Inspection on 13/10/05 for Croston Park Nursing Home

This inspection was carried out on 13th October 2005.

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

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

Other inspections for this house

Croston Park Nursing Home 19/09/07

Croston Park Nursing Home 08/01/07

Croston Park Nursing Home 12/05/06

Croston Park Nursing Home 20/01/06

Croston Park Nursing Home 23/11/04

Croston Park Nursing Home 03/06/04

Croston Park Nursing Home 12/02/04

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Croston Park Nursing Home Croston Park Nursing Home Town Road Croston Preston Lancashire PR26 9RA Lead Inspector Val Turley Unannounced Inspection 13th October 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 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. Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Croston Park Nursing Home Address Croston Park Nursing Home Town Road Croston Preston Lancashire PR26 9RA 01772 601431 add Tel:601131 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) PCR Properties Limited Ms Grace Elizabeth McLean Care Home 46 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (45), of places Physical disability (6), Terminally ill (3) Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. Up to 25 service users in the category of OP who need personal care only. Up to 20 service users in the category of OP who need nursing care. Up to 6 service users in the category of DE(E) who need personal care only. Up to 5 service users in the category of PD aged 50 - 64 who need nursing care. 1 service user in the category of PD who needs personal care only. Up to 3 service users in the category of TI. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission. 23rd November 2004 Date of last inspection Brief Description of the Service: Croston Park is a care home that provides personal and nursing care for 46 service users. The registration includes a 6-bedded unit for service users with dementia; this unit is situated separately in the upper part of the house. The home is a grade II listed building located in two acres of gardens. It is within travelling distance of Preston, Southport, Wigan and Chorley. Accommodation is provided on three floors made accessible by a passenger lift. The home has single and companion rooms some of which have an en-suite facility. Separate lounge and dining facilities are provided. Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day in October 2005 by two regulatory inspectors and one pharmacist inspector. The inspection involved discussion with service users living at the home, visiting relatives a social care professional and also discussion with and observation of the staff working there, an examination of records, policies and procedures and a tour of the premises. As part of the inspection, the inspectors used “case tracking” as a means of assessing some of the National Minimum Standards. This process allowed the inspectors to focus on two of the service users living at the home. All records relating to those individuals were inspected and discussion took place with the service users were possible. What the service does well: What has improved since the last inspection? The home employed 36 members of staff and of these 20 had achieved an NVQ qualification or equivalent. The home had therefore achieved the target of having 50 of the workforce qualified by 2005. Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 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. Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 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 the following standard(s): 3 The pre-admission assessment process was poor, with insufficient detail regarding the service users support needs, being documented. This placed both the service users and support staff potentially at risk. EVIDENCE: The file of one service user who had been recently admitted for respite care was examined. The file contained only some initial assessment information including details of the service users medical condition and medication information. A care plan had not been developed for this service user and support staff were not provided with any information as to the support needs of this service user, potentially placing both the service user and the staff at risk. The service user concerned stated the staff were very caring and that the food was excellent and that he had enjoyed respite care at the home on a number of occasions. Other files were examined which had no pre-admission assessment information in place. Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 9 An Immediate Requirement Notice was issued stating to ensure that service users admitted to the home only did so following the completion of a preadmission assessment which would allow the home to make a decision as to whether they were able to provide appropriate support. Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 7, 9 and 10 The care planning process was inadequate with the support needs of the service users not being documented in sufficient detail, leaving staff without the guidance required to ensure that appropriate support was provided to the service users. Support staff were respectful towards service users and also respected their privacy, helping to provide a relaxed and comfortable atmosphere at the home. Some medication records were not well maintained and so did not accurately record the handling of medication in the home. EVIDENCE: A sample of 20 service users files were examined and of these seven did not have a care plan in place. The staff at the home were therefore not provided with details of these individual service users support needs. The files of two service users, where there was a care plan in place, were tracked to determine if appropriate care was provided to the service users concerned. A number of other files were examined in some detail to determine whether the care planning process was adequate. One of the