Inspection on 29/04/05 for Cold Springs Park

This inspection was carried out on 29th April 2005.

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

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

Other inspections for this house

Cold Springs Park 08/10/08

Cold Springs Park 27/11/07

Cold Springs Park 28/09/06

Cold Springs Park 20/10/05

Cold Springs Park 25/10/04

Cold Springs Park 07/04/04

Cold Springs Park 27/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cold Springs Park Scaws Road Penrith Cumbria CA11 8EY Lead Inspector Cath Wilson Announced 29 April & 03 May 2005 09.30 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 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. Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cold Springs Park Address Scaws Road Penrith Cumbria CA11 8EY 01768 890360 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care First Care Homes Limited (BUPA Care Services) Lynne Diane Stanley Care Home 40 Category(ies) of 40 OP - Old Age registration, with number 5 DE(E) - Dementia over 65 of places Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 40 service users to include: up to 40 service users in category OP - old age up to 5 service users in category DE(E) - dementia over 65 years of age 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Date of last inspection 25 October 2004 Brief Description of the Service: BUPA Cold Springs Park provides accommodation and care for up to 40 older people, five of who may have dementia. The home is owned and run by Care Homes First Limited, a subsidiary of BUPA Care Services. The home is in a residential area approximately one mile from the centre of the market town of Penrith and local amenities. Single occupancy accommodation for service users is on ground floor level with en-suite toilet and hand wash facilities. There are three lounges, that can be used for activities and one permits smoking. The building and garden areas are very well maintained and there are sheltered patio areas. Car parking facilities are available for staff and visitors. All parts of the home and grounds can be accessed by people who use wheelchairs. Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection started at 9.30am and took place over 8 hours throughout a two-day period. The Pharmacist Inspector from the Commission for Social Care Inspection also visited the home on the second day. A more detailed letter following her inspection has been sent to the home. The people in the home and some of their family provided valuable views about their care prior to the inspection through comment cards. People met with the inspector during the inspection and also shared their views and opinions about their life in the home. This was done in an individual meeting with the inspector, in the communal rooms or in the privacy of their own rooms. The manager and staff were also met separately and in the company of residents. A number of records were assessed and the inspector looked around all areas of the home. What the service does well: What has improved since the last inspection? The home continues to generally maintain the homes environment both inside and out to a good standard. The programme for ongoing attention to the furnishings and decorations continues. Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, and 5 The admission procedures ensure that prospective residents receive the information and support they need to make an informed choice before moving into the home. EVIDENCE: There is an up-to-date admission procedure that guides the manager and staff on the necessary actions to take in assessing and planning for each individual entering the home. People informed the inspector that their care has been discussed with them. The manager and staff are fully informed of people’s care needs and rightly placed great importance on people’s continued health and welfare. Individual records that were assessed contained an assessment. The home provides a Statement of Purpose and this has been updated and available to everyone in the home and their relatives. This ensures that people are informed of the services and care provided by the home. The Commission for Social Care Inspection had also been informed of this revision. Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Individual health, personal and social needs are recorded in an accessible and detailed manner. The manager and staff have detailed knowledge of people’s comprehensive needs and requirements through the care planning used. This greatly limits any possible risk to people in the home. However, although outcomes were generally met for medication matters, improvement was needed to reduce risks to residents from inadequate recording and documentation. EVIDENCE: People have an individual care plan that records the needs and the actions needed to meet them. These documents are up-to-date and regularly checked by the registered manager and senior staff; this makes sure people’s care is properly attended to. People said they were comfortable with their care and able to let people know if changes were needed. They were at ease with the manager and staff and this made it easier for them to air any views they have. Important events in the home and daily records are recorded, as are personal and environment risk assessments. People in the home said they felt respected and their care provided in a sensitive and attentive way. Records and documentation for medicines were generally good but need improvements Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 10 to reduce any possible risk to residents to comply with good practice guidelines. Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, and 15 People can involve themselves in a variety of social interests and pastimes and observe their cultural and religious wishes. Meals provide a healthy and varied diet for people. EVIDENCE: Visitors visit the home regularly and arrangements are in place for contact to be maintained in other ways. People’s individual preferences are detailed in their records ensuring that the manager and staff always know people’s personal needs and wishes. Residents approved wholeheartedly at the many little things staff attended to for them. People can choose how they spend their time and can join in with things or change their mind. There are activities and interests available to people that are both pleasurable and stimulating. An activities organiser is also employed to assist in this. Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The complaints procedure is satisfactory and available to people and their relatives. The home follows the vulnerable adults procedure to ensure that people living in the home are protected from abuse. EVIDENCE: The home has a detailed complaints procedure and response system. There have been no complaints received by the Commission for Social Care Inspection or the home since the last inspection. People who met the inspector know how to air their views. They can also bring up any matters of concern to them in regular residents meetings or individually. The manager and staff indicated their awareness of adult protection procedures and the practices needed. Staff spoken to are clear about the responses required and confirmed they had received training in this ensuring people are protected. Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 23, 24, 25 and 26 People are provided with safe, comfortable and relaxing surroundings that include specialist facilities and adaptations. EVIDENCE: There are risk assessments in place for the environment and these are up-todate. This is for the inside as well as the outside of the home. There is a programme in place to maintain the furnishings and fittings and these have been time-placed for completion. The re-decoration and carpet in some areas needs to be upgraded sooner rather than later. This will ensure that the comfortable and homely surroundings are maintained for the ongoing benefit of people in the home. Service users commented on the comparisons between areas that have been improved and those that have not. Whilst there are specialist facilities for bathing the home does not have a specialist bath. Service users would greatly benefit from this facility and this would provid greater choice for them. Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29 and 30 There are robust procedures in place for the recruitment of staff. These offer protection to people living in the home as does the training and development programme for all staff. EVIDENCE: People indicated that staff showed them many kindnesses and did lots of things that made life easier and comfortable for them. They felt staff were kept very busy and the manager is monitoring staff workloads to ensure that enough staff will always be available. People living in the home spoke very kindly of staff and said they were caring and attentive. Staff have supervision and feel supported in their work. The programme for staff supervision is currently being updated. Staff are provided with a training and development plan that makes sure training is both up-to-date and meets people’s detailed and changing needs. Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 37, and 38 There is clear leadership and direction for staff to make sure that people receive a consistent quality of care. These practices promote and safeguard the health, safety and welfare of people in the home. EVIDENCE: There were sufficient staff on duty at the time of the inspection to meet the needs of service users. The manager and staff are very clear about their roles and responsibilities and balance their work so that individual and group needs are met. This includes the completion of the necessary paperwork. This makes sure individual residents needs are up-to-date, and staff appropriately informed to accurately meet people’s ongoing needs. The records assessed ensure that people’s rights and best interests are safeguarded. Individual records for people are clearly recorded and kept up-to-date. Records indicate that fire drills and instructions have taken place regularly. The last visits from the Fire Officer and the Environmental Health Officers are satisfactory. Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 x 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x 3 x 3 3 Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 17 NO Are there any outstanding requirements from the last inspection? 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. 2. Standard 9 Regulation 13 Requirement The medicines records must comply with pharmacy guidelines Timescale for action 30.06.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 26 26 Good Practice Recommendations Consider the provision of a specialist bath. Complete the planned redecoration and furnishing of one of the homes corridors. Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 18 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 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 Cold Springs Park F58 F10 s22545 cold springs park v175235 290405 ai stage 4.doc Version 1.30 Page 19 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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