Care Home: Pinehurst Residential Care Home

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What the care home does well A detailed pre-admission assessment is completed by competent staff to help ensure that the home can meet people`s needs and to plan a smooth admission to the home. The care plans are very good, they have detailed information and risk assessments to help ensure that people have their needs met and that any risks are well managed. One survey from a person living in the home stated, `The care I get is all I need and I have kept quite healthy` A relatives survey stated ``They certainly meet my mothers needs`. Another relative commented that ``It would be difficult for the home to improve anymore` they do a good all round job and stay cheerful and pleasant`.The medication is managed well and regular audits by the manager help to ensure that staff are continually assessed to maintain the standard. People have a choice of meals and are able to influence changes through questionnaires and residents meetings. We spoke to people about raising concerns, they said they felt able to tell the manager who would deal with it and make changes if required. Clear safeguarding procedures and staff training in `Adults at Risk` help to identify and protect people from abuse. The home is well maintained, and attractively and appropriately furnished with suitable adaptations to help older people. The gardens at the rear and the front are well kept and people said they liked to use the gardens when they could. Services and equipment are inspected and serviced as required to provide a safe environment. The homes effective recruitment practice helps to ensure the protection of vulnerable people living in the home. The home has a comprehensive induction in line with the six areas identified by Skills for Care, which helps to ensure new staff have basic skills. There are regular staff meetings and in house training where care plans and other relevant topics are discussed. The manager is qualified and has the necessary experience to run the home and there is a focus on person centred thinking, with an open and transparent management where people can help shape the service. What has improved since the last inspection? There are additional activities and visiting entertainers organised for people to enjoy. Additional special events are provided to include biscuit making, party afternoons and a music concert at Glenfall Church. There is a residents committee that produce a regular newsletter and help to organise activities and fund raise for special events or equipment. In our surveys five people said there was `always` activities to take part in, and two of them said `lots of activities`, seven said `usually` there were activities to take part in and two said `sometimes` there were activities to take part in. Relatives in our survey commented that; `the home does activities well`, gardening and games`, `the home has a caring environment and organises activities for everyone, do treat residents with respect and allow them their own space`, `they could improve by more trips out and a film show once a week`. One relative commented `that there could be more stimulation and activity for residents` The home has produced a new alternative menu to the main menu, which provides a greater choice and variety of meals. All but one of the care staff have either completed NVQ level 2 or above or are in the process of completing the training, which helps to ensure that people receive good quality care. CARE HOMES FOR OLDER PEOPLE Pinehurst Residential Care Home 8-10 Lyefield Road West Charlton Kings Cheltenham Glos GL53 8HA Lead Inspector Mrs Kate Silvey Unannounced Inspection 27th March 2008 09:30 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 Pinehurst Residential Care Home DS0000070647.V360136.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. Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pinehurst Residential Care Home Address 8-10 Lyefield Road West Charlton Kings Cheltenham Glos GL53 8HA 01242 517730 01242 256181 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) Camelot Healthcare Ltd Carol Ann Ball Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 19. New Service Date of last inspection Brief Description of the Service: Pinehurst is a Victorian house with four floors, situated near the centre of Charlton Kings, close to the shops and a bus service to Cheltenham. The house has gardens with a ramp, for easy access for service users, leading from French windows at the rear of the property. The service users all have a single room with ensuite facilities. A shaft lift provides access to all floors. Communal areas include three interconnecting lounges and a separate dining room. There is a spacious garden, which is mainly laid to lawn with a small patio area in one corner with seating and a water feature. There is a green house where people use in the gardening club. The accommodation fees range from approximately £500.00 to £650.00 and information regarding how fees are calculated and the criteria for when local authority funded places are available is in the homes Service User Guide. Pinehurst Residential Care Home DS0000070647.V360136.