Care Home: Pax Hill Residential Home EMF Unit

What the care home does well People wishing to use the service have a comprehensive assessment of their needs before they move into the home. This helps to assure people that the home will be able to meet their needs. The home has good care planning systems, which helps to ensure people`s assessed needs are met. There are good medication administration practices, which protect people. People who live in the home have good quality food and their diverse needs are generally well supported. People are confident that any complaints will be taken seriously and staff have a good understanding of how to protect people from abuse. The home is safe, well maintained, clean and hygienic. Staff receive good training, which helps them to meet people`s needs. The home is well managed and there are good systems to keep people safe. What has improved since the last inspection? The recruitment procedures have been improved and all staff have been thoroughly checked before they start working in the home. What the care home could do better: There are no requirements in this report. The home has a good system of assessing the quality of the service provided and responding to any identified shortfalls. This should continue. CARE HOMES FOR OLDER PEOPLE Pax Hill Residential Home EMF Unit Pax Hill Bentley Farnham Surrey GU10 5NG Lead Inspector Pat Griffiths Unannounced Inspection 8th November 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Pax Hill Residential Home EMF Unit DS0000039926.V349692.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. Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pax Hill Residential Home EMF Unit Address Pax Hill Bentley Farnham Surrey GU10 5NG 01420 23782 01420 22690 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) Dr Nuzahat Nasreen Zaki Dr Mohammed Zaki Post Vacant Care Home 26 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (26) of places Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the DE category can be admitted from 55 years of age. 23rd October 2006 Date of last inspection Brief Description of the Service: Paxhill EMF is registered to accommodate 26 service users with mental health frailty, mainly dementia. The home is situated in the grounds of the larger home with the same name, in the village of Bentley. The home is situated over ground and first floor levels with a passenger lift. There are 26 bedrooms all are en-suite with either a shower or bath. There is a garden, which is secure, and views from all rooms across the countryside. The weekly fee for a place in this home is £776. Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The evidence used to write this report was gained from a review of the information the provider sent to us since the last visit and the previous inspection report. This information included incident reports and an annual quality assurance assessment. A site visit to the home was made on 8 November 2007. During the visit we spoke with people who live in the home and their relatives. We also received completed surveys from people who live in the home and their relatives. We spoke with the manager and staff on duty. The communal areas of the building were viewed and documents relating to the running of the home were inspected during the visit. What the service does well: What has improved since the last inspection? The recruitment procedures have been improved and all staff have been thoroughly checked before they start working in the home. Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 7 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 Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 8 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): Standards 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People wishing to use this service benefit from a comprehensive pre-admission assessment of their needs before moving into the home. The home does not provide intermediate care. EVIDENCE: We looked at three personal care plans and their pre-admission assessments. The assessments were seen to include personal information such as next of kin, as well as assessments for mobility, feeding and nutrition, medication, pain, behaviour and awareness, communication, personal care, need for nursing intervention and moving and handling. We were also able to see the care plans based on these assessments. The manager told us that she visits potential residents in their own homes or hospital to assess their needs, if they live any distance away the information is obtained from their current care Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 9 home or GP. People are also invited to visit the home for tea or lunch and to meet the other residents before they decide to move in. We were also able to talk to people living in the home and their relatives who told us that before admission they had been able to visit the home and had been given an information pack which explained the services available and the care provided by the home. The home does not provide intermediate care. Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 10 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): Standards 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning ensures residents have all their needs met. Medication administration practices protect the residents EVIDENCE: As part of the inspection process the care plans of three residents were looked at to assess the information provided about how the staff planned to meet the individual needs of the people living there. Everyone living in the home had care plans in place, those that we looked at were seen to contain information about personal hygiene, mobility, continence, dementia care needs, any equipment needed, communication, risk of falls and moving and handling assessments. The care plans ensure a person-centred care plan that provides information about the type of support given with personal care on a daily basis. Other information seen in the files included consent forms for flu vaccinations, a social history and ‘end of life’ wishes. Risk assessments are in Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 11 place and reviewed regularly with the rest of the care plan or more often if needed. A separate page was used by the visiting GP or other healthcare professional to record their visits. The home has medication policies and procedures in place for the receipt, storage, return and administration of medication, which are followed by the staff. The home has a homely medicines guideline signed by the GP, which allows staff to give certain over the counter medications that have not been prescribed, such as paracetamol for a headache. The copy seen on the day of the visit was several years old and the manager told us that it was being renewed. A sample of medication administration record [MAR] sheets were looked at and no gaps in recordings were seen. These are the records that are kept of all medication received into the home and are also a signed record of when medication is given to a resident. It is clearly documented when a resident has not take the medication and the reason why the medication has not been taken. The manager told us that staff receive medication administration training from the pharmacist that supplies their medication and staff have also completed a distance-learning modular training course. People living in the home and their visitors said that they were happy with the care provided at the home and that the staff were very helpful and friendly. Comments from a relative included: ‘I cannot speak too highly of the care staff in the unit, they are outstanding in their conscientiousness and professionalism. They are gentle yet firm when a resident is difficult and calm the situation successfully. My relatives responses to the nurses and carers shows that she is as fond of them as they are of her.’ Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 12 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): Standards 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have good quality food and their diverse needs are generally well supported. EVIDENCE: Information in the AQAA indicates that the home provides a variety of entertainment, which is enjoyed and appreciated by the residents. The home employs an activities organiser who works in the home every day. Activities that have been organised include ‘music for health’ armchair exercises, word games, reminiscence sessions, crosswords, arts and crafts and topical news discussions. Outside entertainers often visit in the nursing wing of the home, so residents from the unit also attend. We were told that trips are also arranged to the garden centre or the beach in the summer. Plans for Christmas include a visit from a group of local schoolchildren who will sing carols for the residents. Residents were observed making choices about their daily activities, such as whether to join in with activities, and whether to sit in the sitting room or spend time in their bedrooms. Staff were available to provide help or support when or if it was needed. One comment on the survey Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 13 form from a relative was: ‘The activities organiser makes a huge difference in stimulating the residents’ The manager told us that some of the residents do get out and about with their friends and families and trips to the local garden centre are always popular for lunch and to see the plants and flowers. The manager told us that there is an open visiting policy in the home and families and friends are free to visit as they wish. During our visit to the home we saw visitors coming and going during the day. The manager said that a member of the clergy visits monthly and residents are able to take communion if they wish. We were told that there is a five-week menu plan and there are choices available at each mealtime. The meals are cooked and delivered from the nursing home, which is close by. The food is kept on a hotplate in the dining area and meals are served by the staff in the dining room, allowing residents to say what they would like and how big a portion they would like. There is a kitchen in the home and it is used for the preparation of breakfast and drinks and light snacks during the day. We saw the menu, which showed that a wide variety of meals are available for the residents. Lunchtime was observed and was seen to be relaxed and unhurried, the meal was presented well and looked and smelt appetising. Help and support with eating for those who needed it was provided by staff in a discreet and sensitive way. The manager said that drinks are freely available and offered regularly to the residents. During the course of the day we started to use the Short Observational Framework for Inspection [SOFI], which is a method of observing of the various activities, behaviours and interactions of the people living in the home and the staff. The observation was carried out over an hour in the sitting room and it was noted that the residents got up and moved around a lot, interacting, joining in or ignoring the activities in the room. The staff were constant and timely with their support and interventions, whilst enabling the residents to be as independent as they wished. Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 14 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): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff training in adult protection, and the knowledge that all complaints are dealt with appropriately usually safeguard the people who use this service. EVIDENCE: The home has polices and procedures in place regarding concerns, complaints and compliments, which are also contained in the statement of purpose and on display in the home’s hallway. Visitors that spoke to us said that they knew they could talk to the staff or the manager if they had any concerns or complaints and they felt confident that the matter would be responded to appropriately. Polices and procedures are in place about the protection of vulnerable adults and the actions to be taken if there is a case of suspected abuse in the home. The adult protection training is ‘in-house’ and done by a manager from another of the on-site homes, who has completed a ‘train the trainers’ course. The manager told us that the training is repeated annually. Discussions with staff indicated that they have a good understanding of abuse and would know the correct actions to take if they suspect abusive practices have happened in the home. Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 15 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): Standards 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service live in a safe, well maintained, clean, and hygienic home. EVIDENCE: The home has a warm and friendly atmosphere and we were made welcome by staff and residents on the day of the visit. During the course of the visit the inspector saw various parts of the home, which were seen to be clean and tidy throughout and there were no undue odours. The home is decorated and furnished in a homely manner, the residents are also encouraged to personalise their bedrooms with small pieces of furniture, pictures and ornaments. All bedrooms are single and en-suite, some have baths and showers and there are other bathrooms available. Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 16 There is a passenger lift to enable residents to access all areas of the home. There are several communal areas available to the residents as there is large, long room divided into a large sitting room, a small television area and a small, separate quiet room overlooking the garden. There is also a dining room. There is an activities room upstairs, which apparently is not used very often, but is used to store all the equipment for the different activities available in the home. The laundry is a small area that only deals with the personal clothing of the residents. We were told that sheets and towels were sent to an outside laundry. There is a large kitchen in the home but it is only used for making snacks and drinks as all meals are prepared in the nursing home and brought over to the unit. Risk assessments of the environment have been completed to ensure that people living in the home are protected from risks associated with the building and environment of the home. The gardens were seen to provide secure areas for the residents, with lawns and flower borders and tables and chairs. Staff records indicate that they receive training about infection control and suitable protective equipment is made available to staff, such as aprons and gloves and staff were seen to be using them. A team of cleaning staff are responsible for maintaining the cleanliness of the home, which was clean and free from offensive odours on the day of the visit. Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 17 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): Standards 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Robust recruitment practices and staff training protect people who use this service. EVIDENCE: When the AQAA was completed there were seven full time and five part time staff working in the unit, with two ancillary staff. On the day of the visit a staff rota was available that indicated the number of staff on duty. We were told that all new staff have a three day in-house induction period and then undertake the skills for care induction course. Seven of the twelve carers have obtained a National Vocational Qualification [NVQ] in care and another two have started the course. The home has exceeded the national expectation that 50 of the care staff in each home will have obtained an NVQ in care, as 75 have completed or are working towards the qualification. Staff training records indicate that they receive training to equip them with the skills to care and support the residents living at the home. This includes health and safety, fire safety, moving and handling, food hygiene, adult protection and dementia awareness. We were told that staff have supervision and support sessions to help them understand and develop their role. Staff told us that they felt the training was good and they were happy working in the home. Several of the Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 18 carers are nurses in their own country, but are working as carers in the unit. English language training is available at a local college and a visiting teacher and their colleagues support them as they improve their language skills. The home has recruitment policies and procedures in place. The three staff files that were seen indicated that these procedures were followed, including all the statutory checks required, such as a reference from a previous employer and a satisfactory Criminal Records Bureau [CRB] disclosure. The manager told us that the provider undertakes all recruitment selection and the administration team in the nursing home complete all necessary paperwork, the files were available for inspection on the day of the visit. Comments from friends and relatives were very positive about the staff ‘staff are always friendly and helpful, overall impression is one of a caring environment’ I cannot speak too highly of the care staff in the unit. They are outstanding in their conscientiousness and professionalism. They are gentle yet firm when a resident is difficult and calm the situation successfully. One can tell by my relatives response to the nurses and carers that she is as fond of them as they are of her’ Staff responses were very positive about working in the unit and comments included: ‘- during my time here I have been very happy and work well with all staff, the care we give also extends to out colleagues. We have a very happy work environment which is always good for our residents well-being and happiness and I hope we can continue to build stronger and make our unit the best it can be’ Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 19 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): Standards 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are usually safeguarded by good management and their privacy, independence and dignity is promoted. EVIDENCE: The home has a manager in place who was previously the deputy manager. The previous registered manager left in December 2006 and there was a manager in place for four months earlier in the year, since then the deputy manager has been acting-up as manager. She is an experienced registered nurse who has started her National Vocational Qualification in management and will soon be applying for registration with the commission. She continues Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 20 to undertake further training to develop her professional and clinical practice and is able to support and encourage staff to provide very good care. Staff said the manager had an open door style of management, welcoming comments and suggestions from residents, staff and relatives. The home had a large number of comprehensive policies and procedures, which are available and accessible to the staff. There is a quality assurance system in place and questionnaires are sent out to relatives, residents and other healthcare professionals. The manager said that there had been a poor response to the most recent questionnaires, but the responses had been very positive. Friends and relatives, who were visiting the home on the day of the visit were very positive about the staff and the management of the home and told us ‘it’s a lovely place, lovely staff’ People living in the home leave money for safe keeping with the home and this is held in the office. A record is maintained for each person with receipts for transactions. We were told that is only a small amount of money to pay for tea or coffee when out on trips from the home. Fees for hairdressing and chiropody are invoiced separately. Records indicated that staff attended regular and compulsory fire and other health and safety training, the home’s fire alarm system was checked regularly and emergency plans were in place. There was a fire risk assessment for the premises and regular risk assessments of the premises were undertaken. There were also in-date certificates for the homes fixed electrical wiring, portable appliance testing and for gas safety. No outstanding health and safety issues were observed during the inspection visit and records showed that all equipment was regularly serviced. A relative commented ‘personal care, hygiene and catering are excellent. Outings are organised for those who wish or are able to participate. Entertainment is arranged periodically and appreciated by all of the residents. Relatives are always welcomed with a smile and enthusiasm and there is a good atmosphere – calm and professional. Staff are always ready to discuss any points one wishes to raise and take action if necessary’ ‘I should like to compliment the owners of Pax Hill – the unit is obviously administered and managed very well, selection of staff is excellent and they seem to be content and even enjoy their work – as one of them said, their reward is my relatives smile!’ Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pax Hill Residential Home EMF Unit DS0000039926.V349692.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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