Care Home: Pirton Hall

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What the care home does well Before coming to stay at Pirton Hall people meet with the manager and their needs are assessed to make sure the home is suitable for them. Overall the people living at Pirton hall are positive about the staff who support them. They said the staff are ‘wonderful’. ‘you couldn’t ask for better’, ‘excellent but overworked’. However there are times when people feel the staff approach to their requests for assistance are not helpful. Residents put this down to there not being enough staff. Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 People living at Pirton Hall are provided with a range of well presented meals to choose from and have access to a ‘Nite Bites’ menu that enables them to choose a variety of snacks and light meals when they want them. Pirton Hall is a beautiful period house, located in the heart of the countryside. The house is attractively decorated in its period style providing people with a pleasant environment to live in. What has improved since the last inspection? A new activity organiser has recently started work and together with the manager and a training programme provided by BUPA, is looking forward to developing this area for residents. Residents have made positive comments about the arrangements she has put in place and their contact with her. The standards of decoration and furnishings continue to be maintained through a regular programme of maintenance and renewal. What the care home could do better: The nursing staff must make sure that accurate records, of care and any treatment provided, are kept. This is so that the health and welfare of residents is kept under review. There must be an accurate record of all medicines received into the home and administered to residents. This is so medicines can be accounted for at each stage of the process and people can be assured their medicines are being given as prescribed. People are not receiving the quality of service they expect because they are having to wait. Staff are not available when they need them. They feel that there is a shortage of staff to provide them with the support they need. BUPA need to review the availability and organisation of staff to address this. One person said the home was ‘very short of staff. Should be more available for the money we pay here’. To make sure that the nursing staff have the range of skills currently required of them, BUPA should carry out a skills audit and provide any clinical training and updates needed. The televisions provided in individual rooms need to be reviewed to provide people with a better quality reception. The televisions in the public areas would benefit from being bigger to fit the scale of the room and where people sit. People would like to have the opportunity to watch digital/satellite sports channels.Pirton HallDS0000019553.V375135.R01.S.doc Version 5.2 BUPA need to ensure Pirton Hall has the administrative support and resources needed for the effective running of this service. BUPA need to ensure that the information requested by CQC is returned to us within the timescales set and an application to register the manager is put forward. This is so we can see the company are monitoring the management of the service and taking account of their legal obligations. Key inspection report CARE HOMES FOR OLDER PEOPLE Pirton Hall Pirton Road Shillington Hitchin Hertfordshire SG5 3HB Lead Inspector Sheila Knopp Key Unannounced Inspection 7th May 2009 09:00 DS0000019553.V375135.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pirton Hall Address Pirton Road Shillington Hitchin Hertfordshire SG5 3HB 01462 711626 01462 712019 tolladam@bupa.com www.bupa.com BUPA Care Homes (BNH) Ltd Telephone number Fax number Email address Provider Web address Name of registered company Name of registered manager Type of registration No. of places registered (if applicable) Manager post vacant Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Terminally ill (4), Terminally ill over 65 of places years of age (33) Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Any service user admitted to the home with a known diagnosis of terminal illness is accommodated in a single bedroom only. This home may not accommodate Service Users with a Terminal Illnes under the age of 50. 5th September 2008 Date of last inspection Brief Description of the Service: Pirton Hall provides nursing care and accommodation for older people. It is owed by BUPA Nursing Homes Limited. The home is a country house style, period building, formerly part of an estate. There are extensive, attractive grounds with good views of the surrounding countryside. The nearest village shops are about a mile away in Shillington. The market town of Hitchin is a couple of miles away. The home does not have its own transport. Service users’ accommodation is on three floors connected by a passenger lift. The ground floor consists of a central lobby, the manager’s office, library, lounge, conservatory, dining room, kitchen and servery, laundry, 5 single bedrooms, 2 double bedrooms and a traditional bath and shower room. The first floor consists of 6 single and 6 double bedrooms, a nurse station, a medicine room and a bathroom. The second floor consists of 6 single bedrooms, the hairdressing salon and one bathroom. Information about the home in the form of a Statement of Purpose, Service User Guide and Complaints procedure are available from the manager together with a copy of the latest inspection report. The current fees range from £840 - £1166.50 per week depending on an assessment of need, size of accommodation and funding arrangements. Pirton Hall DS0000019553.V375135.