Care Home: Pembroke Residential Home

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What the care home does well Pembroke provides people that use the service with a warm, friendly and comfortable environment. The home has a welcoming atmosphere and people that use the service are well looked after. Visitors are made to feel welcome at any time. The Manager ensures that a robust recruitment procedure is followed and that staff receive the appropriate training. Ninety three percent of care staff working at the home have achieved a minimum qualification of NVQ level 2 in Care or equivalent. People that use the service are content and happy with the care that they receive. Comments made from people that use the service, relatives and surveys received included, "The staff are very kind and go out of their way to help you" "I am very happy and contented, this is my home" "I have made Pembroke my home, I am well looked after and happy to be here" What has improved since the last inspection? Since last inspection of the service in April 2007 a new Manager has been appointed. It was evident at inspection that the Manager has worked very hard to improve standards within the home environment. Medication systems and practice have improved. The Manager makes sure that appropriate employment checks are carried out and received before new staff starting working at the home to ensure the safety of people that use the service. Some of the homes policies and procedures have been reviewed and updated and the homes fire alarm has been serviced within the last twelve months to make sure that it is in safe working order. The standard of the environment has also improved. The dining room has been redecorated and fitted with new flooring and some of the bedrooms have also been redecorated and had new carpet fitted. What the care home could do better: Appropriate and enjoyable activities do take place at Pembroke, however for some people are not happening as often as they would like them to. The Manager needs to ensure that there is a care plan for those people who come into the home for respite care to help to ensure that their care needs are met. The Manager must ensure that there is a moving and handling assessment on file for each person that uses the service to ensure safety. The Registered Manager should achieve an NVQ level 4 in Care or Equivalent to ensure that she is appropriately qualified. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Pembroke Residential Home Pembroke Residential Home 81 Marine Parade Saltburn by the Sea Cleveland TS12 1EL     The quality rating for this care home is:   two star good service 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. Lead inspector: Katherine Acheson     Date: 2 2 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Pembroke Residential Home Pembroke Residential Home 81 Marine Parade Saltburn by the Sea Cleveland TS12 1EL 01287625334 F/P01287625334 diane.hessay@pembrokeresidential.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Robert Andrew Finney care home 12 Number of places (if applicable): Under 65 Over 65 12 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 12 The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary needs on admission to the home are within the following category: Old Age, not falling within any other category, Code OP, maximum number of places 12 Date of last inspection Brief description of the care home Pembroke Residential Home is located on Marine Parade, Saltburn in a pleasant location overlooking the sea. The home is situated within a row of large houses and is a short walk from the local shopping centre and public transport facilities. The home provides care to a maximum number of twelve older people. There are eight single and two double bedrooms located on the ground and first floor with a stair lift to provide access to the upper storey. Care Homes for Older People Page 4 of 29 Brief description of the care home All bedrooms meet the size requirements of the Care Homes for Older People National Minimum Standards and have hand basins although none contain ensuite toilet or bathing facilities. Downstairs there is a large lounge and a separate dining room. At the rear of the property there is a patio and small garden area with another small garden at the front. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is two star. This means that people who use the service experience good quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some regulations from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. This unannounced key inspection took place on 22nd April 2009 and lasted for seven and a half hours. The Manager completed and returned an Annual Quality Assurance Care Homes for Older People Page 6 of 29 Assessment, (AQAA). The AQAA is the services self assessment of how they think they are meeting national minimum standards. This information was received before the inspection and was used as part of the inspection process. The reason for the inspection was to see how good a job the home does in meeting the national minimum standards set by the Government for care homes. Numerous records were examined including care records of people living at the home, medication records, risk assessments, complaints and staff recruitment and training files. People living the home, relatives and staff working there were also spoken to. Before the inspection surveys for people that use the service and surveys for staff were sent out to the home for the manager to distribute accordingly. Surveys sent to people that use the service were asked to comment on care received. Surveys sent to staff were asked to comment on what it was like working for the home and training provided. We received nine surveys from people that use the service. We received five surveys from staff. Comments made in surveys received can be read in the main body of the report. The cost of care at the time of the inspection visit was four hundred and thirty seven pounds and seventy five pence. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 29 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments of people who are to use the service do take place to ensure that the home can meet their needs. Evidence: Before going into Pembroke people who are to use the service are assessed by a Social Worker. This assessment is forwarded to the home for the Manager to look at to determine if the needs of the person can be met. Once this assessment has been reviewed the Manager said that she visits the person at home or in hospital to introduce herself, answer any questions about the home and carry out a further assessment on the person. The Manager said that in the event of an emergency and someone needing to use the service quickly, she speaks with the persons Social Worker about care required and Care Homes for Older People Page 11 of 29 Evidence: any associated risks. The social worker assessment is sent to the home within twenty four hours. Care files of people who use the service that were looked at during the visit contained appropriate assessments. The Manager said that any person interested or needing to use the service or relatives are encouraged to visit the home to have a look round and meet the staff. One person spoken to during the visit said, As soon as I looked round I knew we had found the right place, the atmosphere was welcoming. The home does not provide intermediate care. