Care Home: The Leonard Pulham

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What the care home does well The Leonard Pulham is a well-run establishment, with a friendly atmosphere and homely surroundings for residents to enjoy. Those residents spoken with told the inspector they were well looked after, had activities provided if they wanted to join in, and were given good food. One wrote `The food is of an exceptionally high standard.` The premises are well maintained with an enthusiastic domestic and maintenance team. There were absolutely no offensive odours in any part of the home which is bright, spacious and fresh throughout. One relative wrote; `The home is like a first class hotel...we`ve never had to complain in 13 years.` The nursing and care staff came in for particular praise from the residents and relatives, and also from local health professionals who visit the home. A local doctor noted there are `Excellent levels of nursing care` at this home, and that staff are `...very responsive to patient`s needs.` What has improved since the last inspection? CARE HOMES FOR OLDER PEOPLE The Leonard Pulham Tring Road Halton Aylesbury Buckinghamshire HP22 5PN Lead Inspector Helen Dickens Unannounced Inspection 23rd November 2007 10:45 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 The Leonard Pulham DS0000019239.V349672.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. The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Leonard Pulham Address Tring Road Halton Aylesbury Buckinghamshire HP22 5PN 01296 625188 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) Abbeyfield (Buckinghamshire) Society Limited Mrs Kim Elizabeth Anwyl Kim Anwyl Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. General Nursing Care Incl 1 respite bed Date of last inspection 23rd August 2006 Brief Description of the Service: The Leonard Pulham Home is a purpose built Nursing Home owned by The Abbeyfield Buckinghamshire Society, situated on the edge of the Chilterns just outside Wendover. The home maintains close links with the Royal Air Force and is adjacent to RAF Halton. The home provides thirty-three single rooms for the long-term nursing care of older people. It is a two-storey building and access to the upper floor is via a lift. The home has several lounges, and a dining room, which overlooks the garden. The home maintains five nominated RAF beds and three Masonic beds. The Leonard Pulham is set within its own gardens and there are plenty of car parking spaces on site. The fees for the home are currently £793.00 per week. The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out by Helen Dickens, Regulation Inspector. The Registered Manager and Matron, Mrs. Kim Anwyl, represented the establishment. A partial tour of the premises took place. The inspector spoke to three residents on a one-to-one basis and talked briefly with many of the remaining residents during lunch. Seventeen questionnaires returned to CSCI prior to this inspection (from residents, relatives and health professionals) were also used in writing this report. Three resident’s files and a number of other documents including two staff files, risk assessments and maintenance records, were examined during the day. The Annual Quality Assurance Assessment completed by the home prior to the inspection has also been used in writing this report. The Commission for Social Care Inspection would like to thank the residents, relatives, Matron, and staff for their hospitality, assistance and co-operation with this inspection. What the service does well: What has improved since the last inspection? The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 6 There have been a number of improvements since the last inspection and 16 of the 17 recommendations made in August last year have now been met. Care plans have improved and are now more detailed – they were found to be clear and well set out. Questionnaires from staff confirmed these were working documents, which were up-dated as resident’s needs changed. A formal audit system has been introduced covering all aspects of the service, including the care arrangements. There is also a regular audit of medication records and the system for transcribing new medication has been reviewed and improved. The manager has started holding regular resident’s meetings and spoke with some enthusiasm about the success of these - there were good notes kept of decisions taken and any follow-up actions. The manager is looking to purchase a resource board for the reception area where notes from meetings, and other current activities and events can be displayed. The manager in her daily diary now notes any minor issues raised, which do not constitute a complaint as such, and actions taken are recorded. Dependency levels of residents have been reviewed and an additional member of staff is being recruited, to bring the home up to 10 staff on each morning shift. 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. The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 7 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 The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 8 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): 3 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents needs are assessed prior to them moving into this home. EVIDENCE: Three residents files were sampled. One had been at the home for some time and therefore the original assessments had been archived. The other two residents files contained good basic information on the prospective resident. The homes practice is to review initial assessments again when the resident actually arrives at the home to ensure there have been no significant changes. Assessments from other professionals are sought where appropriate. There is an admission checklist on each file for care staff to ensure residents are shown around the home, know how to use their emergency bell, and have