Inspection on 16/06/08 for Cleveleys Park Rest Home

This inspection was carried out on 16th June 2008.

CSCI found this care home to be providing an Poor service.

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

Cleveleys Park Rest Home 23/02/09

Cleveleys Park Rest Home 13/08/07

Cleveleys Park Rest Home 05/07/06

Cleveleys Park Rest Home 04/01/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Cleveleys Park Rest Home 2 Stockdove Way Cleveleys Blackpool Lancashire FY5 2AP Lead Inspector Christopher Bond Unannounced Inspection 09:30 16 and 17th June 2008 th 16/06/08 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 Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cleveleys Park Rest Home Address 2 Stockdove Way Cleveleys Blackpool Lancashire FY5 2AP 01253 821324 01253 821324 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) Ms Sonal Solanki ** Post Vacant *** Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (14), Physical disability (1) of places Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 15 service users in the category of OP (older persons over the age of 65 years) and one service user in the category of PD (Physical Disability). Only 1 named service user in the category of PD over the age of 60 years may be accommodated within the overall number of registered places. 13th August 2007 2. Date of last inspection Brief Description of the Service: Cleveleys Park Care Home is situated within easy access of Cleveley’s local shops and amenities. The home provides personal care for a maximum of fifteen residents of both sexes who are elderly. The accommodation, which is on the ground and first floor, consists of nine single bedrooms and three shared bedrooms. Four of the bedrooms have ensuite facilities. There are sufficient bathing and toilet facilities to meet the needs of the residents accommodated. The communal rooms provide sufficient space and comfortable surroundings for the residents. There is a passenger lift to assist residents to move between the ground and first floor, however the home does not have available any special equipment except for a specialist bath, wheelchairs and walking frames. There is a Statement of Purpose/Service User Guide, which is available for persons making enquiries about the home. There is also a copy in each bedroom for residents and their relatives to refer to. The written information explains the care service that is offered and what the resident can expect if they decide to live at the home. A copy of the most recent inspection report is located in the hallway for residents and visitors to read. Information received on the visit confirmed that the fees for care at the home are from £320.0 to £374.0 per week and this includes hairdressing and chiropody. Cleveleys Park Rest Home DS0000065275.V362676.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 the people who use this service experience poor quality outcomes. As part of the inspection process an unannounced site visit took place over a total of 11 hours on the 16th and 17th June 2008. The Commission for Social Care Inspection pharmacist was also involved in this process and the administration, recording and handling of medication was also looked at. The service users personal files and care plans were examined. Care staff records and recruitment records were also looked at. Safety certificates and medication procedures for the service were also examined. We spoke at length to the Acting Manager and care staff during the inspection. Five service users were also spoken to as part of the inspection process. We also spoke to two relatives and friends of people who lived at the home. The Commission for Social Care Inspection also sent out surveys to service users and their relatives/ carers to gather their views about the service they receive. A number of these were sent back to us and the results have been included in this report. We also sent out surveys to the care staff of this home to tell us about their experiences of working at Cleveleys Park. We have used the results from this survey within the body of the report. Every year the registered person is asked to provide us with written information about the quality of the service they provide. They are also asked to make an assessment of the quality of the service. This information, in part, has been used to focus our inspection activity and is included in this report. What the service does well: The care staff were respectful and polite whilst we were there. Two people told us that the care was usually very good and that they were looked after properly. The surveys that were returned to us by the residents said that they were ‘always’ or ‘usually’ looked after well. Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 6 There were visitors to the home during the inspection, and one relative confirmed to us that they were always welcomed and offered privacy if they wished. This person commented. “I’m always made welcome and offered a cup of tea, it’s a nice place to visit, and really quite homely and welcoming.” The residents told us that the food and catering arrangements were good and that they looked forward to mealtimes. A menu was available for the residents and alternatives were served if someone didn’t like the meal on offer. One resident told us, “the food is usually really tasty and the dining room is nice.” A person who was visiting the home at the time of the inspection told us, “The tables are always set nicely and the food always smells really good.” What has improved since the last inspection? What they could do better: There still remains a need for the owner of the home to appoint a manager for the service who will register with the commission. This means that the home has not had a registered manager for some time and this needs to be addressed as a matter of urgency. We found that many of the managerial processes of the