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are well looked after and happy with the care that they receive. Inadequate care plan documentation for those people receiving respite care does not help to ensure that health, personal, and social care needs of the person are met. Evidence: Two files for people who use the service were looked at during the visit. One was that of a person who was living at the home on a permanent basis. This file contained detailed information about the person and the help that they needed. Likes and personal preferences were recorded and care plans contained clear evidence of personal choice. Care plans had been evaluated on a monthly basis and included deterioration and improvement made. The file of the person receiving respite care was not sufficiently detailed. Although staff had carried out an assessment of the person and were evaluating and documenting the persons progress each day, there was no formal plan of care in place. It was also observed that the home do not have a formal assessment for moving and handling of people who use the service. The Manager said Care Homes for Older People Page 13 of 29 Evidence: that staff do assess the capabilities of the person and determine how many staff are needed to assist with moving and handling and look to see if any specialist equipment is needed to ensure safety, however this is not documented. Comments made by people who were spoken to during the inspection and in surveys received included, I am glad I came in here. I look at everyone who lives here and the staff as my friends Life is what you make it whatever and where ever you are Its my home I have lived her for fourteen years I feel so pleased to have found such a good home for mum where she is properly taken care of. Records were available to confirm that people who use the service see their GP, District Nurses and other health care professionals on a regular basis. The Manager said that Senior Care staff who have received medication training are responsible for administering medication to people who use the service. It was highlighted at the last inspection that staff who administer medication need to have their competency checked to ensure that they are following safe practice. The Manager advised that competency checks are not being carried out on staff, however would develop a system to do so as a matter of urgency. She said that she was not the Registered Manager at the last inspection and although she looked at the last inspection report for action needing to take place she must have missed it. In general good practice and systems were observed when dealing with medication. Medication is appropriately stored. Last inspection highlighted that some medication such as a box of paracetamol was being used for a number of people who use the service rather than being given their own individual prescribed and dispensed paracetamol. This has now stopped, examination of records and medication informed that people were receiving medication prescribed and dispensed for them. Examination of records at this inspection highlighted that some people were prescribed medication which could be one or two tablets depending on what was required. Staff sign when they have given the medication, however do not document how many tablets they have given. The amount of medication administered given should be documented to to inform of how much medication the person has had and enable auditing. Care Homes for Older People Page 14 of 29 Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate and enjoyable activities do take place, however for some people are not happening as often as they would like them to. Food provided is varied and enjoyed by people who use the service and as such promotes wellbeing. Evidence: The Manager said that the home do not follow a set plan of activities. She said that Care staff spend time with people who use the service when time permits and on request. She said that people like to do crosswords, play bingo and dominoes and watch DVDs. The homes television has Free view giving additional television Chanels for people to watch. The Manager organises an outside agency to come into the home on a monthly basis to motivate, reminisce, play games and provide activities for people who use the service. On the day of the inspection this agency visited the home. Live entertainment is provided in the home on a monthly basis and in the nice weather staff take people out for a walk along the parade. Contact with family and friends is encouraged, visitors are welcome at any time. Care Homes for Older People Page 16 of 29 Evidence: The Manager said that representatives from the local Methodist Church visit to pray with people and that one person is visited by the Deacon from the parish church where she used to live. One person spoken to during the visit said that they were a little disappointed that there had not been a service at Easter time. Comments made by people spoken to during the inspection and surveys received in respect of activities included, Im happy, I like to spend time in my room. I sometimes like to go into the lounge when there is something on, but mostly I prefer my own company I get a little bored. I like the quizzes but we dont do something every day. I would like to go out for a walk along the parade more often Theres not much happening, I do get bored at times The majority of people in here do not and would not appreciate more activities but I would Two staff surveys received thought that the home could improve by providing more activities and outings. Part of the lunchtime of people that use the service was observed. Tables were nicely set, salt and pepper was on the table and each person was given a napkin and a glass of juice. The lunchtime menu of the day was gammon, roast potatoes, cauliflower cheese and mixed vegetables. Dessert was rice pudding. The Cook said that there is always an alternative choice of food if someone dislikes the menu for the day, however gammon was always a favourite. Visitors are welcome to stay and have a meal, they just have to