their choice of meals and newspaper recorded. A second checklist for nursing staff ensures observations such as blood pressure are taken and basic nursing notes made. One relative noted on their questionnaire that Communication was very good in relation to the information given prior to moving into the home. The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 9 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 and 10 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Each resident has a plan of care which is regularly reviewed. Resident’s health needs are assessed and met, and NHS professionals are complimentary about the nursing care at this home. Medication arrangements are good, and residents are treated respectfully. EVIDENCE: Two care plans were sampled and found to contain a good level of detail about how residents needs would be met, especially on how they would like support with their personal care. Risk assessments had been carried out in relation to moving and handling and falls, and residents had had an assessment in relation to their nutrition and skin viability. Care plans were regularly reviewed. There were a number of complimentary remarks from residents about the staff and the care received. The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 10 One resident who was very immobile and would have been at risk of developing pressure sores, stated that they had no skin problems or lesions, as staff were quite hot on that sort of thing. Recommendations made at the last inspection in relation to care plans have now been met including recording normal blood sugar readings for diabetics, and having written guidelines available to staff regarding the signs and symptoms of hypo and hyper glycaemia. Resident’s health needs are assessed and noted on their care plans. In addition to the health assessments mentioned above, there were also continence assessments on file, and notes regarding any specialist consultations. A dentist and chiropodist visit the home regularly. Residents were weighed and this was noted on their file. Any health issues were recorded in the daily notes on each file. There were some very complimentary remarks made by health professionals in relation to The Leonard Pulham Home, and the manager and staff must be congratulated for their hard work in this regard. One specialist nurse rang CSCI to say the care of a terminally ill resident with a complex wound had been ‘superb’. A doctor who visted the home regularly had given good feedback on their questionnaire to CSCI, noting the staff are Responsive to patients needs’ and give an excellent level of nursing care, providing personally tailored care for each individual. There is a medication policy in place and a copy of the Nursing and Midwifery Council’s guidance. New guidance from the Pharmaceutical Society has been downloaded by the matron who is currently reviewing the home’s systems to ensure they comply with this latest best practice. Medication was found to be securely kept, with good systems in place for ordering and dispensing. The manager monitors for any medication errors and keeps this under review, especially in relation to the occasional unexplained gap on medication administration records. The home has an embedded photograph of each resident at the top of each medication record which means they cannot fall off or get lost. The community pharmacist has not inspected the home’s pharmacy arrangements for some time and the manager was asked to follow this up. Staff at this home were seen to respect the privacy and dignity of residents and there were no negative issues raised in this regard. Personal care was only carried out with doors closed, and residents who needed support with meals were given this in a way which maintained their dignity. Staff sat down beside them and chatted to them. Residents are given their own mail and all those spoken with were complimentary about the staff and how they were treated. It was noticeable how the activities organiser respected the dignity of clients with very differing abilites. For example during the afternoon quiz - she was able to include everyone and this was such a popular event that some residents wanted their interview with the inspector timed so as not to miss the quiz. The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 11 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 and 15 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s have the opportunity to take part in activities and are supported to maintain contact with their family and friends. There are opportunities for residents to exercise choice and control over their lives, and they are offered a balanced diet in pleasing surroundings. EVIDENCE: Residents care plans note their past interests and the current activities they enjoy. There is a programme of organised activities (on the noticeboard) with at least one per day in the afternoon. The activities organiser does one-to-one activities with individual residents in the morning. Daily notes record what residents actually participated in. Most residents also have a TV in their rooms, and there is a very large flatscreen TV in the lounge, donated to the home by Age Concern Buckinghamshire. Several residents spoken with in the dining room said they enjoyed the activities on offer. On the afternoon of the inspection the weekly quiz had a good turnout with 14 residents attending. It was noticeable how the activities co-ordinator adapted the quiz to ensure that all those attending could participate. The residents have a knitting group and The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 12 have been knitting childrens jumpers to send to Africa - a photo on the notice shows some of the children wearing the jumpers. Residents are encouraged to maintain contact with family and friends and those residents spoken to said their families were made welcome. There were a number on