Care Home: Penmount Grange

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What the care home does well Penmount Grange provides a friendly, relaxed environment in which residents` care needs and expectations are met. The registered providers and registered manager have a proactive approach to the development of the service, especially with a view to continually improving the environment. The home properly assesses potential residents prior to admission. Care plans were seen to inform, guide, direct, and included the number of care staff needed. The home has an effective complaints procedure and safeguards residents from abuse. What has improved since the last inspection? The home has addressed all of the requirements and recommendations identified at the previous inspection. The registered providers and registered manager have refurbished 6 bedrooms, installed a new kitchen and office, refurbished the dining room and lounge, and fitted window boxes and planted flowers to the front of the building. What the care home could do better: The home could demonstrate the availability of social/recreational activities even if these are not taken up. CARE HOMES FOR OLDER PEOPLE Penmount Grange Lanivet Bodmin Cornwall PL30 5JE Lead Inspector Alan Pitts Key Unannounced Inspection 22nd July 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Penmount Grange DS0000061897.V366157.R02.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. Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Penmount Grange Address Lanivet Bodmin Cornwall PL30 5JE 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 831220 Mr Leander Joseph Difford Mrs Pauline Janet Difford Mr Stephen John Difford Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Penmount Grange DS0000061897.V366157.R02.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 providing personal care 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 27. Date of last inspection Brief Description of the Service: Penmount Grange is situated on a hill, overlooking the A30 approximately half a mile from the village of Lanivet, near Bodmin. It is a family run care home registered to provide accommodation and personal care for up to 27 older people. The home consists of the main house and two added extensions. Bedroom accommodation is provided for residents on the ground and first floors. En-suite facilities have been, or are being added, to clients’ rooms. There are assisted bathrooms provided for residents, with additional toilets near communal areas. The home offers a respite bed facility when there is space if not all rooms are occupied. A number of clients attend the home for day care. There are two lounges (the smaller of the two being a `quiet area) a dining room and a conservatory. The detached house stands in its own grounds with seating areas provided. Parking is available for 4-5 vehicles in the grounds of the home. Penmount Grange DS0000061897.V366157.R02.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 potentially experience good quality outcomes. This unannounced inspection took place on the 22nd July 2008 over a period of approximately 5 hours. The two inspectors met with the registered manager, staff, and residents, toured the building, and examined documentation. There has been a noticeable improvement since the last inspection, both in terms of action taken to address requirements and in respect of internal improvements to the environment. There are significant further improvements planned, including the installation of a lift and a pavilion to the front of the premises. Overall, Penmount Grange provides individualised care that meets the expectations of the people that live there. Comments from residents were complimentary of the home, the staff, and the care provided. What the service does well: What has improved since the last inspection? The home has addressed all of the requirements and recommendations identified at the previous inspection. The registered providers and registered manager have refurbished 6 bedrooms, installed a new kitchen and office, refurbished the dining room and lounge, and fitted window boxes and planted flowers to the front of the building. Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Penmount Grange DS0000061897.V366157.R02.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 Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides clients and their relatives with the information they need. The home accepts admissions on the basis of a full care needs assessment. Standard 6 is not applicable, as the home does not provide intermediate care. EVIDENCE: The home provides an up to date Statement of Purpose and Service User Guide, both of which are written in plain English and are descriptive of the service offered. The care documentation relating to the most recent admission to the home showed a care needs assessment had been carried out prior to admission, and this was supported by a long-term needs assessment completed following admission to the home. Each client has a plan of care. The home offers respite care, but not intermediate care. Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 9 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 good. This judgement has been made using available evidence including a visit to this service. All residents have a suitable care plan, which is regularly reviewed. This provides a basis for consistent care being delivered by staff. Healthcare support was evident during the inspection, and residents can be assured they will receive suitable support from medical practitioners. Residents are protected by the home’s adherence to its medication procedures. Staff work with the people that live there in a manner which respects their privacy and dignity. EVIDENCE: There is a care plan for each resident, which is comprehensive and informative. Care plans are supported by a variety of care needs assessments and daily records. The records show resident/family involvement in care decisions. The care plan format is suitable and care plans are regularly reviewed. The care plans were seen to inform, guide, direct, and included the number of care staff needed. Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 10 There is a current practise of using different books for recording (e.g. night call record, day diary), and this was discussed with the registered manager with a view to ensuring that all entries are made in the client’s individual file to ensure compliance with data protection and to prevent duplication or omission. Residents said they were satisfied with the healthcare support they received. This includes visits from GPs, district nurses, chiropodists, dentists and opticians. Each resident has a photograph held on their medication sheet to ensure their protection during the administration of meds. Records of medication received into the home and disposed of are kept. There are policies and procedures in place. Medicine Administration Records are free of unexplained gaps. There is sufficient medicine storage in the 3 medicine trolleys used. Medicine Administration Records are pre-printed by the supplying pharmacy. The registered manager undertook to discuss with the pharmacy the format of the Medicine Administration Records to include more specific instruction (e.g. 8am as opposed to “morning”). The staff were observed to knock on residents’ doors prior to entering. There is a record of preferred names and these were observed to be used. Residents were complimentary of the care and kindness of the staff, and also confirmed that they would feel able to express any concerns. Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents largely determine their own lifestyle, though there is a programme of entertainment, and routines are individualised and flexible so that residents can live a lifestyle according to their wishes and needs. The home could do more to show the availability of social/recreational activities, even if these are not taken up. Visiting arrangements are flexible. Arrangements to assist residents with their finances are satisfactory. Meals are provided to a high standard, so residents are provided with a choice of wholesome and nutritious food. EVIDENCE: Residents said that they felt that they had enough to occupy themselves. The residents and the records show that people may get up and go to bed when they wish. Some residents choose to spend the majority of their time in one of the lounges, while others prefer their time in their bedrooms. There is an activity programme and evidence of social recreational activities taking place (staff were seen playing dominoes with clients), but the daily entries made by staff tend to focus on delivery of care. The daily entries do not show when a social/recreational opportunity has been offered and declined. Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 12 The visitor’s book indicated that family and friends visit frequently, and residents confirmed this. Residents also go out with family and friends. Residents confirmed that they would feel able to express their views and/or concerns, and they felt that choice was available to them. Client finances were not inspected at this time. Clients are provided with a daily photographic menu, supported by a text description of what the meal is. The registered manager is introducing a residents’ Tasting Panel. Residents will be asked to try, for example, 3 different types of bread and then say which they prefer. Residents are consulted about the menu, which also includes additional options that are available throughout the day. Fresh fruit is available, and a Cappuccino coffee machine is also provided. Residents said “The food is good and has improved over recent months”. Specialist diets are catered for. Discussion did take place in respect of soft diets and the need to process individual constituents separately. Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 13 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. This judgement has been made using available evidence including a visit to this service. The home operates an effective complaints procedure. Residents are protected by an appropriate adult protection policy. EVIDENCE: Neither the home nor the Commission for Social Care Inspection have received any complaints since the last inspection. There is a current and clear complaints procedure included in the home’s Service User Guide, and displayed in the entrance to the home. Staff cover basic adult protection through their induction training which is based upon the Skills for Care documentation. The registered manager is a safeguarding trainer and cascades additional training to the staff. One resident spoken with confirmed that they would feel confident expressing any concerns to staff or management. Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 14 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. This judgement has been made using available evidence including a visit to this service. Penmount Grange provides a safe, well-maintained, clean and hygienic environment for clients, staff and visitors. Further improvements are planned. EVIDENCE: The registered providers and registered manager have refurbished 6 bedrooms, installed a new stainless steel kitchen, a new office, refurbished the dining room and lounge, and fitted window boxes planted with flowers to the front of the building. Communal areas are spacious, light, and well equipped. Residents said they thought the home was comfortable and pleasant. Bedrooms are individualised with personal belongings. There are currently 13 en-suite bedrooms though the registered manager has plans to increase this number. The first floor may be accessed by stairlifts, though again the registered manager has plans to install a platform lift to improve access around the building. One staircase area was noted to be dated and worn, but Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 15 the home are applying for planning permission to alter this area. Residents have the option of keys to their rooms. Hand washing and bathing facilities were seen to be sufficient, and staff were observed to carry alcohol hand wash solution. The laundry is small, but functional, and again there are plans to build a new laundry. The home was seen to be clean throughout at the time of the inspection. Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 16 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, 29, 30 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient staff to meet residents’ care needs, and there is a commitment to staff training. Residents are protected by the home’s recruitment practises. EVIDENCE: Residents at Penmount Grange benefit from a stable staff team. The duty rota and comments from staff and residents confirm that there are sufficient numbers of staff to meet the care needs of the residents. Residents spoken with were, without exception, positive about the care provided by the staff. There are 16 care staff, of which 13 have achieved NVQ Level 2 or above (approx 81 ). The registered manager said that the remaining 3 staff are enrolled on this training, and they plan to introduce NVQ training for other support staff. All staff are supplied with, and sign for, a General Social Care Council Handbook. Inspection of a staff file showed that the home are adhering to a robust employment procedure that protects residents. The staff file also showed that there is ongoing training in areas such as: dementia care, manual handling, and adult protection. Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 17 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, 35, 38 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run by a suitably qualified registered manager. The home undertakes quality assurance questionnaires. Staff are appropriately supervised. The health, safety and welfare of residents are protected. EVIDENCE: Residents’ comments about staff were positive. The inspectors observed staff attending to residents’ needs in an appropriate and respectful manner. The registered manager, who is the son of the registered providers, has achieved the Registered Managers Award qualification. There are clear lines of accountability. The home’s business plan was spoken about during the course of the inspection with the home having a clear plan on their future direction. Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 18 The registered manager presented as enthusiastic and capable on the day of the inspection. The registered manager is supported by two assistant managers and all three members of this team share on call responsibilities. The home has conducted a quality assurance programme, and the inspectors were shown a summary of the findings and responses to the most recent questionnaires. The registered manager said that the home does act on the findings, and will also look at ways of publishing the summary (possibly in the home’s Service User Guide). Client finance records were not inspected at this time, but this was seen to be satisfactory at the last inspection. The home does not look after any peoples’ money as such, but does have money kept in safe keeping for some people. The registered manager takes responsibility for meeting health and safety requirements of legislation. Maintenance records for equipment in the home was up to date. The accident book was seen to be in order, and discussion took place with the registered manager with a view to periodically auditing the entries. Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 19 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 X X X 3 Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations The registered manager should do more to ensure that records show the availability of social/recreational activities, even if these are not taken up. Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 21 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. Extracts may not be used or reproduced without the express permission of CSCI Penmount Grange DS0000061897.V366157.R02.S.doc Version 5.2 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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