Care Home: Penrice House

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What the care home does well Penrice House provides a good standard of care in spacious and comfortable surroundings. The people who live at Penrice House describe the staff as " marvelous" and "lovely". A number of the staff have worked at the home for many years and know the residents of Penrice House well. There are good systems for the recruitment of staff and staff are provided with basic training in the work. People are offered an excellent range of activities both in the home and in the local community. The home has extensive grounds and people have the opportunity to take advantage of them in a golf buggy. What has improved since the last inspection? The Registered Manager, Mrs Rowenhall, advised us that they are trying to encourage more contact with the local community, both by inviting local groups to visit, and by going out, for example for meals. What the care home could do better: Pre-admission Assessments and care plans lack detail, particularly in relation to conditions such as diabetes. Such documents help to ensure people get the help they need, in the way they prefer. There is also a need to ensure that their are risk assessments in place, for example in relation to moving and handling, in relation to falls and any other identified risks. Medication is generally well managed, however there are a number of areas where improvements need to be made, particularly in relation to being able to audit stocks. Key inspection report Care homes for older people Name: Address: Penrice House Porthpean St Austell Cornwall PL26 6AZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Helen Tworkowski     Date: 0 7 1 2 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 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. 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 Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Penrice House Porthpean St Austell Cornwall PL26 6AZ 0172673067 0172671967 penricehouse@tesco.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Penrice House (St Austell) Limited care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 29. 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: Old age, not falling within any other category- Code OP- maximum 29 places Date of last inspection Brief description of the care home Penrice House provides accommodation and personal care for elderly people in need of care by reason of old age. It offers accommodation on the ground and first floor, the latter being accessed by stair and shaft lifts. Several rooms are en suite and for single occupation unless two people elect to share. There is good communal space with a choice of sitting areas. The home has extensive grounds with level walks and seating for people to enjoy. Day care is also offered. Ample communal space is provided for both the resident population and day care service users. Regular journeys into the local town are arranged to enable service users to visit the shops, bank, hairdresser etc. if they so wish. For people unable to get into town, services such as hairdressing Care Homes for Older People Page 4 of 26 Over 65 29 0 Brief description of the care home and chiropody are arranged on a domiciliary basis. Medical cover and certain nursing treatments are available via the local Health Centre and the Community Nurses. Service users are encouraged to take their main meal in the dining room where the table settings and meal presentation is of a good standard. A persons wish to eat in his/her room is however respected. Regular contact with families and friends is encouraged. Help is given to maintain hobbies and interests. The home has a programme of activity to which all are invited Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was unannounced and included a site visit. The visit took place between 9.30 a.m. and 5.30 p.m. on 7th December 09, and was carried out by one inspector on behalf of the Commission. The inspection included a tour of the building. We also observed medication being administered and the looked at the way medication was managed. We looked at the care of four individuals, including looking at their records of care. We spoke with four of the residents and interviewed four of the staff. We also looked at other records relating to the management of the home including the recruitment and training of staff. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking 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. Care Homes for Older People Page 7 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that there needs will be known prior to a move to Penrice House, although this may not be in sufficient detail. Evidence: We spoke with one person who had recently moved to the home. The individual was able to tell us that both she and her family had the opportunity to visit Penrice House, before a decision had been made about a move. The individual felt that they had been given sufficient information about the home to help make a decision. We looked at the information that had been collected as part of the pre-admission assessment. This is important information as it helps decide if the service can meet a persons needs, and also forms the basis for any care plans. We found that there was information about needs, but that the information was very general and lacked detail. Assessments need to be detailed particularly where an individual has a condition such as diabetes. Care Homes for Older People Page 9 of 26 Evidence: The Registered Manager, Mrs Rowenhall, said that she did visit people before they moved to collect information about their care needs. People also had the opportunity to visit the home before they made a decision. We discussed the Contracts with the Manager, these documents need to contain the room numbers. We also discussed the importance of being clear about the occupation of any shared rooms, and how any changes of circumstance will be managed. Care Homes for Older People Page 10 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Penrice are given a good standard of care, however the written care plans lack detail, particularly for the people with more complex needs. There is a lack of recorded risk assessments, however actions appear to be taken when needed to keep people safe. The medication though generally well managed, lacks the checks that will ensure that all medication can be accounted for. Evidence: We spoke and spent time with four of the people who live at Penrice House. People told us that they were happy with the standard of care. We also spoke with four of the staff, who all felt that a good standard of care was provided. Staff told us that they had the opportunity to read care plans. We looked at the plans of care and other documents. These are documents that should be agreed with the individual about how their care needs will be met. They should be in sufficient detail so that there can be no confusion, particularly