing needs of the resident in detail. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 13 Most showed ongoing monthly review of areas related to care, however risk assessments, skin integrity records and waterlow score charts (risk assessments relating to the risks of pressure damage on an individual) were not reviewed monthly, this was particularly apparent in two residents deemed to have a high risk. Anchor policy identified risk assessments of individuals judged to be at a high risk of harm must be reviewed monthly, but staff had reviewed these six monthly. Night care plans should show the person’s preferred time of rising. Few care plans showed evidence of residents or relatives being involved in the care planning. There was evidence of regular blood pressure checks being done on residents that required this, although the frequency required was not always identified in the care plans. Good nutritional and wound care plans were in place. There has been one concern raised about a care plan not having been completed for a resident who was in the home for several days but this is still being investigated. The daily alert sheet on one care plan showed a resident had sustained an injury requiring surgery, but because the key worker was absent, no care plan was in place to identify the specialised care required on the residents return from hospital, the injury had resulted in a change from a good mobility to becoming immobile, care staff said that the resident was being helped every day to mobilise but there were no instructions in the care plan relating to this. The manager must ensure that there is a continuity of care planning during key worker’s absences. Anchor has discontinued the daily record sheets with care staff now expected to fill in the daily care sheets that record personal care given. On the first floor this had not been done on a regular basis, the home would have difficulty proving that personal care had been offered or given. Staff must ensure that their complete name is signed on care plans. Some improvements were still required to ensure that the care plans are robust, but discussions with staff showed they were aware of any deficits and would work to address these. Discussions with the area manager identified that there is still work to be done regarding the care planning, and staff should be reminded of their accountability in this area. There was evidence of visits from relevant health care professionals including the Speech and Language Therapist and the Specialist wound care nurse. Staff use the nursing home support team for advice and have undertaken updating and refreshing of skills. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 14 Ongoing training is in place to train the registered mental health nurses in general nursing skills, which include venepuncture and catheterisation. Few residents in the home were able to communicate their impressions of the home but the inspector spent time sitting in the lounge dining rooms of the various units and saw that Staff were interacting with residents in a calm and friendly manner, all levels of staff knew the residents by name and correct moving and handling techniques were being used. Residents appeared comfortable with the staff and showed signs of recognition, some residents knew the staff by name. One survey received said ‘ I think it would be good if the staff wore name badges, it would help residents and relatives’. Surveys showed that relatives thought the staff communicated any concerns or changes in care to them on a regular basis, however one survey said that ‘ I would appreciate an occasional interview with the senior nurse or manager to discuss my concerns about my fathers progress’. Residents were dressed in a manner, which respected their dignity and in many cases represented the way they would dress prior to coming into the home. Residents nursed in bed appeared comfortable and well cared for. The pharmacy inspector was present at this inspection and examined all areas relating to the administration of medication in the home. Generally the standard of medication administration was good, but staff should check the medication profile of residents with the residents’ General Practitioner on their admission to the home from hospital to ensure that residents receive all prescribed medication from the date of their admission to the home. It is considered good practice to date and sign photographs of residents in the home, which are affixed to the medication charts. Any changes made to the medication charts must be signed. The dates of opening on two bottles of liquid medication were not recorded and this should commence. There were no guidelines in the care plan on medicines prescribe on a ‘when required basis’. Care plans now include end of life care plans, these had not been completed in several cases and staff should attend to this. There are plans to enable staff to attend end of life training, some staff have received updating and training on syringe drivers and other forms of end of life pain relief. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People who use the service experience good quality outcomes in this area Whilst the activities offered to residents afford some variety, there is scope to improve on these and the amount of time afforded to this important part of holistic care. Residents are able to make choices around the activities of daily living and how they spend their day. Residents enjoy varied and well-presented meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides an activities programme and employs a part time activities organiser. Activities include some crafts, painting, flower arranging, reminiscence and sensory stimulation. Some outings are planned and social occasions held to which relatives and friends are invited. Residents admitted to this home would benefit from more time being spent on activities and a greater variety of activities provided. In this type of home activities are an Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 16 important part of the holistic care of the resident and the provision of activities should be viewed as a care need and treated as a priority. The activities programme is displayed but is not in a format that would bring it to the notice of residents. Records are kept of which residents attend specific activities. Social care plans gave some information on residents’ preferences but these require expanding. Residents are able to walk around the home and