home were lacking and this must be addressed. With regard to care planning, most people who lived at this home had a plan of care that helped the staff to ensure that people were looked after properly. The plans detailed their care needs. The plans, however, had not been reviewed properly. There were also two copies of the care plans and some of these had conflicting information on them, which would have caused confusion and a lack of a consistent approach to care delivery. Two people who were being looked after on a short-term basis did not have a proper care plan. One of these people had complex needs: a care plan should have been available to direct the care staff in delivering pressure area care, wound care, catheter care and instructions regarding ensuring that he was moved safely and comfortably by the care staff. No care plan was available, and with the lack of direct instruction for the carers at all times (the home has no senior carers or assistant manager) the care of this gentleman was Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 7 compromised. The acting manager confirmed that much of the information regarding caring duties was passed on verbally or via the communications book. This is not acceptable. The acting manager had recently dismissed a carer because of poor practice. Protection of vulnerable adult procedures had not been followed. Unfortunately the acting manager had not followed the correct procedure. The matter had not been reported to Social Services in order that the matter be properly and robustly investigated under basic safeguarding protocols. The care plans held little information about the previous lives, interests, hobbies, and preferred activities of the residents. The acting manager told us, when we asked about activities, that most people liked to watch TV. There was no planned programme of activity either within the home or in the local community. Some of the residents told us that they found the television loud and disruptive. One person deliberately stayed in her room for most of the day because of this. As part of this inspection process, a Commission for Social Care Inspection Pharmacist accompanied the inspector during the visit to this home. A random pharmacy inspection was completed earlier on the year and a number of requirements and recommendations were made regarding how the home handles and administers medication. It was found that some of these recommendations had not been dealt with properly and that there were a number of issues that could directly affect the wellbeing of the residents. We found that one person had bed rails attached to their bed. It is important that these should be risk assessed in order that the dangers of such equipment be minimised. Although there had been recent training in moving and handling we found that there was little instruction available when care staff were using specialist equipment within the home. One of the care staff told us that a stand aid had been delivered and only two of the carers had been shown how to use this properly and consequently some people were not using it properly or did not use it at all. The home did not have a hoist to help transfer people with poor mobility. We undertook a random inspection at this home in April of this year. We found that some of the central heating units were very hot and we advised that covers be used to prevent residents from injuring themselves on hot surfaces. The thermostat for controlling the temperatures of these radiators was situated centrally, just by the front door and could be adjusted manually by residents or care staff to alter the temperature of the heating. As we found in our visit in April the potential is that someone could turn up the heating and cause the surfaces to become unnecessarily hot, therefore causing risk of injury to residents. The safest method of ensuring that this does not happen is by using radiator covers. It is advised that these are fitted to all radiators that have the potential of becoming unnecessarily hot. Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 8 There did not seem to be a dress code available for care staff. Two carers were seen to be inappropriately dressed for this type of work. The acting manager said that this had been discussed with them and that they had chosen to ignore the instruction. There was a small area to the back of the building that was set -aside for the residents to sit out in good weather. This area was cluttered and the staff were using this as a staff smoking area. There was an ashtray on the table. There was washing hung out across this area and this wasn’t a very nice place for the residents to sit. The garden furniture was old and worn. We also found that the complaints procedure was not displayed within the home. We found this in the home’s Statement of Purpose/ Service User Guide but this did not mention a timescale by which the owner/ manager should deal with the concern or complaint. The procedure needs to be displayed in a prominent position in the home where everyone is able to read and understand the process. 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. Cleveleys Park Rest Home DS0000065275.V362676.R01.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 Cleveleys Park Rest Home DS0000065275.V362676.R01.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 1, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information given to prospective residents and their families about this home is good, meaning that an informed decision can be made about the suitability of the service and what it can offer potential customers. Current assessment processes were not robust enough. EVIDENCE: There was plenty of information available for prospective residents to make an informed and balanced decision as to whether Cleveleys Park would be able to address their individual needs. The home had a combined Statement of Purpose and Service User Guide. These were given to each individual resident and their families to explain the services that were on offer and the arrangement that were made within the home to care for people successfully. Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 11 Several care plans were looked at and assessments were available to help ensure that the care staff had a good idea of the needs of the prospective resident. These also helped the manager to make a decision as to whether or not the home had the resources to care for the resident before he or she came to live at Cleveleys Park. One person had been assessed as being appropriate for the home but had complex care needs. Concerns are evident in the planning and delivery of this persons care. The person had been in respite care for a number of weeks and did not have a plan of care to inform the care staff of his specific care needs and what action should be taken to care for him properly. It was questionable as to whether or not this person had been assessed properly prior to the manager making a decision as to whether or not the home could meet his needs. The service does not supply intermediate care and this standard has not been assessed. Cleveleys Park Rest Home DS0000065275.V362676.R01.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): 7, 8, 9, and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Poor care planning and practice is putting the residents of the home at risk. EVIDENCE: Most of the people who lived at this home had a care plan that outlined the main areas of care and how the carers should deal with their specific need. There were two people, however, who were living in the home for a set period of time (termed as ‘respite’ care) did not have a proper care plan. We looked at the records of both of these people and found that one gentleman in particular had quite complex needs. There were clear issues that were evident around the care of this resident. We found the gentleman needed pressure area care and had a wound that needed special attention. This gentleman also had a catheter fitted and had mobility issues. There was evidence that the district nurse was visiting the home regularly to help care for these issues. There were, however, no clear and precise instructions to the staff of the home as how to ensure that this person Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 13 was properly cared for. For example, in the communication book it was noted that the district nurse had said that the gentleman should be turned every two hours to help with his pressure area care. There were some references within the communication book from night staff to say that they were carrying out this instruction. It would have been better for the care staff to have a chart where they could record when the gentleman was turned. We did not find evidence that the care staff were carrying out the instructions of the district nurse properly, or whether they had a clear knowledge of how to care for someone with a pressure sore or wound. When we talked to the care staff we found that there had been no training or instruction in this area. There was, however, special equipment available to relieve pressure, such as a special mattress and seat pads. We also found that there was special equipment available within the home for moving people safely. This home did not have a hoist but there was a stand aid in evidence. There had been specialist training in moving and handling for the acting manager and five of the care staff earlier in the year. There had been instruction in using the stand aid for only two of the carers, there were concerns that some of the carers were not using this because they had not been shown how to. Records were also kept of bathing arrangements for the residents. We found that the gentleman who was living in the home receiving respite care had only been assisted to bathe four times in seven weeks. This was concerning, as this person had issues around incontinence, pressure area care and wound care and that cleanliness was of vital importance because of the risk of infection. Similarly, there was no clear and precise instruction regarding catheter care and how the staff should respond to any issues there may be around this. Some of the care staff that we spoke to were very unclear about this and no one that we spoke to had received training or instruction organised by the home. The district nurse, however, was visiting the home regularly to attend to this. There were references within the communication book from some of the care staff to say what action they had taken but without a proper care plan it is felt that this person was put at risk by poorly planned care. The care staff were not confident about providing care for this person. Some of the care plans of other people in the home had not been formally reviewed on a regular basis. When reviews had taken place there were no outcome statements or indication as to whether or not the action that was being taken by the home was effective. Some of the care plans had not been updated to reflect the residents’ current needs. We asked some of the staff about some of the residents’ care and the care plan did not match up with the Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 14 information that we were given. We also found that there were two copies of the care plans with one being kept on the residents’ main file. There was conflicting information on the plans, which could have caused confusion. We spoke to five residents and two visitors during this visit. All five residents said that they were quite pleased about the care that they received and felt that they were well looked after. It was clear that people were being given respect by the care staff and that privacy and dignities were being offered. We saw some good examples of carers dealing properly