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 11:30 20 and 21st January 2006
th 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.V264688.R01.S.doc Version 5.1 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.V264688.R01.S.doc Version 5.1 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.V264688.R01.S.doc Version 5.1 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. 13th October 2005 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.V264688.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over 71/2 hours over two days in January 2006 by one regulatory inspector. The inspection involved discussion with service users living at the home, and discussion with and observation of the staff working there, an examination of records, policies and procedures and a tour of the premises. What the service does well: What has improved since the last inspection?
The manager had started to implement changes within the home by discussing roles and responsibilities within the home with the staff teams. Some improvements had been made in the homes management of medication, with medication storage in the Dementia Care unit having been improved and the homes policy on the management of medication having been reviewed and updated to outline the procedures for the disposal of medication. Service users were being weighed on a monthly basis assisting in the monitoring of the health of the service users. Risk assessments in relation to the environment of Dementia Care unit had been developed with specific reference to the uneven floors and beams. Croston Park Nursing Home DS0000025537.V264688.R01.S.doc Version 5.1 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.V264688.R01.S.doc Version 5.1 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.V264688.R01.S.doc Version 5.1 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 at risk. EVIDENCE: The files of two recently admitted service users were examined. Both of the service users had had their support needs assessed. One of the assessments was thorough and reasonably detailed but the second assessment was only partially completed possibly leaving the service users support needs unmet and therefore at risk. A care plan had not been developed for one of the service users and the plan for the second service user contained only minimal details of the individuals support needs. This lack of guidance for staff could result in service users not receiving the support they require. Croston Park Nursing Home DS0000025537.V264688.R01.S.doc Version 5.1 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 the following standard(s): 7,8 and 9 The care planning process was inadequate with the support needs of the service users not being assessed or documented in sufficient detail, leaving staff without the guidance required to ensure that appropriate health and personal care support was provided. Some medication records were not well maintained and so did not accurately record the handling of medication in the home. EVIDENCE: Standards 7 and 9 were partly assessed at this inspection to determine whether requirements and recommendations made at the previous inspection had been acted upon. Of the two files examined one had no care plan in place, however a record was kept of the daily care provided. The second file examined provided only limited information regarding the support needs of the service user. The plan was undated and there was no evidence that it had been reviewed. There was no indication that the service user had been involved in the development of the plan and yet the manager stated that he would have been able to sign the plan to indicate his agreement. An Immediate Requirement Notice was issued regarding the need to have written and comprehensive care plans in place for each service user.
Croston Park Nursing Home DS0000025537.V264688.R01.S.doc Version 5.1 Page 10 There were no risk assessments in place regarding the use of bed rails by service users leaving them in a position of risk. An Immediate Requirement notice was issued in respect of this. There was some evidence that the service users had access to health care services and professionals. There was documentary evidence that the service users were assessed with regard to the risk of developing pressure sores and there was evidence that a pressure-relieving mattress had been delivered to the home. A chiropodist was visiting the home the day of the inspection and there was evidence on service users files that the district nursing team provided clinical support to the home. However the service users files examined did not provide sufficient detail to indicate that their health needs had been fully assessed, reviewed or addressed. One of the service users had not had their psychological health assessed and the second service user had not had their nutritional screening reviewed since admission. A falls risk assessment had not been undertaken for one service user and there was no evidence on files that opportunities had been provide for service users to participate in appropriate exercise and physical activity. Comment cards were received from seven service users. They expressed their overall satisfaction with the care provided at Croston Park and discussion with three service users indicated that the care provided was excellent. One lady explained that Croston Park was her second home and that she returned on a frequent basis for respite care. Comment cards were received from three relatives and two GP’s. These also expressed their overall satisfaction with the care provided. The management of medication within the home was partly assessed following the findings at the previous inspection. The homes policy in relation to the disposal of medication had been updated and the medication on the third floor was stored in more appropriate environment. The recording of the administration of external preparations however was not specific and needed to be addressed to help ensure that service users were administered topical medication prescribed for them. Croston Park Nursing Home DS0000025537.V264688.R01.S.doc Version 5.1 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 the following standard(s): 12,14 and 15 The service users were not