Inspection on 19/10/09 for Parton House

This is the latest available inspection report for this service, carried out on 19th October 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Parton House 10/12/07

Parton House 20/11/06

Parton House 05/12/05

Parton House 12/07/05

Parton House 05/01/05

Parton House 03/08/04

Parton House 08/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Parton House Parton Road Churchdown Gloucester Glos GL3 2JE Lead Inspector Mrs Ruth Wilcox Key Unannounced Inspection 11:30 19 and 20th October 2009 th DS0000016532.V376832.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. Parton House DS0000016532.V376832.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 Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parton House Address Parton Road Churchdown Gloucester Glos GL3 2JE 01452 856779 01452 856779 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) CTCH Ltd Mrs Margaret Littler Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th October 2008 Brief Description of the Service: Parton House is registered to provide personal care for 36 older people, and is situated in a semi-rural location in the village of Churchdown, between Cheltenham and Gloucester. It is owned and managed by CTCH Ltd. The home is an older style property, which has been adapted and extended for its current purpose, and is set in large grounds. Residents bedrooms are situated on two floors, which are accessible via shaft lift or staircase. All bedrooms have en-suite facilities, and there are separate assisted bathing facilities available. Information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent inspection report is available in the home for anyone to read. The charges for Parton House range from £479.00 to £622.00 per week, depending on the room available or chosen, and the home is able to accommodate residents in certain rooms at the Local Authority contract rate of funding. Hairdressing, chiropody, newspapers and private telephones are charged at individual extra costs. Parton House DS0000016532.V376832.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. One Regulatory Inspector carried out this inspection over two days in October 2009. Care records were inspected, with the care of four residents being closely looked at in particular. The arrangements to manage residents’ medications were inspected. A number of residents, and their relative where possible, were spoken to directly in order to gauge their views and experiences of the services and care provided at Parton House. Some of the staff were interviewed. Survey forms were also issued to a number of residents, staff and visiting health care professionals to complete and return to us if they wished. Some of their comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, provision, and training of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. We required an Annual Quality Assurance Assessment (AQAA) be provided by the home, the contents of which informed part of this inspection. Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 6 What the service does well: Parton House is clean, and overall is satisfactorily maintained. A welcoming and inclusive atmosphere is provided for visitors, and there is a good amount of information about the home, its services and facilities to assist residents and their families. Residents are admitted here on the basis of a sound pre-admission process, which includes an assessment of their individual needs. Arrangements are in place to meet residents’ personal and health needs, and care is provided in a way that respects individuals’ levels of independence, with their privacy, dignity and choice respected. Residents and some visitors spoke well of the home overall, the care they received, the staff and the manager. Residents’ choices and autonomy is fully respected by the staff. The quality and choice of food served to residents is good, with residents’ particular needs and choices catered for. People are assured that the home takes any complaint seriously and there are sound policies and procedures in place for the protection of the vulnerable residents. Sound staff recruitment practices are observed here, and there are good opportunities for staff training and ongoing development. There are some good arrangements for monitoring the quality of the service provided to residents. The AQAA was well completed and provided us with the information we required. What has improved since the last inspection? The standard of documented care planning is improving, with more recent plans being more person-centred than before. Ongoing work is needed with this to ensure that it continues, and that there is consistently more accuracy with certain aspects of recording. A refurbishment programme has continued to progress to the outside of the home, and also to a few areas inside. The laundry room has been made more secure. Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 7 What they could do better: 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. Parton House DS0000016532.V376832.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 Parton House DS0000016532.V376832.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): 1, 3 & 5 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. Access to good information and an assessment process prior to admission to the home gives prospective residents an assurance that their needs can be met. EVIDENCE: Large and comprehensive information folders were available in the home for anyone to read, although these were located out of sight on the lower shelf of the reception lounge table during our visit. A new resident coming into the home on the first day of our visit had been issued with the home’s information brochure, and also had additional useful information placed in his room ready for his arrival. Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 10 Residents confirmed to us that they had received enough information to help them decide if Parton House was the right place for them before coming here. The AQAA stated that CTCH Ltd was considering ways in which it could make information about the home more accessible and varied for people, such as developing their web-site. New residents had been admitted on the basis of a full assessment of their health, personal and social care needs. We saw three examples of preadmission assessments, and although the assessment tool used was very basic, the assessor had added comprehensive notes regarding the prospective resident’s particular needs, thus recording a more in depth assessment. Each assessment had been carried out at locations according to where the person was previously living or being cared for, and showed if their representative had been present. Information gathered also included input from other health and social care professionals who had been involved in each case, with assessments and care plans on file from the local authority where applicable. The home’s AQAA confirmed that prospective residents were encouraged to visit the home prior to making a decision about moving in here. It stated that interested parties were welcomed to view the home with or without an appointment. Parton House does not provide intermediate care. Parton House DS0000016532.V376832.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): 7, 8, 9, 10 & 11 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 living in this home have their health and personal care needs met through care delivery that is mindful of their privacy and dignity, and through a generally safe system for administering their medications. EVIDENCE: Residents had their own care plan that had been drafted on the basis of an assessment of their health and personal needs in direct consultation with them, and their family where applicable. Each plan was kept under regular review. Documented care planning was showing improvement, with more recent examples being more person-centred than previous ones. There were isolated examples of only basic information, with some requiring much more detail to reflect the actual care and treatments being delivered in practice. The manager recognised that this was an area for further development. Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 12 Recorded risk assessments in each case included personal safety, pressure ulcer vulnerability, falls, nutrition, and moving and handling. There was clear planning to address the risk factors in each case and promote improved health and welfare. Mobility aids were provided where needed, and support equipment was provided to help those who were at risk of developing pressure ulcers. Residents were regularly weighed, and those who were at nutritional risk had their diet monitored, encouraged and fortified where necessary. Acute bouts of ill health had been addressed through care in the home and collaborative working with external health care services in the community. Those residents who experienced pain were regularly monitored, with levels of pain assessed and reviewed through appropriate treatments. However, as before, the associated care plans to address this could have been recorded in much fuller detail, showing how the person’s pain might manifest or be shown if they were unable to verbalize it to staff. Residents we met in person indicated to us that they were well cared for. All the residents we saw had been supported to maintain their hygiene and were clean and well groomed. A visiting relative told us that the staff were ‘very good with mum’, and that she was ‘very happy’ with the care given. She said that staff were ‘always very encouraging regarding mum’s reluctance to drink enough’, in order to make sure she took adequate fluids for her needs. She also commented that despite her mother’s particular continence requirements, staff had ‘never made her feel embarrassed or undignified’ when assisting her. Residents confirmed to us that they received the care and attention necessary, and that they always got the medical attention they needed. One resident told us that she ‘couldn’t speak too highly of the home’. She said the staff were ‘marvellous’, and that she ‘only had to ring her bell and the staff came to help’. Another more dependent person told us that she needed a lot of help, but that staff ‘always did what was needed and were helpful and kind’. However, this person relied upon her call bell to summon staff, as she had chosen to remain in her room; when we visited her the extension cable for the bell was on the floor and was not accessible to her. Staff must remain more mindful of this when leaving the room. A visiting healthcare professional who responded to our survey raised no concerns, confirming that people’s health and social care needs were properly monitored and reviewed by the home, and that staff acted on advice to improve residents’ wellbeing. They said that the home was particularly Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 13 proactive in continence promotion in instances where this was an issue. They also confirmed that staff respected residents’ privacy and dignity. A recent survey conducted by the home clearly showed that the residents were overwhelmingly satisfied with the manner in which their privacy and dignity was respected here. Although staff took account of residents’ wishes in relation to the medication aspects of their healthcare these were not recorded anywhere. There were some who had chosen to manage their own medications, and this was being done within a risk management framework. Medication charts clearly showed the medications being managed by the resident, and a record was maintained of all items handed over to the resident to keep. Medications were stored hygienically and securely. The home did not have a designated and secure medications’ refrigerator, and a domestic one was storing nutritional supplement drinks; there were some eye creams which were