and professionally with the residents of the home. One resident commented: “I like living here and feel quite at home.” One person that we spoke to, however, had recently been bereaved and spent much of the day in her bedroom. She said that not many people chose to speak to her and that she was pleased to be going home the following day. This lady was living at the home only for a short period of respite and did not have a care plan. It was unclear as to what arrangements had been put in place to help this person through a very difficult time. We observed part of the lunchtime medicines round. As seen at the previous inspection we saw that contrary to the home’s medicines policy, records are signed when doses are prepared for each person and not after administration. This means that if people then choose not to take their medicines, records have to be altered making them less clear. It was of concern that a recent entry in the communication book reported, ‘ I keep finding medicines on chairs in the lounge, please make sure they take them’. Finding tablets can sometime suggest that people are not able to easily swallow them. If people are having difficulty taking their tablets advice needs to be sought from the doctor to see if there is an alternative that the person could try. A sample of medicines was counted and compared with the records to check that they were given at the prescribed dose. We saw that medicines had mostly been given correctly but it was of concern that one person who asked for painkillers at lunchtime could not be given any because there were none left. When asked about what they were going to do staff said, ‘I wouldn’t know what to do, (the manager) is not here’. The home did not have arrangements in place for giving non-prescribed medicines. When another person had needed a painkiller, a dose had been given from another person’s prescribed supply. While it is understood that staff felt they were acting in the person’s best interests, arrangements need to be made that will allow the safe administration of non-prescribed medicines from the home’s own stock. A basic risk assessment had been completed for one person who was left to take their tablets in their own time. Their care plan said that staff need to go back and check after five minutes, but in practice staff said, ‘ xxx….is left with her paracetamol and takes them by the end of the day, she leaves them in a Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 15 pot by her bed’. Similarly, risk assessments completed with people who selfadminister some of their own medication were quite basic and care plans describing any support needed were not completed. It is important that assessments are completed to help ensure people always receive any help they may need to manage their own medicines safely. Records for the receipt of medicines into the home and disposal of unwanted medicines were mostly clearly made. But, receipt records were sometimes missed for medicines received outside the ‘normal’ monthly delivery. It is important that the receipt of all medicines is recorded to enable their safe handling to be tracked. As seen at the previous inspection the actual times that medicines were administered were not on the medication administration records. This is important; particularly where several doses of the same medicine are given throughout the day, to help ensure enough time is left between each dose. Where handwritten entries were made on the medicines administration records they were not always checked and signed by a second person. This is recommended to reduce the risk of making mistakes. There was a lack of clear guidance for staff about when medicines prescribed ‘when required’ may be needed. This is important to help ensure they are used correctly and that there is consistency in their use. We saw that records of advice from, and communication with doctors’ were more clearly completed helping to reduce the risk of making mistakes, for example if people’s medicines change. We saw that prescriptions for new medicines were mostly quickly started. But it was of concern that we saw one example where an antibiotic was not started until the day after the home received it, although it was possible to give at least one and possibly two doses on the day it was received. This could result in a worsening of the infection. Medicines were safely locked away but the home did not have a controlled drugs cupboard. To comply with current law controlled drugs need to be kept in a proper controlled drugs cupboard. The acting manager said he was seeking advice from the supplying pharmacy about the medicines policy, but it had not yet been reviewed to provide clearer guidance for staff in the safe handling of medicines. We were also told that audits (checks) of medicines handling were being carried out, but these were not available at the home on the day. Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were no planned and stimulating activities available for the residents of this service. The residents’ social, cultural and recreational interests and needs were not being met. EVIDENCE: The care plans held little information about the previous lives, interests, hobbies, and preferred activities of the residents. The acting manager told us, when we asked about activities, that most people liked to watch TV. There was no planned programme of activity either within the home or in the local community. We spoke to two residents in the main lounge after lunch. The television was on quite loudly but the ladies were reading and said that they found this annoying and distracting. There wasn’t a ‘quiet’ area where the residents could sit without being disturbed by the television. Another person that we spoke to said that they preferred to spend their time alone in their room because they disliked the television being on all the time. One of the visitors to