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 The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. We (the Commission) inspected the home on one day with one inspector. This is the first inspection for the new provider’s Camelot Care Limited since they took over the home six months ago. All areas of the home were seen and people were spoken to, which included a visitor, people that live in the home and staff. Seventeen people were accommodated on the day of the inspection. We looked at care records and some policies and procedures, including medication administration, quality assurance information and fire safety procedures. The registered manager returned the Commissions Annual Quality Assurance Assessment, this is a self-assessment about the home and is a legal requirement. We sent surveys to the staff, relatives and people living in the home and received completed surveys from nine relatives, fourteen people living in the home and three care staff. What the service does well: A detailed pre-admission assessment is completed by competent staff to help ensure that the home can meet people’s needs and to plan a smooth admission to the home. The care plans are very good, they have detailed information and risk assessments to help ensure that people have their needs met and that any risks are well managed. One survey from a person living in the home stated, ‘The care I get is all I need and I have kept quite healthy’ A relatives survey stated ‘‘They certainly meet my mothers needs’. Another relative commented that ‘‘It would be difficult for the home to improve anymore’ they do a good all round job and stay cheerful and pleasant’. Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 6 The medication is managed well and regular audits by the manager help to ensure that staff are continually assessed to maintain the standard. People have a choice of meals and are able to influence changes through questionnaires and residents meetings. We spoke to people about raising concerns, they said they felt able to tell the manager who would deal with it and make changes if required. Clear safeguarding procedures and staff training in ‘Adults at Risk’ help to identify and protect people from abuse. The home is well maintained, and attractively and appropriately furnished with suitable adaptations to help older people. The gardens at the rear and the front are well kept and people said they liked to use the gardens when they could. Services and equipment are inspected and serviced as required to provide a safe environment. The homes effective recruitment practice helps to ensure the protection of vulnerable people living in the home. The home has a comprehensive induction in line with the six areas identified by Skills for Care, which helps to ensure new staff have basic skills. There are regular staff meetings and in house training where care plans and other relevant topics are discussed. The manager is qualified and has the necessary experience to run the home and there is a focus on person centred thinking, with an open and transparent management where people can help shape the service. What has improved since the last inspection? There are additional activities and visiting entertainers organised for people to enjoy. Additional special events are provided to include biscuit making, party afternoons and a music concert at Glenfall Church. There is a residents committee that produce a regular newsletter and help to organise activities and fund raise for special events or equipment. In our surveys five people said there was ‘always’ activities to take part in, and two of them said ‘lots of activities’, seven said ‘usually’ there were activities to take part in and two said ‘sometimes’ there were activities to take part in. Relatives in our survey commented that; ‘the home does activities well’, gardening and games’, ‘the home has a caring environment and organises activities for everyone, do treat residents with respect and allow them their own space’, ‘they could improve by more trips out and a film show once a week’. One relative commented ‘that there could be more stimulation and activity for residents’ The home has produced a new alternative menu to the main menu, which provides a greater choice and variety of meals. All but one of the care staff have either completed NVQ level 2 or above or are in the process of completing the training, which helps to ensure that people receive good quality care. Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Pinehurst Residential Care Home DS0000070647.V360136.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 Pinehurst Residential Care Home DS0000070647.V360136.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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are only admitted to the home after a detailed assessment is made to help ensure their needs can be met and the information is used to plan a smooth admission. EVIDENCE: The manager was using a new format for pre-admission assessment, developed by the new providers. We saw a good example of a completed preadmission assessment, which contained sufficient, detailed information to plan the person’s care before admission to the home. The registered manager completes the assessment and involves the deputy manager should the needs assessment be complex. Healthcare professionals are contacted for their assessment when appropriate. Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 10 The information regarding the fees payable for accommodation and how they are calculated should be included in the Service User Guide for prospective people to see, in line with the Fees and Frequency Regulations. Intermediate care is not provided in the home. One survey from a person living in the home stated ‘I did not receive enough information before I moved in and no contract’. Another survey stated ‘This home worked out to be what I wanted’ Thirteen of the fourteen surveys said ‘yes’ that they did receive enough information about the home before they moved in so that they could decide it was the right place. Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans are well written and contain detailed information to help ensure that people’s needs are met and any risks are managed well. The staff treat people in a dignified and respectful manner. Medication administration is safely managed, which helps to ensure that people are protected. EVIDENCE: Three care plans were looked at in detail and the staff were asked about the care, and two people were spoken to individually about their specific care plans. One other person was spoken to individually and most other people were spoken to collectively in the communal rooms, but were given the opportunity to speak to us in private should they wish. The care plans were recorded well using a very good detailed assessment of all areas to include for example; good nutritional assessments and regular weight checks. The doctor contributes to the assessment with information about any Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 12 medical conditions, with the consent of the person. There is a detailed monthly review of the assessments and people’s capabilities. The assessments are completed every six months. Where identified as necessary, manual handling assessments had been completed with good monthly reviews. One person who required a hoist temporarily had a care plan indicating the changes and that two carers must be available during the day. Where a risk is identified a detailed care plan is recorded to help ensure that care staff know what to do, which includes actions at night, where most people have regular recorded checks. Care plan actions were regularly reviewed providing meaningful information. Risk assessments had specific protocols for clear action, for example; recognising signs of depression for early intervention and support, and prevention of slip/falls by escorting people and the use of pressure mats. Visits recorded, where healthcare professionals support people, were generally good, some descriptions could be improved to help ensure continuity of care. There was clear evidence that people were having regular checks of hearing, sight and oral health. The daily records had some clear information but could have been more detailed. People spoken to said; ‘the staff are very good’, ‘ the staff are very busy but I am very satisfied with my care’, ‘ I have new spectacles’, ‘call bells are not answered immediately and staff have to say I will be back in a minute as they are so busy in the morning, they need extra staff’. One survey from a person living in the home stated, ‘The care I get is all I need and I have kept quite healthy’ Ten surveys said that people ‘always’ receive the care and support they need and four said ‘usually’. A relatives survey stated ‘‘They certainly meet my mothers needs’. Another relative commented that ‘‘It would be difficult for the home to improve anymore’ they do a good all round job and stay cheerful and pleasant’. We observed a medication administration round during the inspection, which was completed efficiently and safely. The medication trolley was being used on all floors and the senior carer administering was knowledgeable and had received medication training, and an update was planned. However, the day staff have to complete medication when night staff are unable, due to lack of training and supervision, which takes a considerable amount of time. The registered manager sometimes completes the medication round in the morning. The medication procedure is currently being reviewed. One person on respite care was self–medicating and had lockable storage for a dossette filled by the pharmacist. The medication storage was secure and appropriate with external and internal medication separated. The staff see prescriptions when ordering medication and all medication is signed for on the record when received and when returned to pharmacy amounts are recorded. This helps to ensure that the Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 13 monthly audit by the registered manager can be completed correctly to check for errors. The medication administration records were well documented with exception of one person where twice a controlled drug had not been signed as given. We completed a random check including Controlled Drugs, which was correct. The home had a medication reference book dated 2007, and a new one had been ordered recently. Homely remedy information was correct, which helps to ensure safe administration. Staff administering medication have training and an annual check and supervision to ensure competency. A new member of the day staff is scheduled to complete accredited medication training soon. Staff can only administer medication when they have completed training. We observed the staff treating people in the home with respect and dignity during the day. Pinehurst Residential Care Home DS0000070647.V360136.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a range of activities and entertainment, which people can enjoy and they are able to influence what happens through residents meetings and discussions. There is a wide choice of food and people enjoy the meals provided. Staff are trained in food hygiene, which helps to ensure people have safe food. EVIDENCE: We looked at the regular weekly activity list that included quizzes, games, a musical entertainer, young people from Dean Close school singing, music and movement exercises. There were also special events timetabled, three for February and four for March, for example; biscuit making, party afternoon, a music concert at Glenfall Church, and a Valentine lunch. There is a residents committee that produce a regular newsletter and help to organise activities and fund raise for special events or equipment. We saw the March issue, which mentioned the homes inclusion in the ‘Charlton Kings in Bloom Competition’, and members of Glenfall church had offered their assistance. There is also a Summer Ball planned, which will be held in Leckhampton Village Hall. The funds raised are to be used for transport for trips out and additional Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 15 garden furniture. We also saw the minutes from a residents meeting in December 2007. The people living in the home run a gardening club with the help of people from the church, and make