Care Home: Pen Inney

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What the care home does well The people who live at Pen Inney are provided with a good standard of care and support. Comments from people who live at the home included, "The staff are marvellous, what you want they get. If I wake at 3am they get me a cup of tea", and, "Staff are very pleasant and willing to help in most problems". Feedback from a visiting District Nurse was that they were called in at the right time, and any advice given to staff was followed. People enjoy the food and consulted about the meals. There are sufficient staff, who have received the training they need to do the job. If they have a concern then they know what to do to resolve the matter. The home is well organised with a competent Manager. The home is clean, comfortable and generally in good order.Pen InneyDS0000072806.V375351.R01.S.docVersion 5.2 What has improved since the last inspection? This is the first inspection under the new ownership. What the care home could do better: In one case with found that there had been no proper assessment of a person who had moved to the home, and no care plan had been developed. This means that we could not be confident that the individual`s needs were being met. Whilst there were care plans for most people, there needed to be more information for people who had complex needs, such as diabetes. We also required that there is guidance for staff as to when to give medication that is described "as required". Some people who live at Pen Inney are able to self administer medication, this is very positive, however a risk assessment needs to be completed to ensure that they can do this safely, and to identify and support needs that they might have. Key inspection report CARE HOMES FOR OLDER PEOPLE Pen Inney Pen Inney Lewannick Launceston Cornwall PL15 7QD Lead Inspector Helen Tworkowski Unannounced Inspection 18th May 2009 09:30 DS0000072806.V375351.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Pen Inney DS0000072806.V375351.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Pen Inney DS0000072806.V375351.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pen Inney Address Pen Inney Lewannick Launceston Cornwall PL15 7QD 01566 782318 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) Ladybrook Care Homes Limited Mrs Kathleen Pauline O`Reilly Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Pen Inney DS0000072806.V375351.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 18 First Inspection under New Owners Date of last inspection Brief Description of the Service: Pen Inney House is situated in the village of Lewannick. The nearest town is Launceston; however Lewannick does have a shop. The home has communal rooms on the ground floor, and bedrooms on the ground and first floor. The house has been extended and the bedrooms that are in this more modern part of the house are suited to the needs of people who may have difficulties with mobility. The home has a garden and there is sheltered seating. Pen Inney DS0000072806.V375351.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 star. This means the people who use this service experience good quality outcomes. This Key Inspection included a site visit to the home on 18th May 09, between 9.30am and 4.45 pm. The visit included a tour of the building where we looked at most of the rooms. We looked at how care was provided to four people, including looking at their care plans and medication, and we met these people and talked with them about their care. As part of this visit we checked recruitment of new staff, and staff training and support. We talked with the staff on duty about the care and support they provide. The Registered Manager, Ms Kathleen O’Reilly, was present throughout this visit, and the Responsible Individual, Mr Stephen Difford, representing the Registered Provider, was also present in the home during much of our visit. In addition to the site visit we were sent information about the home in the form of an Annual Quality Assurance Assessment (AQAA). We sent surveys to the people who live at Pen Inney, eight were returned. We also sent them to staff five were returned. Information about the home, in the form of a Statement of Purpose and Service User Guide, are available from the office at the home. At the time of this inspection the fees were £350 to £375 per week. This does not cover personal items such as clothing, chiropody, hairdressing and newspapers. Some transport costs are included in the fee. What the service does well: The people who live at Pen Inney are provided with a good standard of care and support. Comments from people who live at the home included, “The staff are marvellous, what you want they get. If I wake at 3am they get me a cup of tea”, and, “Staff are very pleasant and willing to help in most problems”. Feedback from a visiting District Nurse was that they were called in at the right time, and any advice given to staff was followed. People enjoy the food and consulted about the meals. There are sufficient staff, who have received the training they need to do the job. If they have a concern then they know what to do to resolve the matter. The home is well organised with a competent Manager. The home is clean, comfortable and generally in good order. Pen Inney DS0000072806.V375351.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Pen Inney DS0000072806.V375351.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 Pen Inney DS0000072806.V375351.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not always adequately assessed before they move to Pen Inney. This means that they cannot be confident that their needs will be met or that they will fit in with the other people at the home. EVIDENCE: This home has recently been registered so we did not look in detail at the Statement of Purpose or Service User Guide (these are documents that set out the services and facilities provided by the home). Five of the eight people who live at Pen Inney and who responded to a survey said that they had enough information about the home before they decided to move. We looked at what information the home had about three people before they moved to Pen Inney. We found that one of the people had a pre-admission Pen Inney DS0000072806.V375351.R01.S.doc Version 5.2 Page 9 assessment that included sufficient information so that the home could be confident that they could meet the needs of the person. For a second person the pre-admission assessment was very limited, however when we discussed this with the Manager, it was clear that she knew about the person, and that this information had been used to develop the care plan. We looked at the information about a third person. This person had been admitted at short notice. It was of concern as the limited information that was available suggested that this person did not fall within the remit of the home. The home is registered to care for older people; this means needs of people admitted to the home must be in keeping with those brought on by the ageing process. We were also concerned that in the time since the person was admitted no further information appeared to have been sought and no assessment of need had taken place at Pen Inney. It is important that people’s needs are known, not only to ensure they can be met, but also to ensure that they and they other people at the home are not exposed to unreasonable risks. Pen Inney DS0000072806.V375351.