Latest Inspection
This is the latest available inspection report for this service, carried out on 7th September 2010. CQC found this care home to be providing an Poor service.
The inspector made no statutory requirements on the home as a result of this inspection
and there were no outstanding actions from the previous inspection report.
For extracts, read the latest CQC inspection for Penvose Residential Home.
What the care home does well People living at Penvose have access to a range of health care services both at the home and in the community. People have access to NHS services and routine screening programmes. People are able to maintain links with their family, local community and friends. Visitors are welcome at the home at any time. Relevant checks are carried out before prospective staff start work at the home to show that they are suitable to work with vulnerable people. Staff have started a mandatory training programme to ensure they have relevant qualifications, knowledge and skills to carry out their job and they keep up to date with current practice. A programme of routine and ad hoc maintenance and repairs is in place, and a programme of refurbishment and redecoration has started. What the care home could do better: Although care plans are being improved, systems must be in place to ensure that all the staff understand and follow information and instructions about the person-centred culture and attitude being introduced at the home. Systems being put in place should be clearer for staff to ensure people receive the finer details of care and so are able to make decisions about their lives. This will ensure that care staff involve people in their personal care. People less able to express their views should be consulted about choices in such a way that they are able to make a choice. To ensure that people`s wellbeing is supported, the care staff need to develop how they communicate and interact with people so it is effective and follows the care plan. This will ensure that care is given in a consistent way and this will enable the people using this service to feel secure. To ensure that people are cared for in a flexible way changes to work practices and cultures should make certain that work practices fit around the people receiving care, rather than the other way around. Improvements are needed to the way medicines are managed in the home to ensure that no-one is at risk, and to make sure people always receive their medicines safely as their doctor has prescribed for them. Communication between the Care Quality Commission (CQC) and the registered provider and manager should be more robust. This will ensure that CQC has first hand, up to date information about progress at the home, and CQC can be confident the action plan made following the last inspection visit continues to be implemented in a timely fashion. Random inspection report
Care homes for older people
Name: Address: Penvose Residential Home 1/2 Tothill Avenue St Judes Plymouth Devon PL4 8PH zero star poor service 14/05/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Megan Walker Date: 0 7 0 9 2 0 1 0 Information about the care home
Name of care home: Address: Penvose Residential Home 1/2 Tothill Avenue St Judes Plymouth Devon PL4 8PH 01752663191 01752663191 penvoseresident@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Sharon Louise Spry Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Joyce Sylvia Reed care home 15 Number of places (if applicable): Under 65 Over 65 0 15 dementia old age, not falling within any other category Conditions of registration: 15 0 The maximum number of service users who can be accommodated is 15 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other cattegory (Code OP) Dementia (Code DE) Date of last inspection 1 4 0 5 2 0 1 0 Care Homes for Older People Page 2 of 11 Brief description of the care home Penvose is registered to provide care and accommodation for up to 15 older persons who may also have dementia. The home does not offer a service to people whose mental health issues cause them to display anti-social behaviour or aggression. The home does not provide an intermediate rehabilitation care service, however it occasionally admits people whom need short-term respite care. It is not registered to provide nursing care. The home, originally two houses, is built on a hill so the ground floor is split level. The most direct access between the two houses is via a short flight of stairs joining the two lounges. People using this service therefore need to be able to manage stairs. Access to the first floor is provided by stair lifts on each stairway. Penvose is not suitable for people who use a wheelchair. There are 13 single and one double bedrooms. None have en-suite toilet facilities. The home is situated in a residential area of Plymouth a short bus ride from the city centre. It is opposite a large park. At the back of the house is an enclosed patio garden and at the front there is a garden. Limited off road parking is available for visitors at the rear of the home otherwise on street parking is available subject to parking restrictions. Penvose has a no smoking policy. The current fees at Penvose are subject to an individual assessment of needs. Additional charges include a hairdresser, a chiropodist, personal toiletries and newspapers. Information about Penvose can be obtained directly from the home. Care Homes for Older People Page 3 of 11 What we found:
