Care Home: Petworth Cottage Nursing Home

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What the care home does well The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. The pre admission process ensures that only residents whose needs can be met at the home are admitted.Staff practice reflects a good understanding of residents` personal and healthcare needs, which ensure that needs are met. Residents` lifestyle within the home is their own choice and are provided with opportunities to participate in activities if they wish to. Residents receive a choice of balanced and freshly prepared meals. Residents` benefit from an open culture where they are able to express their views and feel valued and protected from harm. Residents live in a clean and homely environment and are provided with comfortable indoor and outdoor communal facilities. They benefit from being supported by an experienced and committed team of staff and their needs are being met with the number and skill mix of staff on duty. Residents` benefit from the commitment of a skilled and experienced Registered Manager who ensures that the home is managed and run in the interests and safety of the people who live there. The health, safety and welfare of residents and staff are promoted and protected so far as is reasonably practicable. What has improved since the last inspection? Work has been done to improve medication procedures. Medication written procedures are being updated and regular monitoring of the Medication Administration Record charts ensure accurate records are being maintained to safeguard residents. Work has been done and continuing to be undertaken to address any shortfalls noted throughout the content of the last report to improve the standards of services provided to residents. Environmental improvements have been made since the last inspection, which has created a more homely and pleasant feel. This included improving the sitting room in the original wing of the home. What the care home could do better: Robust recruitment procedures need to be followed at all times to ensure residents are safeguarded. The AQAA received from the home evidences that the home is working to improve the quality of the service provided at Petworth Cottage Nursing Home. It provides the CSCI with information on areas that have been improved in the last twelve months and what their plans for improvement are within the next twelve months. Any minor shortfalls noted of which no requirement or recommendation has been made have been highlighted throughout the report, of which the Registered Manager has already identified or will be addressing.When asked, staff and residents could not think of anything that they would wish to change in relation to living and working at the home. CARE HOMES FOR OLDER PEOPLE Petworth Cottage Nursing Home Fittleworth Road Petworth West Sussex GU28 0HQ Lead Inspector Jennie Williams Unannounced Inspection 12th March 2008 10:30 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 Petworth Cottage Nursing Home DS0000024195.V359408.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. Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Petworth Cottage Nursing Home Address Fittleworth Road Petworth West Sussex GU28 0HQ 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) 01798 342785 01798 344639 pcnh@btconnect.com Trustees of Petworth Cottage Nursing Home Mrs Christine Barber Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 04 December 2006 Brief Description of the Service: Petworth Cottage Nursing Home is registered as a care home providing personal care and nursing care for thirty-two (32) older persons. The home is situated in a rural area near the village of Petworth in West Sussex. The premise, previously a cottage hospital, is situated in extensive grounds overlooking the South Downs. The building has been extended to form the home it is today. There are no local amenities within walking distance of the home. There is a bus stop at the bottom of the driveway providing access to local public transport. There is car parking available at the home. The residents accommodation is located over two floors. There are no double rooms at the home. Nineteen (19) of the single rooms are provided with en suite facilities consisting of toilet and hand basin. There is a passenger shaft lift that accesses all floors. There is suitable communal space provided that is furnished and well maintained. There is a well-maintained garden that is accessible to residents. There are suitable numbers of toilet and assisted bathing facilities located throughout the home to meet the needs of the residents. Weekly fees range from £592 to £800 per week. There are additional fees; hairdressing, chiropody, private physiotherapy and personal newspapers/magazines. This information was provided to the CSCI on the 12 March 2008. Prospective residents find out about the home through social services referrals, word of mouth and from themselves/relatives living in the area. Some beds are block contracted with the local authority social services. Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. It should be noted that following recent CSCI consultation, it was identified that service users prefer to be called people who use services. It was confirmed that the home uses the term residents. For the purpose of this report, people who use the service will be referred to as residents. This unannounced site visit took place over seven and a half hours on the 12 March 2007. Evidence obtained at this site visit and information that the CSCI have received since the last inspection forms this key inspection report. Five residents were spoken with individually. Ten resident surveys were sent to the home prior to the site visit, of which eight were returned. Specific areas of care were viewed in five care plans. Ten staff surveys were sent to the home prior to inspection, of which four were returned. Six staff were spoken with throughout the site visit. Discussions were also had with the Registered Manager and her deputy. Four staff files were viewed. Two visitors were spoken with during the site visit. A tour of the environment was undertaken and some individual rooms were viewed, with the resident’s permission. Medication procedures were inspected. Results of the last quality assurance surveys were viewed. The handling of complaints to the home was discussed. An Annual Quality Assurance Assessment (AQAA) was sent to the home prior to the site visit. This was to obtain information about the establishment to assist CSCI in the inspection process. Health and safety records were not viewed as this information has been provided in the AQAA. There were twenty-six residents residing at the home on the day of the site visit. What the service does well: The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. The pre admission process ensures that only residents whose needs can be met at the home are admitted. Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 6 Staff practice reflects a good understanding of residents’ personal and healthcare needs, which ensure that needs are met. Residents’ lifestyle within the home is their own choice and are provided with opportunities to participate in activities if they wish to. Residents receive a choice of balanced and freshly prepared meals. Residents’ benefit from an open culture where they are able to express their views and feel valued and protected from harm. Residents live in a clean and homely environment and are provided with comfortable indoor and outdoor communal facilities. They benefit from being supported by an experienced and committed team of staff and their needs are being met with the number and skill mix of staff on duty. Residents’ benefit from the commitment of a skilled and experienced Registered Manager who ensures that the home is managed and run in the interests and safety of the people who live there. The health, safety and welfare of residents and staff are promoted and protected so far as is reasonably practicable. What has improved since the last inspection? What they could do better: Robust recruitment procedures need to be followed at all times to ensure residents are safeguarded. The AQAA received from the home evidences that the home is working to improve the quality of the service provided at Petworth Cottage Nursing Home. It provides the CSCI with information on areas that have been improved in the last twelve months and what their plans for improvement are within the next twelve months. Any minor shortfalls noted of which no requirement or recommendation has been made have been highlighted throughout the report, of which the Registered Manager has already identified or will be addressing. Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 7 When asked, staff and residents could not think of anything that they would wish to change in relation to living and working at the home. 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. Petworth Cottage Nursing Home DS0000024195.V359408.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 Petworth Cottage Nursing Home DS0000024195.V359408.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, 4, 5 &6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. The pre admission process ensures that only residents whose needs can be met at the home are admitted. EVIDENCE: There is a Statement of Purpose/Service Users Guide available upon request at the home that provides prospective residents/representatives information about the care and facilities provided at the home. It was confirmed that these documents are currently being updated. A copy of the Statement of Purpose was noted to be at the entrance to the home, along with a copy the most recent CSCI inspection report. Seven resident surveys identified that they have received a contract and six identified that they received enough Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 10 information before moving in so they could decide if it was the right place for them. The Registered Manager, deputy manager or a registered nurse will undertake the pre admission assessment on all prospective residents. A visitor spoken with confirmed that a representative from the home came to undertake a pre admission assessment and felt that the admissions process went very smoothly. The AQAA identifies and it was confirmed by the Registered Manager that they are reviewing and planning to expand the pre admission assessment to further safeguard individuals and the home against inappropriate placements. This review has resulted in the home no longer providing the service of emergency respite. They have identified an assessment of the needs of individuals can be very difficult to carry out under such conditions which can sometimes lead to inappropriate placements. Discussions were had about when expanding these assessments to consider including equality and diversity issues. Prospective residents/representatives are encouraged to visit the home prior to moving in wherever possible. The first month is a trial period to ensure the home is able to meet the needs of the individual and that the individual is happy residing at the home. Of the residents that were asked, all confirmed that they or a representative visited the home prior to moving in wherever possible. A registered nurse confirmed that there was no one residing at the home from any minor ethnic/religious groups with any special cultural or religious needs. Staff spoken with confirmed that they felt all residents were appropriately placed and all their needs were being met. They confirmed that the Registered Manager takes appropriate action if someone’s needs change and can no longer be met at the home. The home does not have dedicated accommodation to provide intermediate care, however respite care is provided if there is a spare room available. Petworth Cottage Nursing Home DS0000024195.V359408.