care plans tracked did not contain all of the information that had been collected during the pre-admission process. The plan did not contain any evidence of the service users social or emotional needs. Visits from health professionals had been recorded in such a way that support staff would find it Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 11 difficult to monitor the health of the service user adequately. A nutritional assessment had been undertaken which indicated that a referral to a dietician was advisable. There was no evidence that this referral had been made. The care plan and associated risk assessments had not been reviewed for a several months. It was therefore, not possible to determine whether the care provided adequately met the needs of the service user although the service user stated they were satisfied with the care provided. The second care plan tracked contained more detail and had been reviewed within the previous two months. There was evidence that the service user had been included in the development of the care plan. A risk assessment in respect of the use of bed rails had not been undertaken, potentially placing the service user at risk. Other files examined lacked sufficient detail, which would have helped ensure that care provided was appropriate and consistent. Discussion took place with a visiting social worker who stated that she had a good relationship with the home and had never been made aware of any criticisms of the care provided. Two visitors to the home praised the home stating that the staff were very caring and that they could not fault the care provided. Service users spoken to were also complimentary about the staff and the care provided. There was obviously a good relationship between the service users and the staff. Discussion with staff indicated that they had a good knowledge of the support needs of the service user and they were observed to be caring and sensitive in their approach to the service users. The pharmacy inspector looked in detail at the homes management and administration of medication and prepared a report separately from this inspection report. The report highlighted a number of areas in which the management of medication in the home should be improved. Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 12, 13 and 15 The home arranged a variety of activities for the service users, although more work could be one to ensure that service users were supported to follow their individual interests and hobbies. Although the home appeared to provide well-balanced meals, the timing and availability and recording of meals and snacks should be reviewed to ensure that the nutritional needs of the service users are met. EVIDENCE: A variety of activities were arranged at the home. This included craft activities and entertainers. On the day of the inspection there was a sale of greeting cards. Newspapers and books were available for service user use. Staff were observed to inform service users of the activities on offer and activities were advertised on the wall of the care home. Service users confirmed that activities had taken place. Some of the service users interests and hobbies were recorded within their files and it was evident that some service user had been supported to pursue their hobbies, but this detail had not been carried over to the care plans. Support staff were therefore not provided with sufficient detail to enable them to support service user with specific interests and hobbies except were service users themselves were able to give staff this information. The service users spoken to on the day of the inspection stated that they were able to receive visitors at any reasonable time and could receive them in the privacy of their own room. Visitors present in the home confirmed this. The Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 13 service users guide indicated that service users could choose who they wish to receive as visitors. Information on maintaining the involvement of family in the service users life was included in the service users guide and also in the staff handbook. It was noted that some of the service users were served with lunch at 11.30am. This arrangement was based on staff availability and the support needs of those specific service users. A member of staff stated that there was a possibility that these meals could be rushed to enable the dining room to be free for the next sitting. It was recommended that this arrangement be reviewed to ensure that service users receive meals at appropriate times and in accordance with the service users wishes. The registered manager must also ensure that all service users are offered a snack in the evening, as discussion with support staff indicated that there was a possibility that some service users may be left for a sixteen-hour period over the evening and night, without these being offered. Improved recording of service users intake of food supplements should be introduced to enable staff to make informed judgements regarding the nutritional needs of the service users. The cook at the home was aware of the individual dietary needs of the service users at the home. The dietary needs of one of the service users who suffered from diabetes was included within the care plan. Service users were given the option of receiving meals in their rooms if they wished. The menu was displayed and this indicated, as did discussion with the cook, that there were choices available at each meal. Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 16 and 18 The home had good, comprehensive policies and procedures in place in order to protect service users EVIDENCE: The home had a detailed complaints policy and procedure included all of the relevant detail. A copy of the procedure was displayed within the home. The policy and procedure in respect of the protection of vulnerable adults was detailed and included appropriate guidance for staff. These policies helped ensure the protection of the service users as far as possible. Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 19 and 26 The home was clean and comfortable and provided a pleasant and generally safe environment for the service users and staff, however some additional work needed to be undertaken to ensure that high standards were maintained. EVIDENCE: The home was generally clean, tidy and comfortable. The gardens were attractive with seating, planters and a greenhouse. These provided a pleasant environment for both the service users and support staff. There was evidence that repairs had taken place around the home and the senior staff on duty stated that the owner dealt with repairs promptly when they were reported. A number of outstanding repairs were noted on the day of the inspection and the senior member of staff was informed of these. A requirement made at the previous inspection had not been acted upon and an Immediate Requirement Notice was issued in respect of the Dementia care unit. Risk assessments for the individual service users must be undertaken in respect of the environment with specific reference to the uneven floors and beams. The Environmental Health Officer had visited the home in April 2005 and the kitchen had been decorated in response to the officer’s findings. At a previous inspection it had been noted that the kitchen storage area needed to be Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 16 decorated. This had not been attended to and as such was a potential hazard to the health of both service users and staff. The laundry at the home was clean and equipped to suit the needs of the home. Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 28 Appropriate training is provided for staff and training targets have been met, to help ensure that the needs of the service users are being met. The support needs of the service user group had increased and there were indications that there may not always enough staff on duty to meet their needs. EVIDENCE: The home employed 36 members of staff and of these 20 had achieved an NVQ qualification or equivalent. The home had therefore achieved the target of having 50 of the workforce qualified by 2005. National Minimum Standard 27 was not fully assessed at this inspection, however from discussion with a number of staff it was clear that they felt they were under a considerable amount of pressure. They were concerned that there were not always enough staff on duty. The registered provider had become aware of this and a restructuring of the staffing arrangements was being undertaken. Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 More care could be taken at the home to ensure that service users are protected from any unnecessary risks or hazards. EVIDENCE: This standard was not fully assessed at this inspection, however a number of concerns were noted with regard to the environment of the home and with the health and safety of the service users in mind a number of Immediate Requirement Notices were issued to ensure that the concerns were addressed quickly. These included the regulation of the water temperature in one of the bathrooms, and the need to lock those areas where hazardous substances were stored, including the laundry. Discussion with the staff indicated that there were concerns with regard to the security of the home as visitors were able to enter without reporting to a member of staff. This lack of security at the main entrance was felt to leave both the service users and staff in a vulnerable position. Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 19 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 20 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 OP3 Regulation 14(1) Requirement The registered manager must not provide accommodation to a service user unless a suitably trained person has assessed the needs of their needs. (Timescale of 31/12/05 not met.) All service users must be provided with a written plan of care. (Timescale of 31/12/05 not met) Service users plans must be kept under review Wherever possible care plans must be drawn up in conjunction with the service users and/or their representative. (Timescale of 31/01/05 not met) Service users must be consulted about their social interests and make arrangements for them to follow these. (Timescale of 31/01/05 not met) The registered manager must ensure that the dietary requirements of service users are considered and attended to. The registered person must ensure that unnecessary risks to the health or safety of service DS0000025537.V258551.R01.S.doc Timescale for action 14/10/05 2 OP7 15(1) 30/11/05 3 4 OP7 OP7 15(2)(c) 15(2)(c) 30/11/05 30/11/05 5 OP12 16(2)(m) 31/12/05 6 OP15 16(2)(i) 30/11/05 7 OP19 13(4)(c) 30/11/05 Croston Park Nursing Home Version 5.0 Page 21 8 OP19 23(2)(d) 9 10 OP38 OP38 23(2)(l) 13(4)(c) users are identified and as far as possible eliminated, specifically in relation to the Dementia care unit) (Timescale of 31/01/05 not met) All parts of the care home should be kept clean and reasonably decorated. (Timescale of 31/03/05 not met) Suitable provision should be made for storage in the care home. All unnecessary risks to the health or safety of the service users must be identified and as far as possible eliminated. 30/11/05 14/10/05 14/10/05 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 3 4 Refer to Standard OP7 OP15 OP38 OP38 Good Practice Recommendations Care plans should be reviewed on at least a monthly basis. The interval between snacks and meals should be no more than twelve hours. The registered manager should ensure that hazardous substances are stored safely. Water temperatures must be maintained close to 43ºC. Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Chorley Local Office Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW 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 Croston Park Nursing Home DS0000025537.V258551.R01.S.doc Version 5.0 Page 23 - 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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