complimentary remarks from families in the questionnaires returned to CSCI including This care home (and, I believe, Abbeyfield in general) has its priorities right. Residents are given loving care and treated with respect as human beings. A few issues raised on questionnaires were passed on to the matron for further attention. The home has good links with the local community, including the adjacent RAF base. Residents rooms visited showed that residents had brought many personal belongings with them, and they were offered opportunities to exercise choice and control over their lives. The home has a policy on autonomy and residents were heard to be given choices about what they would like, for example in relation to food and drink, getting up and going to bed, and participating in activities. There is a residents meeting which is advertised in advance by the manager, and is now proving to be popular with residents. There were no complaints about the food at this home, either on questionnaires returned to CSCI, or in direct conversation with residents. On the day of the inspection it was fish and chips for lunch, with the fish being presented in a variety of ways acording to residents preferences and care needs. The home has a very pleasant dining room though residents can also choose to eat in their rooms. Resident’s nutritional needs are assessed on admission and kept under review, and they are weighed regularly. Special diets were catered for, including those who had swallowing difficulties. One residents care plan identified that swallowing was an issue and how staff should ensure the food given to that person was appropriate. It was recommended that these instructions be reviewed to check whether a separate risk assessment is needed. Favourable comments on the food included one resident who said the food was Nourishing and they had no complaints. And another who said the food is good. We are very lucky to be here. On the questionnaire to CSCI another wrote Food is of an exceptionally high standard. One relative said the home was like ‘a first class hotel’. The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 13 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 and 18 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s complaints are listened to and they are protected from abuse. EVIDENCE: No complaints have been received at this home since the last inspection. The Recommendation made at that time to record minor issues has been followed through by the matron who now keeps grumbles in her diary, and this was available to be inspected. No complaints have been received at CSCI. The matron said any complaints would be noted on a complaints form and kept in a file in the office - the inspector suggested a bound book should also be kept to note complaints made and actions taken. The complaints procedure was available in large font, and the matron said it could also be read to any resident or relative, or translated into another format if needed. No protection of vulnerable adult issues have been raised at this home since the last inspection. All staff have protection of vulnerable adults training, even the domestic staff, one of whom completed a questionnaire for CSCI and said they had found this training very interesting. Training is provided by a nurse tutor, employed by the home, who has herself been on the County training course. The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 14 There is an in-house policy and the home also has a copy of the local Buckinghamshire County Council policy on safeguarding vulnerable people. There were a couple of issues highlighted in the homes policy , by the inspector, in relation to investigating alleged incidents and in maintaining clients confidentiality, which the inspector asked the matron to discuss with the local safeguarding team to ensure the homes policy dovetailed with the county procedures. The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 15 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 and 26 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a well-maintained environment which is clean, pleasant, and hygienic throughout. EVIDENCE: The Leonard Pulham Home offers a homely and friendly environment for residents. It is generally safe, accessible and well-maintained. Residents were happy with their own rooms, and with the facilities in the home. A relative likened it to a first class hotel, and a resident told the inspector their room was super. Those bedrooms visited by the inspector were found to be personalised, comfortable and warm. There are two full time maintenance staff who are very committed and enthusiastic and some issues highlighted by the inspector (and discussed under the Management section at the end of this report) were dealt with immediately. The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 16 A programme of decoration and maintenance is in place and there is a system for staff to highlight any repairs or maintenance issues needing attention. The home has CCTV and this is used only in the entrance areas and does not intrude on the daily life of residents. The laundry area was visited and found to be clean and tidy with impermeable floor finishes which are easy to keep clean. Commercial washing machines and driers are in use and this includes extra hot washing facilities. There are 5-6 domestic staff working in the home on weekdays, and 2 the weekends. Both care and domestic staff do infection control training. The home was found to be clean and well kept with no offensive odours. Domestic staff should be commended for the high standards they maintain within this home. The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 17 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 and 30 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s needs are met by the numbers and skill mix of staff and recent shortfalls have been identified and are being