always consulted regarding their social interests and hobbies reducing the possibilities for staff to support them to follow these. Daily routines within the home were often determined by staff availability rather than the expectations, preferences and capacities of the service users, a regime which did not always address their dietary need and requirements. EVIDENCE: Standards 12 and 15 were partly assessed following a number of requirements and recommendations having been made at the previous inspection. A requirement had been made at the previous inspection regarding the consultation with service users and the recording of their hobbies or interests. There was little or no detail on the two files inspected regarding the interests or hobbies of the two service users, consequently this reduced the opportunities for staff to support the service users to follow these. A concern had been raised at the previous inspection regarding the mealtime arrangements. This was discussed with members of staff who stated that meal times were organised to suit the staffing rotas. Staff also stated that bed times were sometimes imposed, again to suit the staffing arrangements at the home. These practices did not respect the dignity and autonomy of the individual service users in the home. Although drinks and snacks were readily available to service users during the course of the day, the manager agreed that there was still the possibility that service users may not receive a drink or snack for
Croston Park Nursing Home DS0000025537.V264688.R01.S.doc Version 5.1 Page 12 over twelve hours if service users go to bed during the early evening. A requirement from the previous inspection had been met and the re had been an improvement in the recording of the intake of nutritional supplements. The service users were weighed on a monthly basis with a record of this being kept, assisting in the monitoring of the health of the service users. Service users had personalised their bedrooms by bringing possessions in with them on admission. Information had been made available for service users and other interested parties regarding access to the local advocacy service. Croston Park Nursing Home DS0000025537.V264688.R01.S.doc Version 5.1 Page 13 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): None of these standards were assessed at this inspection. EVIDENCE: Croston Park Nursing Home DS0000025537.V264688.R01.S.doc Version 5.1 Page 14 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 Although the home was clean, comfortable and homely, there was no programme of routine maintenance in place leaving service users and support staff at risk. EVIDENCE: This standard was partly assessed to determine if a requirement made at the previous inspection had been acted upon. Risk assessments in relation to the Dementia Care unit had been developed with specific reference to the uneven floor and the beams. A number of repairs and some redecoration identified at the last inspection had not been attended to, including some uneven floorboards and some loose and broken ceramic tiles. This left the service users and staff at risk. Croston Park Nursing Home DS0000025537.V264688.R01.S.doc Version 5.1 Page 15 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): 27,29,30 The staff were not deployed in the most effective way to ensure that the support needs of the service users were met. The homes recruitment procedure was not thorough enough to ensure the protection of the service users. The homes training records did not provide an overview of the training undertaken by staff or allow an assessment to be made of the training needs of the staff team. EVIDENCE: The staffing rota at the home was examined. This showed the numbers of staff on duty at any one time and the capacity in which they worked. There were more staff on duty during the mornings and evenings, which were identified by the manager as the busiest times of day. Concerns were raised regarding service users daily routines being regulated by the availability of staff (see standards 12 and 15). A number of staff files were examined to assess the homes recruitment procedures. The manager and the member of staff responsible for selection and recruitment were fully aware of the processes that needed to be followed to ensure the safety of the service users. However the documentation available indicated that staff were appointed to their posts prior to all references and Criminal Record Bureau disclosures being received. An Immediate Requirement notice was issued. Although discussion with the manager and members of staff indicated that there were training opportunities available for staff, there were no records readily available which enabled either the inspector or the manager of the
Croston Park Nursing Home DS0000025537.V264688.R01.S.doc Version 5.1 Page 16 home to gain an overview of the training undertaken by staff or make an assessment of the training needs of the staff team. Croston Park Nursing Home DS0000025537.V264688.R01.S.doc Version 5.1 Page 17 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): 31,33 35 and 38 The home could be more effectively managed to ensure that the health and welfare needs of the service users are met in a safe environment. EVIDENCE: The manager was a trained nurse and had experience relevant to her role in the home. She had undertaken additional training during the course of the last year to extend her skills. There had been some reorganisation of the management team and a re-allocation of responsibilities within the home. As a result of this the job description for the manager should be reviewed to ensure that it reflects the duties of that post and enable her to manage her time more effectively. A staff meeting was held on the day of the inspection to clarify the roles and responsibilities of the senior staff at the home and a similar meeting had been held with the rest of the staff team. The staff team was well motivated and were appreciative of the support that they received from the manager. The home had achieved the Investors in People Award which is a quality assurance award accredited by an outside body. There was evidence that the