being stored in a locked metal box. The arrangements for storing, administering and recording Controlled Drugs were well managed, and audits in this area were accurate. Medications were supplied in a monitored dosage system, with some items being boxed and bottled. Containers were dated to ensure safe use, and to assist with auditing. Medication administration records were printed by the supplying pharmacist and were well maintained by the staff. There were clear instructions for medication usage and clear records of administration. Medications prescribed for use ‘when needed’, either orally or topically featured in an associated plan of care which gave indications for its usage, plus there were supplementary protocols attached to the medication charts on their usage also. There were some handwritten additions to the charts, and in cases such as this staff should ensure that their handwriting always remains entirely legible and clear to the reader. A recent medication error that had been reported to us had arisen from the inadequate way in which a dosage change had been managed in the home at the time. We checked more recent arrangements for such an eventuality and could see that in two cases dosage changes had been safely managed and recorded. The home did not have an up to date drug reference book, the most recent being over one year old. Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 14 We witnessed a member of staff carrying out the lunchtime round of medications, and this was done in a safe and methodical manner. Staff responsible for medication management had received training through a local college, and confirmed that they had been assessed for their competency in the home. Initial assessments could take account of people’s wishes and views regarding the care they might want or expect at the end of their lives; however these had not been consistently completed in every case. It was appreciated that this could be a particularly sensitive area for most, but the manager acknowledged that this was an area where work was required, and that training needed to be sourced for the staff. There were no recorded plans of care regarding any residents’ advanced wishes for this aspect of their care to inspect. Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 & 15 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 living in this home have a good level of choice and autonomy, and have a nutritious diet, however the social activity programme currently provides only limited opportunities for them. EVIDENCE: A degree of account was taken of residents’ interests and needs regarding social activity within their assessment and care plan, although recording in this area was somewhat brief. The home did not have a designated social coordinator position, with a member of the care team allocated to take responsibility for this daily. However, on each of the two days we were in the home we did not see any group activity taking place, with a number of the residents sitting unattended in the communal lounge, whilst others remained in their room. Staff told us that there was often little interest amongst residents for group activity. Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 16 A volunteer worker had recently been recruited to focus purely on social activity and improve opportunities for the residents, although the impact of this was yet to be seen. A social activity programme was displayed for the current month, and when we compared this to some previous months’ programmes it showed a lot of repetition, with little creativity demonstrated towards catering to residents’ social needs. However, further to residents’ comments a knitting circle had been started, and a curry night was being held. Staff told us that ‘only very occasionally an entertainer would come in’. There were also problems with the mini-bus, resulting in very few trips out for people. A number of residents went outside in the grounds to walk, whilst some continued to maintain strong social links within the community, and were actively pursuing their interests and hobbies. Residents told us that the home arranged social activities that they could take part in. One person told us that the home ‘could put more activities on’, but that staff were ‘always ready to talk to me’. A member of staff told us that ‘due to time constraints staff were unable to spend the social time with residents that they should’. A visitor commented that ‘not much goes on, but to be fair staff do sometimes try, but often residents are not really interested in group activity’. Visitors were encouraged into the home, with residents free to welcome their family and friends at any time. We spoke to one visitor, who confirmed to us that they felt very welcome here, and that the staff and manager were always very approachable and helpful. There were a number of more able residents who enjoyed a high degree of independence and autonomy, retaining full control of their affairs. Staff were mindful of residents in this area, and demonstrated respect towards their choices and way of life. Residents were able to personalise their rooms, with many having introduced personal treasures and items that were important to them. The home had copious information for people, including how to source advocacy support and access a variety of advice and support organisations; funding information, Mental Capacity information, plus the local parish information. Residents had a good choice of food at mealtimes, and a list of their choices was submitted to the cook each day. We were told that residents could have a cooked breakfast if they wished, although no-one was currently having one. One newer resident told us that she ‘didn’t know she could have a cooked Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 17 breakfast, and had not asked’; Staff should ensure that all residents are fully aware of this option. We observed service of the lunchtime meals on both