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 09:30 19 and 21 September 2007
th st 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.V344401.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. Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 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 01772 601131 crostonpark@parklanehealthcare.co.uk www.parklanehealthcare.co.uk Park Lane Healthcare (Croston Park) Ltd 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 Bernadette Roe 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.V344401.R01.S.doc Version 5.2 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. 8/1/07 Date of last inspection Brief Description of the Service: Croston Park is a care home that provides personal and nursing care for 46 residents. The registration includes a 6-bedded unit for residents 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 most of which have an en-suite facility. Separate lounge and dining facilities are provided. The current scale of charges at the home ranges from £475 - £720. Additional charges are made for newspapers and some hairdressing. Since the last inspection the ownership of the home has changed and a new registered manager has been appointed. Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an inspection that took place over a nine-month period and culminated in a site visit to the home over two days in September 2007 by one regulatory inspector. The inspection involved discussion with people living at the home where this was possible, discussion with staff, observation of staff supporting the residents and an examination of records, policies and procedures. Every year the registered persons are asked to provide us with written information about the quality of the service they provide and to make an assessment of the quality of their service. We use this information, in part, to focus our inspection activity. Information was also provided through surveys completed and returned by 2 residents living at the home, 6 relatives and 2 health professionals. As part of the inspection, the inspector used ‘case tracking’ as a means of assessing some of the National Minimum Standards. This process enabled the inspector to focus on four of the people living at the home. Records relating to those individuals were inspected and discussion took place with them and the staff team in relation to their support needs. An ‘Expert by Experience’ accompanied the inspector on the site visit to the home. The Expert by Experience spent time talking to residents, visitors and staff gathering additional information which is also included in this report. What the service does well:
Croston Park provides a clean, comfortable, tidy, safe and homely environment for the residents who live there and the staff who support them. The home has a comprehensive plan in place to refurbish the home, which will further improve the environment and improve working conditions for the staff. The home has a good approach to assessing prospective residents, with staff collecting as much information as possible about their support needs, enabling them to make a decision as to whether they can provide the support required. The information collected is developed into a care plan that gives clear and detailed information to staff as to how they can best support each resident. Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 6 There was evidence that a range of health professionals including GP’s, District Nurses, and chiropodists visit the home regularly. Residents also have access to sight tests, hearing tests and dental treatment. One resident had been referred to a physiotherapist and residents are supported to attend out patient appointments. The home is well equipped with a range of aids to enable residents to be moved safely and equipment for the prevention and treatment of pressure sores was also provided. Two GP’s wrote that they thought that the health needs of the residents were usually met. From discussion with residents, visitors and staff and from observation of the staff supporting the residents, it was evident that the daily routines within the home are flexible and varied enabling the residents to make choices about their own routines. Residents are free to move about the home and are given choices about what they would like to do and where they would like to sit or eat their meals. Visitors are able to visit at any reasonable time. Bedrooms are personalised with residents being able to bring in their own possessions, furniture and pictures. The staff team are caring and sensitive in their approach and the residents appreciate this. One relative wrote ‘the staff are wonderful. They seem to genuinely care for the clients and are always very patient. The staff are all ages and it’s nice to see young members of staff being so caring with elderly people’. A resident wrote that she was ‘completely happy with the care and support provided’. Staff are recruited carefully and all of the necessary checks are made and references taken up before they start work in the home, helping to ensure that residents are kept safe and are well supported. The staff team are provided with good training opportunities to improve and keep their skills updated. The home had good policies and procedures in place designed to protect the residents as far as possible. The home is well managed by a registered manager who has a clear view of her responsibilities and a determination to ensure that the quality of care and support provided at the home continues to improve. The Expert by Experience wrote that ‘Croston Park comes across as a friendly caring home with an enthusiastic management team and caring staff’. What has improved since the last inspection?
More detail is now collected when staff are undertaking a pre-admission assessment enabling the home to make good judgements as to the care and support needed by a prospective resident. Work has also been undertaken by the parent company to review all of the residents’ contracts to ensure that there is clarity about the charges that are made.
Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 7 Care plans are much more detailed and give clear and detailed guidance as to the care that residents need. Wherever possible residents have agreed and signed their care plans. The manager checks each resident’s file to ensure that all of the documentation is correct. She also plans to introduce a quality monitoring system that will include regular auditing of residents files. Care plans have been reviewed on a monthly basis to help ensure that the changing support needs of the residents are met. Risk assessments regarding the residents health needs are in place within the care plans and these have been reviewed on a monthly basis to assist staff in identifying any specific health or support needs. The management of medication in the home has also been reviewed and improved. The manager now takes responsibility for ordering the medication. Medication is now all kept within one locked clinical room ensuring that it is secure and can be managed more effectively and safely. All of the recommendations made at the last inspection have been addressed by the manager, again improving the way in which the medication is managed and administered within the home. Since the last inspection the home has employed an activities organiser who has introduced a programme of activities five afternoons a week. These, especially the gardening group and the painting on glass and sing along sessions, have proved to be very popular. Improvements have been made to the mealtimes since the last inspection. Residents and staff are now aware that there is a choice of meals available at mealtimes and that there are always alternatives on offer if the residents do not like what is on the menu. Residents have been given the opportunity to make suggestions as to what they would like for their meals. There are comprehensive plans in place to refurbish the home and this process has started. This includes repairs to the structure of the building, redecoration of all areas both inside and outside the home, repairs to windows, recarpeting, upgrading of bathrooms, installation of a new call alarm system, replacement of furniture in the dining rooms and the kitchen is to be re-fitted. Outside there are plans to landscape the grounds and extend the car parking areas. This process has been approached sensitively to cause the minimum of disruption to the residents and it is anticipated that the work will be completed in a relatively short timescale. Since the change of ownership at the home the roles of the staff have been clarified and staff have been redeployed more effectively. Staff are happy with the support that they receive, are pleased with the improved training opportunities that they are provided with and are more confident in their role and are enjoying the new responsibilities that they have been given. The manager is continuing to review the staffing levels on a regular basis with a view to adjusting them as the needs of the residents change. Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 8 The home’s new registered manager has introduced a range of quality assurance monitoring systems to ensure that the home is run in the best interests of the residents. As well as in-house quality assurance checks, monthly monitoring visits are also made by a representative of the parent company and an external auditor will also undertake checks on the home twice a year. Hazardous substances kept in the home are stored securely to ensure that any risk to the residents is eliminated. 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. The summary of this inspection report can be made available in other formats on request. Croston Park Nursing Home DS0000025537.V344401.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 Croston Park Nursing Home DS0000025537.V344401.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): 1 and 3. Standard 6 was not applicable to this service. The home has a good pre-admission process in place to enable the home to determine if they are able to meet the support needs of a prospective resident. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the course of the site visit the files of three recently admitted residents were examined in detail. From the information available and from discussion with staff it was clear that the home had been thorough in its approach and had undertaken a full assessment of the support needs of these prospective residents. Senior staff had visited the prospective residents in their own homes to undertake the assessment and had taken into consideration information provided by other health professionals. This enabled the home to reach a decision as to whether they could provide the support and care that they needed. From the assessments the home had developed a care plan for each
Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 11 of the residents. These gave staff clear guidance as to the support they required and how it should be provided and the staff spoken to had a clear knowledge of the needs of the residents. The residents had signed their care plans where this was possible. The manager said that she checked each file to ensure that all the relevant documentation was in place and that in addition to this she planned to introduce a quality monitoring system that would include regular auditing of residents files. The manager also stated that the parent company was in the process of reviewing all contracts with the residents to ensure that these were correct and that residents and their relatives or representatives were able to discuss any concerns in relation to their contracts with the owner of the home. The home had updated its Statement of Purpose and Service Users Guide to reflect the change of ownership of the home. This document included all of the required detail and gave a good picture of the service the home provided. Croston Park Nursing Home DS0000025537.V344401.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 excellent. The care planning process in the home has been improved to help ensure that the needs of the residents are fully recognised and met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of four residents were examined in detail. The plans had been developed using the information collected through the pre-admission process. The plans included good clear and detailed information for staff on how best to provide support for the residents. There was evidence to suggest that the residents had been involved in this process and they had agreed and signed their plans wherever possible. The care plans had been reviewed on a monthly basis to help ensure that the changing needs of the residents were recognised and met. The care plans included a number of risk assessments that were also reviewed on a monthly basis. These assist support staff in identifying any specific support or health needs and included nutritional screening, a health
Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 13 assessment, a falls risk assessment, a handling and capabilities assessment. There was also evidence that the residents are weighed monthly giving staff additional information as to the general well being of the residents. There was evidence on files that a range of health professionals including GP’s, District Nurses, and chiropodists visit the home regularly. Residents also have access to sight tests, hearing tests and dental treatment. One resident had been referred to a physiotherapist and residents are supported to attend out patient appointments. The home is well equipped with a range of aids to enable residents to be moved safely and equipment for the prevention and treatment of pressure sores is also provided. From discussion with staff it was clear that they are aware of the needs of the residents and are aware of how best to support them. Discussion took place with three of the four residents. They said that they are very pleased with the care provided. One resident said that the staff looked after her well and that they would call for the GP if she were unwell. Surveys returned by two GP’s both stated that they felt the health needs of the residents were usually met. The management of the home’s medication was examined in some detail. Here the manager had also made some improvements. All of the home’s medication is now kept within the one locked clinical room; ensuring that it was more secure and that it could be audited more easily. The manager said she had taken on the responsibility of ordering the home’s medication and that discussion with the community pharmacist had resulted in the medication being better organised when delivered to the home. There were clear records kept of the medication administered including any reasons why medication may not have been administered. All of the recommendations made at the previous inspection had been met with a homely remedies policy being agreed with GP’s, photographs for each resident had been attached to their medication administration record sheet (MAR sheets) to help prevent medication being administered to the wrong resident, any alterations to the MAR sheets had been done clearly. Receipts of medication into the home had been consistently entered on the MAR sheets and guidance had been provided for staff where medication needed to be given as required. Where residents managed their own medication, the home undertakes a risk assessment on a monthly basis to determine if this is a safe practice as well as monitoring the well being of the resident on a daily basis. On the day of the site visit one of the senior staff was ensuring that a new admission to the home who would be self-medicating had an appropriate place to keep medication securely in their bedroom. The training matrix indicated that all staff administering medication had received relevant training. During the course of the site visit it was noted that the staff spoke respectfully to the residents. They were seen to knock on bedroom doors and bathrooms before entering and were sensitive when providing care or attention of a personal nature. There were screens in shared rooms so that the privacy of the
Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 14 residents was not compromised. Residents were spoken to with staff using their preferred names, a phone was available for their use and the manager was observed to hand out post unopened to the residents. The Expert by Experience spoke to several visiting relatives of whom the majority were very pleased with the standard of care provided. The manager said that she had a good relationship with relatives where there were some concerns about the care provided and that these were discussed and addressed as far as possible. The Expert by Experience found all residents cheerful and quite happy and those with difficulties communicating looking cheerful and content. Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 15 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 good. The home has flexible routines enabling the residents to make decisions as to how they would like to spend their day. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From discussion with residents, visitors and staff and from observation of staff providing support to the residents, it was evident that the daily routines within the home are flexible and varied enabling the residents to make choices about their own routines. There were details in each of the bedrooms outlining residents preferred routines and any specific support needs that they may have. Bedrooms were personalised with residents being able to bring in their own possessions. The home made an inventory of possessions the residents brought in with them on admission to the home. Since the last inspection the home has employed an activities organiser who had introduced a programme of activities five afternoons a week. There was information available within the resident’s files regarding their interests and
Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 16 hobbies and it was anticipated that the activities organiser would work directly with individual residents as she got to know people better. A record was being kept of the activities arranged and how well they were received so that improvements could be made where necessary. Discussion between residents and the Expert by Experience indicated that the residents have enjoyed the gardening group and the glass painting and the sing along sessions in particular. Trips out have also been arranged for groups of residents. A timetable of the week’s activities is displayed around the home enabling residents to make a choice about what they would like to be involved in. Residents had also been supported to attend the local church for communion. On the day of the site visit arrangement were being made to celebrate the birthday of one of the residents and careful thought had been given to what gift the home should buy him. Two relatives said that they thought more time should be spent interacting