Care Home: Pendrea House

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What the care home does well People considering making Pendrea their home are provided with comprehensive information about the home before they make a decision to do so. The home undertakes an assessment of people`s health, welfare and social needs to enable them to be sure that these assessed needs can be met at the home in a way that suits individuals. All people living at the home have individual plans of care, based on pre admission assessments and individual health care needs are well met. Evidence was obtained in various ways through this inspection to show that those living at the home are treated in a dignified manner and their privacy is upheld at all times. Those who were able expressed complete satisfaction in the way they are treated by the staff. The staff were calm and unhurried and assisted people in a friendly, caring and respectful manner. All people we spoke to praised the standard of meals provided. The menus are balanced, varied and nutritious meals and suit all individual dietary needs. People are given choice and meals are well presented. Visitors are also made to feel welcome at the home and a wide choice of drinks is available to them. Activities are an important part of daily life at Pendrea. Outings, celebration parties, arts, crafts, reminiscing are only some of the activities that people can take part in if they wish. There is nothing to suggest that people living at the home are anything but well cared for. People told us they were " very happy living here" and " couldn`t wish for anything better". People living at the home are listened to and any issues they may have are taken seriously. Their opinions are listened to and they are encouraged and supported to take an active part in the running of their home. Regular " residents meetings" are held, and outcomes dealt with. People living at the home benefit from doing so in comfortable homely surroundings. The home is well decorated and furniture and fixtures are good quality. The home employs sufficient staff to meet the needs of those living there. Good recruitment practices ensure people are safeguarded from abuse. Staff are competent and deliver high quality care in a safe manner. There is an open and positive atmosphere throughout the home. What has improved since the last inspection? All staff working at the home have received training in fire safety since the last inspection. What the care home could do better: One requirement was made as a result of the finding on the day of this inspection: A record is not kept of all medication received at the home and the date medication is received at the home is not recorded.Eight recommendations for good practice were made as a result of the finding on the day of this inspection: When directions for the administration of medication are hand written two people are not checking the details to ensure that people receive the correct medicine and dosage, which is considered good practice. When ointments, creams or eye drops are opened a date after which they should not be used is not made clear. When changes are made to the directions of frequency and dosage of a medication the changes are not clearly made on the medication record. Records do not clearly show when, why and who made, the changes. Pre admission assessments of people`s needs are not sufficiently detailed to enable a plan of care to be compiled that clearly shows how the assessed needs will be met at the home. Care plans do not provide staff with sufficient information to enable them to meet people`s individual needs in a person centred way. Adequate supplies of protective clothing and hand washing facilities are not made available throughout the home. Not all staff have received up to date training in how to use safe techniques for moving people and objects that avoid injury to people living at the home and staff. Arrangements should be made to ensure that all people living at the home are kept safe at all times. The home was not complying with fire safety recommendations at the time of this inspection by having a fire door, which should be kept closed at all time, wedged open. This was rectified immediately it was drawn to the providers` attention. CARE HOMES FOR OLDER PEOPLE Pendrea House 14 Westheath Avenue Bodmin Cornwall PL31 1QH Lead Inspector Michelle Finniear Unannounced Inspection 10:00 8 October 2008 th 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 Pendrea House DS0000009202.V366828.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. Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pendrea House Address 14 Westheath Avenue Bodmin Cornwall PL31 1QH 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) 01208 74338 Mrs Pauline Janet Difford Mrs Brenda Eileen Keen Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 2007 Brief Description of the Service: Pendrea House is registered to provide personal and social care for up to sixteen people over the age of sixty-five years. Nursing care is not provided. The detached house is situated on the outskirts of Bodmin close to the local hospital, shops, amenities and bus routes. The home offers level access throughout. Accommodation is provided on the ground and first floors and there is a stair lift to the first floor for people with reduced mobility. There are three bathrooms in the home with assisted bathing facilities. All rooms, apart from one that is a double room, offer single occupancy and many rooms have en-suite facilities. The home has a large lounge (in two parts) and a pleasant dining room that also has a seating area. There is a large conservatory, with plenty of seating and a call bell system, to the front of the house, overlooking the colourful, well-maintained garden. There is also car parking to the front of the building. The registered provider also provides day care for up to four people each day at the home Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that people who use this service experience good quality outcomes. One inspector undertook this inspection spending 7.5 hours at the home. During this time we spoke with people living there and staff and also spent time observing the care and attention given to people by staff. Prior to this inspection we sent surveys to 10 people living at the home, five of which were completed and returned to us from people expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit and three people were spoken with in depth to hear about their experience of living at the home. We also spoke with 6 staff, including the provider, director and ancillary staff, individually. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. Currently fees of between £400-£425.are charged weekly. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . Copies of the inspection report are available from the office. What the service does well: People considering making Pendrea their home are provided with comprehensive information about the home before they make a decision to do so. The home undertakes an assessment of people’s health, welfare and social needs to enable them to be sure that these assessed needs can be met at the home in a way that suits individuals. All people living at the home have individual plans of care, based on pre admission assessments and individual health care needs are well met. Evidence was obtained in various ways through this inspection to show that Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 6 those living at the home are treated in a dignified manner and their privacy is upheld at all times. Those who were able expressed complete satisfaction in the way they are treated by the staff. The staff were calm and unhurried and assisted people in a friendly, caring and respectful manner. All people we spoke to praised the standard of meals provided. The menus are balanced, varied and nutritious meals and suit all individual dietary needs. People are given choice and meals are well presented. Visitors are also made to feel welcome at the home and a wide choice of drinks is available to them. Activities are an important part of daily life at Pendrea. Outings, celebration parties, arts, crafts, reminiscing are only some of the activities that people can take part in if they wish. There is nothing to suggest that people living at the home are anything but well cared for. People told us they were “ very happy living here” and “ couldn’t wish for anything better”. People living at the home are listened to and any issues they may have are taken seriously. Their opinions are listened to and they are encouraged and supported to take an active part in the running of their home. Regular “ residents meetings” are held, and outcomes dealt with. People living at the home benefit from doing so in comfortable homely surroundings. The home is well decorated and furniture and fixtures are good quality. The home employs sufficient staff to meet the needs of those living there. Good recruitment practices ensure people are safeguarded from abuse. Staff are competent and deliver high quality care in a safe manner. There is an open and positive atmosphere throughout the home. What has improved since the last inspection? What they could do better: One requirement was made as a result of the finding on the day of this inspection: A record is not kept of all medication received at the home and the date medication is received at the home is not recorded. Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 7 Eight recommendations for good practice were made as a result of the finding on the day of this inspection: When directions for the administration of medication are hand written two people are not checking the details to ensure that people receive the correct medicine and dosage, which is considered good practice. When ointments, creams or eye drops are opened a date after which they should not be used is not made clear. When changes are made to the directions of frequency and dosage of a medication the changes are not clearly made on the medication record. Records do not clearly show when, why and who made, the changes. Pre admission assessments of people’s needs are not sufficiently detailed to enable a plan of care to be compiled that clearly shows how the assessed needs will be met at the home. Care plans do not provide staff with sufficient information to enable them to meet people’s individual needs in a person centred way. Adequate supplies of protective clothing and hand washing facilities are not made available throughout the home. Not all staff have received up to date training in how to use safe techniques for moving people and objects that avoid injury to people living at the home and staff. Arrangements should be made to ensure that all people living at the home are kept safe at all times. The home was not complying with fire safety recommendations at the time of this inspection by having a fire door, which should be kept closed at all time, wedged open. This was rectified immediately it was drawn to the providers’ attention. 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. Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 8 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 Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 6 Quality in this outcome area is good. Good information about the services offered here is available to people to help them decide if the home suits their needs. People benefit from a good admission practice, which ensures that the home is able to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people living at the home that responded to surveys (5) told us they had been given enough information about the home before deciding to move in. One person wrote, “We had very good recommendations about the home. We Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 10 visited to inspect and got an information pack”. Another person wrote, “I know I could not be in a better place”. Some people spoken with told us they had visited the home before making a decision another person told us they liked the home when they first visited and was “very happy” several people said that they had “heard good things about the home” and when they visited they “felt at home immediately” One person told us that their “Daughter visited prior to admission and was pleased with the home” and “ I am glad I made up my mind. I love it here”. We looked at a copy of the home’s Service User’s Guide [SUG], which gives people an idea of what to expect of the home. A copy of this and the most recent inspection report is available in the hallway