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 8 and 9th January 2007
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.V322077.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.V322077.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 add Tel:601131 croston.park@virgin.net 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.V322077.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. 12th May 2006 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. The current scale of charges at the home ranges from £420 - £625. Additional charges are made for chiropody, newspapers and hairdressing. Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over two days in January 2007 by two regulatory inspectors. The inspection involved discussion with service users living at the home, visiting relatives and staff working there, observation of staff supporting service users and an examination of records, policies and procedures. Information provided on 13 comment cards completed by relatives, a letter from relatives and comment cards completed by two GP’s were also included within the report. As part of the inspection, the inspectors used ‘case tracking’ as a means of assessing some of the National Minimum Standards. This process enabled the inspectors to focus on five of the service users living at the home. Records relating to those individuals were inspected and discussion took place with the service users where this was possible. What the service does well:
Croston Park provides a clean, comfortable, tidy, safe and homely environment for the service users who live there and the staff who support them. All of the service users and most of the relatives consulted as part of the inspection process were very satisfied with the care and support provided by the home. Service users were involved in making decisions about the care that they received as far as they were able, with staff routinely consulting with them. Written comments from relatives included ‘there is a kindness, consideration and genuine care for people that runs throughout the staff at all levels.’ The home had good working relationships with local health professionals and one GP described it as ‘a well run home’. From discussion with service users, visitors and staff and from observation of the staff providing support to the service users, it was evident that the daily routines within the home were flexible and varied enabling the service users to make choices about their own routines. Service users were free to move about the home and were given choices by the staff as to what they wanted to do and where they would like to sit or eat their meal. Visitors were able to visit at any reasonable time. Bedrooms were personalised with service users being able to bring in their own possessions, furniture and pictures.
Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 6 A range of activities are arranged in the home and it was clear that some of these had been organised because of specific interests that some of the service users had. This included a Wimbledon afternoon when strawberries and cream were served. What has improved since the last inspection?
Since the last key inspection a great deal of work had been undertaken to consolidate some of the changes that had taken place in the home. The manager and the deputy manager had reviewed their job descriptions and the lines of accountability within the home had become much clearer. The manager had made efforts to ensure that the requirements and recommendations made at the last key inspection had been addressed satisfactorily, ultimately improving the way the home was run. The home had reviewed and updated its Statement of Purpose and Service Users guide. These now provide prospective service users with up to date information about the home and help them make a decision as to whether it could meet their individual needs. The homes policies dealing with protection and complaints had also been reviewed and updated to reflect best practice. All new service users admitted to the home are now assessed prior to their admission. This process allows the home to decide if they are able to meet the support needs of an individual service user and put into place any specific services if required. A record was now being kept of any possessions they bring into the home. The home had developed a clear training record that shows the training achievements and needs of the staff team. A range of courses had been arranged since the last key inspection and the home was well on its way to ensuring that all staff had completed the necessary mandatory training and any associated refresher courses. Staff recruitment procedures in the home had improved and it was ensured that all the necessary references and checks were in place before a prospective member of staff commenced work at the home. The registered provider had commenced monthly monitoring visits to the home and through this process provided extra support where necessary. The manager had begun regular reminiscence meetings with service users and this had resulted in a number of suggestions being made regarding improvements that could be made in the home.
Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 7 Since the last inspection the homes electrical system had been checked and was found to be safe. What they could do better:
Although the manager had made many improvements to the way in which the home was run, there was still a need for the manager to make sure that the staff team fulfilled their duties and so help ensure that the needs of the service users were consistently met. Care plans must be developed for each service user living at the home that clearly include all relevant information collected in the pre-admission assessment. The plans must outline their support needs and the action staff need to take to ensure that these needs are met. Care plans should take into account peoples preferences and requirements as they near the end of their life and if appropriate the home would benefit from seeking expert advice in this area. The plans should be reviewed monthly to help ensure that the changing needs of the service users are recognised and met. In conjunction with this risk assessments must be routinely completed and reviewed regularly to enable staff to take any necessary action to safeguard the health and safety of the service user. Any action taken must be recorded to inform staff of the future care needs of the service user. Although medication in the home was generally well managed there were a number of areas that could be improved to further safeguard the service users and recommendations were made in respect of these. The home displayed its complaints policy and included it within its Statement of Purpose and Service Users Guide, however not all relatives were aware of how they may make a complaint if they wished to. It was recommended that the details be sent out to all relatives to help overcome any potential difficulties. Service users should be informed of the choice of meals that are available each day and encouraged to choose what they would like. Consultation with service users about the running of the home should also be extended and more specific to enable them to suggest changes and improvements.
Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 8 Although the home is generally safe and well maintained it was noted that repairs were required to one window to ensure it could be opened and left open safely and the storage of hazardous substances within the home needed to be reviewed to safeguard the service users. 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.V322077.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.V322077.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): 1and 3. Standard 6 was not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of the service users were assessed prior to admission enabling the home to decide if they could meet their needs safely. EVIDENCE: The homes Statement of Purpose and Service User Guide had recently been updated and contained all of the information necessary to help prospective service users make a decision as to whether the home could meet their individual needs. The files of three service users who had been recently admitted to the service and one, who had been a resident for two years, were examined. All four
Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 11 service users had been assessed prior to their admission to the home, enabling the home to make a decision as to whether they could provide appropriate care for each individual. The pre-admission assessments contained reasonably detailed information about the support needs of the service users and could have been used to develop a plan of care for each individual. Croston Park Nursing Home DS0000025537.V322077.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 adequate. This judgement has been made using available evidence including a visit to this service. Care planning processes in the home could be further improved to help ensure that the health and personal care needs of the service users are met consistently. EVIDENCE: A total of five files were examined on the day of the visit to the home to find out if the health, personal and social care needs of the service users were being met. Three of the files contained some very good guidance for staff in relation to the care needs of the service users, however not all of the details from the pre-admission assessments had been carried over to the care plans. These omissions could make it difficult for staff, especially new staff or agency staff to provide service users with appropriate care and support. Although the
Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 13 care plans had been reviewed periodically it was recommended that they be reviewed on a monthly basis and that extra care be taken to ensure that the plans accurately reflect the needs of the service user. Care plans should take into account peoples preferences and requirements as they near the end of life and if appropriate the home should seek expert advice in this area. Of those three service users who had been recently admitted to the care home, two did not have a care plan in place. It was therefore not possible to assess whether their individual support needs had been fully recognised or attended to. Care provided was dependent on the information collected as part of the pre-admission assessment and on individuals support needs being passed on verbally between staff. This approach left service users potentially at risk, as there could be no guarantee that the guidance provided was accurate or consistent. An enforcement notice had been issued following the last key inspections as not all service users had a care plan in place. The manager had addressed this and an additional inspection in June had shown that all service users had a care plan in place. There was evidence that a number of external health professionals were involved in providing additional support and care in the home. These included GP’s, district nurses, a chiropodist, dentist, optician etc. Their involvement was recorded within service users files and service users also spoke about their involvement. Staff were also observed making contact with health professionals where there were concerns about the health of individual service users. The home had a number of risk assessments in place to enable the changing needs of the service users to be monitored and attended to. These were not always routinely completed. Where the risk assessments did highlight possible changes in the health needs of the service users it was not always possible to determine if concerns had been acted upon by the staff. Discussions with service users, staff and the management team indicated that wherever possible the service users were involved in making decisions about the care that they received. Where possible service users should sign their care plan to indicate that they are satisfied with its content. During the course of the visit to the home it was observed that staff consulted routinely with service users about the care that they received. Discussion took place with some relatives on the day of the visit to the home; most stated that they were very pleased with the standard of care that the home provided. Written comments from relatives included ‘there is a kindness, consideration and genuine care for people that runs throughout the staff at all
Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 14 levels.’ Where relatives were not fully satisfied with the care provided they had raised concerns with the staff and these concerns had been addressed. Medication in the home was generally well managed although there were a number of areas that could be improved to further safeguard the service users and recommendations were made in respect of these. Staff had received appropriate training in the safe administration and management of medication and the policies and procedures supported their approach. There was evidence that the service users medication had been reviewed and staff spoken to had a good knowledge of the medications prescribed and stated that it was practice within the home to contact the GP if it was felt that a service user was suffering from the side effects of medication. Croston Park Nursing Home DS0000025537.V322077.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. This judgement has been made using available evidence including a visit to this service. Service users are given opportunities to make choices and decisions about their daily life in the home. EVIDENCE: From discussion with service user, visitors and staff and from observation of the staff providing support to the service users, it was evident that the daily routines within the home were flexible and varied enabling the service users to make choices about their own routines. There were brief details kept in the bathroom of those rooms that had an en-suite facility that gave a brief outline of the service users preferred routines, including their preferred time to get up each morning. Bedrooms were personalised with service users being able to bring in their own possessions, furniture and pictures. The home had started to make an inventory of possessions the service users brought into the home with them on admission.
Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 16 A range of activities had been arranged in the home and it was clear that some of these had been organised because of specific interests that some of the service users had. This included a Wimbledon afternoon when strawberries and cream were served. On those files examined, the interests and hobbies of the service users had been recorded as part of the pre-admission process although this information had not always been carried over to the care plans. The inclusion of this information in the care plans would provide staff with information that would enable them to support service user to follow their interests and hobbies more easily. Service users were free to move about the home and were given choices by the staff as to what they wanted to do and where they would like to sit or eat their meal. Relatives stated that they felt comfortable in visiting the home and that they were able to do so at any reasonable time. One visitor described Croston Park as ‘a friendly home’. Information included in one of the care plans stressed the importance of the service user receiving visits from his family and friends and outlined the support he needed to enable these visits to be a success. Service users were observed able to be able to receive visitors in the privacy of their own home. Information regarding advocacy services was made available within the home for anyone who wished to access such a service and this information was also available with in the Statement of Purpose and Service Users Guide. Service users spoken to stated that they were happy with the meals provided. There were menus displayed within the dining rooms and service users confirmed that they had a choice of food at breakfast including a cooked breakfast. Choices were also available at lunchtime and although these were displayed, the service users were not always aware that choices were available. Consequently it was common practice for all service users to be served the same main meal at lunchtime. The support staff spoken to were also not fully aware that choices were available, although they were aware that if a service user for any reason did not want the meal provided, then the home was able to provide a range of alternatives. The cook had a good knowledge of the likes, dislikes and dietary needs of the individual service users and indeed on the day of the visit to the home, had provided an alternative meal for some people. It was recommended that service users are made aware of the different courses available each day and are given an opportunity to select their preference the day before the meals are served. The home had good stocks of fresh, frozen, chilled, dried and tinned foods, indicating that a varied and balanced diet was provided. Croston Park Nursing Home DS0000025537.V322077.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. This judgement has been made using available evidence including a visit to this service. The homes staff training and policies and procedures in relation to the safeguarding of vulnerable adults helped to ensure that service users were protected as far as possible. EVIDENCE: The home had a number of policies and procedures in place that were designed to protect the service users living at the home. These policies had been updated to reflect best practice. There had been opportunities for staff to receive training in protection issues and the home was working towards all staff attending this course. In addition to this four members of staff had received training in the management of challenging behaviour and others had attended a course on dementia. Discussion with staff and management confirmed that this training had taken place. The home had its complaints policy and procedure displayed in the entrance hall and it was included in the statement of purpose and service users guide. Information received through the comment cards indicated that there were a number of relatives who did not know how to make a complaint and it was
Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 18 recommended that the home should try to ensure that all service users and relatives aware of how to complain if they dissatisfied with the services provided. Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 19 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. This judgement has been made using available evidence including a visit to this service. The home was clean, tidy and homely and provided a pleasant and safe environment for both the service users and the support staff. EVIDENCE: The home was clean, tidy and homely and reasonably well maintained. Both the service users and visitors spoken to were happy with this aspect of the home. There were workmen present in the home at the time of the visit, attending to repairs and redecoration. The grounds were spacious and well maintained and attractive, providing service users with an enjoyable outdoor space.
Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 20 It was noted that repairs were required to one of the bedroom windows to ensure that this could be opened and left open safely. An Immediate Requirement notice was issued in respect of the water temperature in two of the bedrooms, and the registered provider dealt with this matter quickly. The laundry at the home was well equipped and was clean and well maintained. Training in the use of new equipment had been provided for the staff working there. The home had good policies in place regarding infection control and protective clothing was in place for staff to use to help stop the spread of infection. Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The homes recruitment procedures and training programme had been improved to help ensure that the staff team had the skills to meet the needs of the service EVIDENCE: The home had placed a great deal of emphasis on training since the last key inspection. The staff team had a range of qualifications and experience with 30 of staff having achieved a nationally recognised qualification in care. The home was continuing to work towards 50 of the work force achieve a qualification. Those members of staff spoken to were pleased with the range of training opportunities on offer. Records showed a range of mandatory courses were available to the staff and the home had made good progress in ensuring that the staff team attended these, although they recognised that there were still staff who needed to attend refresher courses in some of these courses to ensure that their skills and knowledge were updated. In addition to the mandatory courses, there were other training opportunities available dealing
Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 22 with specific conditions and issues e.g. Parkinson’s Disease, dementia and also in the management of challenging behaviour. The staffing rotas showed that there were sufficient staff on duty at any one time although the staff spoken to said that they sometimes felt under pressure especially when staff were off due to sickness. It was recommended that the staffing ratios be reviewed regularly and adjusted when necessary to reflect the changes in the dependency levels of the service users at the home. Recent staffing difficulties had resulted in the home using a number of agency staff to cover staff sickness and vacancies. The manager was aware that this was not an ideal arrangement and was working towards employing sufficient numbers of staff to avoid the use of agency staff wherever possible. The files of four recently recruited members of staff were looked at. These showed that the home made sure that all the appropriate checks and references were in place and that these were satisfactory before staff began to work in the home. An enforcement notice had been issued following the last key inspection as it was judged that the home had poor recruitment procedures, however the manager had taken appropriate action and the procedures now followed protected the service users as far as possible. Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence including a visit to this service. The general management and administration of the home has improved, leaving a few areas that could be further developed for the benefit of service users and staff. EVIDENCE: The registered manager is a qualified nurse who has also achieved an NVQ level 4 in care and the registered managers award. Since the last key inspection a great deal of work had been undertaken to consolidate some of the changes that had taken place in the home. The manager and the deputy
Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 24 manager had reviewed their job descriptions and the lines of accountability within the home had become much clearer. The manager had made efforts to ensure that the requirements and recommendations made at the last key inspection had been addressed satisfactorily ultimately improving the way the home was run. Although improvements had been introduced there was still a need for the manager to make sure that the staff team fulfilled their duties and so help ensure that the needs of the service users were consistently met. The home had a number of quality assurance monitoring systems in place to help ensure that the home was run safely with the interests of the service users in mind. A number of policies and procedures had been reviewed and updated to reflect best practice. The home had undertaken regular audits of the environment and of the medication. It was judged that the auditing of care plans should be improved to ensure that they are in place and that they are reviewed at least on a monthly basis (see standard 7). The home had achieved an Investors in People Award which is a quality assurance award accredited by an external body. The home had undertaken a survey of the views of professionals and relatives and had received positive comments back from those who had responded. The manager had begun regular reminiscence meetings with those service users who were interested and this had resulted in a number of suggestions being made regarding improvements that could be made in the home. It was recommended that consultation with the service users about the way in which