This was a random inspection undertaken by one Compliance Inspector. It was to check compliance with regulation following a key inspection on 14th May 2010 when the service was rated POOR for the second time. There had been no significant improvement and outstanding requirements made in 2009 still had not been met by the time of that visit. Consequently the local authority Commissioners continued to follow their policy of not commissioning with poorly rated services. Therefore at the time of this visit no one new had moved into Penvose since 2009. The fieldwork part of this inspection was unannounced and took place on Tuesday 7th September 2010 between 10:00 and 16:16. On our arrival we were met by the new manager who was the person in charge of the home at that time. On this occasion we found there has been compliance in meeting all the requirements made at the last inspection, and those outstanding from the previous two inspections in 2009. We found that a new care plan format is now in use. This divides information into five sections: Care; Health and social care visits; Charts (e.g. weight, food intake, fluid); Daily records; and previous care plans. In addition to the daily record there is also a daily report for handover between shifts this is completed by the staff at the end of their shift. The second section allows visiting health and social care professionals to record the outcome of their visit, record reviews held by the local authority, or care staff can record telephone calls, hospital appointments, and any other relevant information involving health and social care professionals. The new care plan format also includes a personal information sheet with the persons preferred name, and background information about the reason the person has moved into Penvose. We found that each care file had risk assessments and these identify hazards and the measures needed to control the risk. Each risk had been identified as a stand alone risk. This means they are easier for staff to manage because they are put more into context. We looked at two care files. The records were sparse and seemed to be mostly about bathing and personal hygiene. We found however that information was written sensitively and objectively. The format of the care record allowed opportunities for a very detailed personalised plan of care. We queried the lack of detail with the manager who explained that other information was recorded elsewhere. She later showed us the activities book where staff had been recording different things with which individuals had been involved. We also asked about recording information about the finer details such as how an individual prefers to dress, if they like to wear make up, perfume, aftershave, jewellery. The manager told us that she is calling these details quality moments. A care assistant is collating all this information and putting it together into a picture profile of each person residing at Penvose. It will also include details of particular interests, the persons lifestyle before they moved into Penvose, and if there are things that they would like to continue to do. The staff member told us that she is gradually collecting information. She said it tended to come from impromptu chats rather than sitting with someone to specifically ask lots of questions. The staff member described how she would use the information to
Care Homes for Older People Page 4 of 11 create a life story book. This did not however define everyday specifics that could be important to people in defining who they are rather than who they were. We found that all the all care files needed the photographs updating. The manager was aware of this and planned to take new photographs to put on peoples care plan and also their medication records. We found that each person had signed their care plan but there were no dates to show when plans were compiled or signed. No care plans had been reviewed as it was too soon since the revised plans were written. We found that the manager is introducing an untoward accident/incident form. The purpose of this form is to record any unexplained bruising or cuts. For example whilst assisting with personal care, a care assistant noted that the person had a cut on their arm. The person was unable to recall how it happened although they thought they may have knocked against something. The care assistant therefore recorded this information on one of these new forms. We asked the manager if staff use body maps in conjunction with these incident forms. She said there were body maps available and these were usually completed when someone was being admitted to hospital. We suggested that perhaps this could be useful in incidents such as the one on the day of our visit. The care assistant had recorded that the cut was below the elbow, however it did not state how far below the elbow. From the medical and health information known about this particular person, it was likely that they would have further cuts and bruises due to the medication they are prescribed, and poor skin/tissue viability. The manager agreed it would be useful to build up a picture with detail on body maps. She confirmed that she plans to audit the incident sheets approximately once a month. Also we were told that families or representatives would be informed the same day if any unexplained bruising or cuts were found by care staff. We found the manager is pro-active about recognising when a Best Interests meeting is necessary. We found two good examples with two different people residing at Penvose, and the manager talked through the possibility of a third that she considered should be held. We observed that people can choose to be involved in daily activities such as laying the tables at meal times, and assisting with the washing up. Some frustration was expressed by the staff about how to engage people in different activities. The manager told us that she is trying to encourage the staff to facilitate activities that are inclusive. We were told about two spontaneous events recently. One of these was a food tasting afternoon. Using the success of this event, the cook plans to involve everyone residing at Penvose with menu planning and introducing new foods. We found the medication tray left unattended in the dining room after lunch. We had to prompt the care supervisor to lock it away. Since the last inspection neither the home nor CQC has received any complaints. Some staff completed safeguarding training last year. On this visit we found that all the staff have attained at minimum the Level 1 Alerters training organised and run by the local authority. The staff are also working through a distance learning training course about the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS), and what it means for staff working with people in registered care services. Top up training is also