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 1 star. This means the people who use this service experience adequate quality outcomes. Our last key inspection was on 15th June 2007. We carried out an annual service review in June 2008 that did not involve an inspection. However we received a mixed response from residents and relatives, who sent us surveys, regarding their experiences. This prompted us to carry out an unannounced inspection on 4th September 2008. It was our assessment at that time that people living in the home were positive about the care and support they were receiving. The information in this report is based on a visit to Pirton Hall by one inspector. Information and observations from 13 residents, 3 visitors and 4 staff who were present on the day has been included. To make sure we include a range of views in this inspection we made survey forms available to residents and health and social care professionals, who have regular contact with the people living at Pirton Hall. We received completed surveys from 14 residents and 2 health care professionals. We have reviewed the information received about Pirton Hall between our visits. This includes the Annual Quality Assurance Assessment (AQAA). Each year managers of care services are required to send us their Annual Quality Assurance Assessment (AQAA). This document tells us how well outcomes for people using the service are being met. It also provides us with some numerical data. We have also reviewed the notifications we receive about accidents and incidents in the home. We have not received any complaints about this service between our visits. What the service does well: Before coming to stay at Pirton Hall people meet with the manager and their needs are assessed to make sure the home is suitable for them. Overall the people living at Pirton hall are positive about the staff who support them. They said the staff are ‘wonderful’. ‘you couldn’t ask for better’, ‘excellent but overworked’. However there are times when people feel the staff approach to their requests for assistance are not helpful. Residents put this down to there not being enough staff. Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 6 People living at Pirton Hall are provided with a range of well presented meals to choose from and have access to a ‘Nite Bites’ menu that enables them to choose a variety of snacks and light meals when they want them. Pirton Hall is a beautiful period house, located in the heart of the countryside. The house is attractively decorated in its period style providing people with a pleasant environment to live in. What has improved since the last inspection? What they could do better: The nursing staff must make sure that accurate records, of care and any treatment provided, are kept. This is so that the health and welfare of residents is kept under review. There must be an accurate record of all medicines received into the home and administered to residents. This is so medicines can be accounted for at each stage of the process and people can be assured their medicines are being given as prescribed. People are not receiving the quality of service they expect because they are having to wait. Staff are not available when they need them. They feel that there is a shortage of staff to provide them with the support they need. BUPA need to review the availability and organisation of staff to address this. One person said the home was ‘very short of staff. Should be more available for the money we pay here’. To make sure that the nursing staff have the range of skills currently required of them, BUPA should carry out a skills audit and provide any clinical training and updates needed. The televisions provided in individual rooms need to be reviewed to provide people with a better quality reception. The televisions in the public areas would benefit from being bigger to fit the scale of the room and where people sit. People would like to have the opportunity to watch digital/satellite sports channels. Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 7 BUPA need to ensure Pirton Hall has the administrative support and resources needed for the effective running of this service. BUPA need to ensure that the information requested by CQC is returned to us within the timescales set and an application to register the manager is put forward. This is so we can see the company are monitoring the management of the service and taking account of their legal obligations. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Pirton Hall DS0000019553.V375135.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 Pirton Hall DS0000019553.V375135.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (standard 6 does not apply to this service) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People looking to move into Pirton Hall will have their nursing and personal care needs assessed by the manager, who will also request information from other professionals and representatives involved with their care. This is to make sure the staff at Pirton Hall are able to provide the required level of support needed. EVIDENCE: By looking at the process for admitting a new resident we were able to confirm that an assessment of their needs was carried out before admission so that a plan of care can be agreed and put in place once the person had arrived. The assessment also identifies the need to have specialist nursing equipment available on admission. Information is obtained from family members, Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 10 hospitals, general practitioners and care managers. This is so staff have a full picture of what is required, from people who know the person concerned. Pirton Hall DS0000019553.V375135.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards – 7, 8, 9 & 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident their health and personal care needs are being met. However lapses in record keeping mean that information, needed to review the effect of treatments and make sure people have received the medicines they have been prescribed, is not always up to date. EVIDENCE: To assess whether staff are meeting peoples needs we spoke with residents and staff, looked at the care environment and reviewed relevant care records. We also looked at the systems for giving people their prescribed medicines. Everyone we met, including people who spend time in their room or stay in bed, had received good attention to their personal care and hygiene. People were comfortable with drinks and call bells to hand. Thought had been given to providing gentle back ground music for people in their rooms. Equipment to aid Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 12 comfort and prevent pressure sores was in place. People had comforting items put near them to touch, where appropriate. Nursing equipment used for individual residents was clean and regular checks are carried out on hoist slings and hoists. This is to make sure they are maintained in a safe condition and are ready to use. We looked at 4 care plans in detail and followed up information