Inspection on 23/06/09 for Cleveland Park Care Home

This inspection was carried out on 23rd June 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC 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 11/03/09

Cleveland Park Care Home 04/12/08

Cleveland Park Care Home 02/06/08

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 25/11/2009.

Key inspection report 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 23rd June 2009 09:30 DS0000065838.V375969.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. Cleveland Park Care Home DS0000065838.V375969.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 Cleveland Park Care Home DS0000065838.V375969.R01.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 (66) registration, with number of places Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE, maximum number of places 66 2. The maximum number of service users who can be accommodated is: 66 11th March 2009 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.V375969.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 0 star, this means that the people who use this service experience poor quality outcomes. An unannounced visit was made on the 23 June 2009. This is the fourth key inspection the service has received in just over 12 months as well as a random inspection carried out on the 10 June 2009. A total of eight hours were spent in the service by two regulatory inspectors. The operations manager and a manager from a sister home were present during the inspection. This inspection was carried out following the service of a Code B Notice using our statutory powers in Part II of the Care Standards Act 2000, and paragraph 6.7 of the Police and Criminal Evidence Act 1984 (Code of Practice for the Searching of Premises and the Seizure of Property Found on Persons or Premises). The organisation’s representatives co-operated fully with us and there was no need to copy or seize documents or property to support the outcome of our inspection. Before the visit we looked at: Information we have received since the last visits on the 11 March 2009, and the 10 June 2009; How the home has dealt with any complaints and concerns since our last visits; Any changes to how the home is run; The provider’s view of how well they care for people; The view of people who use the service, their relatives, staff and other professionals who visit the service. We have also reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. During the visit we: Talked with people who live in the home, staff and the operations manager; Looked at information about people who use the service and how well their needs are met; Looked at other records which must be kept; Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 6 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. We told the operations manager what we found. 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. Continues to encourage the involvement of families and friends in events that take place in the home, and helps residents to keep in touch with their families and friends. 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 who know the residents well and who support them in a sensitive and dignified way. Makes sure that people who live in the home are able to see a range of healthcare professionals as and when their health and wellbeing requires this What has improved since the last inspection? The vacant manager post has been advertised and interviews are planned to take place as soon as possible. New condiment sets, place settings and table centres have been purchased to make mealtimes a more pleasant experience for the residents. The separate lounges and dining rooms on both floors have now been changed back into four lounge/diners for the comfort of residents and their visitors. New furnishings have been provided in the lounge/diners as well as refrigerators in the servery areas. Cleveland Park Care Home DS0000065838.V375969.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. Cleveland Park Care Home DS0000065838.V375969.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 Cleveland Park Care Home DS0000065838.V375969.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): Standards 3 and 6. People who use 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 are given good information to help them decide about moving into the home. Their varied need and wishes are fully assessed so that everyone is sure they can be met. EVIDENCE: We looked at the records for two people admitted to the home since the January 2009. There was a copy of the local authority or hospital discharge assessment available that gave clear information about the care and support needed for each person. For both people the assessments were fully completed. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 10 The organisation has its own pre-admission assessment documentation that is routinely used to assess a person’s level of need. To help identify each person’s needs, wishes and beliefs, the home uses a range of professionally recognised assessment tools. These had been used for each resident and included skin care, mobility, nutritional needs and areas of risk. The home does not provide intermediate care. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people who live in the home are set out in care plans that do not always reflect their differing and changing needs or promote their well being. They do not always get the support they need to take their medication when it is due. EVIDENCE: As well as the records for people recently admitted to the home we looked at the care files for residents seen during our inspection and the associated personal care and nutritional recordings. In one person’s records we saw a body map to support their skin integrity, this had entries on it dated 26 October 2008 and 17 June 2009, and neither of these was signed by the person making the entry. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 12 The scoring systems used on different assessment tools were not being properly used and were not being added up to check the level of risk. The bowel assessment record for one resident showed that between October 2008 and June 2009 they had scored 27 or 31, all the entries should have totalled 30. For another person their pressure area assessment sheet showed that for over six months they had achieved a score of 2, when the totals entered onto the sheet added up to 22. Turn charts were not being regularly completed and a mobility risk assessment had not been updated to take account of a resident being provided with a profile bed. Staff had however continued to re-assess the risk assessment on a monthly basis. Care plan evaluations were being carried out but not always on a monthly basis, the information recorded was limited and included little information about how the individual resident had benefited from the care and support they had received. Daily records were also limited in content and some recordings were illegible. A moving and handling assessment had not been carried out for a resident whose falls risk assessment said they were at ‘high risk’. For the same resident, who was at first admitted to the home for respite care, their assessment and care plans had not been updated to show that they were now a permanent resident. Food and fluid intake records for individual residents did not provide sufficient information to show that they were receiving enough nutrition. Staff were recording that drinks had been given but they were not completing the amount of fluid taken, neither were they totalling up the fluid intake charts to check whether residents had taken the amount identified in their care plan. Staff were unaware that one resident should have had his fluid intake recorded beginning from the 1 June 2009. We saw the personal hygiene charts for June 2009, these showed that residents were not getting the chance to have a regular bath or shower. No resident had had a bath during this period, and the most showers a person had had were recorded as one in 23 days. On the day of the inspection, 23 June 2009, no resident had had a bath or shower. A female resident was seen in a first floor lounge/diner waiting with three other residents for her breakfast. She told us she was always rushed to get out of Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 13 bed and had to wait a long time for her breakfast. She was heard asking carers for jam, juice, sauce and to close a window because she was cold on five occasions during a ten minute period. Two frail residents had been left sitting on their own in the hairdresser’s room, one lady was asleep and one had a dressing on her toes which were not covered. An inspector and the nurse on duty waited for seven minutes before someone returned to the hairdresser’s room with another resident in a wheelchair. Another resident was heard screaming constantly. Her care plan stated that she ‘refuses pain relief’ but there was no record of what action had been taken to try and resolve this problem, or to establish whether she was in pain. A resident on the first floor was seen with a badly bruised face. Her injuries had been recorded in the accident book but there had been no follow up to the allegation she made that a door had been shut in her face. No referral had been made to the Safeguarding Adults team or a care manager, and neither had a capacity assessment been carried out. Residents on both floors were seen with dishevelled and dirty clothing. Staff did not appear to be monitoring the behaviour of a resident even when a care plan stated that their behaviour could impact on female residents. After lunch we saw a resident who had been left in her bedroom and was shouting out. A care worker in the lounge/dining room told us she had been put there to give everyone else ‘a bit of peace’. She was returned to the lounge where we saw her quietly enjoying music on her iPOD. Another gentleman told us he did not want to be in the home and that he had complained to a nurse but no one listened to him. Eleven pairs of service users’ spectacles were found in cupboards and a cutlery draw on the ground and first floors. A member of staff knew that one pair of glasses with a lense missing belonged to a female resident but she did not know if anything had been done about getting them repaired. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 14 and 15. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not always helped to live a comfortable life or to take part in stimulating activities and social events in and outside the home. The control of food stocks in the home and the cleanliness of areas they are stored and prepared in put people living in the home at risk. EVIDENCE: The personal care records for residents also included a sheet to record what activities they had been involved in. We saw entries that indicated that most of the residents had, on the day of the inspection, taken part in ‘gentle keep fit and chair exercises’, watched the television and had one to one discussions with a member of the care team. None of these events were seen taking place and half the staff on duty were agency staff who did not know the home’s routines or the residents. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 15 After lunch, an agency nurse was seen sitting stretched out in a lounge/diner on the ground floor, he was not speaking to residents and was not encouraging them to join in any activity. At the other end of the same room to care workers were chatting to each other. An audit of the kitchen and associated areas had been carried out by a manager from a sister home on the 26 April 2009. A score of only 59 was awarded. We saw new table mats, glasses and cutlery that had been bought since the last inspection. Food storage and preparation areas were still untidy and unclean. A detailed list of what we found in contained in the environment section of this report. We also saw uncovered food such as pork pies and gateaux being stored in refrigerators in the servery areas of the lounge/diners. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. People who use 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. The views of people who live in the home are not always listened to and events that may put them at risk of harm are not always properly recorded, followed up or reported to the appropriate professionals. EVIDENCE: The organisation has policies and procedures in place supporting the acceptance, recording and investigation of complaints. There is a whistle blowing policy in place that encourages staff to report any incidents of poor practice they may see. Four complaints had been received since the last inspection. Two were about cleanliness, one about the attitude of nurses and a further one about the timing of a resident going to bed. Staff have to have a Criminal Records Bureau (CRB) check carried out at an enhanced level before they can work in the home. Care staff are also employed in line with the General Social Care Council (GSCC) code of conduct. Nurses working in the home have a current registration with the Nursing and Midwifery Council. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 17 An incident had been reported to CQC on a regulation 37 notification. The information provided differed from that in the home’s records and did not indicate that there had been several incidents over the same day. It was recorded that a referral had been made to the local authority safeguarding team, but there was nothing to indicate whether the authority had accepted the referral or asked the home to carry out a different course of action. Staff were supposed to observe the resident at half hourly intervals and record these observations. There were no dates on the observation sheet for the 22 and 23 June 2009, and on the day of the inspection entries stopped at 11:30 even though the record was not seen until well after the lunch period. We spoke to a lady on the first floor that had a badly bruised face. She told us that someone had ‘shut a door in her face’. The incident had been recorded but it had not been followed up to try and establish what had happened. Neither had a referral been made to the local authority safeguarding team. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 24, 25 and 26. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an environment that does not promote their health, safety and well being and is not kept clean. EVIDENCE: Random Inspection, 10 June 2009 During the above inspection, the following issues were identified during our walk around the home. We looked around both floors of the home starting on the ground floor, moving in an anti-clockwise direction from the main entrance. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 19 Ground floor Lounge/diner • Staff told us that they were waiting for new refrigerators to be provided in the servery so that they could keep drinks and milk cool; • Food from the previous evening (namely crumbs and chips) were seen under a dining table; • Although labels had been removed from the new furnishings the white string that had attached them to the furniture was still hanging below chairs; From the dining room we moved out into the corridor looking in bathrooms, toilets, showers, domestic store, laundry, sluices and a random selection of resident’s bedrooms where we identified the following issues: • • • • • • • Domestic style peddle bins, without bin liners, were being used to dispose of clinical waste products, namely used continence pads; There was no clinical waste or other bin in the second toilet; Although the store room had been tidied, there were unused continence pads on the floor; The station clock in the corridor needs to be secured, the top of the bracket was hanging away from the wall as a screw had worked loose; A large number of damaged or discoloured ceiling tiles are still in need of replacement; At the end of the first corridor a drink had been spilled down the window cill, wall and skirting board and had not been cleaned up; There were no plugs available for use in the bath or wash hand basin in the bathroom, the waste outlet was blocked with hair and other debris, the front was missing of the shower control so it was not possible to see the settings, there was no thermometer available to check water temperatures and the room was generally dirty; Signs hanging on nails in corridors should be secured in a way that prevents anyone from hurting themselves; In the bedroom next to the toilet, an over sink light in the en-suite was not working, there was a bulb out in the main light, a knob was missing from the wardrobe door and the ceiling had not been repaired from water damage that occurred some time ago; There was no cover over the emergency light outside this bedroom; The door from the laundry to the outside was propped open by means of a bent piece of hardboard, that staff would have to step over to