days, and each day offered residents good portion sizes, and wholesome, nutritious and nicely presented food. The mealtimes were taken in the pleasantly appointed and spacious dining room, with tables attractively laid. Despite our previously reported comments about the potentially disruptive way in which staff served meals to residents, at least three staff continued to bring in two or three meals at a time, repeatedly passing through a very evident swing door between the dining room and the kitchen. However, the meals were served in an unrushed way, and staff were polite and offering choice and help throughout. A tray of snacks was readily available for residents at any time of the day and night. We visited the kitchen after the lunchtime meal, whilst the cook was cleaning in there. The kitchen appeared to be clean and well organised, with the necessary catering records being maintained. Food storage areas were clean, and the stock levels of food were high. Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 18 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): 16 & 18 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 living in this home can be reassured by the homes complaints procedures and the policies regarding the prevention of abuse. EVIDENCE: The home had a clear complaints’ policy, which was displayed on a notice board, and which was included in the information brochure issued to each resident. A record of any concerns and complaints that had been received was maintained. We viewed the records for two issues that had been raised, and these demonstrated that action plans were drafted to help resolve the complainant’s issues, with actions instigated to prevent any further recurrence. Residents in the main confirmed that they knew how to raise a complaint if they had one, and that staff acted upon anything that they did raise. The results of the recent resident survey demonstrated that all were satisfied with the procedures for addressing complaints, and also felt assured that they would be helped. The home had clear policies and procedures for safeguarding the interests, wellbeing and safety of the residents. The local authority’s ‘Alerter’s Guide’ had Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 19 been issued to staff, and information leaflets about the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were readily available. Safeguarding training had been provided for the staff, which had included recognition and prevention of abuse, whistle blowing procedures, and the Mental Capacity Act 2005 (MCA). Staff we spoke to were conversant in all aspects of the safeguarding procedures, and two commented that they had found the training very stimulating. The manager had undergone a full day’s training in MCA and DoLS, whilst other staff had received a half day’s training, most of which was provided by the local authority. One resident told us that he had ‘great faith and trust’ in the staff and the home. Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 20 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): 19 & 26 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. Despite isolated areas needing some decorative improvement, people living in this home are provided with accommodation that is generally suitable and safe to meet their needs. EVIDENCE: Waiting times for maintenance issues to be addressed had reportedly been reduced due to the appointment of an additional maintenance person and gardener. Since the last inspection the drive-way and car park had been resurfaced. The front lounge had been refurnished, and three bedrooms had been redecorated and carpeted. New sun-shades and garden benches had been provided for the Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 21 residents’ comfort and use. A covered smoking area had been prepared outside, to avoid discrimination against any resident choosing to smoke. Most areas of the home were reasonably maintained, and the newer part provided accommodation to a high standard. However, it was disappointing to note that, despite our recommendations last year regarding some poorer areas, nothing had been done to rectify them. There was an area on the ground floor where wall paper was dirty and torn, plaster wall coverings were chipped and damaged, and woodwork was badly scored and damaged through excessive wear and tear. We were told that this had been reported to the maintenance department for action, but that action was still awaited. Due to one housekeeper leaving the one remaining housekeeper was working hard to keep the home clean. It was clear that only one person will not be suitable or adequate to maintain this for any longer than absolutely necessary, given the nature of the work and the size and spread of the environment. The laundry room door had been fitted with a lock since our last visit, so as to restrict access to potentially dangerous chemicals by vulnerable residents. The laundry room was clean and organised, and the facilities allowed for sluicing and disinfection of any infected items. There were hand washing facilities around the home, with liquid soaps, paper towels and sanitising hand gels. Staff were provided with aprons. The home did not have a contract for the disposal of clinical waste, with continence waste being put into the household waste for collection by the local council. We have been assured on a previous occasion that CTCH Ltd has consulted with the city council about this. Residents confirmed to us that the home was always kept fresh and clean. One resident told us that there was ‘always plenty of heat and hot water’. Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29 & 30 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. Despite a degree of instability within the minimal staff team, people living in this home receive care from a competent work force, and are protected by a safe staff recruitment procedure. EVIDENCE: The home had four members of care staff on duty during all day time hours for the 36 residents, some of whom enjoyed a good level of independence, and some of whom were in a lower dependency group also. The manager worked in a supernumerary capacity. There were two waking night staff. Ancillary support was provided by a cook, and two house-keepers, although one of these had recently left and needed to be replaced. The level of maintenance and gardening support had been slightly increased since our last visit. A number of care staff had left, and because of that, plus some other absenteeism, there had been significant usage of agency carers. The deputy manager had also moved on because of promotion, and a new deputy manager had been appointed, and was starting her induction on the second day of our visit. Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 23 Residents confirmed that staff were readily available, although one person told us that there had recently been a spell when too many agency workers had been used. They went on to say that ‘hopefully the recruitment of four new staff would eradicate the need for this’, and that they ‘admired the kind, helpful and dedicated carers’. Other residents we met during our visit spoke very favourably about the staff, and confirmed that they did not have to wait long before their call bell was answered by them. Two members of staff expressed concern over the impact on residents that was caused by staff having to do laundry and domestic duties. They also said they were unable to spend the social time with residents that they should; this particular issue has been previously reported under an earlier outcome group. We explored this further during our visit, and found that day-time care staff were expected to return laundered items back to residents’ rooms during the afternoon, and vacuum the dining room after lunch, which we did not deem particularly excessive given the current dependency levels in the home. Night carers were expected to put laundry on to wash up until midnight and again after 6am. Care staff were also involved in preparing and serving breakfast and supper meals to residents. We pointed out that we have an agreement with the Care Provider that, given care staff are provided to minimum numbers, they will not be involved in any significant laundry duties. We continue to recommend that designated catering and laundry staff are provided to cover all aspects of this work, and that staffing levels remain under continual review to ensure their suitability for the changing needs of the home and its residents. The AQAA stated that the home was looking to increase the numbers of NVQ (National Vocational Qualification) qualified carers. Seven care staff had already achieved the award, and a further three were currently working towards it. We inspected the recruitment arrangements for two members of staff. Each staff file contained an application form, an offer of employment letter and a contract. Interview notes were included. A criminal convictions declaration had been signed, and medical fitness confirmed. Proof of identity had been sought, the nature of which was recorded in the staff file. Two written references were on file in each case including from previous employers, having been received in advance of them starting work here. A Protection of Vulnerable Adults (POVA first) check had been done in each case with a full enhanced Criminal Records Bureau (CRB) disclosure on file. Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 24 Induction training was provided for all new staff. New workers were assessed for the level of induction training that they needed using a skills scan assessment tool. Records showed that those with no previous experience received training with an external training provider in accordance with the Common Induction Standards (CIS) for care workers. We were told that for a worker with previous care experience, any gaps in training and knowledge identified on the skills scan assessment would also lead to further training. New staff worked under supervision during their induction period, and worked in a supernumerary capacity for at least the first week of their employment alongside an experienced carer. Parton House is a member of a Learning Exchange Group with the local Workforce Development Team, although the manager conceded that she had not attended any of the organised meetings to date. A designated training computer had been installed, and although this was not ready for use yet, a library of learning materials was available to the home when it was. Infection Control, Nutrition and Medication training had been provided to staff through a local college. The home manager was doing the Dementia Link worker training with the Care Home Support Team, whilst at least two others had done Dementia training with a local college. The manager was a ‘trained trainer’ for moving and handling, and provided refresher training for all staff. Some of the staff had received training in specific clinical issues, such as Diabetes and the use of insulin, Stroke Awareness and Continence Management. Those staff to whom we spoke directly were able to talk freely about the training they had undertaken, indicating to us their enjoyment of particular topics. They also said that they had staff meetings and had good handover information between shifts to ensure their up to date knowledge regarding residents’ needs. Staff who responded to our survey told us that that they had good training opportunities that were relevant to their role and that they were kept up to date with new ways of working. Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 25 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): 31, 33, 35 & 38 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 management systems in place here ensure that the interests, and health and safety of the residents living in the home are safeguarded. EVIDENCE: The manager of Parton House is experienced, and has been registered with us for her role. She has achieved the Registered Manager’s Award and the NVQ Level 4 in Care. She is also undertaking additional training to become a Dementia Link Worker for the home. Staff who responded to our survey told us that they regularly met with their manager and received enough supervision and support for their job. One Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 26 member of staff commented that the home was ‘well managed’, and that the manager was ‘very approachable’ and was a ‘good listener’. A resident told us that the manager had ‘worked her socks off to make a good home’. The manager demonstrated her commitment towards monitoring and driving improvements in the home to benefit the lives of the residents in particular. A range of auditing had been carried out, and we were able to view the records for this, plus the actions planned and implemented to address areas of concern. The home provided a good amount of quality assurance information for people, including details about all external and internal processes. Residents’ views had been sought as part of the quality assurance process, not only through consultation during audits, but also at resident meetings. Action plans had been drawn up to address issues arising, which had incorporated the views of not only the residents, but their families and other stakeholders also. Staff meetings had been held, which provided an emphasis towards directing staff and monitoring their performance. The home’s AQAA did not include a comprehensive list of policies and procedures, and those which did feature in it had not been kept under review, and were not current. There were currently no residents who were subject to a Deprivation of Liberty Safeguard (DoLS), however the home had consulted with the DoLS team at the local authority in one particular case about whom there had been concerns. We had been kept informed about this at the time, and we were shown a copy of the letter from the DoLS team, which concluded that the person was only subject to a restriction of their freedom, rather than a deprivation. This person no longer resided here. Some residents had chosen to place personal money in the home’s main safe. Records were maintained, which contained evidence of money totals, running balances and transactions. Random audits showed that clear records were held in each case, with receipts attached to account for any financial transaction carried out. We were able to audit payments made for chiropody treatments and hairdressing in designated chiropody and hairdressing books. Residents had access to their records, and some were signing their own, but in the absence of this, two members of staff were signing to confirm and witness transactions carried out on residents’ behalf. A fire safety risk assessment had been carried out, although the records showed that this had not reviewed or updated lately. A fire safety evacuation plan had been formulated. The ‘Special instructions’ recorded in the policy for night staff did not refer to the evacuation of residents in the event of fire, but the manager confirmed that they were expected to implement the plan, and would review this part of the policy straight away to ensure its clarity. Fire Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 27 safety training had been provided to staff, and regular fire drills were being carried out. Safety checks and maintenance of utilities and equipment had been undertaken. Recent passenger shaft lift inspection records showed that a number of recommendations for improvement had been made by the engineer. The manager told us that this had been reported to the proprietor. A new gas boiler had been installed, and the commissioning certificate for this was checked. There was a Legionella risk assessment in place, which was provided to us in advance of our visit. This demonstrated that regular checks were carried out on cold water tanks, hot water temperatures at outlets and at storage and distribution, with a flushing programme for irregularly used areas. Staff had been trained in basic first aid, and first aid facilities were available; the container box in the staff room had a broken catch, and should be replaced. Accident records were being maintained and any incidents were being regularly audited, with safety and risk reducing measures instigated as appropriate. Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 2 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 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 29 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. Standard Regulation Requirement Timescale for action 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 OP9 Good Practice Recommendations The registered person should ensure that: • Residents’ choices regarding the management of their medications are fully recorded • A designated secure medications’ refrigerator is provided • An up to date drug reference book is available in the home. The registered person should ensure that residents’ wishes regarding the care they would want or prefer at the end of their lives are fully recorded. The registered person should ensure that the original part of the house is better maintained in areas where the standard of decoration is deteriorating. The registered person should ensure that the home provides designated laundry, breakfast and supper catering staff. 2 3 4 OP11 OP19 OP27 Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 30 5 6 OP33 OP38 The registered person should ensure that the home’s documented policies and procedures are reviewed and fully updated. The registered person should ensure that the broken first aid box in the staff room is replaced. Parton House DS0000016532.V376832.R01.S.doc Version 5.2 Page 31 Care Quality Commission Care Quality Commission South West 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. 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