in other records, as well as discussions with staff and the manager, to confirm what guidance is in place to monitor the health and well-being of residents. The care plans do not have a formal area for residents and their representatives to sign to say they have been agreed. Staff record the discussions they have with residents and their representatives, on a resident / relative involvement record. One person told us they are included in discussions regarding the care and treatment of their relative. The care plans are very detailed and include risk assessments in place, for the safety of residents and staff. People have their nutritional status monitored and a new resident had been weighed on admission so this could be assessed. Overall the records were clear and provided the information staff would need to deliver the nursing and personal care required. However we found some inconsistencies in recording. Nurses are required to keep clear accurate records of assessments, treatment and how effective these have been (NMC Code of Conduct). A wound assessment form had not been completed for a resident admitted to the home with a pressure sore and although it was referred to on the hospital discharge form, staff did not refer to it on the personal risk managment plan completed on arrival in the home. The nursing staff confirmed the wound was being treated. On 2 consecutive days the re-positioning charts for a resident had not been completed after 8pm at night until the following morning. Therefore there was no evidence that this person was nursed according to their plan of care during this time. The nurses on each shift are responsible for supervising staff and ensuring care is delivered and recorded. One record provided details of a laboratory test sent off to identify whether an infection was present but there was no record of the outcome. Staff have access to a tissue viability nurse who visits and advices on treatments to be followed. We also looked at the systems for ordering, receiving, administering, recording and disposing of medicines to see if people are getting their medicines safely and according to the prescriber’s instructions. We were not able to verify that all the medicines had been given as necessary because the records of the amounts received into the home and then transferred into the medicines trolley, could not be accounted for in 7 out of 9 cases. These issues have also been identified as part of the company quality assurance auditing systems. This means that the issues are being managed without us needing to make a legal requirement. We saw a detailed report of an audit carried out on 27/4/09. An action plan has been out in place. The manager has made sure the nursing staff have copies of the BUPA procedure and the Nursing & Midwifery guidance Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 13 on medication to make sure they are aware of their responsibilities. The manager feels the medication recording issues are due to a recent increase in the use of agency staff, who are not so familiar with the homes procedures. Pirton Hall DS0000019553.V375135.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are experiencing an increase in opportunities for social interaction and stimulation but need to be confident that staff will be available to assist them to exercise control over their lives. EVIDENCE: Each resident has a personal plan that includes details of their social history, family connections and personal lifestyle preferences. Residents spoke well of the new activity organiser who has ideas for developing this area within the home and will be supported through BUPA’s training programme for activity staff. There are two activity staff employed for a total of 25 hours over the five day week. A mobility bus is booked to take residents shopping. People have been enabled to do some gardening on the patio. The grounds are wheelchair accessible with paved walkways for people to get around. People acknowledge there are activities they can be involved in but are able to opt out if they wish. Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 15 People are encouraged to feel part of the local community by involving local groups in visiting Pirton Hall. The manager’s self assessment (AQAA) states that plans for improvement over the next 12 months include continuing ‘to develop our activities program until we can offer a “five day” programme that is appropriate to our service users’. Visitors tell us they feel very welcome. They are given trays of tea or coffee to have with the person they are visiting. One person told us about meals they have with their relative. BUPA publish a regular company wide newsletter to keep people in touch. Pirton Hall does not currently have its own newsletter but the manager reported there are plans to develop this in line with other BUPA homes we visit. Overall people are positive about the quality of the meals they are served and choices offered from the menu. The catering staff have detailed information about people’s personal preferences and dietary needs. Wine, sherry and beer are available for people to have with their meals, should they wish. A resident confirmed staff offered them choices from the ‘Nite Bite’ menu. This enables people to choose meals whenever they want. The surveys we received and conversations we had, indicate people do not always feel they have control over their lives. Five people who live in the home and a relative spoke of residents having to wait for attention. One resident said ‘it’s the endless waiting’. This was reported to be worse in the afternoons. They said ‘staff do their best’, ‘staff are very busy’. Pirton Hall DS0000019553.V375135.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards - 16 & 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have to information telling them how to raise any concerns but tell us they do not always feel listened to. People can be confident that appropriate action will be taken to address concerns brought to the attention of the manager regarding the care of vulnerable people. However the manager needs to ensure that sensitive information about the way care is provided, is included as part of each persons care plan. EVIDENCE: We have not received any complaints about the service provided at Pirton Hall since our last review. Nine (64 ) out of 14 People who completed our surveys said they knew how to make a complaint or would raise concerns with family members. Some people felt there were times when they were not listed to or the approach from some staff was not helpful. Records of compliments and complaints are kept. These indicate that a low level of formal complaints are received, with many more compliments. Each person has a copy of the complaint procedure in their bedroom. Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 17 There has been one investigation under the Hertfordshire Safeguarding Adult procedure. The concern was brought to the attention of Hertfordshire County Council Adult Care services by the manager and fully investigated. No evidence was found to support the issues raised. The manager of Pirton Hall took appropriate action. It was recommended that further discussions should take place with staff on how to use the company’s whistleblowing procedure, so issues could be raised without prejudice to other staff members. We understand from the records we have seen and our discussions with staff that this has taken place. Staff also receive training in the protection of vulnerable adults. With reference to the investigation we found that important information, about how the individual concerned wished to be supported, had not been added to their care plan. We brought this to the manager’s attention so that staff are provided with clear guidance. To make sure people’s rights and status under the Mental Capacity Act are identified and kept under review a member of staff has been trained to pass this knowledge on to other staff. Individual care plans are being updated to provide information on who is able to act on behalf of the person concerned where they are not able to make decisions for themselves. Pirton Hall DS0000019553.V375135.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards – 19 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Pirton Hall are provided with fresh, clean, safe accommodation within a country house style house setting, surrounded by beautiful countryside. EVIDENCE: The grand entrance hall, lounges, conservatory and dining room are furnished in keeping with the style of the house. Individual rooms are varied, many with period features and views over the surrounding countryside. People are able to add their own personal items to make them feel at home. Risk assessments assessing the lay out of individual rooms, use of equipment and moving and handling needs are in place to make sure the environment is safe for residents and staff. Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 19 All areas of the home we visited were fresh and clean. The housekeeping staff have a programme of cleaning in place that addresses day to day needs and deep cleaning schedules. There is a ‘resident of the day’ system in place which means the different staff teams within the home review the needs of the individual concerned. This includes a deep clean of the room and review of maintenance. There is a programme of continued maintenance and refurbishment to maintain standards. This includes the replacement of carpets identified as a problem at our last key inspection. People move into freshly decorated rooms. The safety records we reviewed were up to date. Water temperatures are controlled, window restrictors are in place and low surface temperature radiators are provided to prevent accidents. A new call system has been installed since our last key inspection in 2007. It includes pendants that residents’ can wear. The manager is able to print out response times. In view of the comments from residents these should be reviewed to identify what the problems are and whether peak times for calls are covered. A resident told us they had waited for 40 minutes to go to the toilet. On the day we visited a resident used their call pendant but we went to find staff after 10 minutes as the person concerned was uncomfortable. Staff told us the pagers didn’t have batteries in them. A visitor commented that staff did not seem to know how to use them when multiple numbers came up. People are provided with freshly laundered linen and clothing. There are appropriate systems in place to prevent the spread of infection. Staff and residents have access to liquid soap and disposable hand towels in the required areas. Staff receive training on preventing infection. Pirton Hall DS0000019553.V375135.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards - 27, 28, 29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that staff are carefully selected before they start work. However people’s experience is that staff may not be available when needed. EVIDENCE: Nine (64 ) out of 14 residents who completed surveys said that staff listened to them and acted on what they said. Some people qualified their response with the following comments referring to staff ’usually’, ‘some of them’ or they ‘sometimes do not hear me’. With reference to the availability of staff, 6 (43 ) residents who completed surveys said staff were ‘sometimes’ available when needed. Eight (57 ) residents said staff were ‘usually’ available. Eight people added additional qualifying statements such as ‘’long delay after pressing the bell due to shortages’, ‘staff are busy and often get delayed when answering buzzers’, ‘could be delayed due to staff shortages’, long delay in answering buzzers, ‘the attitude of some of the staff is that this is a job ‘not a vocation!’. Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 21 We looked at the personnel records of four staff recruited since our last visit. The required checks on peoples work history, criminal background and health status had been carried out. The professional identity numbers of the nurses employed at Pirton Hall are verified to make sure they are registered to practice with the Nursing & Midwifery Council and their registration is maintained over time. A health professional has raised concerns with us regarding the skills of the nursing staff to carry out the clinical procedures required of them. The manager reported that BUPA have recently introduced a programme of training linked specifically to competencies around clinical procedures. BUPA needs to carry out an audit to make sure the nursing staff have the necessary clinical skills required of them, particularly when they are having to make clinical decisions when working without direct supervision. Pirton Hall does not currently