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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff practice reflects a good understanding of residents’ personal and healthcare needs, which ensure that needs are met. The documentation in place for some people does not fully reflect the level of care provided and there is a risk that care may not be consistently provided. Residents are safeguarded by the medication procedures in place. EVIDENCE: Care plans were not viewed in detail as the last inspection identified that there is a comprehensive plan of care in place, which has been designed following information from the pre-admission assessment. The plans contained detailed information to guide the staff team to the individual needs of each person. On brief observation it was noted that care plans did not reflect a holistic approach and some did not read as being person centred. There was detailed information on specialist needs of individuals, however no clear information on Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 12 preferred daily routines and personal care needs ie; are dentures/hearing aids in use etc. It was observed that different information was contained within different files. The Registered Manager and deputy confirmed that they have already discussed implementing new person centred approach care plans. It was observed at the site visit that staff had a good understanding of residents needs. The home is in the process of trialling “all about me”, which is a form they encourage individuals/representatives to complete before admission. This will provide the home with detailed information about themselves and their needs/wishes and routines. This information will assist in ensuring that care plans developed will be person centred. Of the staff that were asked, all confirmed that the care plans in use provided clear information and were user friendly and regularly reviewed. Six resident surveys identified that they always receive the care and support they need and two identified they usually receive the care and support needed. Residents spoken with confirmed that they felt their needs were being met at the home. Some written comment from residents surveys were “couldn’t be treated any better” and “everyone takes very good care of me”. A visitor spoken with confirmed that staff discuss their relatives care with them. There was evidence that additional equipment was in use to improve the communication between staff and a resident who has communication difficulties. The home has access to pressure relieving equipment when needed and seeks advice from a tissue viability nurse when required. The same nurses usually do wound dressings, promoting continuity. Nurses should ensure that after each time a dressing is changed, a clear description of the wound is recorded to monitor the effectiveness of the treatment in place. Information recorded was not consistent, however the overall outcome for wound care practices within the home is good and the practical care provided is effective. Seven of the resident surveys confirmed that they always receive the medical support they need. One written comment was “visits from the local GP or to a hospital are arranged promptly as required”. The procedure for dealing with medication has improved as required since the last inspection. Medication Administration Record (MAR) charts viewed demonstrated that medication is being signed for at the time of administration. Registered nurses administer medication. There were a few minor gaps noted in the MAR charts. No requirement or recommendation has been made in relation to this, as the Registered Manager is able to identify who was responsible and address it with the individuals involved. A designated person within the home now randomly monitors the MAR charts to ensure clear records are being maintained. Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 13 Residents are provided with an opportunity to control their own medicines if they wish and a risk assessment identifies it is safe for them to do so. A record is kept of all incoming and outgoing medicines at the home and it was confirmed that unused medication is disposed of through a licensed company as required by current guidelines. Residents confirmed that staff respect their privacy and dignity. Staff were observed to have a good professional rapport with residents and were seen to knock on room doors prior to entering and were heard calling residents by their preferred term of address. All of the resident surveys received identified that the staff listen and act on what they say. Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 14 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ lifestyle within the home is their own choice and are provided with opportunities to participate in activities if they wish to. Residents receive a choice of balanced and freshly prepared meals. EVIDENCE: Residents spoken with confirmed that their lifestyle within the home is their own choice. Residents were observed to move freely within the home on the day of the site visit. Most residents and staff spoken with confirmed that they felt there were sufficient activities provided at the home, should they choose to be involved. Resident surveys showed that four thought there were usually enough activities and two identified that there are sometimes activities arranged by the home that they can take part in. One written comment was “they [activities] are available but I don’t wish to take part in all”. A written comment from a staff member was “Depending on the workload you Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 15 sometimes feel stretched. It would be nice to have a little more time to spend with the service users doing vocational activities”. Outings are arranged through an external company that consists of trained volunteers, for those individuals wishing to participate and residents are also supported to attend weekly clubs if they wish. The AQAA identifies that management has already identified that having more in house activities to benefit residents is an area that they could do better. Their plans for the next 12 months are to employ an activities organiser to visit the home twice a week to carry out in house activities. No requirement or recommendation has been made in relation to this, however management need to ensure they ascertain the wishes and preferences of individuals and take action if it is identified. There is a non-denomination religious service once a month at the home and other religious needs are arranged by the individuals/representatives. A written comment from a resident stated “I do enjoy the church service with communion once a month”. There are no restrictions for visiting times. Residents confirmed that their visitors can visit at any time and they are able to see them in private. Visitors also confirmed that there are no restrictions and are made to feel welcome at the home. The home welcomes visitors bringing pets into the home and it was observed that a resident looked forward to her dog visiting. Most residents spoken with were complimentary about the food provided at the home. The Inspector ate a tasty lunch with the residents. It was observed that not many residents use the dining room for meals. Others remain in their rooms by choice or due to their health/medical needs. For those that chose