Care Homes for Older People Page 5 of 11 being arranged with the local authority. We found that a programme of redecoration and renewal has been put in place by the provider. Works are being carried out around the home including painting & decorating. Picture Signage is in place to assist people to find their way around the home. All the bedroom doors now have locks. These are a Yale type lock without an option to lock the door from inside when the door is closed. Staff can gain access to a bedroom in an emergency using a master key. Equipment identified at our last visit as hazardous or worn has been replaced. New carpet has been laid in some parts of home. We found that the manager is starting to implement a training plan. She told us that staff are volunteering for training and willing to do training in their own time. Since our last visit the staff have completed mandatory training including fire safety, moving and handling, and first aid. Some staff were attending an Infection Control study day covering dementia infection control; foot care and infection control, and incontinence & infection control shortly after this visit. Additionally the manager planned to implement use of the Health and Social Care Act 2008, and what this means for staff regarding their practice of the control of infection. The manager told us this was a priority alongside dementia care training whilst diet and nutrition, and epilepsy, were on a training To Do list. The manager was also planning to arrange end of life care training for all the care staff. A staff member told us that she had completed practical fire training about 2-3 weeks before this visit. Also since our last visit she has attended training about moving & handling; first aid, and recently she completed the distance learning course about the Mental Capacity Act. The same staff member said that she had not had any training on food hygiene, infection control or dementia care. We found that one new staff member has been recruited since our last visit. We observed that the new staff member was following the Skills For Care induction training course. The manager told us that there was an advertisement currently for a cleaner and she hoped to employ two cleaners who would to cover the whole week. She confirmed that staff numbers will be increased once the local authority lifts its bar on new people moving into Penvose. Likewise there will be a return to two waking staff once there is an increase in numbers of people residing at Penvose. Currently at night there is one staff member awake and one sleeping because risk assessments show everyone currently residing at Penvose is a low risk at night. Staff files were found in a more structured order. All staff have been given details of information they need to bring in for the manager to complete their file. All the files need a photograph of the person. At the time of this visit the provider employed a manager, two care supervisors; nine care assistants; a cook; and two cleaners (pending references and re-advertisement). There were eight people residing at Penvose, one of whom was in hospital. On the day of our visit the manager was working from 08:00 until 15:00. One care supervisor was working a twelve hour day. Two care assistants worked a six hour shift covering either the morning or the afternoon/evening. In addition in the morning there was the cook. The care staff were also responsible for the cleaning, clearing up after meals including washing up, and preparation of drinks, meals (except lunch) and snacks for people throughout the day. Since our last visit the registered provider has resigned as the registered manager. She continues to be the registered provider. A new manager was appointed. Following this visit the Registration Team approved this person as the new registered manager of
Care Homes for Older People Page 6 of 11 Penvose. What the care home does well: What they could do better:
Although care plans are being improved, systems must be in place to ensure that all the staff understand and follow information and instructions about the person-centred culture and attitude being introduced at the home. Systems being put in place should be clearer for staff to ensure people receive the finer details of care and so are able to make decisions about their lives. This will ensure that care staff involve people in their personal care. People less able to express their views should be consulted about choices in such a way that they are able to make a choice. To ensure that peoples wellbeing is supported, the care staff need to develop how they communicate and interact with people so it is effective and follows the care plan. This will ensure that care is given in a consistent way and this will enable the people using this service to feel secure. To ensure that people are cared for in a flexible way changes to work practices and cultures should make certain that work practices fit around the people receiving care, rather than the other way around. Improvements are needed to the way medicines are managed in the home to ensure that no-one is at risk, and to make sure people always receive their medicines safely as their doctor has prescribed for them. Communication between the Care Quality Commission (CQC) and the registered provider and manager should be more robust. This will ensure that CQC has first hand, up to date information about progress at the home, and CQC can be confident the action plan made
Care Homes for Older People Page 7 of 11 following the last inspection visit continues to be implemented in a timely fashion. 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 set out on page 2. Care Homes for Older People Page 8 of 11 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 11 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, 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 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 Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 11 of 11 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