inform the cook so that she can ensure that she prepares a sufficient amount for all. Comments made in respect of the food provided included, The food is great, well presented and enough of it The food is good, the girls are good if I want something different I can do, but I like mostly what is provided. We have stayed for lunch with mother, they like you to stay. We had fish and chips one day and steak pie on another. The cook is very good. Care Homes for Older People Page 17 of 29 Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are encouraged and supported to make any complaint they feel necessary. Adult protection procedures are in place which helps to protect people from abuse. Evidence: The home has a complaints procedure which informs people of who they can contact if they should wish to make a complaint and timescales for action. People spoken to during the inspection said that they would have no hesitation in approaching the Manager or any member of staff to raise any concern that they may have. The home have received one complaint in the last twelve months. The home has an adult protection procedure which informs staff of who to contact if abuse is suspected. The Manager said that staff receive adult protection training when they start working at the home and then receive regular updates. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are provided with a safe, homely and comfortable environment. Evidence: The home is situated within a row of large houses and is a short walk from the local shopping centre and public transport facilities. The home enjoys beautiful views of the seaside. The Inspector walked around the home with the Manager. The lounge area was warm and homely and the dining room had benefited from redecoration and new flooring since the last inspection visit. There are eight single bedrooms and two double rooms none of which contain ensuite facilities, however they do have a sink. Since last inspection some bedrooms had been redecorated and fitted with new carpets. People who us the service had been involved in choosing the colour scheme and wallpaper. Externally there is a small enclosed concreted patio area which has plant pots and benches and chairs for people to spend time outside. Laundry facilities are situated to the rear of the home and are accessed externally by staff. On the day of the inspection the home was clean and odour free. Care Homes for Older People Page 20 of 29 Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home follows robust recruitment procedures and staff are appropriately trained, this helps to ensure that people are safe and well cared for. Evidence: The homes duty rota showed that there are two care staff on duty from 8am until 9pm, one of which is a senior member of staff. On night duty there are two care staff on duty, one of which does a sleeping night duty and can be called upon if the need arises. In addition to care staff on duty the Manager works during the day five days one week and four days the next. The Manager said that ninety three percent of care staff working at the home have achieved a minimum qualification of NVQ level 2 in Care or equivalent. The files of two newly appointed staff were examined which confirmed that the home follow a robust recruitment procedure. Appropriate checks had been carried out on staff before they started working at the home. Records were available to confirm that new staff receive induction training. Other Care Homes for Older People Page 22 of 29 Evidence: mandatory training such as moving and handling, abuse, fire and first aid is also provided to staff on a regular basis. The Manager said that some staff are due a refresher in fire training and that she is in the process of arranging a date. Some staff had also received additional training on oral hygiene, incontinence,risk assessment, Parkinsons disease and pressure sores. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and managed in the best interest of people who use the service. The health safety and welfare of people that use the service is promoted. Evidence: Since last inspection a new Manager has been appointed. The Manager had worked at the home for a number of years prior to her appointment. The Manager has achieved a management qualification and said that she is to do an NVQ level 4 in care in the very near future. Appropriate quality assurance monitoring systems are in place. Surveys are sent out to people who use the service on a yearly basis asking them to comment on care received. The results of surveys are made available to inform people of the findings. The Manager said that there are meetings for people that use the service and their relatives, however with the home being small she is able to regularly chat with everyone on a day to day basis. Care Homes for Older People Page 24 of 29 Evidence: The home looks after small amounts of money for people who use the service. Appropriate records are kept of transactions made. A sample of health and safety records were examined and found to be in order. Records were available to confirm that the homes fire alarm, fire extinguishers and gas boilers had been serviced in the last twelve months. On average weekly tests of the homes fire alarm system is carried out to ensure that it is in working order. The Manager said that staff have regular fire drills which involves the evacuation of people she said that the last one took place in January 2009. Care Homes for Older People Page 25 of 29 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The Registered Person must ensure that all people who come into the home for respite care have a plan of care that sets out personal, health and social care needs. To ensure that they receive the appropriate care. 30/05/2009 2 7 13 The Registered Person must 30/05/2009 ensure that a moving and handling assessment is available on file for each person that uses the service. To ensure safety. 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 9 The amount of medication administered to people who use the service should be documented to inform how much medication the person has had and enable auditing. Page 27 of 29 Care Homes for Older People 2 9 The Manager should ensure that the competency of staff administering medication is checked to help to ensure safe practice. The Registered person should consult with people who use the service and plan a suitable and varied range of activities and outings to ensure that people lead fulfilling lives. The Registered Manager should achieve an NVQ level 4 in Care or equivalent to ensure that she is appropriately qualified 3 12 4 31 Care Homes for Older People Page 28 of 29 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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