make full use of the garden. The home has a recently provided reminiscence area in the ground floor lounge, this has been furnished to resemble a family lounge of the 1940’s 1950’s period and a fireplace relevant to this period has been put in. Staff said that residents have responded well to this area. Residents have a choice of what time they get up in the morning, but their preferred times should be identified in the care plans. It was seen that breakfasts are given out individually as residents come into the lounge and any medication the resident requires are given with their breakfast, and particular preferences i.e. seating were respected. Staff were attending to residents in an unhurried manner. Visitors can visit at any time of day and surveys received said ‘ Staff are very kind to us when we come’ ‘Staff are always helpful and co-operative’. On the day of the inspection there was a full church service with two local ministers visiting, staff said that this occurred on a monthly basis, Brighton and Hove mission also visit the home monthly and hold prayers and hymns. The standard of catering has much improved, with a monthly rolling menu in place, which showed a nutritious and varied diet. Residents who require pureed foods now have the same choices of menus as other residents and components of the meals are pureed separately. All meals on the menu showed at least two choices available to residents. Residents are individually asked what they would like to eat when the food is being served, which lessens the risk of them forgetting what they have ordered. The presentation of the food was good and residents appeared to be enjoying their meal, those who were able to respond said that the food was good. Fresh fruit and vegetables were available and most puddings and cakes are made in the home. Very little reliance is now placed on ready prepared or tinned food. Whilst most tables had tablecloths and napkins at lunchtime, this was not apparent at breakfast time and this would help to maintain residents dignity. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 17 A recent environmental health authority visit awarded the home 5 stars in the scores on doors initiative. This reflects the improvement in the kitchen environment and the catering that takes place. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area Residents and relatives were aware of how to make a complaint and were confident that any concerns they may have would be addressed in an open and transparent manner. Staff are aware of their responsibilities in the safeguarding of those in their care and the home operates robust policies in addressing any issues relating to safeguarding. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, which is made available to residents and visitors, and has records of complaints received and the actions taken to address these. Two complaints in the last 12 months, both of which were upheld and actions put in place to prevent reoccurrence. One concern recently raised is in the process of being investigated by social services. There have been 4 adult protection issues in the past 12 months, two of these were still being investigated on the day of inspection and information received since the inspection are that these were unsubstantiated, two previous allegations were also not proven. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 19 The majority of staff have had training in the safeguarding of adults and training is in the process of being arranged for recently employed staff and for updating of this training for other staff. There is evidence in the home that any safeguarding issues are reported to the relevant authority and that the home follows the protocols laid down in the ‘Multi agency safeguarding guidelines’. The policies in the home regarding safeguarding issues were clear and accurately reflected nationally approved procedures. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25,26. People who use the service experience good quality outcomes in this area Residents live in pleasant, clean and comfortable home. The temperature of the hot water in outlets used by residents was below recommended parameters that could impact on resident’s comfort. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is well maintained and has benefited from the provision of new carpets in communal areas. There has been considerable improvement in the maintenance of the garden areas and this is now a very pleasant area of the home. Residents can access the garden from the conservatory that leads off the ground floor lounge, and residents are free to go into the garden when they wish. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 21 There are lounge/dining areas on each unit. The ground floor lounge area includes a reminiscence area, which is used for residents from all the units Residents have freedom of movement across the units they live in, and areas, which may put residents at risk, are protected by keypads. Staff will accompany residents to other units and the garden as required. Resident’s accommodation is provided in single rooms, all with ensuite facilities consisting of a washbasin, shower and wc. Individual rooms are comfortable and made homely by residents own possessions and pictures. All rooms are provided with a ‘magic eye’, which sounds an alarm if residents get out of bed in the night, and have accessible call bells. Residents are able to have keys to their rooms under the auspices of a risk assessment. Each resident is provided with a lockable drawer. Window restrictors are in place in all areas above ground floor and water temperatures to residents’ outlets are monitored on a regular basis, with records showing that some water temperatures were lower than recommended parameters. Assurances were given that these would be raised to ensure residents’ comfort. The home has assisted bathrooms, one of the baths is currently awaiting repair. There are sufficient aids around the home to ensure that residents’ independence is maximised. The home was clean and tidy, with no evidence of odour in any area. Staff have received training in infection control and said that there were sufficient aprons and gloves provided. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 22 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): 27,28,29,30. People who use the service experience good quality outcomes in this area. Sufficient staff with suitable training are on duty over a twenty-four hour period to ensure that resident’s needs can be met. Robust recruitment systems safeguard the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has employed several new staff since the last inspection and staff confirmed that agency staff are rarely used and that there are generally sufficient staff on duty to meet the needs of the residents and that permanent staff have been recruited for night duty. There are two registered nurses and three care staff working at night, nine care staff and three registered nurses in the morning and seven care staff and two registered nurses during the afternoon and early evening. Whilst recruitment of staff is ongoing there are a core of staff who have worked at the home for several years. They stated that the current staffing levels and retention and training of staff has improved the care that can be given to residents in the home. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 23 A deputy manager has been recruited and the manager stated in the Annual Quality Assurance Assessment that recruitment of Registered Mental Health nurses is taking place. This is needed in order to fulfil the needs of the residents in the home. New staff participate in the Anchor Induction Course, which includes elements from the ‘Skills for Care’ induction course (this is a nationally recognised induction course leading to the first levels of the National Vocational Qualification). Five members of staff (17 )have attained the National Vocational Qualification level 2 in care, and one member of staff has achieved the National Vocational Qualification level 3 in care. All staff have attended the Dementia Care training provided by Anchor and one registered nurse has attended a five-day course provided by the Alzheimers society. Registered nurses are receiving ongoing training both in refreshing their skills and to learn new ones and arrangements are being made for both care staff and registered nurses to attend end of life training All staff undertake mandatory training and infection control training and members of the catering staff have the food hygiene course. Four personnel files were examined and the majority of these contained compete documentation as is required by regulation. One personnel file included only one reference, this is being addressed. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 24 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): 31,32,33,35,36,37,38. People who use the service experience good quality outcomes in this area Management systems in the home are robust and ensure the home is safe for those that live and work there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The appointed manager has been in post for nine months, is a registered general nurse and has previous experience of managing nursing homes. She is in the process of applying for registration with the CSCI. Observations during the visit to the home showed that there is a calm and ordered atmosphere and that there is good communication between residents, Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 25 staff and management. Staff said ‘ things have improved 100 , it is a much nicer place to work’. ‘Its more resident orientated and we have regular staff meetings and approachable management’. One relative survey commented ‘ the manager has a good relationship with the staff and there is a happy atmosphere’. The Annual Quality Assurance Assessment was received by the CSCI by the date required, was informative and accurately reflected the current situation in the home and systems still to be put in place and improvements to be made. The area manager said that surveys regarding the care provided had been sent to residents and relatives in the past few months but no evidence of this could be found in the home. Anchor provides a central quality monitoring system, but evidence of this having been undertaken recently was not apparent. Views of residents and relatives should be gained at regular intervals to ensure that the home is meeting their expectations. It is recommended that views of health and social care professionals be obtained; this will give the home knowledge of where improvements are still to be made. Staff meetings are taking place and formal supervision of staff has commenced, but this is not always at the intervals and frequency directed by the National Minimum Standards, Regulation 26 visits (monthly visits by the provider required by CSCI) have been undertaken and reflected the situation in the home. These were kept in the home and seen on the inspection. The home does not act as appointee for any residents, any monies brought to the home for residents are kept in resident’s bank accounts, regularly audited and receipts and statements sent to the resident or their representative. Accounts were recently audited by Anchor. Policies and procedures have been reviewed and records kept in the home were secure and generally up to date. The CSCI are kept informed of any accidents or incidents affecting residents. Servicing of utilities and equipment was up to date and all staff have received mandatory health and safety training. There were no issues seen in the home that could affect the safety of residents or staff. Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 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 3 3 3 x 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 x 3 2 3 3 Partridge House Nursing And Residential Care Home DS0000014021.V361060.R01.S.doc Version 5.2 Page 27 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 Reg 15 (2)(b) Timescale for action Arrangements should be made to 30/06/08 ensure that all staff are aware of their responsibilities regarding care planning as discussed in the main body of the report. That activities for residents are 30/06/08 recognised as an important part of their holistic care and that the provision of these is a priority. This was a previous requirement with a compliance date of the 30/06/07 Requirement 7. OP12 Reg 16(m)(n) 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 OP9 Good Practice Recommendations Medicine prescribed on a ‘when required’ basis would benefit from guidelines in the care plan which give criteria as to when to administer this medicine. This would ensure a common approach in the use of this medicine. DS0000014021.V361060.R01.S.doc Version 5.2 Page 28 Partridge House Nursing And Residential Care Home Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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