have a moving and handling trainer available. The manager is sending staff to other BUPA homes in the area to receive this training. Our last report (5/9/08) identified that the manager was making changes to working practices. Our interviews with staff during this visit indicate that there are still issues between groups of staff with regard to their approach to the changes, which may affect the team work required, to manage each shift. While it was the intention of the manager to provide 2 registered nurses on each shift, when we reported on 5/9/08, this is not consistently in place and there has been an increase in agency nurse use. On the morning of our visit in addition to the manager, activities organiser and hotel services staff, there was 1 registered nurse and 5 care assistants supporting 22 residents. An additional nurse was attending a study session. The rota for the previous week indicated that there had been one nurse on each shift increasing to 2 nurses on 4 out of 7 days. The number of staff is reduced in the afternoon. A registered nurse and 2 care assistants cover the home at night. A frequent visitor to the home observed that the nursing care offered to the very dependent residents, in their rooms, was very good but staff were not so available to attend to the needs of the more mobile residents. Pirton Hall DS0000019553.V375135.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards – 31, 33, 35 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are concerned about the lack of management support and administrative resources currently available. They feel this has an impact on their lives and we have found that BUPA’s quality auditing systems are not fully up to date. However we understand that the gap in administrative resources will be addressed by the appointment of a full time administrator. People can be confident that appropriate accounting systems are in place to support access to their personal finances. People can be confident that the home is well maintained providing them with a safe place to live in. Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 23 EVIDENCE: The current manager has been in post for over a year but BUPA have not forwarded an application for registration under the Care Standards Act. Mrs Chell has previous experience as a registered manager. A local authority care manager told us that the service had improved under Mrs Chells’ leadership. Managers are required to send us their Annual Quality Assurance Assessment when we request it. On this occasion we had to send a follow up letter. The manager was able to provide us with a copy obtained from a company administrative office, on the day we visited. BUPA need to investigate why this was not forwarded on to us as return of the AQAA is a legal requirement. A late submission last year was attributed to computer problems On the day we visited the home did not have an administrator or a receptionist. We understand that BUPA have restructured the administrative functions within the home, to enhance the support available, and were at the point of carrying out interviews when we visited. Two residents felt there was a lack of management when the manager was away. Pirton Hall does not currently have a deputy manager. BUPA have recently audited their notification processes and identified that not all the information we require to be informed about had been sent from Pirton Hall. In this case, two notifications regarding people who had pressures sores are being sent to us retrospectively. BUPA have a monthly auditing cycle in place to alert them to any changes and monitor the quality of the service. The manager reported she has not been able to fully implement the new auditing programme, that started in March, because of the lack of administrative support, while new staff are recruited. Interviews were due to take place the day after our visit. However the audit did pick up the medication issues we identified in the personal care section of this report. BUPA produce an annual report on the quality of the service provided at Pirton Hall. The views of the people who live, work and visit the home are included. An auditor has been visiting Pirton Hall weekly to audit, invoice and record financial transactions. The manager has a system in place to make sure staff receive the training they need to support safe working practices. The care staff team have not yet achieved the 50 level of people with National Vocational Qualifications in care. The level is currently 42 . Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 24 The maintenance man keeps detailed records of services, tests and checks carried out on equipment and systems within the home. These included fire safety checks, fire drills, electrical safety, gas safety and hot water temperatures. The records were well organised and up to date. There is a system in place to audit the frequency of accidents to identify any problems. Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 25 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 x 3 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 3 Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 17 Requirement Timescale for action 30/06/09 2. OP27 18 3. OP30 18 The registered provider must make sure that accurate records of the nursing care provided to people living in the home are kept in line with the standards for nurses set out in the Nursing and Midwifery Council Code of Conduct (1/5/08). In this instance there were gaps in the records of re-positioning and wound treatment. Taking into account the views of 30/09/09 residents and staff the registered provider must audit the organisation and availability of staff during the 24 hour day. This is so residents have access to staff when they need them. A copy should be forwarded to CQC with an action plan. 30/09/09 The registered provider must conduct an audit to make sure that that the registered nurses have the clinical skills and competencies to carry out the work required of them at Pirton Hall. A copy should be forwarded to CQC with an action plan. Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 27 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 Pirton Hall DS0000019553.V375135.R01.S.doc Version 5.2 Page 28 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: 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. 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