Croston Park Nursing Home DS0000025537.V264688.R01.S.doc Version 5.1 Page 18 manager reviewed and updated policies and procedures as necessary. There were no formal processes in place where the views of the service users, their relatives or involved health and social care professionals were sought. The responsible individual had not undertaken monitoring visits aimed at reviewing and improving the quality of care at the home and submitted a report in respect of the review to the Commission for Social Care Inspection. The home had only minimal dealings with service users finances, holding small amounts of money on their behalf to pay for small purchases. The financial records for three service users were examined to ensure that the monies held corresponded with the record of expenditure. The records in respect of safe working practices were examined. The homes gas certificate was almost due for renewal. The electrical systems at the home had not been maintained placing service users and staff at risk. An Immediate Requirement Notice was issued in respect of this. At the previous inspection Immediate Requirement Notices were issued in respect of the need to lock those areas where hazardous substances were stored, including the laundry. These had not been acted upon and further notices were issued. Discussion with the staff at the previous inspection 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. These concerns had not been acted upon and an Immediate Requirement Notice was issued in respect of this concern. Records indicated that first aid training, food hygiene training and fire training had been provided for the staff team. Croston Park Nursing Home DS0000025537.V264688.R01.S.doc Version 5.1 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 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X X STAFFING Standard No Score 27 2 28 X 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 1 Croston Park Nursing Home DS0000025537.V264688.R01.S.doc Version 5.1 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 persons must ensure that a suitably trained person has assessed the needs of prospective service users prior to their admission. (Timescale of 14/10/05 not met.) All service users must be provided with a written plan of care. An action plan outlining how this is to be achieved must be submitted to the Commission for Social Care Inspection. (Timescale of 30/11/05 not met) Service users plans must be kept under review. (Timescale of 30/11/05 not met.) Wherever possible care plans must be drawn up in conjunction with the service users and/or their representative. (Timescale of 30/11/05 not met). Risk assessments must be undertaken in respect of the use of bed rails. An action plan outlining how this is to be achieved must be submitted to
DS0000025537.V264688.R01.S.doc Timescale for action 28/02/06 2. OP7 15(1) 31/01/06 3. OP7 15(2)(c) 31/03/06 4. OP7 15(2)(c) 31/03/06 5. OP7 13(4)(c) 31/01/06 Croston Park Nursing Home Version 5.1 Page 21 the Commission for Social Care Inspection. 6. OP8 13(1)(b) The registered person shall make 31/03/06 arrangements for the service users to receive where necessary treatment, advice and other services from health care professionals. Arrangements must be made to 28/02/06 ensure the application of topical medications is recorded. Service users must be consulted 31/03/06 about their social interests and make arrangements for them to follow these. (Timescale of 31/12/05 not met) The registered person must 31/03/06 make arrangements ensuring the home is conducted to ensure that the dignity of the service user is maintained and their preferred daily routines are respected. The registered manager must 28/02/06 ensure that the dietary requirements of service users are considered and attended to. (Timescale of 30/11/05 not met) All parts of the care home should 31/03/06 be kept well maintained, clean and reasonably decorated. (Timescale of 30/11/05 not met) Staff must be available in such numbers as are appropriate for the health and welfare of the service users The registered person must not employ a person to work at the home unless the necessary checks have been made. The registered persons must ensure that records of staff training are maintained and are available at the home. Consultation must take place
DS0000025537.V264688.R01.S.doc 7. 8. OP9 OP12 13(2) 16(2)(m) 9. OP27OP12 12(2)(4) 10. OP15 16(2)(i) 11. OP19 23(2)(d) 12. OP27 18(1)(a) 31/03/06 13. OP29 19 28/02/06 14. OP30 18 31/03/06 15. OP33 24(3) 30/06/06
Page 22 Croston Park Nursing Home Version 5.1 16. OP33 26 17. OP38 23(2)(l) 18. OP38 13(4)(c) 19. OP38 13(4)(c) with the service users and their representatives with a view to improving the service provided. The registered provider must undertake at least monthlyunannounced monitoring visits to the home and supply a copy of the report to the Commission for Social Care Inspection. Suitable provision should be made for storage in the care home. An action plan outlining how this is to be achieved must be submitted to the Commission for Social Care Inspection. (Timescale of 14/10/05 not met.) The security of the home must be improved. An action plan outlining how this is to be achieved must be submitted to the Commission for Social Care Inspection. The electrical systems at the home must be maintained. An action plan outlining how this is to be achieved must be submitted to the Commission for Social Care Inspection. 31/03/06 31/01/06 31/01/06 31/01/06 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. Refer to Standard OP7 OP15 OP30 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 manager should develop a staff training and
DS0000025537.V264688.R01.S.doc Version 5.1 Page 23 Croston Park Nursing Home 4. 5. 6. OP31 OP33 OP38 development programme, which fulfils the aims of the home and meets the needs of the service users. The manager’s job description should be reviewed to reflect the responsibilities of the post. The views of health and social care professionals should be sought as part of the homes quality assurance audits. The registered manager should ensure that hazardous substances are stored safely. Croston Park Nursing Home DS0000025537.V264688.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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