addressed by the home. Resident’s are in safe hands though more care staff need to register for NVQ qualifications. Improvements continue to be made in recruitment practices to safeguard residents, and staff are trained and competent to do their jobs. EVIDENCE: On the day of the inspection resident’s needs were being met and there were extra staff on at busy times. However, the matron said that in recent months they had identified that an extra member of staff would be needed in the morning. Rotas had already been rearranged to free up extra staff, for example the timing of breaks had been changed, and there was further work being done on this. Some questionnaires returned to CSCI had commented that sometimes staff were very busy, and a couple of people also mentioned this during the inspection. An extra staff member had now been agreed by Trustees and the matron had started the recruitment process. There are sufficient domestic staff employed and though they have only two working at the weekend (some questionnaires had commented on this), there are 5-6 domestics during the week and the home was found to be very clean and well kept. The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 18 As a home registered to provide nursing care, there are always registered nurses on duty in the home and they are supported by a total of 23 care staff, some of whom are part-time. The matron said that as a number of staff had left in the previous year, their ratio of care staff with NVQs had now fallen. The NMS recommends that at least 50 of care staff should be trained to NVQ Level 2 or above and currently only 7 of the 23 care staff have this qualification. Three more were due to start in January 2008 and the manager said she will review this number to ensure more care staff are available to start this qualification in the new year. Two staff files were checked and found to contain the relevant information inluding application forms, CRB and pova checks, two references, and photographic identification. The application form asks candidates when they finished full time education which is what is required to identify whether a full employment history has been given. However, both files had small gaps in employment history, and the matron was asked to get this information, fax it to CSCI, and follow up on any areas of concern. This was done by the next working day. The application form only asks for a 10 year employment history and this will need to be amended to a full employment history. The matron said they are currently re-organising their staff recruitment files to ensure they are kept in a more orderly fashion. There is a rolling programme of staff training at this home. Staff who returned questionnaires to CSCI commented positively on the training, some listing all their recent relevant training including infection control, protection of vulnerable adults and moving and handling. One stated that the training they have been given ‘ has been quite relevant to my work’, and another wrote ‘Most of the training sessions are carried out in-house, but we are also given opportunities to attend sessions by outside agencies.’ A member of the domestic staff said the fire safety training had provided ‘Good reminders of updated notices and extinguishers.’ Two of the three health professionals who returned questionnaires confirmed resident’s needs were met by staff and staff ‘always’ have the right skills and experience to support individual’s health and social care needs. A third, with more limited knowledge of the home, said The Leonard Pulham had ‘A good professional, caring atmosphere.’ The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 19 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 and 38 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a well managed home, and their views are taken into account. Their financial interests are safeguarded by the home’s practices. Arrangements for health and safety promote the welfare of residents, but further improvements must be made. EVIDENCE: The registered manager (the Matron) is a level one qualified nurse who was the deputy prior being appointed as the manager 7 years ago. She keeps her own training up to date and in the last year taken courses in employment law, appointed person first aid, risk assessments, fire safety, and dealing with absenteeism in the workplace. An accountant and treasurer manage the budget for the home but the manager confirmed there was no problem about The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 20 getting what she needs in a timely fashion. Clear lines of accountability are in place with a deputy, 2 senior staff nurses, and 1 full time and three part-time staff nurses. There is also an administrative assistant and an accountant employed at the home. The Chair of the Trustees visits weekly, and the matron reports to them. There is a quality assurance policy in place and a number of ways in which the home measures the quality of the service provided. Regulation 26 visits take place every month and a more formal auditing system has started - during the course of one year all aspects of the home and the service will be looked at. There is an annual residents/relatives survey and a further survey is being developed to give to recently admitted residents - this will check what their experience was of moving into the home. Residents meetings have started since the last inspection and the matron was enthusiastic about the success of these meetings which she oversees herself. Good notes are kept of decisions made by residents and follow up actions. Meetings are currently at least every month. A review of the building has been carried out and a programme of building/refurbishment has been devised for the next 10 years. The Committee of Trustees oversees this home - they have a house meeting every 2 months, and an Executive meeting every 3 months, and the manager gives a