the home Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 17 said that they found that the care provided by the service was good but that it was disappointing that there was so little stimulation for the residents. A trip out was in the process of being planned and a poster had been put up in the hallway. The venue for the trip had not been decided, neither had the date or time. Three of the care staff that were spoken to agreed that there should be more organised for the residents in the way of planned activity. The acting manager told us in the home’s Annual Quality Assurance Assessment that a party had taken place to celebrate the 100th birthday of one of the residents. This was the only planned activity that we could find that had taken place, apart from the occasional game of dominoes. The home must assess the interests and abilities of the residents and organise a regular programme of activities. We did find, however, that one person who lived in the home was receiving visits from a clergyman and this helped to meet the person’s religious needs. Several of the residents said that they enjoyed the food at the home and looked forward to meal times. One person commented, “I have a good appetite and I enjoy nearly everything that I eat. The food is cooked very well.” We looked at the menu for the home. This rotated on a four weekly basis and there was a choice available. The cook was spoken to and it was confirmed that fresh meat and vegetables were ordered on a regular basis. The dining room was pleasant and the tables were properly set, with tablecloths. We observed what happened over the lunchtime period and the residents were spoken to politely and served courteously. The meal was not rushed and people were given time to enjoy their meal. There were visitors to the home during the inspection and several of the residents were able to confirm that they had regular visits from friends and family. One visitor confirmed that she was always welcomed at the home and was given privacy when chatting to her friend. The acting manager confirmed that meetings were held for the residents to voice their opinions and suggest changes to the home. One of the carers, however, was concerned that she had been asked to chair a meeting after only being at the home for a short period of time, before she really got to know the residents. Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures for reporting abuse were not followed by this service meaning that people could be put at risk. EVIDENCE: All of the staff that were spoken to said that they knew what to do if someone was unhappy about the service. The complaints procedure, however, was not displayed in the home but was part of the Service User Guide/ Statement of Purpose. No timescale was specified as to as to how long the home would take to deal with complaints and concerns. This is 28 days, and is required by law. The procedure should be altered to reflect this and the procedure must be displayed in a prominent area of the home where people are able to read it properly. Four residents told us via surveys sent to them by the Commission for Social Care Inspection that they knew how to make a complaint about the home if this was required. We also spoke to three residents during our visit who said that they would speak to the acting manager about their concerns, should they have any. The acting manager had also introduced a complaints and concerns log at the home for staff to record when a resident was displeased with the service that they received. There were no entries in this log at the time of this visit. Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 19 Training records told us that instruction had taken place for the acting manager, the owner of the home and five of the care staff in abuse awareness and protecting vulnerable adults. The acting manager told us that a carer had been dismissed shortly after this training on suspicion of verbally abusing a resident. Unfortunately the acting manager had not followed the correct procedure. The matter had not been reported to Social Services in order that the matter be properly and robustly investigated. We spoke to three of the care staff and two of them told us that they had received training in adult safeguarding issues and knew what to do if they suspected that things were wrong. One of the care staff who had recently been employed told us that adult safe guarding issues were not covered on her induction to the home. There were policy documents for the staff to read about how to ensure that people were safeguarded from harm. Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 23, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service requires investment and re-organisation to help ensure that this is a pleasant home in which to live in. EVIDENCE: We looked round the home during this visit. Most of the residents had single bedrooms. There were three shared bedrooms but these were not being used as such during the inspection because the home was not full. All of the rooms that we saw were well furnished and held lots of personal possessions such as photographs, pictures and ornaments, that helped to personalise each room and help to ensure that people retained their individuality. We noticed, however, that some of the beds were narrower than standard single beds. We also saw that some of these beds were in poor condition and had stains down the side of the divan bases. The beds were quite old looking Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 21 and were in need of replacement. Some of the carpets throughout the home were also quite old and were wearing thin. There was also a lot of ‘rucking’ of some of the carpets in communal areas, which could cause a safety hazard. We also found that some of the floors were uneven due to old or damaged floorboards. This could cause people to become disorientated