where people have more complex needs. We looked at four care plans. These contained some information about what each persons needs were, however this was not in any Care Homes for Older People Page 11 of 26 Evidence: detail. The plans included phrases such as needs assistance without any clarification of what sort of assistance would be needed. We also noted that a few people had conditions such as depression or diabetes, but there was little information as to how these conditions are to be managed. We were told that district nurses visited on a daily basis to support an individual with diabetes. However, there was no information on file as to what actions the staff were to take if the individual became unwell. When we spoke to staff they explained actions they might take, however it is important that this is written down and agreed with the visiting Healthcare professional and the individual themselves. We found that Care Plans had been reviewed each month, and we were told that the individuals were consulted about their care needs at this time. However there was no record of anyone being consulted or a having agreed their care plans. There were documents that included information about when people liked to get up and some preferences. However, there were no risk assessments, including moving and handling assessments. We found that there was a system for monitoring accidents and falls, however this was not linked to a risk assessment. The Manager told us that where there were concerns that a referral was made to the local falls clinic. In discussion with staff and people who live at the home we noted that some people were able to keep their own medication. We saw that each person has a lockable cupboard in their room which can be used for storing medication or other valuables. There was a record on file of an agreement for each person as to whether they wished to self medicate or if they wished for staff to manage their medication. This was not based on any assessment of competence and did not include information when individuals managed some but not all of their medication. We observed medication being administered at lunch time, this was done appropriately. We also looked at the medication system with one of the senior staff, the home uses a blister pack system which is prepared by the pharmacist. We found that the medication system was generally well managed, however there were a number of areas where improvements need to be made. Some individuals are prescribed a variable dose of pain relief (one or two tablets), there is no record kept of the number of tablets given. It is also important where medication is as required, that there is clear guidance as to the circumstances it is required. Some medication had been received into the home when a person had recently moved. The medication administration sheet had been hand written, where such sheets are handwritten by staff, it is best practice that they are checked and countersigned by another person. We also saw that there was no record of the quantity of medication received. Also, we Care Homes for Older People Page 12 of 26 Evidence: found that it was not possible to audit and check that the amount of medication held in the home was correct, as carried forward totals were not used. We also note that where medication, had been refused, for example pain relief, this medication was kept in a pot and offered again at the next occasion medication was administered. Refused medication should be disposed of in the correct manner rather than re-administered. We also found that lactulose prescribed for one person was being dispensed to other individuals, rather each person having their own supply. Medication belongs to the person it is prescribed for and should only be administered to that person. We also noted that where some people were given medication to self administer, there was no record of this transaction. Such records are important as they not only help ensure that it is possible to audit and account for medication held, but it also helps monitor the needs and well being of people who are self-medicating. We looked at the Controlled Drugs book and checked that the amount of medication in stock was correct, which it was. The current Controlled Drugs cupboard does not meet the most recent regulations and must be replaced. We noted that people were treated with respect by staff, staff knocked on door and addressed people in a courteous manner. It was clear from what was said that many of the staff and people in the home had longstanding and very good relationships. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a good range of activities to take part in, both at Penrice House and in the local community. Meals are of a good standard and well presented. The routines of daily living are flexible and varied to suit the individual. Evidence: The Manager told us that they had a regular programme of activities. She explained that they were trying to ensure that people not only had an opportunity to do things in the home, but also to go out into the community and to have the community come to them. She said that the majority of the residents had recently gone out to a local restaurant for a Christmas meal, there was also plans to have the Mevagissy Male Voice Choir for a concert at the home. A local voluntary group was also involved in taking groups of residents out shopping to a local garden centre. We saw that there was a programme of the weeks events on each dining room table. The people who we spoke with confirmed that the planned activities all took place. The home is surrounded by substantial grounds. The Manager told us that they had a golf buggy so that people could go out for rides when the weather was reasonable. She said that they had plans to build more paths so that more of the grounds could be accessed. Care Homes for Older People Page 14 of 26 Evidence: We asked people in the home about who made decisions about times to get up or go to bed. We were told that there were no rules about such things. People were able to decide things for themselves. We also asked staff about rules, they confirmed that the people who live at Penrice house are able to make their own decisions. We sat in the dining room whilst people had lunch. There is a choice of food at meal times, and people told us that the food is generally good. The Manager told us that she was trying to give people more choice at meals by putting the vegetables in serving dishes, people were then able to decide what vegetables they would like and how much. We also noted that each table had a range of condiments and sauces for people to choose from. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Penrice House have the opportunity to raise any concerns, if they should feel the need. Evidence: The Manager told us that no complaints had been received in the last year. We spoke to some of the residents about the way Penrice was run and if they had any concerns. We were told that people felt well looked after, and if there were any issues then the Manager would sort them out. We also saw that member of the Committee that runs Penrice House visit each month to assure themselves that the home is being properly run. As part of this process the person meets with some of the people who live at the home. We saw that there was information about how to report allegations of abuse to Social Services, in the hallway. We asked staff about what they would do in relation to an allegation of abuse, and was told that staff would speak with the Manager. We asked staff if they had received any training in this area, and was told they had not. We have however been told by the manager that staff have received training on abuse and that this is recorded in the staff development file. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Penrice House provides clean, comfortable and spacious accommodation for the people who live there. Evidence: We were shown around the home by one of the care staff and saw all of the communal areas. Most of the areas of the home have level access, and there is a shaft lift and stair lifts, however there are a some bedrooms where there are steps. The rooms were all of a good standard, and some people had chosen to bring items of their own furniture. All of the bedrooms were of a good size, and those that did not have ensuite facilities had bathrooms close by. The communal rooms are spacious and there is plenty of space for individuals to entertain guests. The house is clean and tidy. There were no unpleasant odours anywhere. The home has a large laundry which is well equipped. Care Homes for Older People Page 17 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Penrice House are supported by long standing and caring staff. Training has historically been limited, and now needs to include and reflect the changing needs of people who live at Penrice and new legislation. Evidence: We spoke with four of the staff who work at the home. All of the staff spoke about how much they enjoyed the work. Some of the staff had worked at the home for many years, others had left to work in other homes, but had subsequently returned to work at Penrice House. Staff said that they liked the way that the home is run, that standards are kept up. We were also told that there is good team work and communication. We asked some of the residents what they thought about the staff, comments included Marvelous, The staff are lovely, Many of the staff have worked at the home for a number of years, and there is a low staff turnover. We asked both staff and the people who live at the home whether there were sufficient staff, and the general consensus was that there were. We looked at the records of three staff who had recently been recruited and found that appropriate checks had been completed. We reminded the manager of the need to ensure that each person provides a full employment history including an account of any gaps in employment. Care Homes for Older People Page 18 of 26 Evidence: The Manager said that she was in the process of setting up a new training matrix, so that she could get a better grasp of training needs. We looked through some of the individual training records. We found that staff had received training in relation to food hygiene and basic health and safety. However there was little evidence of any training in relation to specific conditions, such as diabetes, or to the care of the elderly. We also noted that there was no record of any training in relation to keeping people safe from abuse, or in relation the Mental Capacity Act. Senior Care Staff were not aware of this legislation which affects everyone who works in the home. The Manager told us that the Management Committee had recently agreed a training budget. Care Homes for Older People Page 19 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Penrice House is a well managed home. It has an ethos of putting the people who live in the home first. Evidence: The Registered Manager, Mrs Rowenhall, has been registered and found to be fit by the Commission since the last inspection. Mrs Rowenhall said that she had been in the fortunate position of having worked at the home some time before taking over as Manager, and therefore knew the people and the home well. On the notice board in the hallway we saw that there was a summary of the results of a quality assurance survey that had been completed. The results showed that the people and their relatives were very satisfied with life at Penrice House. We also saw minutes of a Residents Meeting that had recently been held. As has already been mentioned, the home receives regular monthly visits by representatives of the board that run the home. Care Homes for Older People Page 20 of 26 Evidence: The Manager showed us records of monies held in the home, on behalf of some of the people. These were all in good order. We also looked at the Health and Safety records, including risk assessments. Those records seen were in good order. Care Homes for Older People Page 21 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Pre-admission assessments 28/02/2010 must contain sufficient detail to ensure that needs are known about and met from the day they move. Detailed Pre-admission assessments help ensure that needs are met. 2 7 13 Risk assessments (including 28/02/2010 self-medication risk assessments) must be developed and implemented. The management of risk helps keep people active and safe. 3 7 15 Care Plans must be detailed, 28/02/2010 and included clear guidance in relation to particular medical conditions such as diabetes. Staff need to know the agreed manner for providing care. Care Homes for Older People Page 23 of 26 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 9 13 The medication system must 28/02/2010 be reviewed. Medication must only be given to the person it is prescribed for. Refused medication must be disposed of in the appropriate manner. The controlled drugs cupboard must comply with current legislation. There must be a readily auditable record of all medication held in the home. People need to be confident that they will receive the medication that has been prescribed. 5 30 18 Staff training must be reviewed to better reflect the needs of people in the home, and should include conditions such as diabetes, The Mental Capacity Act, and Safeguarding people. Staff need the skills to carry out their work. 31/03/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 9 18 Administration sheets should be countersigned if filled in by a member of care staff. Staff should receive training in relation to safeguarding Page 24 of 26 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations people from abuse. Care Homes for Older People Page 25 of 26 Helpline: 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. 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. 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