with the residents. Visitors are welcome at the home at any reasonable time and were seen to be made welcome by the staff. Residents are able to meet visitors in the privacy of their own room or in one of the lounges that the home has. Information was made available about an advocacy service that the residents could access if they wished. Improvements have been made to mealtimes since the last inspection. The home has a four-week menu that provides choices to residents at all meals. Meals have been discussed with the residents at one of their meetings and they made suggestions as to what they like to eat. The manager said these suggestions had been acted upon. On the day of the site visit the Expert by Experience was able to spend time with the residents and asked their opinion of the food provided. All of the residents she spoke to said they enjoyed the food and made complimentary remarks about the chef. They were aware that they had a choice at meal times and that if they did not like what was on offer they could ask for something else. Breakfast time is flexible with residents being able to have breakfast at any time during the morning. Staff were observed to ask each resident what they would like to eat at lunchtime. The residents in their rooms can take meals if they wished or if they were unwell. Drinks and snacks are available at all times and the residents spoken to seem happy with these arrangements. The staff working in the kitchen were fully aware of any likes, dislikes or special dietary needs that the residents may have. This information was collected as part of the preadmission assessment. One recommendation was made and that was that food in blended meals should be kept separate to enable residents to appreciate the different flavours. Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 17 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): 16 and 18. Quality in this outcome area is good. The home’s staff training, policies and procedures in relation to the safeguarding of vulnerable adults help to ensure that the residents are protected as far as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a number of policies and procedures in place that help to protect the residents living at the home and these had been reviewed recently by the new manager to ensure that they were updated. The training matrix showed that training has been provided for most staff in the safeguarding of vulnerable adults. There was evidence that a copy of the complaints policy had recently been sent out to all relatives and a copy of the complaints procedure is displayed in the home. Meetings had also started with the residents, enabling them to express their views about the home and suggest any changes that they would like to be made. In addition to this the residents of the home have access to an advocacy service for additional support and advice if this is necessary. The home held only small amounts of money for each resident and this was stored safely with a record of any expenditure being maintained. The home also kept a receipt book for any valuables held on behalf of residents.
Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. The home is clean and tidy and provides a homely and pleasant environment for residents, visitors and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Croston Park provides a clean tidy and homely environment that is appreciated by both the residents and their visitors. The grounds are spacious and provide residents with an enjoyable outdoor space. The Expert by Experience described the home as ‘a lovely old building set in beautiful grounds’. The new owners have begun the process of refurbishing the home. This includes repairs to the structure of the building, redecoration of all areas both inside and outside the home, re-carpeting, upgrading of bathrooms,
Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 19 installation of a new call alarm system, replacement of furniture in the dining rooms and the kitchen is to be re-fitted. Outside there are plans to landscape the grounds and extend the car parking areas. This process has been approached sensitively to cause the minimum of disruption to the residents and it is anticipated that the work will be completed in a relatively short timescale. At the previous inspection it was required that repairs to the windows in the older wing of the home were required. As part of the refurbishment process, all of the windows in this wing were being examined and the manager stated that all repairs were being attended to. A safety film was also being applied to these windows. Checklists were in place for each room and these showed what work needed to be undertaken in each. A monthly maintenance check was also undertaken on each room to ensure that the rooms were safe for the residents. A risk assessment was carried out on each room prior to a resident being admitted to the home with a view to ensuring that it their met their individual needs The laundry was clean, well equipped and managed and the home had policies and procedures in place to help prevent the spread of infection. Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 20 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 good. Staff have been recruited safely and receive appropriate training to ensure the needs of the residents can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The change in ownership of the home since the last inspection has made some real differences to the way the home is run. Those staff spoken to were very happy with the support that they received from the manager. They said that the change of ownership had made a positive difference to the way the home operates with roles being much clearer and with improved training opportunities being provided. They felt that a good team spirit had developed because of this. The staff appeared to be relaxed and confident in their work and were enjoying the new responsibilities they had been given. They said that they felt confident that the manager would deal with any concerns that they raised efficiently. They spoke sensitively and with warmth about the residents they supported. Staff observed interacting with residents were respectful in their approach and this was clearly appreciated by the residents. One relative wrote ‘the staff are wonderful. They seem to genuinely care for the clients and are always very patient. The staff are all ages and it’s nice to see young members of staff being so caring with elderly people’.
Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 21 Most staff spoken to said that they felt that there were sufficient numbers of staff on duty to attend to the needs of the residents although some said they thought there should be more staff on duty in the afternoon. One resident also commented that the home would benefit from more staff being on duty in the afternoon and a GP wrote that staffing levels should be improved. The manager was fully aware that the changes in the way the home was being run and the recent changes in the staff team could have an impact on the residents. She said that staffing levels were being regularly reviewed to ensure that residents needs were being met but also appreciated that some residents may have been unsettled by the changes. She also stated that the staffing levels had not been reduced since the change of ownership but staff had been deployed more effectively. The home did not use any agency staff being able to cover any absences and vacancies with regular staff and so providing residents with a continuity of care. The files of several staff members were examined and these indicated that the home had a thorough recruitment policy and procedure with all the necessary checks and references being undertaken prior to a member of staff starting work. The manager said she had checked to make sure that every member of staff had a Criminal Records Bureau check and that staff files would be audited regularly to ensure that all documentation and records were correct. There were improved opportunities for staff training and there was a training matrix and a training plan in place. This indicated that a good range of training was being provided. Since the change of ownership a number of training courses had been held and on the day of the site visit there was an infection control training course taking place. The manager said that there had been a good take up of the training offered to the staff. A newly recruited member of staff said she had found her induction training very useful and was very pleased with the support that she was receiving from her colleagues. Almost fifty percent of the staff team had achieved a nationally recognised qualification in care and there had been a good take up of NVQ training by the rest of staff. All staff received induction and mandatory training and the manager had implemented a supervision schedule with all staff due to receive supervision by a senior member of staff. The Expert by Experience discussed staffing levels with a number of residents. Most said that they had not noticed any change in the service since the change of ownership although one said that she felt the organisation was better. After discussion with residents and staff she wrote that ‘Croston Park comes across as a friendly caring home with an enthusiastic management team and caring staff’. Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 22 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): 31, 33, 35, and 38. Quality in this outcome area is excellent. The home is very well managed in the best interests of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the registered manager of the home has changed. The new manager is a qualified nurse, has the registered managers award and has several years of management experience. She has built upon the improvements instigated by the previous manager and with the co-operation of the staff team has succeeded in introducing major changes. The result is a home which is well organised, benefiting both the residents and the staff team.
Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 23 There are clear lines of accountability in the home with the manager taking full responsibility for the day-to-day management of the home. Some of the residents also appreciated the visits to the home, made by the new owner. A range of quality assurance monitoring systems have been established to enable the manager to ensure as far as possible that the home is run in the best interests of the residents. A survey has been undertaken of the views of the residents, relatives and visiting professionals and at the time of the site visit some of these had been returned enabling the manager to start an analysis of this information. There are plans to hold regular meetings for the residents and one of these had been held already giving the residents a chance to air their views about the home and make suggestions as to how things may be changed or improved. A meeting has also been held with relatives to outline the planned changes in the home and giving people opportunities for individual discussion. Regular staff meetings have also commenced giving the staff an opportunity to be brought up to date with developments and for them to make suggestions and comments about the running of the home. A monthly audit of any accidents occurring in the home had already commenced with the manager looking at the reason for the accident and monitoring the action taken following the accident. A monthly audit of medications has also been started to ensure that the medication in the home is managed safely and appropriately. A number of audits have been planned with one having taken place in August, looking at choice of home, care of residents and management and administration. An external auditor will be involved in additional audits that will take place twice a year. Monthly monitoring visits are also made by a representative of the parent company as an additional quality assurance check. All of the homes policies and procedures have been reviewed and some additional ones have been introduced by the registered manager to help ensure that residents receive an appropriate and safe service. The home holds a minimum amount of money for some of the residents. This money is held safely and records are kept of any expenditure on behalf of the resident. The home also has a facility to hold any valuables on behalf of the residents and a record and receipt book is in place in respect of these. The home provides mandatory training for all staff to help ensure that working practices are safe. All hazardous substances were locked away and lockable cabinets had been installed in bathrooms providing safe storage there. There was evidence that all systems and equipment had been serviced and maintained appropriately and that the home ensures as far as it is possible that the environment is safe and secure for the people who live there and the staff who support them. Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 24 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 4 X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X X X X 3 Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP15 Good Practice Recommendations Foods in blended meals should be kept separate to enable residents to appreciate the different flavours. Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway 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 Croston Park Nursing Home DS0000025537.V344401.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