full use of the greenhouse for growing flowers etc. for the home, the garden looked very attractive. Peoples religious/ spiritual need are met with regular services in the home or visiting the local church. In our surveys five people said there was ‘always’ activities to take part in, and two of them said ‘lots of activities’, seven said ‘usually’ there were activities to take part in and two said ‘sometimes’ there were activities to take part in. All the surveys said’ the staff listen and act on what they say’. Relatives in our survey commented that; ‘the home does activities well’, gardening and games’, ‘The home has a caring environment and organises activities for everyone, do treat residents with respect and allow them their own space’, ‘They could improve by more trips out and a film show once a week’. One relative commented ‘that there could be more stimulation and activity for residents’ We spoke to the people living in the home who said that they would like to play whist, watch some films, and have more trips out. There have been some well organised improvements in the activities and people joining in the local community. We spoke to a friend who was on the relatives committee and also occasionally gives interesting talks to everyone about his travels. The last quality assurance survey in the home focused on planning meals and as a result a new summer menu was produced and an alternative menu to the main menu. This means that people can choose anything from the alternatives menu daily for example; various omelettes and salads. The manager stated that this information would be included in the Service User Guide to ensure people know about choices. Snacks and drinks are always available and we saw everyone had access to drinks in their bedroom or the communal areas. The homes cook recently took part in a two day training course at a local college, which is an initiative run by Gloucestershire’s Partnerships for Older People Project (POPPS). The course included nutritious food for older people, a key focus for POPP. A relief chef was on duty during the inspection. Special diets can be catered for, currently one person has a soft diet prepared with guidance from the Speech And Language Therapist (SALT). The kitchen looked clean and well organised, and the dining room was calm and looked attractive and comfortable for people during lunch. Six people in our surveys said they ‘always liked the meals’ and eight said ‘they usually liked the meals’. One person said ‘there is too much food and there is a good selection of food’ another person said ‘the food varies’. The home has completed ‘Safer Food Better Business’ requirements for the Food Standards Agency. The Environmental Health Officer visited in March 2008 and wanted all the procedures relating to food safety collated in a folder Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 16 for easy access. The care staff usually prepare supper and all staff that prepare food had completed food hygiene training. Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 17 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, 17 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to comment on concerns and help make changes in the home. There is a clear and accessible procedure to enable people to make complaints. Staff have received safeguarding training and know how to recognise and report abuse, which helps to ensure that vulnerable people are well protected. EVIDENCE: The home has a clear and accessible complaints policy and procedure in the Service User Guide and displayed in the home. In our surveys twelve people said they knew how to make a complaint and two people did not know. There had been no complaints recently, but people spoken to said they felt able to talk to the manager about any concerns and that some issues were raised at residents meetings. The AQAA stated that all people have a copy of the homes terms and conditions, which will enable them to compare what is provided in the home. We spoke to a friend of a person living in the home who said that the staff always answered any questions honestly, and he added that he felt that the home was very good. All staff had received Adults at Risk training and when spoken to were able to describe what they would do if they witnessed abuse. The home has a ‘whistle blowing’ procedure’ for staff to follow. The manager stated that she will be Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 18 completing the enhanced Adults at Risk training to help her to train and support staff in safeguarding people. The registered manager has completed training about the new Mental Capacity Act and is able to help assess people to ensure they are supported correctly. Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 19 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, 20, 21,22, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained providing a safe environment for people living there. It is clean and free from offensive odours providing a pleasant home where visitors are welcome. Staff are trained in infection control procedures which helps to reduce the risk of infection. EVIDENCE: The home is well maintained, and attractively and appropriately furnished with suitable adaptations to help older people. The gardens at the rear and the front were well kept and people said they liked to use the gardens when they could. Bedroom ten was being refurbished and the manager stated that rooms are regularly decorated before new people move in or when required. All of the bedrooms were seen and most were clean and free from unpleasant odours. Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 20 Seven of our surveys from people living in the home said the home was ‘always’ clean and fresh and seven said the home was ‘usually’ clean and fresh. Two people spoken to individually said their rooms were always regularly cleaned. The bedrooms are well personalised as people are able to bring their personal possessions with them. Bedroom twelve had a portable heater, and the flex may be hazardous, it was recommended that a risk assessment be completed and regularly reviewed. Bedroom nine had a stained ceiling due to a water leak that required attention. It was noticed that a communal shower room washbasin had a hand towel left there by a person living in the home, which does not promote infection control, it is recommended that paper towels are provided as there was no other towel to use. The manager stated that infection control procedures were maintained in the laundry room and care staff complete all the laundry duties. Eight staff have received infection control training and were seen using disposable aprons and gloves. Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are generally satisfied that the care they receive meets their needs, but there are times when they may need to wait for staff support and attention. Evidence indicates that more staff are needed during the morning when needs are higher with bathing people and administering medication. The service recognises the importance of training, and tries to delivers a programme that meets the National Minimum Standards. The recruitment practice followed recognises the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. EVIDENCE: We looked at a copy of the staff rota, which indicated that there are two care staff on duty during the day and one at night, with another carer sleeping on the premises. Seventeen people were accommodated in the home with varying levels of dependency. Four staff were spoken to individually including the registered manager. We interviewed the new assistant manager who had completed NVQ level 3 training in January 2008, and was planning to complete NVQ level 4 and the Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 22 Registered Managers Award. The assistant manager said the registered manager had supervised her. Another staff member interviewed by us had completed NVQ level 2 and dementia care and medication training, as well as all mandatory training. Supervision is completed by the manager and recorded for all staff. Staff spoken to were knowledgeable about the people they supported and cared for. All the care staff had recently received good training in skin care and the recognition/prevention of pressure ulcers, from a company providing skin care products. The AQAA stated that two of the eleven permanent care staff have NVQ level 2 in care and two are working towards the qualification. However, the manager stated that all but one of the care staff have either completed NVQ level 2 or above or are in the process of completing the training. People told us; ‘As afternoon staff prepare supper there is not much time to do activities’, ‘extra staff are needed in the morning’, and ‘staff are very busy I would like staff to talk to more often’. In our surveys ten people living in the home said staff are ‘usually’ available when you need them and four said they are ‘always’ available. The staff surveys said; ‘We need an extra member of staff on because we have to move quickly to another service user and can’t always give the time they need, this makes me feel uncaring and I feel bad’, we could do with extra staff, sometimes the workload is too much which is not fair on the residents’, ‘we need more staff on the morning shift’ and ‘we are a good team at Pinehurst but with extra staff it would make all the difference’ We observed that many of the telephone calls had to be answered by the manager most of the time, and that there was a lot of interruption by the doorbell, and visiting professionals etc., which the manager dealt. The observations by us on the day of the inspection, and by talking to staff made it apparent that the managers agreed two hours helping with care each weekday was not always possible. With this triangulated evidence, which included evidence from the surveys, staff and people in the home spoken to and observation it would appear that there is a real need for extra care staff, particularly in the morning and to help with the activities and or supper preparation during the afternoon. Care staff also complete ancillary duties, which give them little time to talk to people. The providers ‘Camelot Healthcare Limited’ have four care homes in Cheltenham, and there is usually a staff member referred to ‘as a floater’, who covers all the homes for staff sickness and holidays. However, this is not a member of staff who can come when the home is very busy, and the manager stated that the ‘floater’ rarely comes to Pinehurst. The local ‘Hospice at Home’, do support the homes staff to provide terminal care for people, particularly during the night, when required. The home has good recruitment records and one example was looked at in detail and included interview records, a well completed application/curriculum Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 23 vitea, copy certificates of training, two references including a last employer reference and a job description. Criminal Records Bureau checks are kept at the company’s head office and another inspector saw all recent checks there. The assistant manager stated that she had two interviews and an induction completed by the registered manager. The home has a comprehensive induction in line with the six areas identified by Skills for Care. A staff survey stated that the manager completed the induction and gave individually attention for a day working through the remaining checklist at other times. Staff told us there are regular staff meetings when care plans are discussed and other relevant topics. Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 24 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, 32, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is qualified and has the necessary experience to run the home. There is a focus on person centred thinking, with people helping to shape the service, and an ethos of being open and transparent in all areas of running the home. The manager is improving and developing systems that monitor practice and compliance with the policies and procedures of the home. EVIDENCE: The registered manager is well qualified and experienced to run the home and has made several changes to help ensure that people’s needs are met. She has recently completed training about the Mental Capacity Act and other training to ensure that good information is passed on to the staff during inhouse training sessions and staff meetings. The manager said she feels well supported by the operations manager and the new providers. Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 25 Staff spoken to had been regularly supervised by the manager and generally felt well supported. However, the comments in Standard 27 of this report, about staffing levels, requires that the manager must look at deployment of care staff more carefully to help ensure peoples needs are met appropriately. Only three staff survey’s were returned to us and two said; ‘we have a lot of ad hoc training with the manager when specific issues come up’, and ‘the manager will always listen to us and is always honest about what she can do for us’. The home ask people to complete questionnaires soon after they have moved in to ensure they received sufficient information and support before and after admission to the home. The results of the recent quality assurance survey given to everyone had not been collated, but the operations manager agreed to provide us with the information. Some outcomes arising from a food quality survey had already been started, which included the new summer menu with several suggestions from people in the home, and an alternative menu to provide more daily choice for the main meal. We saw a random sample of the storage and recording of people’s personal monies. The money and recordings were correct with receipts for purchases kept and two signatures for every transaction, which helps to safeguard people from financial abuse. The AQAA information provided by the manager, which could have been more detailed, stated that all required procedures were in place, but were undergoing a review with the new providers. The information also indicated that all equipment, gas appliances and electrical installations had been serviced or tested as recommended by the manufacturers instructions. The manager is responsible for health and safety matters in the home and should have appropriate training to ensure that this is completed well and people are safe. We looked at the fire safety records and staff fire training records, and all were complete. The staff watch a fire training video and are regularly given a written and practical test to help ensure they understand the importance of the training and what to do in the event of a fire. We looked at accidents records and there were none that required reporting under RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995). Some equality and diversity issues are addressed and people are encouraged to become more actively involved in running the home within the new residents meetings. Large print signs around the home help partially sighted people to be more independent and the regular newsletters keeps people informed to enable them to comment on what is happening. The manager stated that there are equality and diversity areas that require more attention, particularly with reference to different religions and people’s sexual orientation for future reference and to meet the need of new people when required. Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 26 Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 27 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 4 x X x HEALTH AND PERSONAL CARE Standard No Score 7 4 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 3 18 3 3 3 3 3 X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 4 4 X 3 Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? N/A 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 OP27 Regulation 18 Requirement The registered manager must ensure that there are sufficient staff on duty at peak periods of activity to help met peoples needs in a dignified manner. Timescale for action 31/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The information regarding the fees payable for accommodation and how they are calculated should be included in the Service User Guide. It is recommended that there are sufficient staff to enable people living in the home to play whist and have more trips out It is recommended that there are sufficient staff to prepare supper. It is recommended that the manager ensures that DS0000070647.V360136.R01.S.doc Version 5.2 Page 29 2 OP12 3 4 OP15 OP16 Pinehurst Residential Care Home everyone knows how to make a complaint, which may mean reading people the procedure and helping them understand it. 5 OP19 It is recommend that a risk assessment is completed and regularly reviewed for a portable heater used in bedroom twelve. It is recommended that the stained ceiling due to a water leak in bedroom nine is attended to. It is recommended that the communal shower room washbasin should have paper towels for hand drying to promote infection control. It is recommended that the manager who is responsible for health and safety matters in the home, should have appropriate training to ensure that this is completed well and people are safe. 6 7 OP19 OP26 8 OP38 Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pinehurst Residential Care Home DS0000070647.V360136.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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