for all those living at the home and visitors to read. The SUG was comprehensive very easy to read and understand and included photos of the manager various areas of the home and garden. The manager visits people at home or in hospital before they move to the home to talk about and assess their needs and ensure that the home is able to meet their needs. All of the people we spoke to during this inspection told us they had either been visited at home or had visited Pendrea when an assessment was undertaken. Although most pre admission assessments identified care needs on which a basic plan of care could be written they were not sufficiently detailed. All relatives responding with surveys felt confident that the home was meeting the needs of their relative, one wrote, “A very high standard of care” and another said, “The care given by the home is good”. Staff surveyed said they had not been asked to care for people outside of their area of expertise, suggesting the home admits people appropriately. Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8,9 & 10. Quality in this outcome area is adequate. Systems in place generally inform staff about peoples’ care needs, although lack of adequate detail in some care plans may prevent truly individualised care for everyone. People’s health needs are well met with good multidisciplinary working and people feel they are treated with respect and that their privacy is upheld by caring staff. The management of medication potentially puts people living at the home at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 12 Surveys received from 5 people living at the home showed that they “always” or “usually” received the care and attention they needed, Relatives told us at the time of this visit that they felt their relatives’ needs were “always” and said that staff are “Very caring and competent & always a cheerful atmosphere.”. One person living at the home said “ The staff are always ready to help me if I need it” and “ Best care ever had. Very happy”. A new care planning system is in the process of being put in place since the last inspection, which aims to ensure that staff have enough information about people’s individual needs. Three care plans were looked at during this inspection, two that have been updated to the new process and one that has not. They generally detail individuals’ needs and wishes and are developed with the individual and/or family member. One person told us they had been “fully involved” in care planning and thought this was very valuable and gave them confidence that individual needs are considered and planned for. Two of the care files we looked at contained important information about people’s past life and occupation, providing staff with an understanding of the individual. There was some good detail about peoples’ likes and dislikes, for example, what time they liked to get up or go to bed. Care plans included “aims” but tended to concentrate on individuals weaknesses rather than their strengths. For example, one care plan stated that a person “needs assistance with personal care as can no longer cope” but did not include anything the person may be able to do independently. This potentially puts people at risk of losing what independence they may have as staff are not provided with the appropriate information. Staff demonstrated a good knowledge of how to meet peoples’ needs although not all needs were identified in individual care plans. This potentially puts people at risk of their needs not being consistently met in a way they wish. Daily notes did not always refer to whether the individuals care plans had been met. For instance, details on a care plan gave clear guidance on helping a person to mobilise but there was no record either on the plan or in the daily report of how this had been managed. This means that deterioration or improvement in a persons abilities are not being monitored. Another person has a breathing problem and is prescribed daily treatment, however no plan as to how this would be monitored or treated had been established. This puts this person at risk of not receiving consistent care. A daily “health report” is also maintained for all people living at the home. This included health related issue such as a person who had developed a rash. However, a plan of care had not been written recording how this was to be treated, how the person responded to treatment or if/when the problem had been resolved. Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 13 Although this information hadn’t been recorded in an easily retrievable format details had been recorded in various parts of the persons care-planning file. To include details on a specific plan could make it easier and less time consuming for staff to monitor and record details about people’s health care. We discussed this with the provider and director at the time of this visit who were keen to improve recorded information to ensure that all people living at the home are treated as individuals and receive consistent care. Risk assessments were in place and generally reflected behaviour or situations which may cause harm to people, for example poor mobility, falls and the use of equipment such as bed rails. Moving and handling assessments and plans, skin care and tissue viability and continence assessments were in place and generally provided staff with the instructions needed to deliver care. People’s nutritional needs are assessed and records of people’s weight shows that they either gain or maintained weight after admission to the home. People living at the home said that they always or usually receive the care and support they need and always receive the medical support that they need. When spoken with people confirmed that staff are very quick to call for the doctor when they are not well. One person told us how quickly they had their medication had been changed after staff contacted a doctor and how the quality of their life had improved as a result. During this visit a senior carer rang a doctor because staff had noted that a person “wasn’t their normal self”. Care files also showed that people have access to outside professionals such as G.P, chiropodist and optician in order to ensure their health care needs are met. We looked at medication records maintained at the home. Generally they were well recorded when medication is administered but some improvement is needed. The current procedure, when checking medications into the home, does not include recording the date of receipt. Alterations to the dosage/directions of a medication had been changed by crossing out the original directions and writing in the changes. There was no indication who had actioned the changes and we were not able to trace why, when or by whom the changes had been made. We noted several hand written directions on medication records that had not been signed by two members of staff to ensure accuracy and one that was not dated, signed, amount recorded, the month it related to or the amount received. This means that people may be at risk of not receiving prescribed medication. Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 14 The home’s medication storage and records were looked at. The service has a separate, lockable fridge to store some medicines and other storage was satisfactory, including the arrangements for storing of controlled medicines. Suitable arrangements are in place for the safe disposal of unwanted medication. Whilst visiting some rooms opened containers of creams/ ointments were seen with no indication of when they had been opened or expire. Creams lose their efficacy when open for more than 3 months. This puts people at risk of being treated by creams/ointments that may be ineffective. We looked at the home’s register of controlled medication and checked the record of medication against the actual medication and found it to be correct. The home supports people to look after their own medication following a risk assessment. Several people we spoke to during this visit were happy to be doing this and told us how it made them feel independent. A lockable facility is provided in each room for safe storage. When looking at the medication administration records we noted that medications received into the home for one person who was looking after their own medicines had been recorded but another had not. All medications received at the home should be recorded to ensure safety. People confirmed that they are treated with respect and their privacy is protected. We spoke to several people during this inspection and all confirmed that they receive personal and healthcare support in an individual manner and that staff respect their right to privacy, they feel they are all treated equally and as individuals. Care staff confirmed this when telling us about the home’s privacy and dignity policy, when seen knocking before entering peoples’ rooms and when seen being discreet in offering to provide personal care or assistance. All personal care was carried out in private and people wear their own clothes, which are very well cared for. People spoken with are generally happy with the care given People’s personal care is well attended to. People were well dressed and groomed, and attention to their personal care was good. Many of the ladies were wearing make up and jewellery, one told the inspector, “I see the hairdresser regularly”. The gentlemen were all smartly dressed and well shaved. Staff spoken with and observed demonstrated a good understanding of the people’s needs and preferences. Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is excellent. Everyone living at the home is offered good choices in all aspects of daily living. Social activities are well managed. They provide daily variation and interest for individuals and create opportunities for increasing their independence. Meals are nutritious and balanced and provide individuals with choice and variety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this visit we spoke to eight people who live at the home, all were very complimentary about the care and support they receive. Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 16 We also spoke to the owner and director who confirmed that the aim of the home is to make sure that people who live there are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. In response to questionnaires 4 people confirmed there were always activities arranged by the home that they could take part in and one person felt there were sometimes activities and commented “ “ a bit old for activities. If I ask I know it will be OK, I can help myself to a good book in the lounge”. All those that we spoke to said that there is always something going on at the home that they can take part in if they wish and that their individual interests are also met. Several people told us how much they had enjoyed a recital given by a harpist the previous day. The harpist also visited people who prefer to stay in their own rooms. On the day of this visit a singer came to the home and several people enjoyed listening and also joined in with the singing. The home has an extensive range of books, magazines, craft materials, reminiscence therapy resources and board games, several of which are available in Braille for those people with limited eyesight. A weekly programme of events is clearly posted in the hall and those people who normally stay in their rooms are told of events. The programme of activities includes exercises, painting, quizzes, bingo, board games, pottery and crafts. We were also told that people living at the home hold raffles and the proceeds go to which ever Charity they have decided they would like to support. People also spoke of the enjoyment they had when taking part in the Bodmin Carnival, photos of which are posted on a notice board for all to see. Celebrations such as birthdays, Mothering Sunday, Valentines Day, St Pirans Day and Halloween are enjoyed at the home. A monthly Communion service is held at the home for all those who wish to receive it. Those people who chose to remain in their room, or are unable to attend, may receive Communion privately in their rooms. We asked staff how they prevent people who prefer to stay in their room from the risk of social isolation. We were told that staff visit them frequently, talk to them about daily events, their interests and tell them what activities are taking place so that they may change their minds. Staff were very aware that just because someone didn’t want to take part on one day did not mean that they may never wish to be included. People who preferred to stay in their rooms confirmed this was the case when we spoke to them during this inspection. Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 17 Several people spoke about how their relatives/ visitors are made to feel welcome at the home and can visit at any time and the visitors’ book confirmed this. Visitors, and people living at the home who are able, are encouraged to make themselves drinks, which are easily obtained from a drinks machine, complete with a selection of wrapped biscuits and teas including decaffeinated and fruit teas. We looked at the visitors’ book and it was clear that many people received visitors and they came at different times of the day. People moving into Pendrea are encouraged to bring personal possessions and small items of furniture with them to make their rooms feel homely and this is agreed before admission. Most of the rooms seen during this inspection were personalised and people spoke about the pleasure having their own things around them gave them. All of the people spoken to during this inspection praised the home for the quality and choice of the food served. In response to questionnaires people commented, “The meals are great”,“ Very nice, well cooked, variety is good” and “Happy with choice of food and alternatives”. The home has introduced a ‘tasting panel’, where people living at the home are given the opportunity to sample several different types of the same foods and drinks so that they can decide which they prefer and would like. For example, different types of sausages, teas and even sherry. People spoke to us about this and told us how their appetites had improved. One person said they had to ask for “ a small portion” as they didn’t want to “put on too much weight”. The home has produced a comprehensive menu complete with photographs of the dishes available, which can be produced in Braille or translated into any language if necessary. The menu includes choices, including vegetarian dishes, and also has a list of other alternatives that are always available, for example, jacket potatoes with various fillings, sandwiches, soup and salads. Copies of the menu is displayed on each table and during the evening people are asked what they would like to order for lunch the following day. Meals are served in a comfortable, homely dining room where there is sufficient space for all those living at the home to enjoy their meals. Meals are served directly from the kitchen through a serving hatch. On the day of this inspection the meal served was hot and attractively served. During this visit a person did not want either of the lunchtime choices, or the alternatives, and Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 18 was given toast as they requested, in their room. The provider and director told us “ This is their home and they can do what they like when they like” and the people we spoke to during this inspection confirmed this. Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 19 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): 16 & 18. Quality in this outcome area is good. There is a clear and simple complaints procedure that ensures complaints are responded to promptly with satisfactory outcomes. Staff have a good knowledge and understanding of the forms of abuse thereby ensuring that people living at the home are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a detailed, clear and simple complaints procedure, which is prominently displayed for all people living at the home and visitors to see. The home has developed a system to maintain records of all complaints received and how they are managed. The provider told us that all complaints are taken seriously at the home and action is taken to resolve any issues. This was confirmed when we looked at the record of complaints received at the home since the last inspection. Two complaints had been made relating to domestic issues that had been dealt with appropriately and to the satisfaction of those who made the complaints. Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 20 People living at the home that we spoke to during this inspection said that if they were unhappy about anything they would not hesitate to raise any matter at any time and were sure that it would be dealt with to their satisfaction. Staff said that if anyone made a complaint they would report it to either the senior carer on duty, the manager or the owner. If it was something that they were able to sort out themselves then they would. They were confident that no issue that was raised would ever be ignored. A suggestions box is available in the entrance to the home where comments can be made anonymously if preferred. There was nothing to suggest that people living at Pendrea are anything other than well cared for. People spoken to told us that staff are very helpful, respectful and that nothing was ever too much trouble for them. Records were seen showing that staff have received training in Adult Protection issues. The provider, director and manager have recently undertaken a training seminar on “ No Secrets”, which has enabled them to give induction level training to staff at the home. This training is endorsed by Cornwall Adult Protection Committee and meets the “Skills for Care” Common Induction Standard. This means that staff are aware of measures to protect people living at the home from the risk of harm. A procedure for responding to abuse is available and staff are aware of this. They were able to describe differing types of abuse and gave good details of what they would do if they suspected abuse was occurring. They were aware of the home’s ‘Whistle-blowing’ policy and that it would support them in reporting bad practice. They felt confident that they would be listened to if they raised concerns about bad practice. All of the 5 people living at the home who responded to questionnaires agreed that the always know who to speak to if unhappy or wanted to make a complaint. One person commented, “ I can always have a word with the manager but I am happy” and another completed by a relative confirmed “ Is very happy and satisfied. Knows who to see if there was a problem”. Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. The standard of the environment provides a comfortable, clean environment for those living in, working at and visiting the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean, comfortable and homely at the time of this inspection. We visited the rooms for all people living at the home were visited during the inspection, and these were all well maintained. Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 22 We saw bedrooms that were well decorated, bright and homely. The majority of them had been personalised and people living at the home told us that they were happy at the home. Environmental risk is being well managed and decoration, fitting and fixtures such as furniture, curtains, carpets, pictures, lamps throughout the home are of a good quality. The home has a large lounge, a light and airy conservatory and a large separate dining room. Ample space is available for activities and for those who like to walk or have mobility problems and need the use of a wheelchair. A Consultancy Company has recently carried out a risk assessment of the whole home in relation to any hazards/ risks to peoples’ safety. The provider and director told us that they are working towards meeting these on a priority of risk basis. During this inspection we saw a fire door, which must be kept closed, wedged open. [Please refer to Standard 38] The home was clean and fresh and people living there commented positively on the cleanliness of the home, and this was observed on the day of the inspection. In questionnaires all 5 people who responded confirmed that the home was always clean and fresh. One person commented “ Very, very clean, very pleased” and another “ very well kept”. There is generally a good supply of protective clothing and hand-washing facilities at the home and the laundry has equipment that should effectively reduce the risk of cross infection. However, no gloves or aprons were available in the laundry, a toilet had paper towels available but the soap dispenser did not work and there was no bin to dispose of towels in. Although we were told that staff carry gloves and antiseptic gel with them at all times this means that some people may be at risk of cross infection. We discussed this with the provider and director who agreed to ensure that the appropriate equipment was put in to place immediately. All those living at the home during this inspection were well dressed at the time of this visit and several said that their clothes are well looked after. Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 28 & 29. Quality in this outcome area is good. People living at the home benefit from having trained, skilled staff in sufficient numbers to support them, and the smooth running of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who responded to questionnaires and those spoken to during this inspection said that staff responded to their needs promptly. This was confirmed during this visit when staff responded promptly to peoples needs in a kindly, friendly and respectful manner. Throughout the day we saw staff asking people if they wanted a drink, were comfortable, reassuring people, visiting those who wished to stay in their rooms and engaging people in conversation. The home aims to have the manager, 2 carers, 2 kitchen staff [until 2pm] and a domestic on duty throughout the day. Since the last inspection an additional Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 24 member of staff is on duty throughout the night making 2 members of staff on duty throughout the day and night. Depending on peoples’ individual needs one member of night staff may be carrying out a “sleeping duty”, but on some nights there may be 3 staff on duty. This means that changing needs of people living at the home are assessed and met. The provider discussed the recruitment procedure at the home and how it has been developed so that it considers the needs of people living at the home. She stressed the importance, and time taken, to make sure that only good quality carers are recruited so that a high standard of service is offered at the home. We looked at two recently employed staff files. All included evidence that the home had conducted a robust recruitment procedure. Files included details of past employment, application form, training, evidence of identity, police checks and references. This procedure means that people living at the home are protected by the home’s recruitment procedure. We noted that the home had employed a person who had resigned, left employment at the home for 3 weeks and then returned. The provider had not applied for a police check [CRB] for this person, however, after discussing the procedure they arranged immediately for an application form to be completed. We were notified by phone the day following this inspection that the application had been completed and sent to the appropriate service. All newly employed staff undergo a period of training when they start working at the home to enable them to get to know the residents, the home’s philosophy of care, safety procedure, care procedures, and the general layout of the home. The time taken to complete this training will depend on past experience and individual ability. Individual staff files include confirmation of all training undertaken and all planned. We saw records that confirmed that staff had received fire safety, dementia care, first aid, infection control and medication administration training since the last inspection. Staff are due to receive an annual update in manual handling training, which was last provided in September 2007.This will mean that staff will be kept up to date with current safe practice when assisting people to move. [ refer to standard 38] Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 25 Information received prior to this inspection stated that 62 of care staff at Pendrea has achieved a nationally recognised qualification [NVQ] at level 2 or above and all other staff are registered and studying for the award. This means that all staff are kept up to date with current good practice. Training planned to take place during the next 12 months include manual handling, food hygiene and dementia awareness updates. Ensuring that people living at the home are cared for by a competent team of staff further promotes person centred care and safety. Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, & 38. Quality in this outcome area is good. People benefit from living in a well managed home that is working hard towards trying to make sure the home is run in their best interests. Health and safety is generally well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prior to this inspection the manager sent us information about the management of the home and how the home has carried out improvements Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 27 based on the feedback from the last inspection. The manager and staff have worked hard to meet the requirements made at the last inspection. Records are securely stored and would be made available to people living at the home, or their representative, with their consent. Records are kept in lockable filing cabinets, and those seen were up to date. Peoples’ feedback about such things as the quality of their life at the home, staffing, meals, cleanliness and activities is sought on a daily basis by all staff at the home. The home undertakes annual quality assurance audits and surveys to ensure that people living at the home are given a say in the home’s running. The results of this survey will be included in the home’s statement of purpose and be made available to other interested parties. Within the first 28 days of making Pendrea their home, new users of the service, and their family and friends, are given a quality assurance questionnaire to seek their initial views on life at Pendrea. “Resident meetings” are held regularly at the home and people are encouraged to discuss any topics they wish. At the most recent meeting held in September 2008 people discussed activities and entertainment, chairs, menus and discussed a recently recruited member of staff. This means that people living at Pendrea have a say in the running of the home and are encouraged to make choices and their wishes known. Information provided prior to this inspection indicated that the result of the most recent quality assurance survey showed a 98 satisfaction rating from people living at the home in relation to the services they receive at Pendrea. We were told that staff are due to receive an annual update in manual handling training, which means that a staff use a safe technique when assisting people to move. All staff at the home have received training in the prevention of fire since the last inspection. Information received before this inspection indicated that all equipment is well maintained regularly. We looked at a record of accidents that have occurred at the home since the last inspection. All incidents were well documented. During our tour of the building we noted a fire door, at the top of a staircase, wedged open. This potentially puts people at risk of harm. We spoke to a person living in a room close to the door, who also likes to keep the door to their room open. The person was aware of the procedure to be taken in the event of a fire, the location of fire escapes and had been involved in fire drills carried out at the home. We discussed this with the provider and director who immediately called the maintenance person to the home to fit an automatic Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 28 door closure to the fire door. We were notified the day following this inspection that this had been completed. Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 29 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 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 X X X 3 Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 30 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. 1 Standard OP9 Regulation 13[2] Requirement A record must be kept of all medication that is received at the home. A record must be kept of the date medication is received at the home. When directions for the administration of medication are hand written two people must check the details to ensure that people receive the correct medicine and dosage. Timescale for action 12/11/08 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 OP3 Good Practice Recommendations Pre admission assessments of people’s needs should be sufficiently detailed to enable a plan of care to be compiled that clearly shows how the assessed needs will be met at the home. DS0000009202.V366828.R01.S.doc Version 5.2 Page 31 Pendrea House 2 OP7 Care plans should provide staff with sufficient information to enable them to meet people’s individual needs in a person centred way. This relates to some files not having plans written to meet current health care needs such as asthma. When ointments, creams or eye drops are opened a date after which they should not be used should be made clear. This is to ensure that they are not used after their shelf life. When changes are made to the directions of frequency and dosage of a medication the changes should be clearly made on the medication record. Records should also clearly show when, why and who made, the changes. This is to ensure that people receive the correct medication at the correct times. Clear instructions should be recorded when variable doses are prescribed and results monitored to provide further information to enable monitoring of medication. This relates to when directions state, for example “1 or 2 to be given”, or “ Give 1 at night if required”. Attention should be given to ensuring there are adequate supplies of protective clothing and hand washing facilities available throughout the home. This relates to no gloves or aprons being available in the laundry and no soap, or bin for the disposal of paper towels, available in one toilet All staff should receive training in how to use safe techniques for moving people and objects that avoid injury to people living at the home and staff. This relates to staff receiving up to date manual handling training. Arrangements should be made to ensure that all people living at the home are kept safe at all times. This relates to a fire door being wedged open, at the time of this inspection, when it should be kept closed at all times. The provider and director attended to this at the time of the inspection and confirmed that a door closure had been fitted the day following this inspection. 3. OP9 4. OP9 5. OP9 6 OP26 7 OP38 8 OP38 Pendrea House DS0000009202.V366828.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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