to use the dining room, lunchtime was observed to be a social time with residents and staff interacting well. Staff were observed to provide discreet assistance to those requiring this and relatives/representatives were observed to be involved in the mealtime process where they have chosen to be. It was confirmed that the home has access to large grip cutlery and it was recommended that the Registered Manager review if residents would benefit from using these, as a couple of residents were observed to have difficulty holding the standard cutlery. Three of the resident surveys identified that they always like the meals and three stated they usually like the meals provided at the home. A kitchen assistant was spoken with briefly who confirmed that there is a rolling menu at the home and the kitchen staff have a list of residents likes/dislikes/allergies in relation to food to ensure their choice and preference are catered for. Care staff spoken with felt that the residents have a good choice in food. The AQAA identifies that they have introduced new individual menu plans in the last 12 months to provide more choice. Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 16 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from an open culture where they are able to express their views and feel valued and protected from harm. EVIDENCE: Residents and visitors spoken with confirmed that they would feel comfortable to raise any concerns and knew who they would speak to. All of the resident surveys identified individuals knew who to speak to if they were not happy and seven identified that they knew how to make a complaint. A visitor confirmed that they were informed of the complaints procedure when their representative was first admitted into the home. All staff surveys identified that they know what to do if someone raises concerns about the home. There is a complaints procedure located at the entrance of the home. It was pointed out to the Registered Manager that the contact details for the CSCI will need to be amended. The AQAA identifies that there have been no complaints made to the home within the last 12 months. The home has resident liaison sheets in individual files where staff will record if there are any concerns expressed by an individual or visitor and what action was taken to resolve it. It was discussed with the Registered Manager and deputy that a central log of complaints be Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 17 kept to assist with them monitoring the issues raised and to assist them to easily collate information that will be required to be provided to the CSCI. Staff confirmed that they receive Safeguarding Adults training and are clear with the procedures to follow in the event of an allegation being made. The AQAA identifies that staff receive this training within the first week of employment to ensure residents are further safeguarded. The AQAA identifies that there have been one Safeguarding Adults investigations made in the last 12 months that was not upheld. The reviewing social services authority identified no concerns regarding the care provided in the home. Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 18 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and homely environment and are provided with comfortable indoor and outdoor communal facilities. EVIDENCE: Residents spoken with confirmed that they were happy with the environment and their individual rooms. Rooms viewed demonstrated that the rooms are personalised to reflect the individual’s choice and character. One written comment from a resident was “I am very happy here in a lovely room with a view”. There is an ongoing programme for replacing all bed mattresses. A tour of the environment was undertaken that demonstrated that the environment is comfortable for residents and there is ongoing maintenance within the service to improve these standards. The AQAA identifies that the Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 19 homes plans for the next 12 months is to commence redecoration and refurbishment of the original wing of the home. Staff confirmed that there are enough assisted bathing facilities and equipment/aids provided throughout the home to meet the needs of the residents. The home was observed to be clean and free from offensive odours on the day of the site visit. There is a sluice room located on each floor to assist in infection control. There are suitable processes in place for the disposal of clinical wastes. The AQAA identifies that 28 staff have received training on the prevention of infection and management of infection control. Seven of the residents surveys received showed that the home is always fresh and clean. One written comment from a staff member in what they feel the service could do better was “have more cleaning staff as some areas are looking a bit rushed”. Staff spoken with confirmed that this is currently being addressed. Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 20 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from being supported by an experienced and committed team of staff. Recruitment procedures need to be more robust to ensure residents are safeguarded. Residents’ needs are being met with the number and skill mix of staff on duty. EVIDENCE: Residents spoke positively about the staff working at the home. Comments ranged from ‘very friendly’ to ‘they are all very helpful’. Residents and staff all confirmed that they felt there were sufficient numbers of staff on duty at all times and there is good teamwork within the home. For the resident who felt there were not enough staff, confirmed that there was always someone available to assist them when needed. Staff shortfalls occasionally occur in the event of sudden illness with a staff member. Staff confirmed that agency staff are used when needed. It was confirmed that there is generally six care staff in the morning; four in the afternoon and two or three care staff working a waking night. There are generally two registered nurses on duty during the day until five or six o’clock in the evening. One registered nurse works a waking night. A registered nurse confirmed that staffing numbers are regularly reviewed and amended accordingly to the dependency levels of the residents. Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 21 Recruitment files viewed demonstrated that further improvements are needed to ensure robust recruitment procedures are in place. Ensuring application forms are fully completed will assist in addressing the shortfalls. These should include detailed employment history ensuring any gaps in employment are explored and reasons for leaving employment obtained. Staff files viewed demonstrated that some staff had commenced employment without a Protection of Vulnerable Adults (POVA) First check in place or a current enhanced Criminal Record Bureau (CRB) having been received, despite this being made a requirement at the last inspection. The Registered Manager confirmed that she had delegated the paperwork for recruitment to another staff member and on discussion of the shortfalls noted; she has acknowledged that she will now monitor this herself. The Registered Manager wrote to the Inspector following the site visit providing additional information that was not obtained at the time and confirmed that with immediate effect all new employees will have a POVA First check with their enhanced CRB. The application form has also been amended and updated since the site visit to assist the Registered Manager in addressing the shortfalls. The AQAA identifies that all the people who have worked in the home in the past 12 months have had satisfactory pre-employment checks. This includes all volunteers who work at the home. The AQAA identifies that there are 22 permanent/agency/bank care staff, with eight having National Vocation Qualification (NVQ) Level 2 or above with three staff currently working towards these qualifications. This training is continuing to be accessed for staff. Staff spoken with confirmed that they were provided with an induction at the commencement of employment, are up to date with mandatory training and were provided with enough training opportunities. Registered nurses receive additional training that are relevant to their roles and assist in maintaining their Nursing and Midwifery Council (NMC) registration. Staff surveys identified that the induction covered very well everything they needed to know to do the job when they started. All staff surveys confirmed that they are given training that is relevant to their role, helps them to understand and meet the individual needs of residents and keeps them up to date with new ways of working. Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 22 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from the commitment of a skilled and experienced Registered Manager who ensures that the home is managed and run in the interests and safety of the people who live there. The health, safety and welfare of residents and staff are promoted and protected so far as is reasonably practicable. EVIDENCE: The Registered Manager was attending a course on the day of the site visit and arrived at the home in the afternoon. A registered nurse facilitated the initial part of the site visit, which evidenced that there is a competent person left in charge in the absence of the Registered Manager and deputy manager. Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 23 The Registered Manager is registered with the CSCI and has the suitable skills and experience to manage the service. She has current registration with the Nursing and Midwifery Council (NMC) and has completed the Registered Manager Award course. The service is run by a charitable trust. Staff spoken with were complimentary about the management of the home. Staff confirmed that the Registered Manager is fair, supportive and approachable. They confirmed that the Registered Manager was open to trying new ideas regarding working practices within the home if it can improve the outcomes for residents. Staff spoke positively about their enjoyment of working at the home and this was also observed throughout the site visit. Of the staff that were asked, all confirmed that there are clear roles and responsibilities within the home. It was observed on the day of the site that the home is run with openness and transparency as all staff appeared to have a clear understanding of the running of the home (at various levels) An AQAA was completed as required, however discussions were had with the Registered Manager on how information could be expanded to provide more detailed evidence. The home has a quality assurance and quality monitoring system in place and takes action to address any shortfalls that may be identified and can be improved. Discussions were had with the Registered Manager on ways to ensure that any results from their quality assurance process are made available to residents and other stakeholders. New staff surveys have been designed, however not yet implemented. There are surveys at the entrance of the home for visitors to complete if they wish. It was recommended to the Registered Manager that surveys are made anonymous with the option of people providing their name to promote confidentiality and provide an opportunity for people to express any issues whilst maintaining their anonymity if they prefer. The Registered Manager informed the Inspector that the home has no involvement in residents’ finances. Relevant staff have recently undertaken a manager and senior supervisory course and it was confirmed that formal supervision is due to be commenced again. The Registered Manager often works with staff and residents where she is able to directly observe individual work practices. The AQAA identifies that equipment in use is serviced or tested as recommended by the manufacturer or other regulatory body. The AQAA identifies that there are relevant policies and procedures in place and these were last reviewed in 2007 to ensure they contain up to date guidance. Staff confirmed that they receive fire training, participate in fire drills and are provided with other relevant training to ensure the health, safety and welfare of residents and staff are promoted and protected so far as is reasonably practicable. Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 24 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES 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 OP29 Regulation 19 Schedule 2 Requirement That robust recruitment procedures are followed to ensure residents are safeguarded. Timescale for action 30/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Petworth Cottage Nursing Home DS0000024195.V359408.R01.S.doc Version 5.2 Page 27 - 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. 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