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people at Pen Inney are provided with a good standard of personal care, and their health care needs are met. There is clear information for staff on what help they need to provide, however this can be improved in relation to more complex conditions such as diabetes. Aspects of the medication system need to be improved; this includes ensuring that people get the help they need to manage their own medication. EVIDENCE: We spoke with a visiting District Nurse about the quality of the service at Pen Inney. Her view was that care is very expertly given and all the people are well cared for. Staff at the home are very open and the District Nurses are called in when they are needed, and are kept well informed about people’s needs. Pen Inney DS0000072806.V375351.R01.S.doc Version 5.2 Page 11 We talked to six people who live at Pen Inney about the care they receive. Comments included, “The staff are marvellous, what you want they get. If I wake at 3am the get me a cup of tea”, and, “Staff are very pleasant and willing to help in most problems”. We received surveys back from eight people who live at Pen Inney, all said that they received the care and support they needed, one person commented “the care is always very good”. We looked at the Care Plans to see if there was information for staff about what help people needed. The Manager, Kathleen O’Reilly, explained that they were now using a new system for care plans. These documents contained much of the information that was needed; however we felt that they would benefit from more detail being included. It is recognised that this system has recently been implemented and will take a little time to be develop. We were concerned that there was no care plan for the person who had been admitted without a proper assessment. A care plan is required for every person who lives in a care home, even if that plan states they are self caring. We saw that the recording made by day staff is done in individual records; however that done by night staff is done in a book. Communal recording is poor practice, because it does not allow a person to see their own records without compromising the confidentiality of others. It also means that it is difficult to follow what has been happening for one person over the course of a 24 hour period. We noted that some of the people at Pen Inney have conditions such as diabetes. Where people have such conditions it is important that these needs are fully addressed in the care plan. It must be clear who has responsibility for monitoring each aspect of the condition, the sort of checks that are to be made, and when medical assistance should be sort. It was very positive to see that some of the people do take responsibility for managing their own medication. This is one of the ways people can maintain some of their independence. However there were no risk assessments in relation to self medication. Such assessments help ensure people get the help they need to look after and administer their own medication. We also discussed with the Manager the need to have guidance on when “as required” medication is to be administered. Such guidance ensures that the appropriate people are consulted and that there is agreement about the circumstances when a particular medication is to be given. Pen Inney DS0000072806.V375351.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Pen Inney are given the opportunity to maintain contact with family and friends, and to take part in activities at the home. Meals are well cooked and generally enjoyed. EVIDENCE: Five of the six people, who live at Pen Inney, who responded to a survey said that there was always or usually activities arranged in the home for people to take part in. Comments included “Plenty of activities but I do not wish to take part in them”, and “There are activities here if I wish to go too”. The Manager explained that most of the people who live at Pen Inney are from the local area and often know each other or have friends in common. A local “Golden Circle” group meets at the home; this gives people who live in the home a chance to catch up with friends and acquaintances, and helps to ensure that the home is part of the village life. Four or five people from Pen Inney attend the group regularly. Pen Inney DS0000072806.V375351.R01.S.doc Version 5.2 Page 13 We asked about some of the people who live at Pen Inney about visitors, and we were told that they were made welcome, and as a rule offered tea or coffee. We were told that there are no rules, and that people can come and go as they please at Pen Inney. Seven of the eight people who responded to the survey said that they always or usually enjoyed the meals at Pen Inney. Comments included “If not I know to tell staff and cook will come to see me”, and, “sometimes they are good, sometimes they are not so good”. The cook told us that they go and speak to the residents each day, in this way they find out what they like and don’t like, and get immediate feedback on meals. This sort of feedback is very important and is a very positive aspect of the service at Pen Inney. Pen Inney DS0000072806.V375351.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people at Pen Inney can feel confident that any concerns they raise will be responded to, and that there are systems in place to protect them from abuse. EVIDENCE: Six of the eight people responding to our survey said that they knew who to speak to if they were not happy and knew how to complain. We asked some of the people we talked with at Pen Inney, whether they felt able raise a concern, and we were told that they felt that could say if something concerned them. The Responsible Individual, Mr Stephen Difford, told us in the Annual Assurance Assessment, that no complaints had been received since the home was registered, and no referrals had been made to “safeguarding”, because of concerns that someone might be being abused. The Commission has received no complaints. Mr Difford has also told the Commission that he has undertaken training to allow him to give induction level training in relation to “safeguarding”. We looked at the home’s safeguarding policy and have suggested that they remove the terms “minor” and “serious”, as all forms of abuse are serious. All five of the staff who completed a survey said that they knew what to do if someone raised a concern. Pen Inney DS0000072806.V375351.