verbal report to these meetings. In addition there is also an annual general meeting. The home has a system whereby residents or their families can leave small amounts of money in safekeeping, which residents can use for day to day expenses such as the hairdresser, chiropodist and to pay for their newspapers. On the day of the inspection it was not possible to check accounts as the accountant does not work on Fridays, and the printout for that week was not available. A Recommendation at the previous inspection to put residents money into an interest bearing account had been followed up by the home but was too difficult to put in place. This was discussed at length with the matron and the following noted. The home only offers to keep small amounts of money so that residents have easy access to pay some day to day expenses - this is intended as a petty cash arrangement, and not as a savings account. Residents and their families will need to organise savings accounts themselves and there is no compulsion to leave any money with the home, it is merely an additional service offered to help residents. There is already a policy in place which describes the current arrangements but it was unclear whether families have all had a copy - the matron said she would ensure they all received this and new people would see it in the service user guide. The only discrepancy was that the policy says that on average each resident who chose to use this facility would keep £60-£70 with the home at any one time - in reality six residents had ended up with over one hundred pounds, and one with over £400, and this needed to be rectified. Very little cash is kept at the home as this money is in the charity’s account for security reasons. Accounts are monitored by the homes auditor The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 21 and the manager said an annual check is made by the charitys external auditors. Arrangements for health and safety at this home are generally good with one person being responsible for overall safety. He was interviewed by the inspector and found to be very knowledgeable on those issues discussed for example in regard to legionella, permits to work for contractors, and on arrangements in the laundry. He is currently undergoing a specialist training course in health and safety. Monthly health and safety audits are carried out and assessments are in place and reviewed in relation to the building itself, and in relation to fire safety. However, a number of safety concerns were noted by the inspector and, whilst the overall risk may be low due to residents being unable to move around without assistance, nevertheless, practice needs to be monitored more closely. The issues were: • an upstairs window had no restrictor (purchased and fitted within one hour); • the unlocked cupboard in the laundry contained cleaning materials (another padlock was brought and put in place); • the hazardous substances cupboard had not closed properly (threads from the mop were caught underneath - immediately rectified by maintenance staff); • chemical rinser was left on the worktop in the sluice (removed immediately and the risk assessment is to be up-dated on the sluice, particularly the door not being locked.) It was also noted that the home are not reporting all notifiable incidents to CSCI as per Regulation 37. The matron believed that only instances requiring hospital admission, major events, or for example a death at the home were notifiable to CSCI. Any event which adversely affects the well being of a service user must be reported and the matron said she was now clear on this point. One such incident report was requested retrospectively. The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 22 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 2 X X 2 The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 23 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 OP29 Regulation 19 Schedule 2 Requirement Timescale for action 23/12/07 2. OP38 13(4) (a)(b)(c) 3. OP38 37 All staff files must contain the information set out in Schedule 2 of the Care Homes Regulations 2001 (as amended), and in particular a full employment history. Files must be checked retrospectively, and the current staff application form amended as necessary. Health and safety monitoring 30/11/07 arrangements must be reviewed as discussed under Standard 38, to ensure all risks to resident’s safety (e.g. cupboards being left open) are identified internally and dealt with in a timely way. All incidents affecting the well 30/11/07 being of residents must be reported to CSCI as per Regulation 37. Details of one incident, discussed during the inspection, must be sent retrospectively to the Commission. The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 24 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. 2. 3. Refer to Standard OP9 OP15 OP18 Good Practice Recommendations The community pharmacist has not inspected the home’s pharmacy arrangements for some time and the manager was asked to follow this up. It was recommended that instructions on one care plan regarding difficulty swallowing, be reviewed to check whether a separate risk assessment is needed. It is recommended that two aspects of the home’s protection of vulnerable adults policy (investigating incidents and maintaining client confidentiality) be discussed with the local safeguarding team to ensure the home’s policy dovetails with the county procedures. It is recommended that the number of care staff with NVQ Level 2 or above be increased to meet the NMS target of 50 . It is recommended that the policy on the safekeeping of monies for residents be reviewed as discussed in this report under Standard 35. 4. 5. OP28 OP35 The Leonard Pulham DS0000019239.V349672.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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. 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