get outside; A shelf in the linen cupboard was not secure and was causing items to rest on the floor. Table cloths, towels and sheets seen in the laundry were of a very poor quality and frayed; There were dried faeces on the door of the bathroom at the next corridor corner and the bath itself was dirty. Again there was no plug or thermometer available; DS0000065838.V375969.R01.S.doc Version 5.2 Page 20 • • • • • Cleveland Park Care Home • • • • • • • • • • One toilet opposite this bathroom was taken out of action as the taps were both broken so no one could use the hand washing facilities; The shower room next to the toilets was full of beds, chairs and other equipment which meant that it could not be used; The emergency light in this area was not working; The cleaners store in this corridor was extremely dirty and disorganised; The shower opposite the dining room could not be used as it was full of wheelchairs, bins and other items. Some of the wheelchairs were dirty and there was a bin in the corner behind the wheelchairs with ‘something’ soaking in it; In the same shower room there was a half empty, uncapped bottle of bath crème; There was also a dirty, peddle bin in the shower room, with no liner, and full of used continence pads; Taps in bathrooms, toilets and bedrooms were seen to be dripping, running and without tops; In the ‘visitors toilet’ there was no sink plug, a leaking tap, an unemptied waste bin, dirty floor and there were cob webs and insects around the emergency light fitting. The domestic assistant had told us earlier that she had started work at this end of the corridor; In the second lounge/diner servery the floor a cupboards were dirty, jugs of juice were on the bench and were not covered, broken biscuits were loose on a cupboard shelf, we found a pair of residents spectacles in a cupboard, and ‘fortisip’ drinks that were over a year out of date were being stored. In one of the draws we found a loose food probe next to a dirty hairbrush. Salt and pepper pots were all dirty with hardened food. Kitchen and store area (ground floor) • On the inside of the kitchen door the metal plate where staff push the door open was missing; • The food dumb waiter and the tiles surrounding it were dirty; • The floor in the corridor between the kitchen and store was dirty; • The food store floor, skirting boards and shelves were filthy. We asked chef to remove rotten turnips and onions and found dried, wizened vegetables under the shelving together with sweet and food wrappings; • Plastic boxes used to hold mixes and dried fruits etc were dirty; • A bin full of wholemeal flour had, according to the in-house label, passed it’s ‘best by date’ in April this year; • We gave chef a packet of pasta that we had found left open to the air, when we returned to the room later this had been wrapped in cling film and returned to the box, we again asked for this to be removed; • It was not always possible to identify from labels on boxes whether the handwritten date referred to when it was opened or when it should be disposed of; • Lasagne sheets that were labelled as best before February 2009, were still on the shelf; • Suet also appeared to be past it’s ‘best buy date’. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 21 • • • • There was no soap in the dispenser above the wash hand basin in the kitchen; There was a dirty mop bucket containing stale water and a dirty mop in the passage way between the kitchen and the kitchen staff toilet; The sink in the kitchen staff toilet was full of black bags, there was no paper towel dispenser and the soap dispenser had not been used for some time as it was blocked with old soap; Fluorescent tubes in the kitchen area had no diffusers fitted and no one was sure whether they should have been or whether they were ‘shatter proof’. First floor We first visited the staff room area before walking around, again in an anticlockwise direction. • • • • • The taps were not working in the male staff toilet, the floor was dirty and the toilet had not been cleaned for some time with faeces evident around the bowl; In the lounge/diner we again saw jugs of juice that were not covered; The tops of unit doors in the servery area were dirty; The bin in the treatment room had no lid on it; In bedroom identified to staff at the time of the inspection there was a knob missing from the wardrobe door, the light over the bed had cobwebs hanging from it, fitted furnishings were damaged and there was a dirty wheelchair; there was also a strong odour in the en-suite for this room; In the next bedroom the mechanical ventilation unit was not working in the en-suite and there was a strong odour, a tap was running in the wash hand basin and the plug was in the sink, there were no toilet rolls available, no hand towels and tooth paste was being stored uncapped, in a dirty cup under the sink; there was a shelf missing from the fitted furnishings and screws were sticking out of the wood. The door rebate was also damaged with a large piece of the wood missing; The cleaners store was again found to be dirty, there was a leaking tap and mops were incorrectly stored with their heads down; In the bathroom on the corner of the first corridor we found towels and a resident’s clothes, there was no clinical waste bin, no sink plugs, a leaking tap and the shower holder was broken; There was an odour in shower room FF6C, water was stagnating under the floor grilling to the shower, taps were not working and we found a pair of discarded resident’s slippers; Toilet FF9C could not be opened; In a bedroom further down the corridor the over sink light was not working; There was no light