or fall and should be remedied. Generally the home needed a programme of refurbishment and redecoration where old furniture, carpets and soft furnishings could be replaced over a planned period. Both the acting manager and staff told us that the home needed attention. The acting manager told us in the Annual Quality Assurance Assessment that the home needs a programme of refurbishment and redecoration. One of the residents had bed-sides attached to their bed to stop them falling out during the night. A risk assessment should be available to show that the service has looked at the possible dangers and tried to minimise them. There were no risk assessments completed in this instance. We undertook a random inspection at this home in April of this year. We found that some of the central heating units were very hot and we advised that covers be used to prevent residents from injuring themselves on hot surfaces. The thermostat for controlling the temperatures of these radiators was situated centrally, just by the front door and could be adjusted manually by residents or care staff to alter the temperature of the heating. As we found in our visit in April the potential is that someone could turn up the heating and cause the surfaces to become unnecessarily hot, therefore causing risk of injury to residents. The safest method of ensuring that this does not happen is by using radiator covers. It is advised that these are fitted to all radiators that have the potential of becoming unnecessarily hot. The bathrooms on the ground and first floor had been decorated since our last visit and presented a more pleasant environment for the residents. Some of the other areas of the home, however, needed to be redecorated to ensure that the residents lived in a bright and pleasant environment. We found the main lounge areas to be very cluttered. There was an area where old furniture was being stored that wasn’t being used. There was also a large box with old files and books in it and two ‘put me up’ beds being stored there. There was space available to make a quieter area for residents to sit who did not want to watch television. Too much emphasis was being placed on the TV area with chairs arranged around this so that people didn’t really have a choice where to sit. There was a small area to the back of the building that was set aside for the residents to sit out in good weather. Again this area was cluttered and was mainly used as a staff smoking area. There was an ashtray on the table. There was washing hung out across this area and this wasn’t a very nice place for the residents to sit. The garden furniture was old and worn. The acting manager Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 22 said that there were plans to purchase some new garden furniture. There was space nearer to the road, which could be utilised as a garden/ seating area for residents, which could be made private and comfortable. The home was generally clean and there were no unpleasant odours. There was a member of the cleaning staff on duty whilst we were there. Two of the residents and two visitors remarked on how clean the home was. All of the surveys that we received said the home was ‘always’ or ‘usually’ fresh and clean. Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 And 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Insufficient induction procedures mean that some care staff are not given the skills and knowledge to complete their duties appropriately. EVIDENCE: At the time of the inspection there were enough care staff on duty to help ensure that the assessed needs of the residents were being attended to. The staffing rotas were looked at and the home was found to be generally well staffed. There is a need to ensure that the numbers of staff with a nationally recognised qualification in care (National Vocational Qualification level 2 or 3) remains above 50 . The acting manager saw this as one of the targets to achieve over the forthcoming year. We spoke to two of the care staff about their employment and induction. Both carers said that they had joined the home within the past month. Both said that they had received a 1day induction to the home before they were asked to carry out their duties as part of the care staff team. One carer said that another staff member and not the manager carried this out. Although both carers had experience in working within the care sector we feel that a single days induction to working within the home is insufficient. Both said that they had the necessary checks carried out before they started to work at the home, such as Criminal Records Bureau disclosures. We checked the records of five Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 24 care staff who worked at the home and most of the records that are required were in evidence. Recent photographs were required on some of the files. We also looked at the Criminal Records Bureau disclosures of all the care staff. The owner of the home needs to demonstrate that those care staff who have been employed with criminal convictions or cautions have been spoken to about this and that the owner is fully satisfied that the residents are cared for only by suitable staff. There were no such records, or risk assessments available within the home to show that this had taken place. There were records to show that there had been recent training in health and safety, moving and handling and adult safeguarding awareness. Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. No registered manager is in post. Management processes in this home were not being followed correctly leading to insufficient care planning and poorly prepared care staff. Procedures regarding adult safeguarding issues were not followed correctly meaning that people could be put at risk. EVIDENCE: There was an acting manager in charge of the home when we inspected the service. He had achieved a national qualification in care (National Vocational Qualification level 4) and had enrolled to undertake a recognised qualification in management. He had been in this position for approximately three months and, at the time of the inspection, the owner wished to register him with the Commission for Social Care Inspection as manager of the home. It is very Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 26 important that a competent and experienced manager be registered as soon as possible. The service does not have an assistant manager in place and there are no senior carers to ensure that things are running smoothly at all times and that processes are carried through. This puts more responsibility on the manager. The home was presently running an ‘on-call’ system where the acting manager makes himself available at times when he is off duty to provide advice and support for the care staff when required. We found that some of the residents of the home were pleased with the way that the service was being managed. Some of the care staff also felt that there had been improvements in the way that the home was being managed, and they felt more supported. There were issues, however, that were concerning regarding the way that the processes of managing the home were being dealt with. We found that safeguarding procedures had not been followed regarding a recent allegation of verbal abuse. We also found that two people who lived in the home did not have a care plan and existing care plans were not being reviewed properly. A gentleman had been admitted to this home with complex care needs and it was evident that the care staff did not have the training, skills or confidence to deal with this person’s needs in a planned and competent way. There were other areas of concern around the way in which the home was being managed. Most of the care staff were properly dressed in suitable clothing, considering the tasks they were performing on a day-to-day basis. Two of the care staff that we saw, however, were dressed very casually. We did not feel that they were dressed appropriately or suitably for the manner of work they were to perform. We did not see that the service had a dress code for the care staff to adhere to. The acting manager said that this had been addressed with the two carers concerned but they had chosen to ignore the advice given to them. Two of the care staff had disclosures on their Criminal Records Bureau information and there was no evidence to suggest that the risk to residents had been addressed properly or assurances recorded by the manager or the owner as to the conduct of these carers. There had been recent mandatory training in Moving and Handling and Health and Safety for the owner of the home, the acting manager and five of the care staff. We found, however, that specialist equipment was either not available for the care staff to use (a hoist), or was installed without first ensuring that all the care staff were properly trained to use it (a stand-aid). We did not find evidence that there had been recent training for the care staff regarding fire safety within the home. We found that the care staff locked the front door with a key and that the door remained locked for most of the day. The key itself was kept close to the office area and that the care staff had to Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 27 retrieve this when the door needed to be opened. This process held important implications regarding the freedom of the residents to come and go as they pleased. There were also safety issues evident in the event of an emergency. If a fire broke out in the kitchen/ dining room area, close to where the key is kept, the residents would not be able to evacuate the building. This is an important issue and must be addressed by the acting manager. The service did not use a computer. The acting manager, however, held quite a lot of information about the home on his personal laptop computer, which he brought with him on a daily basis from home. There are implications regarding confidentiality within this process and it is important that the Data Protection Act (1998) is considered and addressed. Some of the residents had money that was held by the service for safekeeping. Financial records were seen during the inspection and were found to be satisfactory. It would be advisable, however, for personal monies to be held more securely. At present this is being held within a lockable filing cabinet. Records were available to show that the home was properly insured and that recognised trades people had checked the gas appliances, lift, fire equipment and electrical appliances to show that they were safe. The acting manager could not find the certificate to verify that the electrical wiring system had been properly checked. We have asked that this be forwarded to the Commission for Social Care Inspection for verification. We could not find evidence of an effective quality assurance and quality monitoring system whereby the performance of the home is commented on by its customers and external stakeholders. Such systems are important when assessing the quality of the service and the way it cares for its residents. The owner of the home is required to visit the home on a regular basis and prepare a report about what she finds and about the experiences of the residents. The owner sent us a report in January 2008. We could not find any reports that have been completed since then. Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 2 X X 3 2 X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 2 X X 1 Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 29 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 OP31 Regulation 8(1)(a) Requirement An application must be made to the Commission for Social Care Inspection to register a manager who is qualified, competent and experienced to ensure that the home is well run for the benefit of the residents. (Timescale of 30/06/07 not met) Care staff must follow the homes procedures for the safe administration of medication. [Timescale 30/05/08 not met] When people look after their own medicines assessments must be carried out to ensure they receive any support they may need to do so safely. [Timescale 30/05/08 not met] A legally compliant controlled drugs cupboard must be used to store controlled drugs to help ensure they are not mishandled or misused. Timescale for action 31/07/08 2. OP9 13(2) 31/07/08 3. OP9 13(4)(c) 31/07/08 4. OP9 13(2) 17/09/08 Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 30 5. OP3 14 6. OP7 15 (2) (b) (c) 7. OP8 12 (1) (a) (b) 17 (1) (a) 8. OP8 9. OP12 16 (2) (m) (n) 10. OP18 12 (1) (a) Prospective residents must have their social, cultural and health needs assessed properly and a decision must be made as to whether or not the home can attend to these needs successfully. All of the people cared for by the service must have a properly prepared care plan that is reviewed regularly and updated according to the assessed need of the individual concerned. The health care needs of all residents must be attended to properly, with sufficient direction for care staff. Incidents of pressure sores must be recorded in the care plan so that their condition and treatment can be reviewed on a regular basis. A planned and organised programme of activities and stimulation must be available to all people who use the service. These must be arranged with the interests, wishes and needs of the residents in mind and must include any residents who may have a cognitive disorder. The person in charge of the home must report all incidents of abuse or suspected abuse to the relevant agency. This enables the incident to be investigated properly and for any carers to be placed on the Protection of Vulnerable Adult register if this is deemed necessary. 31/08/08 31/07/08 31/07/08 31/07/08 31/07/08 31/07/08 Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 31 11. OP25 13 (4) (a) (c) 12 OP29 19 (4) © 13 OP38 23 (4) (5) 14 OP32 26 15 OP38 13 (3) (c) Radiators and pipe work must have guaranteed low surface temperatures. Where this is not possible, covers should be provided to minimise the risk of injury to the residents of the home. Evidence must be made available to show that Criminal Records Bureau disclosures that are returned with convictions and cautions are investigated properly with the safety of residents in mind. Evidence of this process must be made available when required. Training must be available for all staff in core areas of safety. This must include fire safety, first aid, and infection control. This is to ensure that the care staff are fully aware of safe working procedures and safety aspects of the home. The owner of the home must prepare regular monthly reports, with regard to the quality of the home and the experiences of the residents who live there. These must be submitted to the commission. Risk assessments must be undertaken for people at the home when considering the appropriateness of the application of bed rails. 31/08/08 31/07/08 31/07/08 31/07/08 31/07/08 Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 32 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 OP30 Good Practice Recommendations The registered provider should ensure that staff have continual access to relevant training courses in order that they are able to meet the changing needs of the residents A planned programme of maintenance, refurbishment and redecoration of the home should be produced to ensure that the residents live in a well -maintained and homely environment. Training should continue, to ensure that over 50 of care staff achieve a minimum of National Vocational Qualification level 2. Where people are prescribed medicine to be taken ‘when required’ individual guidance (protocols) are needed to help ensure staff know when the medicine may be needed. The medicines policy should be reviewed and expanded to proved clear guidance for staff in the handling of medicines at the home. Consideration should be given to implementing a policy describing the safe handling of home remedies. To reduce the risk of mistakes, handwritten entries on the medication administration record should be signed and countersigned. 2. OP19 3. OP28 4. OP9 5. 6. OP20 OP30 All residents should have access to safe, comfortable and pleasant outdoor facilities. There should be a planned and recorded induction process for all care staff undertaken by the person in charge of the home at the time. This should include training on the principles of care, safe working practices, the organisation and worker role, the experiences and particular needs of the service user group, and the influences and particular requirements of the service setting. There should be an effective quality assurance system to gauge DS0000065275.V362676.R01.S.doc Version 5.2 Page 33 7. OP33 Cleveleys Park Rest Home the effectiveness of the service and to record the views of residents and other stakeholders. 8. 9. 10. OP35 OP29 OP16 A secure method of safe keeping residents’ money should be available. Staff record files should contain a current photograph of the person concerned. The service must provide a simple and legible complaints procedure, which makes reference to stages and specified time scales. The procedure must be displayed in a prominent position within the home where all residents may access this if they wish to voice their concerns about the service. Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Regional Contact Team 3rd Floor Unit 1 Tustin Court Port Way Preston PR2 2YQ 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 Cleveleys Park Rest Home DS0000065275.V362676.R01.S.doc Version 5.2 Page 35 - 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. 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