Care Home: Pavilion Care Centre

What the care home does well The home provides a good range of activities for the people who live there. People have their needs assessed and an individual care plan is developed so that staff can follow consistent practices when supporting people. A good choice of nutritious meals are provided with a lot of home baking. Routines within the home are flexible and designed to support residents to make choices with daily living. The staff team are experienced and trained and have built up a good knowledge of the residents and this helps them with the care process. The building is well maintained and in good decorative order. The manager is experienced and qualified and is supported by a good management team to ensure that the service is run in the best interests of the people who live here. The manager ensures that any requirements and recommendations made in inspection reports are addressed. What the care home could do better: The care plans and risk assessment documents should be updated particularly for those people who display challenging behaviours. Medicines administration records must be completed in accordance with the guidance issued by the Royal Pharmaceutical Society. And there should be no unexplained gaps on medicines administration records.If meals are changed on the day then this should be reflected in the menu lists that are placed on the dining room tables. Inspecting for better lives Thematic inspection report Care homes for older people Name: Address: Pavilion Care Centre North View Terrace Chilton Moor Houghton-le-spring Tyne And Wear DH4 5NW two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a thematic inspection of this care home. A thematic inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Clifford Renwick Date: 2 6 0 3 2 0 0 9 Information about the care home Name of care home: Address: Pavilion Care Centre North View Terrace Chilton Moor Houghton-le-spring Tyne And Wear DH4 5NW 01913853555 Telephone number: Fax number: Email address: Provider web address: www.europeancare.co.uk Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : European Care (England) Ltd care home 40 Number of places (if applicable): Under 65 Over 65 0 0 40 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 20 5 0 10 The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care home with nursing - Code N 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 - Code OP, maximum number of places 40 Dementia, Code DE, maximum number of places 20 Mental Disorder, excluding learning disability or dementia - Code MD, maximum number of places 5 Physical Disability, Code PD maximum number of places 10 Date of last inspection Care Homes for Older People Page 2 of 12 Brief description of the care home The Pavilion is a large detached building set in its own grounds in a small village near Houghton-le-Spring, near the boundaries of Durham. It was originally built in the 1960?s and is currently owned by European Care Ltd, an independent provider. The home provides personal care for up to 40 older people. The home is divided into 2 distinct units with 20 bedrooms on the ground floor, and 20 bedrooms on the first floor for older people with dementia care and mental health needs. The home is not registered to provide nursing care. Each floor provides a range of lounge and dining rooms, bathrooms and small kitchens. All necessary facilities are provided and are suitable for the people who live there. A staff call system, which is accessible to the service users, is provided in all parts of the home. Set back from the main road the home is close to local amenities and bus routes. There are well kept gardens around all sides of the home and the large front lawn has a wishing well and other garden features of visual interest for the people who live there. The laundry and staffroom are located on the second floor of the home. A place at this home costs #372 - #416 per week. Additional charges are made for toiletries, newspapers/magazines, private chiropody and manicurist (if required) and hairdressing. Items, which are included in the cost, are listed in the homes terms and conditions. Care Homes for Older People Page 3 of 12 What we found: Since the last inspection of the service the registration categories have changed with the home now providing nursing care. Discussion with the deputy manager confirmed that no on is admitted without a full assessment of need being completed. And assessments that had been provided by social services and health were available in care files that we looked at. In addition to obtaining an assessment from placing authorities the home also complete their own assessment document in order that they can develop a care plan so that staff know what support people need. Prospective residents also have the opportunity to visit the service prior to deciding if they wish to move into the home. As part of our visit we looked at care files for two people we call this process case tracking and it involves looking at all records that are place to demonstrate how people care needs are met. The care plans that are in place follow a person centred approach in that they are tailored to the individual and their specific needs that have been identified through the assessment process. They also link into other documents such as risk assessments and manual handling in order that staff have all of the information that is necessary to ensure that care practices are consistent. The care plans are evaluated monthly and staff then make any changes to reflect progress that has been made by individual residents. The care plans in use contain a lot of valuable information but some development is required in areas where staff are supporting people who have behaviours that challenge. One person has previously exhibited and can still display behaviours that are challenging towards staff some of which can involve physical aggression. The staff have worked well with this person and also with health professionals in order to reduce the level of challenging behaviour. However the care plan does not reflect this positive work that has been carried out. For example staff know how to approach the person, the tone of voice that needs to be used in order to avoid triggering behaviour and also how to respond safely should the person display physical aggression towards them. Care Homes for Older People Page 4 of 12 A risk assessment has been carried out for this person but does not list in detail what improvements have been made and also what kind of challenges this person is currently presenting. Observations made of staff working with this person and also discussion with staff confirmed that they are consistent in their approach and have very clear strategies in place to work with this person. Like the care plan some updating is required to the risk assessment and this needs to record in detail what behaviours are displayed and what risks are present. And also what staff do to respond to this. The use of terms such as aggression and violent when describing the behaviour would be better if they were replaced with a more constructive description of what it is that the person does. Overall the care staff have a good knowledge of the people they are supporting and for another care plan that was viewed. This contained good information about the support that a person was receiving. Good records are also in place that confirm people have access to the G.P and other health professionals when required. We looked at medication records for both the nursing and residential units in addition to the storage that is available on both floors of the building. For those residents who are receiving nursing care, a nurse is responsible for administering prescribed medicines and for people assessed as requiring residential care, care staff administer the medicines. The records of administration are not being completed correctly and in a number of instances there were gaps on the records with no recorded reason. Therefore it could not be