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Pen Inney benefit from clean and comfortable surroundings. EVIDENCE: All of the people who live at Pen Inney who responded to the survey said that they thought that the home is clean and fresh. This was confirmed when we looked around most areas of the building. Mr Difford, the Responsible Individual, told us in the AQAA that a significant amount of furniture has been replaced in the home, and the communal areas have been painted. The bedrooms and communal areas we saw were well furnished, and people had chosen to put up their own pictures and to bring items of their own furniture into the home. We noted that one of the bathrooms, on the first floor, lacked a Pen Inney DS0000072806.V375351.R01.S.doc Version 5.2 Page 16 pull cord to operate the call system. Staff told us that no one uses this room on their own; however it is important that staff can call for assistance in an emergency. We also noted that the radiator in the dining room lacked a cover, which would protect people from burns. Mr Difford has told us that the Registered Providers are looking to do a complete survey of the home’s health and safety systems in the coming year. We also noted that there are plans to make significant alterations to the building, including adding extra bedrooms. The Commission must be notified of any such changes to the building, including any changes of room use, either by applying for a variation and or an amendment to the Statement of Purpose. Pen Inney DS0000072806.V375351.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Pen Inney are supported by well trained and competent staff. EVIDENCE: We survey the staff to find out their views, five of staff returned surveys. They all though that there employer had made proper recruitment checks before they started work and that they had received training that was relevant to the work and that they were kept up to date with new ways of working. Four of the five staff thought that there were always or usually enough staff, the fifth person thought that there were sometimes enough staff. We were told that no new staff have been recruited to the home since the new company had taken over Pen Inney. We discussed the recruitment process with the manager and she confirmed that appropriate references and checks would be made prior to a person starting work. We were told that the induction would be comprehensive, following the “Common Induction Standards”. We were also told that training would include moving and handling training (theoretical and practical), safeguarding training and in relation to dementia. Pen Inney DS0000072806.V375351.R01.S.doc Version 5.2 Page 18 We were told that there was a training Matrix, that showed the training received by the staff group as a whole, whoever this was not available for us to inspect. The Manager said that there were generally 3 care staff on duty in the morning with a senior carer or manager. In the afternoon and evening there was one care staff with one senior care staff. At night there is one person who is awake and a second person who is available in an emergency. The information we received from staff and people who live in the home, indicated that this was sufficient. Pen Inney DS0000072806.V375351.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed, well organised and generally safe. EVIDENCE: The Manager, Kathleen O’Reilly, has recently been registered and therefore determined by the Commission to be fit run Pen Inney. We found that changes were being made in the organisation, for example in relation to care records and to the staffing at night. These changes were being implemented in a considered and organised manner. The Manager also had a clear vision, of the role of the home in providing for people in the local community. Pen Inney DS0000072806.V375351.R01.S.doc Version 5.2 Page 20 We were told that some cash is kept on behalf of people who are not able to manage their money. We saw that there were records of transactions and that receipts are kept. We looked at the fire records, and were told that fire checks were done, and that the last staff fire training had happened last month. We asked to see the “Fire Risk Assessment”, this is a document that looks at how any risk of fire can be minimised and managed. No document had been developed. The home must have such an assessment. As has already been noted, there is no radiator cover on the radiator in the dining room. A risk assessment must be completed in relation to this potential danger. We briefly discussed the quality assurance system with the Manager, and considered what was in place was suited to the needs of the home. Pen Inney DS0000072806.V375351.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 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 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 3 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 2 Pen Inney DS0000072806.V375351.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? N/A 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 OP3 Regulation 14 Requirement Timescale for action 01/08/09 2. OP8 15 3. OP9 13 4. OP38 13 No one, except in an emergency, may be admitted into the home without having had his/her needs assessed and been assure that these will be met. Where someone is admitted in an emergency then an assessment must be carried out at the first opportunity. Care Plans must include detailed 01/09/09 information about how conditions such as diabetes are to be managed. There must be clear guidance on 01/09/09 when to administer “as required” medications; and there must be risk assessments for people who are self administering medication. Risk assessments must be 01/09/09 developed and implemented in relation to all identified risks, this must included a Fire Risk Assessment. Pen Inney DS0000072806.V375351.R01.S.doc Version 5.2 Page 23 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 OP18 Good Practice Recommendations The terms serious and minor should be removed from the home’s safeguarding policy, to avoid confusion. Pen Inney DS0000072806.V375351.R01.S.doc Version 5.2 Page 24 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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