Inspection on 02/06/08 for Cleveland Park Care Home

This inspection was carried out on 2nd June 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cleveland Park Care Home 20/08/09

Cleveland Park Care Home 23/06/09

Cleveland Park Care Home 11/03/09

Cleveland Park Care Home 04/12/08

Cleveland Park Care Home 31/07/07

Cleveland Park Care Home 15/08/06

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

CARE HOMES FOR OLDER PEOPLE Cleveland Park Care Home Cleveland Road North Shields Tyne And Wear NE29 0NW Lead Inspector Elaine Charlton Key Unannounced Inspection 2nd June 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cleveland Park Care Home DS0000065838.V363984.R03.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. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cleveland Park Care Home Address Cleveland Road North Shields Tyne And Wear NE29 0NW 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) 0191 2585500 0191 2584141 cleveland.park@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Manager post vacant Care Home 66 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (61) of places Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Admission into the home of residents to receive personal care should only occur where assessment confirms the persons care needs and lifestyle are compatible with those of the existing residents. 31st July 2007 Date of last inspection Brief Description of the Service: Cleveland Park provides residential and nursing care for older people with an enduring mental health problem. The home is on Cleveland Park Road in North Shields, and is close to local shops and good public transport links. The building has 66 bedrooms, all with en-suite facilities. Bedrooms are located at ground and first floor levels and there is a passenger lift to help people who may have mobility problems access the first floor. There is a large lounge and dining room on each floor as well as additional bathrooms, toilets and shower facilities. The home has its own kitchen and laundry. Care in the home is provided by Registered Mental Nurses supported by care staff. Fees depend on the service provided and the type of bedroom occupied. They range from £373.99 to £426.00 a week. The home has a statement of purpose and service user guide that give information to help people decide if their, or their relatives’ needs can be met. Cleveland Park Care Home DS0000065838.V363984.R03.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 0 star, this means that the people who use this service experience poor quality outcomes. An unannounced visit was made on the 2 June 2008, with further follow up visits on the 3 and 9 June. A total of 15 hours were spent in the home at various times of the day. The regulation inspector was accompanied by a regulation manager for part of the time and a pharmacy inspector carried out a full audit of the systems for administering medication, and of all medicines kept in the home. The manager was present for each visit. Before the visit we looked at: Information we have received since the last visit on 31 July 2007: Annual Quality Assurance Assessment (AQAA). The AQAA gives CSCI evidence to support what the home says it does well, and gives them an opportunity to say what they feel they could do better and what their future plans are; How the home has dealt with any complaints and concerns since the last visit; Any changes to how the home is run; The provider’s view of how well they care for people; Arranged for an inspection of medicines and the medication administration systems to be carried out by a CSCI Pharmacist; The views of people who use the service, their relatives, staff and other professionals who visit the service. During the visit we: Talked with people who use the service, visitors, staff, and the manager. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building/parts of the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. Observed the teatime meal in the ground floor unit. We told the manager what we found Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 6 What the service does well: Gets good information about people wanting to move into the home so that everyone can be sure their care and support needs can be met. Encourage and support the involvement of families, friends and the local community visiting the home and joining in events. Provides an environment where people can have their own private accommodation and move around the home, and garden safely without constant supervision. Has a stable staff team, some of whom have worked in the home since it opened, making it possible to get to know the people who live there well. Holds general manager surgeries one evening each week so that relatives and friends who can only visit in the evening have the chance to talk to her or raise any concerns. Engages well with a range of healthcare professionals to make sure that the physical and mental well being of people living in the home is regularly assessed to make sure their needs are being met. Relatives said: “I find the staff very caring”. “The care home gives excellent support”. “From what I have seen and experienced the needs of individuals are met satisfactorily”. We asked relatives what the home did well. They said: “Does most things well”. “In general I just feel that my relative is well looked after and cared for”. “Gives appropriate care and support to residents”. “The standard of care is very good. Staff are very approachable and helpful if I have any queries. I am always informed if my relative has to see the doctor or needs to go to hospital”. When asked what the home did well healthcare professionals told us: “The are very willing to engage with professionals. Make time for meetings. Open for suggestions. Confident, reflective practice”. “We have a good working relationship with staff who always discuss advice appropriately”. “Early intervention. Work in partnership with multiple health professionals to ensure needs are met”. “The experienced staff are excellent. Occasionally bank/temporary staff have difficulty with more complex needs”. “Manages risk and nursing needs. Supports carers. Sees the person not the illness”. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 7 Uses the Nutmeg system to ensure that menus give people living in the home a well balanced, nutritional, choice of food. What has improved since the last inspection? What they could do better: Look at all care plans and make sure they provide all the information, support and where necessary guidance, so that staff are able to fully support people living in the home. Look at the skills of staff and support them with training and guidance so that they understand the principles of privacy, dignity, equality and diversity and are able to show that people living in the home are valued. Follow proper procedures when delivering nursing care to people living in the home and make sure that records are up to date to support the safe ordering, receipt, recording, dispensing and disposing of medication. Make sure that meals are served hot and are not left uncovered whilst staff are bringing residents to the dining room. Increase the opportunities for people to take part in meaningful activities and social opportunities to enhance their quality of life. Consider changes to the lounge and dining room areas to give people the chance to have more private areas where they can spend time and to reduce the number of people having to sit in one area together. Improve hygiene routines throughout the home and especially in the staff room and toilet areas to promote good infection control. Provide staff training to improve practice to make sure that people are provided with care and support in a sensitive and appropriate way. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 8 As a result of a safeguarding referral made earlier this year, that has been concluded as far as the vulnerable adult is concerned but not regarding the organisation, there are still concerns about nutrition and fluid charts, staff being unable to show that a referral had been made to a dietician, record keeping, moving and handling, administering of medication, risk assessments and training. The outcome of this investigation will be reflected in the next key inspection report for this home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 9 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 Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 10 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): Standards 3 and 6. People who use the service experience good quality outcomes in this area. People are given good information to help them make an informed decision about moving into the home. Their needs and wishes are fully assessed so that everyone is sure they can be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: In the AQAA the general manager told us that there is a designated sales team who meet and greet people who might want to move into the home and their relatives. She also said that they would like to be able to offer clients and their families the chance to spend time in the home, and/or have a meal before they made any decision about moving in. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 11 Relatives are given a booklet in which they can record information about the residents’ life, social interests, family and hobbies. This is good practice and helps people to get to know residents. We were told that two families had recently visited the home and decided it was not right for their relative because of the noisy environment. This is partly due to the changes that have taken place to make one lounge and one dining room on each floor. Some residents were helped by either the manager or a member of staff to complete CSCI “Have your Say” questionnaires. Those returned gave us little information that could be used to inform the inspection process but did highlight the degree of frailty and confusion people living in the home suffer with. Relatives who sent back questionnaires told us that they always or usually got enough information, were kept well informed and up to date. Healthcare professionals who visit the home said that the home always seeks, and acts upon, advice about people’s differing needs. We looked at the records for six people who live in the home. Each file contained a copy of the Local Authority or Hospital assessment that had been obtained before the person had been admitted into the home. Southern Cross, the organisation, also has its own pre-admission assessment document that is used to assess a person’s level of dependency. Recordings on the assessment sheets indicate ‘marital status’. This does not take account of recent changes in equality legislation and does not encourage staff to ask questions that would encourage people to disclose their relationship choices more easily. All assessment documents seen were fully completed, dated and signed. The home does not provide intermediate care. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9 and 10. People who use the service experience poor quality outcomes in this area. While health and personal care needs are generally effectively met, the planning of care varies in quality and is not person centred. This could mean that the wrong, or insufficient, care and support is given. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: In the records we saw, four out of six “Standard Service User Profiles” had not been signed by the resident or their relative/advocate. One had been signed by a relative on behalf of a resident. In the other, the resident had been able to indicate their agreement by making a cross. A range of care plans that recorded basic needs were seen in each file. There were differences between what was written in the assessments, where we saw some good information that could have been used to provide a person centred approach to care, and the care plan where important information was being left out. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 13 This means that staff did not have access to all the information that they needed to help them provide the right care and support. We told the manager about the following issues we had seen: • • • • A resident’s need to have their food cut up which would help them continue to eat independently was not included in the care plan. For one person who needed their meals to be presented on a “small plate”, there was no additional information about dietary intake, or about snacks and supplements that may be needed. A continence care plan did not record that a resident may “strip off”, or tell staff what to look for or how they can distract the person. Another record said ‘all staff are to maintain the same approach’ when dealing with disinhibited behaviours, but it was not clear whether any risk taking agreement or management plans had been discussed or agreed or what ‘acceptable behaviours’ were. One assessment that recorded a resident could “grab female carers”, and needed two staff at all times for personal care, was not supported by a care plan that detailed whether this should be a male and female member of staff, or two males. A care plan about maintaining a safe environment recorded that the resident should be “positioned correctly when sitting/lying”. There was no supporting guidance to say what the correct positioning was and/or whether any aids to daily living were needed to support this. A person’s preference to have a “long soak in bubble bath at least once a week” was recorded. There was no risk assessment to support this or advice about whether the resident needed a carer with them at all times. For a person who was not able to make themselves understood verbally, their record said “relies on non-verbal communication”. There was no communication book or guidance as to what certain gestures may mean to help staff understand the person’s needs, or whether they were in pain, happy or unhappy. Useful information in an assessment about a person who absconds (and demonstrates wandering behaviour), thinks food is poisonous, has a reduced appetite and is nutritionally compromised, could have been better used to inform the care plans. Another care plan included ‘control measures’ rather than risk management strategies and the language used was not clear enough to advise staff, for example, ‘placed on upper floor’ and ‘staff not to allow X to see how the key pads on the doors and how it is operated’. • • • • • • Care plans are not written in a person centred way even though we were told by the operations manager that the organisation adopted a person centred approach to care planning and staff had been trained to do this. The practice we saw did not reflect that staff understood and were able to deliver care in a person centred way. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 14 Monthly evaluations of care plans are carried out but the quality of recordings varies and they are not outcome based. When recording care plan evaluations and completing daily records staff need to be more aware of how they write up events and incidents. Some examples of what could be considered insensitive, judgemental, recordings were seen. These included: “Won’t leave male residents alone.” “She has been kept separated from another resident.” “Kept separated until she calmed down.” “Had to be put out of the lounge.” We saw evidence to show that residents see a range of healthcare professionals depending on their individual needs. This includes regular visits from a GP, dentist, optician, chiropodist, and consultants. Records for one resident showed that they had been given incorrect nursing care when their catheter needed changing that was not in line with the GP prescription or the National Institute for Health and Clinical Excellence (NICE) guidance. This was despite the care plan clearly detailing what needed to be done and the equipment to use. The resident had had to have this replaced increasing the risk of trauma, discomfort and urinary tract infection. There was no record of why this had occurred or what action had been taken to investigate the event and the incident had not been reported to CSCI. The general manager was asked to carry out an immediate investigation and report her findings to CSCI. When the manager showed us around the home, in one locked bathroom, we found a residents toiletries, cream and spectacles. Staff need to make sure that residents have their glasses on, or with them, at all times and that they are clean. A nutritional care plan recorded that a resident needed to take an identified level of fluid, over a 24 hour period, to prevent “constipation and pain”. The recording of this person’s fluid intake only showed they had had “1 drink”. This meant it was not possible to evidence that the correct fluid intake was being regularly achieved. Policies and procedures are available in the home to support the safe ordering, receipt, administration, storage and disposal of medication. This includes the need for a monthly audit. The audit document for the month of May was available. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 15 A Pharmacy Inspector from CSCI carried out a review of the systems for ordering, receiving and returning medication. The findings of this part of the inspection were: All unused medication is returned at the end of the month but there were inconsistencies in the disposal records for “refused medication”. An up to date medication reference book was available. A signature sheet to support entries on the medication administration record (MAR) was in place and handwritten entries on the MAR charts were checked and signed by a second person. Photographs of residents are in place and details of any allergies they may have are recorded. Care plans looked at had medication changes recorded under professional visits and people refusing medication on a regular are brought to the attention of the GP. Any action to be taken is recorded in their care plan. The rooms used to store medicines were tidy and clean. Room and refrigerator temperatures are monitored daily. A minimum/maximum thermometer is available for checking refrigerator temperatures but this was not being used correctly. We saw the medication round taking place on the ground floor. There was a “no touch” system of administering medication, and residents were given time and encouragement to take their medicines. At the start of the round the person administering the medication was the only member of staff in the sitting room. The medication trolley was left open, unattended and out of sight, whilst medication was being given. Three residents who take medication that should be administered on an empty stomach to help absorption, were given this with other medicines, after breakfast. We were later told that staff had taken advice from GPs who had agreed that these medications should be dispensed after breakfast during the normal medication round. Discrepancies between medications that had been received into the home, had been signed for as being administered, and what remained in stock, were seen on three MAR records. On the first floor, the date of opening was not recorded on all medication in the trolley. Two packs of Viscotears (eye drops) had also not been dated when opened. There was also another discrepancy between medication received into the home, signed for as administered and what was remaining in stock. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 16 The controlled drugs cupboard appears to meet safe custody regulations. All entries in the register were neat, countersigned and accurate. A resident said “staff are lovely, nice and smile”. Relatives who completed questionnaires told us that they felt the home met residents needs, gave the care and support expected and kept in touch with them. Relatives also said: “I find the staff very caring”. “The care home gives excellent support”. “From what I have seen and experienced the needs of individuals are met satisfactorily”. Healthcare professionals who returned questionnaires told us that healthcare needs, privacy and dignity were always or usually met/respected. They also said that staff always or usually have the right skills to respond to differing needs. Other comments made by the same healthcare professionals who were asked what the home did well, included: “Very willing to engage with professionals. Make time for meetings. Open for suggestions. Confident, reflective practice”. “We have a good working relationship with staff who always discuss advice appropriately”. “Early intervention. Work in partnership with multiple health professionals to ensure needs are met”. “The experienced staff are excellent. Occasionally bank/temporary staff have difficulty with more complex needs”. A healthcare professional said they had concerns about a person needing a soft diet not being given proper choices and that thickening for food had been requested but not provided to staff. We saw some practice that did not promote the privacy and dignity of people or showed that they were valued as individuals. Examples of this were: • • A person being moved between the lounge and dining room with bare feet. A member of staff kicking the dining room door open and talking to other staff and not checking to see that the door wasn’t closing on the person she was helping. We were told after the inspection that this member of staff was no longer employed in the home. Staff referring to people as ‘wanderers’, rather than their names. • Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 17 • • • We saw people who were wearing clothes that were stained, who had not been properly shaved or needed their face washing following a meal. A person being assisted to eat by a carer who was standing up. A resident who asked to talk to the inspector was visibly uncomfortable with the noise and it was difficult to speak freely. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 18 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): Standards 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. People are helped to live a comfortable life but the chance to take part in individualised activities and events are limited. Menus are assessed to make sure they are balanced and offer good levels of nutrition. Choices and opportunities are restricted by a people’s abilities and/or their level of frailty. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: When asked if people were supported to live the life they choose, two relatives said “to the best that their illness will allow” and “they are well cared for”. Healthcare professionals said: “Constrained by resources. Naturally unable to provide one to one, or freedoms of being at home. Awareness of people’s individual needs for example, diet, social needs, religion. Actively encourages partnerships with family and friends”. “This is very difficult as patients with severe dementia often do not ‘choose’ to live in a home but are unable to manage independently. Staff try Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 19 to maintain as ‘normal’ a community and caring environment as possible to stimulate home circumstances.” We talked to the activities co-ordinator who is enthusiastic and wanting to expand opportunities for people. She attends quarterly Activities Forums organised by the operations manager where there is a chance to talk to other co-ordinators about what they are doing, what has worked well and what might not have worked quite so well. Three people had recently been taken out to a tea dance organised by the Alzheimer’s Society. No-one stayed for the whole afternoon, and one person had to return to the home quite quickly. We discussed the need for residents to be introduced to activities like this in a managed way. The activities co-ordinator told us that she would like to do any training that would help her to increase her knowledge, understanding and ability to engage, with people who have a dementia like illness. During the inspection we saw little activity going on. One person who was watching television got quite verbally aggressive when a new activity was being tried out (banging on a drum and trying to get residents to join in). Although he shouted out most staff ignored this without going across to speak to him or explain what was happening. The activity seemed a bit ad hoc, unplanned, and only one person was actively taking part. Relatives and people who visit the home are encouraged to join in events. Notices about what is happening in the home are displayed in the entrance hall, in the lift and around the home. There is a library club, poetry club, movie and cheese and wine afternoons. A monthly religious service is also held in the home. This helps people who may no longer be able to go out to their church or other spiritual home, to take part in and enjoy a service. The home maintains close links with Monkseaton Middle School and some local sheltered housing projects. The manager told us that residents can choose what time they want to get up and go to bed. We saw evidence that people were not going to bed until midnight or later if this was their usual routine. Whilst we were talking to a resident a member of staff came and gave him a large cup of tea, which is something he enjoys, but the mug was placed on the Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 20 floor between two residents and no attempt was made to provide a table so that the drink could be easily reach and was not at risk of being knocked over. On the second day of the inspection a lady was seen sitting in the lounge on the ground floor where she was getting help to have her lunch. The member of staff was helping the lady from a standing position and had not taken the time to find a chair so that she could sit alongside her which would have made the mealtime a more pleasant experience. In the dining room on the ground floor, five plated pork chop dinners were seen uncovered on the servery top. As well as being uncovered the meals were not being kept hot in any way. We were told that this was because carers were looking for the “wanderers”. The general manager made immediate arrangements for the meals to be removed and thrown out. On the second day of the inspection we were shown the Nutmeg system that is used to plan menus for the home. This gives an excellent analysis of menus, their nutritional content, what might need adding or taking out. This is an excellent system. The home uses a good nutritional tool that incorporates a graph easily and clearly showing staff whether a resident is in the right weight range, overweight or obese. Unfortunately, this was printed on blue paper and did not give the same visual signal to staff as it would if printed on white with the colour bandings (yellow and red) over the weight ranges. Monthly newsletters are produced to keep people up to date with what is going on. These are sent out to relatives, healthcare professionals and other people who might be interested. The newsletter also includes information about events, who is celebrating a birthday, news, quiz, ‘useless information’ and the Geordie recipe of the month. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 21 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): Standards 16 and 18. People who use the service experience adequate quality outcomes in this area. The views of people who live in the home are listened to. They are usually protected from harm through policies, procedures and staff training. Events and incidents are recorded and reported to CSCI. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Relatives said they knew how to make a complaint and that problems or queries were dealt with promptly. One person said: “Complaints and opinions are encouraged and received and dealt with by management”. Two healthcare professionals said: “They have worked proactively with the local authority in monitoring, managing risk and addressing complaints. Open, honest, reflective practice. All staff professional. Very “person centered”. Working with agencies to provide the best service for vulnerable adults”. “We frequently discuss issues raised by patients or carers in an open manner. This includes involving others, for example, social services/community matrons. Staff are involved in larger multi-disciplinary meetings where these are held”. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 22 The general manager holds a ‘surgery’ every Monday night so that relatives can speak to her if they have any concerns. We saw the complaints folder that included information about two events. CSCI has been made aware of three referrals to the Adult Protection Team since the beginning of 2008 that have raised concerns about poor moving and handling practice, inadequate care plans, recording, administration of medication, risk assessments and training. As a result of a safeguarding referral made earlier this year, that has been concluded as far as the vulnerable adult is concerned but not regarding the organisation, there are still concerns about nutrition and fluid charts, staff being unable to show that a referral had been made to a dietician, record keeping, moving and handling, administering of medication, risk assessments and training. The outcome of this investigation will be reflected in the next key inspection report for this home. Staff training records show that all but two have completed training in safeguarding adults. The content of training has been questioned by the local authority as it has not been adapted to include local safeguarding procedures so staff may be unaware what action to take in the event of a disclosure or allegation being made. Staff are required to have a Criminal Records Bureau check carried out at an enhanced level before they can work in the home. Care staff are employed in line with the General Social Care Council code of conduct. Nurses working in the home have a current registration with the Nursing and Midwifery Council and we saw evidence that these were up to date and regularly renewed. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 23 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): Standards 19 and 26. People who use the service experience adequate quality outcomes in this area. People live in a safe environment that provides them with private accommodation. The layout of the dining and lounge areas mean that staff spend a lot of time transferring people from one place to another and create noisy rooms that people may find it difficult to relax in. Not all areas of the home were clean and pleasant. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has been owned by three different providers/organisations in the last 18 months. During this time the four dining/lounge areas (two on each floor) have been changed into separate dining and lounge areas (one on each floor). Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 24 Relatives, residents and staff feel that this has not been a good idea. Staff have to spend increasing amounts of time transferring people from the lounge to the dining areas, there are fewer places where relatives can spend time privately with a resident and both lounges were very noisy on each day of the inspection. The manager told us that they were trying to create a small, private corner in each of the dining rooms so that people could be away from the noise. We did not see anyone making use of these areas. Bedroom doors are painted in nice, bright, primary colours, and have brass door knockers and letter boxes fitted, making them look like a house front door. Name plates on doors no longer include a person’s photograph, but have been designed around the resident’s interests, hobbies or previous job. All bedroom doors, toilets and bathrooms are kept locked. Tactile boards and items of interest have been fixed to the corridor walls to make them more attractive and interesting to residents who spend some of their time walking around the home. ‘Themed corners’ have also been created where staff have tried to reflect hobbies or jobs that people may have had. Examples are a music corner and one reflecting life at the coast. The manager told us that carpets, curtains and dining room furniture have been replaced since the last inspection. The quite room, on the first floor, was being re-decorated and will provide an light, bright, tranquil, area that can be used for meetings, activities and where relatives and residents can spend time quietly. A requirement made at the last inspection to repair the air exchange unit is still outstanding. On both days of the inspection there was a strong odour in the lounge on the ground floor and it was not a pleasant area to be sitting in. Cushions to chairs in the first floor lounge had been covered with yellow continence bags or black bin bags before the covers had been replaced. The bags were clearly visible. The manager noted smaller repairs that needed to be carried out. This included a broken shower head holder, an en-suite door not closing into the rebate, ceiling tiles that were missing following a repair and a missing clinical waste bin lid. The staff room, changing area and kitchenette were found to be in a very untidy, unclean and messy state. Unwashed pots were in the sink and five fluorescent light tubes out of six were not working. The changing/shower area was the same as was the toilet for staff working in the kitchen. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 25 In a store room on the ground floor we saw a box of continence products that was open and exposed to the air and the chance that dust and other things could fall into it. Alongside this was a large box full of used slippers. A member of staff was seen washing a dining room floor with a grey, stale smelling, floor mop. This left an unpleasant odour and did not promote good infection control. The laundry was seen to be well organised and clean. We spoke to the laundry assist who told us about the routines and how clean laundry/clothes were returned to residents. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 26 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): Standards 27, 28, 29 and 30. People who use the service experience adequate quality outcomes in this area. People working in the home are properly recruited and the residents know they are trained and able to help them with the care and support they need, in the way they want. Staff are supported through supervision although this is not always regularly carried out and recorded. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A large number of staff have worked in the home since it was opened and the manager was in the process of planning a party for residents and staff to celebrate this. We looked at the records for four members of staff. All contained an application form, evidence that a person’s identification had been checked, Criminal Records Bureau (CRB) checks carried out and of two references being obtained. Interview records had only been signed by one person so it was not clear whether one or two interviewers had been involved. If it is the practice for one person to take notes whilst the other carries out the interview it would be better for the record to show that the comments “reflects the opinions of both interviewees”. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 27 Equal opportunities monitoring forms are used but these were seen in staff files. No evaluations had been carried out to support the need for candidates to complete this form. Care staff are employed in accordance with the General Social Care Council code of conduct and nurse registrations were seen to be up to date and regularly renewed. Staff are issued with a copy of the Staff Handbook ‘Care with Commitment’. This covers the company philosophy, terms and conditions of employment, health and safety, grievances, whistle blowing and reporting incidents and policies/procedures. Seventy five per cent of care staff working in the home have achieved a National Vocational Qualification (NVQ) at a minimum of level 2. This is well above the National Training Organisation required minimum of 50 . NVQ level 3 training covers race relations, Sex Discrimination Act, Mental Health Act, Human Rights Act and explores equal treatment, discrimination and barriers to communication. A male member of the staff team was seen taking a lady to the dining table bare foot. He had brought her from the lounge, through the entrance area and across the cold floor in the dining room. When he was questioned by a member of the inspection team he became defensive and said “I’m just going to get the slippers now”. Systems for supervision and annual appraisal are in place but we saw large gaps between some staff supervision opportunities. The format for recording supervision is a basic tick box sheet and covers working practice rather than being from a staff development perspective. All staff sign induction and training records and to show that they have read policies and procedures. Nurses keep their own personal development portfolios up to date. This is a necessary part of their registration with the NMC. Because of the current layout of the dining and lounge areas staff spend a lot of time transferring people from one room to the other. This detracts from the time they can spend with people. Staffing levels should always be set to meet the dependency of people living in the home and not the number. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 28 The general manager and a nurse have completed Yesterday, Today, Tomorrow training with the Alzheimer’s Society and are cascading this to all staff in the home. The course takes two to two and a half days to complete. To date only 10 staff have been able to receive the training but another course is planned. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 29 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): Standards 31, 33, 35 and 36. People who use the service experience adequate quality outcomes in this area. People benefit from living in a home that is welcomes and encourages the involvement of people. Staff supervision and records are not always up to date. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The general manager provided us with the AQAA which had been properly and fully completed. There is currently no registered manager in the home. The last applicant left the home whilst on suspension as a result of medication errors. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 30 The general manager is to apply to become the registered manager and has already started this process. She has an NVQ at level 4, the Registered Managers Award, and is experienced in the management of a care home. Accident records showed that in February this year one resident had had seven falls. There was no evidence to show what follow up action had been taken, or whether a referral had been made to the Falls Prevention Team. Records of accidents made by staff included ‘speculation’ about what may have happened or caused an accident when no one had actually seen the event. The organisation has comprehensive fire safety training and evacuation arrangements. The manager and handyman have completed competent person fire training. ‘Sledges’ are in place to enable non-mobile residents to be quickly evacuated in the event of an emergency. Arrangements are also in place to use a local pub and two sister homes should an evacuation become necessary. The arrangements for looking after residents’ monies are computerised and the home’s administrator was able to thoroughly explain the system to us. Her records are up to date and regularly audited. Maintenance and servicing records are in place and up to date. We asked relatives what the home did well. They said: “Does most things well”. “In general I just feel that my relative is well looked after and cared for”. “Gives appropriate care and support to residents”. “The standard of care is very good. Staff are very approachable and helpful if I have any queries. I am always informed if my relative has to see the doctor or needs to go to hospital”. Healthcare professionals said: “Manages risk and nursing needs. Supports carers. Sees the person not the illness”. The events surrounding the admission of a resident to hospital were not reported to CSCI as required by Regulation 37 of the Care Homes Regulations 2001. Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 31 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 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 2 2 Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans and guidance on risk management/taking must be expanded and written in a person centered way to ensure that residents needs can be fully met. This includes social care plans. This will mean that staff have the right information to provide individual care and support and that residents are able to take part in events and activities that interest them. A written report must be provided to CSCI to explain the incorrect catheterisation of a resident. This will mean that any weaknesses in practice can be identified and resolved helping to keep people who live in the home safe. A copy of the investigation report has been sent to CSCI. 3. OP8 12 The records for promoting fluid intake of residents must be properly completed and be able to give clear evidence of the amount of fluid taken. This will DS0000065838.V363984.R03.S.doc Timescale for action 02/12/08 2. OP8 12 31/07/08 31/07/08 Cleveland Park Care Home Version 5.2 Page 33 mean that people are kept properly hydrated and well. 4. OP9 13 Proper procedures for the safe handling of medication must be followed at all times. This will mean that people living in the home are kept safe and well. The general manager was given feedback about issues on concern by the Pharmacy Inspector on the day of the inspection. 5. OP10 12 The way staff promote the privacy and dignity of residents, speak to and support them must improve. This will mean that people living in the home know they are valued. 31/07/08 05/06/08 6. OP15 16 Staff must follow good food 02/06/08 handling and hygiene routines when serving residents with their meals. This will mean that people receive food that is warm and palatable. The general manager was told about, and dealt with the specific incident, on the day of the inspection. 7. OP19 23 The air exchange system operating in the home must be repaired, or suitable alternative arrangements put in place, to ensure an odour free environment. This will mean that the home is pleasant for people to live in and visit. Previous timescales of 28 February 2007, and 31 October 2007, not met. 30/09/08 Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 34 8. OP19 23 The laundry ceiling must be repaired on completion of the building work. This will promote safety and a hygienic working environment. Previous timescale of 31 October 2007, not met. 31/10/08 9. OP19 23 Minor repairs and furniture replacements identified during the inspection and in this report must be carried out. This will mean that people live in a safe and comfortable environment. The staff room and associated facilities and toilet for kitchen staff must be kept in a clean and tidy condition to promote good hygiene routines and infection control. The general manager was told about, and spoke to staff about these issues, on the day of the inspection. 30/09/08 10. OP19 16 02/06/08 11. OP19 16 Hygiene routines within the home must be improved to promote good infection control. This will mean that people live in a clean and odour free environment. On-going training that promotes privacy, dignity and communication with people who have a dementia must continue to be provided. This will mean that staff have the skills and knowledge to understand residents’ needs and provide the care they need. Accident records must not include speculation, and evaluations must be more DS0000065838.V363984.R03.S.doc 31/07/08 12. OP30 18 31/12/08 13. OP37 17 30/09/08 Cleveland Park Care Home Version 5.2 Page 35 outcome based and regularly completed. This will mean that staff have access to all the information they require that promotes and values residents. 14. OP37 37 Events and incidents that affect 30/07/08 the wellbeing of people living in the home must be reported to CSCI. This will mean that people living in the home are kept safe. 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 OP3 Good Practice Recommendations The assessment document should be reviewed to consider changing the ‘martial status’ box to encourage and promote discussion about sexual orientation. Staff should encourage residents, their relatives or an advocate to sign service user profiles to evidence that their choices and wishes have been taken into account. Staff should receive training in report writing to help them understand how and what they should write and how this can appear insensitive and disrespectful to people living in the home. Staff should ensure that people are properly dressed and, where appropriate, have access to their spectacles at all times. The opportunity for people to take part in more individualised social opportunities and activities should be expanded. Staff should ensure that residents have access to a table or other furniture so that they can safely get to drinks they have been provided with. Better practice when DS0000065838.V363984.R03.S.doc Version 5.2 Page 36 2. OP7 3. OP7 4. OP8 5. OP12 6. OP15 Cleveland Park Care Home helping people with their meals should also be promoted. 7. OP17 The organisation should engage with the local authority to ensure that safeguarding training meets the needs of staff and promotes their understanding of local procedures. The layout of the dining rooms and lounges should be reviewed to ensure that people have the opportunity to spend time in private and promote a quieter environment. Interview notes should be completed by all people taking part in the interview panel or contain a statement that the notes are agreed by all parties. Care practice and the environment should be properly assessed when accidents occur and the frequency of falls should be monitored to ensure that any necessary changes or interventions are made and/or arranged. 8. OP19 9. OP29 10. OP38 Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 37 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cleveland Park Care Home DS0000065838.V363984.R03.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!