determined if people had received their medicines or not on that particular day. The home have their own audit systems in place for medication and this normally picks up on any administration errors or shortfalls. However these gaps on the administration records had occurred since the last audit had been completed. Overall because of these gaps the records are not being maintained satisfactorily and this was discussed with the manager and also the area manager who were present during part of the visit. And who took immediate steps to rectify this. Observations made during our visit confirmed that staff treat people with respect and personal care tasks were carried out in the privacy of peoples rooms. There was a good rapport between staff and residents and people are referred to by their chosen form of address. Routines of daily living are flexible within the home and residents are supported by staff to follow their own routines as much as possible. Care Homes for Older People Page 5 of 12 There are no restrictions on visiting the home and residents are able to maintain contact with relatives and friends. There are good links with the local community and one resident goes out on a regular basis with a support worker from a health agency. Activities are planned for the week and a residents are able to tale part in those activities that they are interested in. There are photographic displays throughout the building of activities and outings that have been carried out in the past. Since our last visit some changes have been made to the mealtime arrangements and this has included providing menus on the table and also moving the menu board to a more prominent position within the dining room so that residents can see it. Lunch was taken with the residents in the ground floor dining room. The meal was very tasty, hot, well presented and of sufficient proportion and hot and cold drinks were available throughout the meal. In discussion with the residents they said the food is always very nice and there is always plenty of it. The residents also confirmed that if you did like what was on the menu you are always offered an alternative. The atmosphere throughout the meal was pleasant and the mealtime was unhurried offering the residents the opportunity to chat and catch up with what had been happening during the day. Though menus are on the table these did not match with the meals that were served for lunch during our visit and in discussion with the cook it was confirmed a last minute change had to be made. In circumstances like this it would be advisable to ensure that the menu on the table is changed in order to keep people fully informed. It was good to see that some people who live upstairs have the option to use the ground floor dining room as opposed to staying upstairs. It was also positive to note that a smaller additional dining area has been created on the first floor and this enables people who require support from staff and wish to eat privately from the larger dining room can do so. A complaints procedure is in place in the home and all residents and their relatives have been provided with information about how to report any concerns. Previous knowledge of the service has demonstrated that few complaints are made and any issues that are raised by residents or their relatives are addressed immediately. Care Homes for Older People Page 6 of 12 Robust policies and procedures are in place that deal with safeguarding adults and staff have received appropriate training. This ensures that the residents are protected from potential abuse. During our visit we looked at a number of areas of the home and this included all communal areas, some bathrooms and a number of the bedrooms. The home was clean and tidy, free of any noticeable safety hazards and in good decorative order. Most of the residents have personalised their bedrooms and this makes each room different. The first floor has had some minor changes made as part of the change to registration and is now exclusively used to provide nursing care for people who have needs related to dementia. The first floor was well lit and the walls were decorated with a number of pictures and photographs from an era that covered the war years and through the 50s and 60s. Some of the pictures and photographs and items of memorabilia were significant to the area that the home is located in and as such were of interest to the residents. The imaginative use of seating and different visual aids such as the large flower picture that are spread throughout the upper floor offered residents a pleasant area in which to sit and spend time. At the time of our visit some painting work was being carried out as part of the ongoing maintenance of the home. There is also a good external garden area with seating that residents can use during the warmer weather. And bing self enclosed enables the residents to be able to walk around the garden without their safety being compromised. At the time of our visit there were sufficient numbers of staff on duty to meet the needs of the residents. Discussion with the deputy manager confirmed that there had been some changes with the staffing team and some new staff had been recruited. The company have robust recruitment procedures in place and ensure that all of the necessary checks are carried out before someone is employed to work in the home. Since our last visit the home have also recruited and employed nurses. In discussion with the deputy manager it was confirmed that staff have good opportunities for training and attend a variety of courses that are aimed at keeping them up to date with their skills and knowledge. The manager is experienced and qualified and is supported in her role by a deputy manager. Care Homes for Older People Page 7 of 12 The manager has ensured that she has kept her skills and knowledge up to date by carrying our regular and updated training. Good records are in place for the recording of fire drills and fire instruction and this ensured that the health and safety of residents and the staff is promoted. A record is kept of any accident in the home and this also includes the appropriate actions that are carried out by staff. Records are also maintained of hot water at all bathing points in order to ensure the safety of residents whilst bathing. The home benefit from having their own administrator and who is responsible for maintaining a range of records some of which include financial records and any monies held on behalf of the residents. These were not looked at during this visit but previous visits have confirmed that robust procedures are in place. What the care home does well: What they could do better: The care plans and risk assessment documents should be updated particularly for those people who display challenging behaviours. Medicines administration records must be completed in accordance with the guidance issued by the Royal Pharmaceutical Society. And there should be no unexplained gaps on medicines administration records. Care Homes for Older People Page 8 of 12 If meals are changed on the day then this should be reflected in the menu lists that are placed on the dining room tables. 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 set out on page 2. Care Homes for Older People Page 9 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 12 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, 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 1 9 13 There must be no unexplained gaps on the medicines administration records. This will ensure that people are receiving their prescribed medicines. 01/04/2009 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 1 7 Individual care plans and risk assessments that deal with behaviours that challenge should be updated to reflect the actions that are being carried out by staff. Menus must be up to date and should reflect the meals that are being served on a daily basis. 2 9 Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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