working in the sluice and unused plastic aprons were laid on the floor; • • • • • • • Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 22 • • • • In a bedroom near the lounge/diner the ‘crash mattress’ was dirty; Store room D1, the domestics store, had an extremely sticky and dirty floor; In one of the new full en-suite bedrooms, there were no bathroom storage facilities/shelves or mirror and the mechanical ventilation unit were not working. In FF10D the ‘visitor’s toilet’ there was an unsecured mirror on the floor. All the bedding we saw was of a very poor quality and beds had not been properly made. Sheets had merely been laid over the mattress and not secured or ‘tucked in’ in any way. One bed we looked at, that had been made, was full of crumbs. At the end of the premises tour we saw a carer assisting a resident from a bathroom/toilet. It was not clear whether either or both had washed their hands as there was a hoist in front of the wash hand basin making access difficult. The home was in a state of disarray and staff are not following their routines, good infection control practices or cleaning schedules, despite improvements made after the home’s rating went to a ‘poor’ last year and the work done to bring it back to a ‘good’ rating. Key Inspection, 23 June 2009 This inspection was carried out to check whether the requirements made at the random inspection on 10 June, had been carried out. We found that little progress had been made. We were told by staff that there is disharmony amongst them around who should carry which tasks. Uncovered food, including a pork pie and a gateaux, were seen in refrigerators in the servery areas in a lounge diner on the ground floor and first floor. Paper towel dispensers were not available in en-suite facilities though out the home. The toilet and changing facility in the kitchen area remained dirty and cluttered. Black dustbin liners were still stored in the wash hand basin, the soap dispenser was clogged with soap and there was no paper towel dispenser. Paper towels were instead being stored on the floor. The toilet was dirty. A mop, with a grey coloured mop head, was improperly stored in a mop bucket in the same area. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 23 The sluice room in the ground floor corridor leading from the lounge/diner on the right of the entrance to the home was dirty and the hand towel dispenser was on the floor. The ‘domestic’s cupboard’ on the ground floor was still unacceptably dirty and the wash hand basin was clogged with wet, waste materials and the taps were still broken. Plastic aprons were seen on the floor. Mechanical ventilation units throughout the home in communal and private areas are not working. Beds are still not properly made with bottom sheets just being laid over the mattress. One duvet was seen to be in an extremely poor, threaded condition, in another room the bed was dirty in a further room the pillow was soiled and the curtains were ‘paper thin’. Hot and cold water taps throughout the home, in both communal and private en-suite rooms, were seen to be either dripping, running, not working or had tops missing so they could not be used. Two bathrooms, two showers and a communal toilet on the ground floor cannot be used because of missing plugs to sinks and baths, and a temperature regulator cover to an over bath shower. Damage to a wall and ceiling areas in a bedroom close to the laundry, and identified to the operations manager, had been repaired with large pieces of wood that had been screwed to the wall making each area unsightly. In the laundry a similar repair to the ceiling was coming away putting staff at risk of the wood repair falling on their heads. Toilet rolls were not routinely available in en-suite and communal areas. The exception was the down stairs ‘visitors’ toilet’ where there was a basket full of unwrapped toilet rolls. The manager facilitating the inspection had these removed immediately. In the treatment room on the ground floor we saw evidence of scorching to the ceiling around a fluorescent light fitting. A nurse on duty told us that this had happened during the previous two weeks and as soon as the light had been turned on staff realised there was a problem and got the maintenance man to deal with it. The fluorescent tubes were not fitted with diffuser covers. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 24 We asked the nurse to remove an electrical hoist charger and electrical adaptor socket from underneath the hand washing basin to prevent them coming into contact with water. The area from the wash hand basin and behind a filing cabinet and equipment cabinet were very dusty and dirty. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the homes recruitment and selection policy and procedures but staff need extra training so that they understand the needs, and can provide the right care and support to the residents. EVIDENCE: We asked for the records for two people who had been employed in the home since the inspection in March. It took some time for the records to be located and they were then only in plastic poly-pockets and had not been set up in a staff file. The staff file checklist for both staff was not fully complete and there was no interview record for one person. Both people had provided the names of referees that included their previous employer, evidence of their identification, had signed the rehabilitation of offenders’ statement and completed an enhanced Criminal Records Bureau check. For one person who had put on their application form, under previous employment ‘various factory jobs from 1986-2003’. There was nothing on record to indicate that this period of employment had been explored at interview. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 26 We asked for the induction record for one of these members of staff. The operations manager said the member of staff and her nurse mentor would still be working on this and the documentation was not available. The number of staff on duty is based on how many people are living in the home and does not take account of the complex and differing needs of residents. We saw evidence to show that checks had been carried out to make sure that nurses’ registrations were up to date. We were told that infection control training was taking place in the near future, but no one was sure who was attending this, or whether it would be rolled out to all staff working in the home. Staff do not always treat residents in a respectful and dignified way and they would benefit from training to help them understand the needs of people with a dementia like illness. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 36, 37 and 38. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People live in a home that is not conducted and operated in a way that consistently meets National Minimum Standards and Regulations and puts their health, safety and well being at risk. EVIDENCE: The home does not have a registered manager and there are no clear lines of leadership or accountability. The accumulative evidence of this inspection demonstrates shortfalls in the way the home is being managed. In spite of the recent and significant input from the operations manager concerns remain about the health and welfare of people living in the home. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 28 We were given copies of action plans that had been put in place since our last inspection. The action plans included the staff that were responsible and target dates. Some of the timescales had already been missed. The supervision and leadership skills of the nurses taking charge of shifts and the overall arrangements for the daily operation of the home and monitoring of care delivery to the service users require urgent review. We saw differences in the recordings of events surrounding a regulation 37 notification submitted to the Commission about a resident allegedly hitting a member of staff. An in-house record said that the incident had been reported to the safeguarding adults’ team but no one knew if there was to be any follow up and did not know the outcome of the referral. The daily records indicated that there had been more than one incident on the same day. There was no record of a resident asking to move from the home, and the operations manager was not aware of this request. We checked the maintenance and servicing arrangements for equipment and systems in the home. All were up to date and in place and we were provided with evidence of follow up actions where minor defects had been identified. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 29 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 X 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 2 1 X X 2 2 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X X 1 2 1 Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 30 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, and social opportunities must be expanded and written in a person centred way to ensure that residents needs’ can be fully met. This will mean that people who live in the home are kept safe and well and lead an interesting life. Previous timescales of 2 December 2008, 30 March 2009 and 22 June 2009, not met. 2. OP7 15 Care plan evaluations and dependency assessments must be regularly reviewed and updated. This will mean that people living in the home are getting the right care and support and staff are kept up to date with changes in peoples well being. Previous timescales of 30 March 2009 and 21 June 2009, not met. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 31 Timescale for action 04/08/09 04/08/09 3. OP8 12 The opportunity for residents to have a bath or shower must be increased to promote their personal hygiene and help them feel fresh and clean. The behaviour of people who live in the home that may disrupt the lives of others must be properly monitored and managed. This will mean that people who live in the home are kept safe and well. 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. Previous timescale of 30 March 2009 and 22 June 2009, not met. 23/07/09 4. OP8 12 23/07/09 5. OP9 13 23/07/09 6. OP15 12 Food supplies in the home must be checked to make sure they are not out of date and measures must be put in place to audit food stocks in the home. This will help to keep people who live in the home safe and well and provide them with nutritious food. Previous timescale of 21 June 2009, not met. 23/07/09 7. OP16 22 All complaints must be taken seriously and properly followed up. This will mean that people who live in the home know that they are listened to and any concerns they have are investigated. All incidents and allegations must be reported, recorded and followed up. This will mean that people who live in the home are DS0000065838.V375969.R01.S.doc 23/07/09 8. OP18 13 23/07/09 Cleveland Park Care Home Version 5.2 Page 32 kept safe and well. 9. OP19 13 The Commission must be provided with evidence that a manageable and achievable programme of planned maintenance is in place including the replacement and repair of damaged ceilings and ceiling tiles throughout the home. This will mean that people who live in a comfortable and safe environment that is well maintained. Previous timescale of 21 June 2009, not met. 10. OP19 13 All hot and cold water taps in the home must be in working order, and all dripping and running taps must be repaired or replaced. This will mean that people living and working in the home can follow good personal hygiene routines. Previous timescale of 21 June 2009, not met. 11. OP19 13 Wash hand basins and baths must be fitted with plugs so that they can retain water. This will mean that staff and people living in the home can follow good personal hygiene routines. Previous timescale of 21 June 2009, not met. 12. OP24 12 The stock of bedding, towels and 23/07/09 table cloths in the home must be audited and sufficient new stocks purchased for the comfort of the residents. Previous timescale of 21 June 2009, not met. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 33 23/07/09 23/07/09 23/07/09 13. OP26 13 Hygiene routines within the home must be improved to promote good infection control and clear, auditable schedules must be put in place. This will mean that people live in a clean and odour free environment. Previous timescale of 31 July 2008, 30 March 2009 and 21 June 2009, not met. 23/07/09 14. OP26 13 Peddle bins currently being used for the disposal of clinical waste throughout the home must be replaced with properly identifiable clinical waste bins. This will mean that used products that need to be treated as clinical waste can be disposed of safely and hygienically. Previous timescale of 21 June 2009, not met. 23/07/09 15. OP26 13 Cupboards/stores used by the domestic team and sluices must be thoroughly cleaned and redecorated. This will promote good hygiene routines and infection control. Previous timescale of 21 June 2009, not met. 23/07/09 16. OP26 13 Soap and towel dispensers must be provided throughout the home. This will promote good hygiene routines and infection control. Previous timescale of 21 June 2009, not met. 23/07/09 17. OP26 13 Mechanical ventilation units throughout the home must be thoroughly cleaned and in working order. This will promote DS0000065838.V375969.R01.S.doc 23/07/09 Cleveland Park Care Home Version 5.2 Page 34 odour control throughout the home. Previous timescale of 21 June 2009, not met. 18. OP30 18 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. Staff must receive additional training in the promotion of infection control. This will help them to do their job, understand the importance of what they do and help keep people who live in the home safe and well. 31/12/09 19. OP30 13 21/09/09 20. OP37 12 23/07/09 Records should be completed to reflect events, accidents, incidents and changes, in a true and accurate way and be legible. This will mean that staff can read records clearly and have access to all information relating to an event or incident helping to keep people who live in the home safe and well. Records and assessments must be fully completed, dated and signed so that there is a clear audit trail to changes in a persons care and support. This will help to keep people who live in the home safe and well. Risk assessments must be regularly carried out and reviewed to make sure that they reflect the current risks to a person living in the home. This DS0000065838.V375969.R01.S.doc 21. OP37 12 23/07/09 22. OP38 13 23/07/09 Cleveland Park Care Home Version 5.2 Page 35 will help to keep people who live in the home safe and well. 23. OP38 13 Where a moving and handling risk is identified a clear moving and handling plan must be put in place. This will help to keep people who live in the home safe and well. 23/07/09 24. OP38 13 Emergency lights throughout the 23/07/09 home must be checked, replacing bulbs and covers where necessary. This will mean that in the event of an emergency suitable and sufficient lighting is available promoting the health and well being of people who live in the home. Previous timescale of 21 June 2009, not met. 25. OP38 13 Fluorescent tubes in the kitchen must be covered with diffusers. This will promote the safety of people living and working in the home. Previous timescale of 21 June 2009, not met. 23/07/09 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 OP8 Good Practice Recommendations Residents’ spectacles should be accessible to them at all times and should not be left in kitchen cupboards/draws. Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 36 2. OP12 The opportunity for people to take part in more individualised social opportunities and activities should be expanded. The organisation should continue to engage with the local authority to ensure that safeguarding training meets the needs of staff and promotes their understanding of local procedures. The provision of storage facilities in the en-suite bathrooms should be reviewed throughout the home for the benefit of residents. Bulbs should be replaced in en-suite facilities and over sink lights throughout the home so that people have a good light source when they are carrying out their personal hygiene routines. Signs and pictures in the corridors should be securely fixed to walls and unused picture hooks and nails removed for the benefit and protection of people who live in the home. Consideration should be given to providing an alternative means of securing the laundry door to promote the flow of air for the comfort of staff. Shelves in the linen cupboard should be secured so that items are stored above floor level promoting good infection control. 3. OP17 4. OP19 5. OP19 6. OP19 7. OP19 8. OP19 Cleveland Park Care Home DS0000065838.V375969.R01.S.doc Version 5.2 Page 37 Care Quality Commission North Eastern Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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