the home is run and any improvements that could be made should be extended to be more specific in its approach. The registered provider undertook monthly monitoring visits to monitor the running of the home and provide extra support were necessary. The home kept only small amounts of money on behalf of the service users and a record was kept of any transactions made of their behalf. The home had secure facilities for the safekeeping of any money or valuables kept on the behalf of the service users. Only senior staff had access to the money. A record of valuables was kept on behalf of service users. It was recommended that receipts be given out for any valuables held on service users behalf. The Environmental Health Officer had visited the home since the last key inspection and the home had acted upon the recommendations made as a result of that visit. The home had a comprehensive training programme in place. It had recognised there was a need for additional training and was working towards every member of staff completing all mandatory courses and any refresher training. This included any training to help ensure that safe working practices were in place. Accident forms were completed appropriately. Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 25 The equipment and systems in the home had all been appropriately checked, serviced and maintained. An enforcement notice had been issued following the last key inspection in respect of the homes electrical system. This was acted upon and the system had been checked and was found to meet the required standard. On the day of the visit to the home it was noted that the sluice, the laundry and storage cupboards were not routinely kept locked when not in use. It was also noted that shampoos, aerosols etc were left out in bathrooms and toilets. Care should be taken to store any hazardous substances safely to reduce any risk of service users accessing them or using them inappropriately. Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 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 3 X 3 X 2 X X 2 Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 27 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 2 Standard OP7 OP8 Regulation 15(1) 13(4)(c) Requirement All service users must be provided with a written plan of care. Risk assessments regarding the service users health needs should be reviewed regularly to ensure that the needs of the service user are recognised and acted upon. Windows must be repaired to ensure that unnecessary risks to service users are eliminated. (Timescale of 30/6/06 not met) All hazardous substances should be stored securely to ensure that unnecessary risks to the service users are eliminated. Timescale for action 28/02/07 28/02/07 3 OP19 13(4) 28/02/07 4 OP38 13(4) 28/02/07 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 OP7 Good Practice Recommendations Care plans should be reviewed on at least a monthly basis.
DS0000025537.V322077.R01.S.doc Version 5.2 Page 28 Croston Park Nursing Home 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 OP7 OP7 OP7 OP9 OP9 OP9 OP9 OP9 OP9 OP9 OP12 OP15 OP16 OP27 OP28 OP31 OP33 OP35 Care plans should set out in detail those actions that need to be taken by staff to ensure that all of the service users needs are met. Wherever possible service users should agree and sign their care plan. Where appropriate expert advice should be sought regarding service users preferences and requirements as they near the end of life. The homes homely remedy policy should be agreed with GP’s. Handwritten entries on the medication administration records (MAR sheets) should be signed by two members of staff. Receipt of medications into the home should be consistently entered on the MAR sheet. Alterations to the MAR sheets should be clearly made, with entries being crossed out and new details being written in clearly in a new box. A photograph of the service user should be included in the medication records. Where ‘as required’ medications are prescribed, guidance should be available as to when these should be administered. A risk assessment should be undertaken where service users choose to self-administer their medication. Care plans should include details of a service users hobbies and interests. Service users should be made aware that a choice of meals is available and be given an opportunity to choose from the options available. The home should ensure all service users and their relatives are made aware of how to raise any concerns should they be dissatisfied with the service provided. Staffing ratios should be reviewed regularly and adjusted as necessary to reflect the needs of the service users. The home should work towards having 50 of its staff achieve a nationally recognised qualification. The registered manager should be more methodical in her approach to ensure that the home meets the Care Home Regulations and National Minimum Standards. Consultation with the service user about the way the home is run should be extended and more specific in its approach. Receipts should be issued for any valuables held on behalf of service users. Croston Park Nursing Home DS0000025537.V322077.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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