Inspection on 21/11/05 for Deer Park Care Centre

This inspection was carried out on 21st November 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Deer Park Care Centre 25/06/08

Deer Park Care Centre 05/09/06

Deer Park Care Centre 09/05/05

Deer Park Care Centre 28/09/04

Deer Park Care Centre 14/05/04

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

CARE HOME ADULTS 18-65 Deer Park Care Centre Deer Park Care Centre Detling Avenue Broadstairs Kent CT10 1SR Lead Inspector Sandra Crosby Announced Inspection 21st November 2005 09:30 Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 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 Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Deer Park Care Centre Address Deer Park Care Centre Detling Avenue Broadstairs Kent CT10 1SR 01843 868666 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) Phoenix Care Homes Ltd Kate Hayward Care Home 38 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (38) of places Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Residential Care for older people with mental health difficulties is for residents aged 50 years and over. Residential Care for people with Demenita is restricted to two (2) Service Users whose dates of birth are 26/10/25 and 13/08/22. 09.05.05 Date of last inspection Brief Description of the Service: The Deer Park Care Centre is a large detached property with accommodation on two floors. There are 38 single bedrooms 24 of which have en-suite facilities. All bedrooms are connected to a call bell system and have a TV point. There is a shaft lift at the home. The gardens are mainly laid to lawn with flowerbeds and shrubs. There is ample car parking space at the home. The home is located not far from the seafront at Dumpton Gap and a local bus service is available. There are a couple of local shops within walking distance and Ramsgate town centre is about fifteen minutes walk or by bus takes about five minutes. The philosophy of care aims at providing a caring and homely atmosphere, which respects the individuality, dignity and rights to privacy of each Service User. It is based upon the establishment of a positive relationship between Service Users, their families and staff, and upon the creation of a noninstitutional regime, that enables Service Users to lead a fulfilled life and to achieve the highest potential that their condition permits physically, socially, emotionally and spiritually. Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was announced and carried out over two days on Monday 21st November 2005 between 09.30 and 13.30 and on Tuesday 22nd November 2005 between 09.30 and 12.30. During the inspection the Inspector spoke with six Service Users, the Registered Manager, four members of the care staff, the cook and laundry person. Records were seen and an accompanied tour of some areas of the premises was made. The atmosphere of the home was welcoming, calm and relaxed, and the home was clean and orderly at the time of the inspection visit. Twenty-eight Service Users Comment Cards were received and all but one indicated positive comments about the home. Nine Relatives/Visitors Comment Cards were received and on the whole provided positive comments about the home. Any issues raised were discussed with the Registered Manager during the course of the inspection visit. The Pre-inspection Questionnaire and Assessment and Inspection Record completed by the home prior to inspection and the information provided by Service Users and staff at the time of the inspection, has been used in this report. Discussion with the Registered Manager resulted in some of the issues raised at the inspection visit being addressed immediately, together with confirmation being given that action would be taken in relation to all issues raised. The home continues to show commitment towards meeting the National Minimum Standards. What the service does well: Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 6 The home promotes and develops independent living skills. A wide range of activities is currently being undertaken at the home, arts and craft, swimming, external exercise session, together with trips out to the Zoo and a visit to Circus. Several Service Users have been enabled to attend Thanet College. Staff members are multi skilled, and staff communication is good with daily handovers and regular staff meetings. The home is well run by a competent experienced supportive Registered Manager, who works well informing and consulting with other professional services and endeavours to provide best practice. Adaptations and equipment at the home suit the needs of the Service Users. What has improved since the last inspection? What they could do better: The Registered Responsible Person to undertake monthly Regulation 26 visits with written records kept in accordance with regulations. The Registered Responsible Person to provide regular supervision for the Registered Manager of the home. The Registered Responsible Person to ensure that POVA First checks are carried out, prior to employment of staff, and that evidence is available to show that CRB checks have been undertaken for all staff. Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 7 Provide a current electrical certificate for the home. It is recommended that the Cook undertake the Intermediate Food Hygiene course. Regular two-monthly supervision with written records kept to be undertaken for all members of staff. 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. Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4 The homes Statement of Purpose and Service User Guide provide Service Users and prospective Service Users with the information they need to make a decision about moving into the home. To ensure that service users are appropriately placed at the home a thorough assessment is undertaken, and Service Users move into the home knowing that their needs can be met. EVIDENCE: A Statement of Purpose/Service User Guide seen at previous inspection visits has been compiled in keeping with the information required in the National Minimum Standards and the Care Home Regulations Evidence was seen as part of the Service User Plan documentation that assessment information provided by the Social Services Care Manager was used to compile a Service User Plan. Previous information provided indicates that trial visits are offered, together with a ‘settling in’ period following admission. Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 Service users know that their personal goals are reflected in their individual service user plans, and that potential risks are managed. Service Users know that their views are listened to and that their records will be kept securely maintaining confidentially. Staff were seen supporting Service Users needs in a respectful manner that protects privacy and dignity. EVIDENCE: Each Service User has an individual Service User plan. Support needs are detailed with actions taken by staff to support these needs. Potential risks are identified and the home takes steps to eliminate these risks where possible without restricting Service Users independence. There was evidence that plans are regularly reviewed to reflect any changes in a persons needs. Formal reviews are held regularly to ensure that the home continues to meet service user needs. One issue raised and discussed with the Registered Manager and member of staff was addressed immediately. Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 11 There are lots of examples where Service User’s are enabled to take responsible risks and these are reflected in Service User’s Plans and assessed through the risk assessment process. Some people go out independently and there are procedures in the event of a Service User being missing. Staff had a good understanding of Service User needs. This was evident from the positive relationships and interactions between Service Users and staff witnessed by the Inspector. Records are kept secure when not in use, in the office. Those records seen during the inspection were up to date. There is a policy regarding confidentiality. Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Service Users have opportunities for personal and social development and are enabled to develop life skills within their individual capacity. Links with the community are good and support and enrich Service Users social and educational opportunities. Service Users have opportunities for personal and social development and are enabled to develop like skills. Life long learning is supported by the home. Daily routines respect service users rights, responsibilities and individuality. Service Users know the relationships they form will be supported by the home. The meals in this home are good offering both choice and variety and catering for special diets. EVIDENCE: Resources on site enable Service Users to participate in a range of activities, including cooking art and computing. On the days of the inspection visit, several Service Users were attending the local college. Positive comments in relation to the range of activities provided were received from relatives/visitors. Communication with family and friends is supported by the home Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 13 Service Users have unrestricted access to communal areas and the grounds of the home. The atmosphere was relaxed and unhurried, interactions between staff and Service Users was respectful and positive. The Inspector spoke with one of the cooks. The choices of food for the day were on display on the notice board in the dining room. The food records were seen and indicated that a varied and nutritious diet was provided with alternatives choices always available. Service Users spoken with said what they had had for dinner and that they liked the food. Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Personal care is offered in a way to protect Service Users privacy and dignity and promote independence. The health needs of Service Users are met, and the medication system at this home is well managed promoting good health. EVIDENCE: The medication records were seen and on the whole indicated that they were appropriately signed for and up to date. A couple of issues were discussed with the Registered Manager and she agreed to address these issues. The home works closely with health professionals and specialist equipment is provided as necessary. Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The home has a satisfactory complaints system in place, and there are policies and procedures in place to protect Service Users from abuse, neglect and selfharm. EVIDENCE: The home has a complaints policy, and the Registered Manager confirmed that there had been no complaints made. All staff members complete a detailed induction that includes the protection of vulnerable adults. The home has an adult protection policy. Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 The standard of the environment within the home is good providing Service Users with a homely environment. Service Users bedrooms suit their needs and lifestyles. The home was clean and hygienic at the time of the inspection visit. EVIDENCE: The home was clean and orderly on the days of the visit. Improvements to the environment include new carpets in four bedrooms, and new carpet in some corridor areas. The furnishings, fittings, adaptations and equipment were mainly to a good standard, however it was discussed that some armchairs could do with replacing. It was indicated during the accompanied tour of the home that the premises are suitable for its stated purpose, and meets the needs of the current group of Service User’s. All bedrooms are single occupancy, and bedrooms are personalised. Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Staff members are multi skilled ensuring good quality care and support. Service users are protected in the main by the homes recruitment procedures. The arrangements for the induction of staff are good with the staff demonstrating a clear understanding of their roles. EVIDENCE: Staff retention is good, and some staff members have been at the home for a long time and are experienced with the Service User group. Staff files were seen, and although a thorough recruitment procedure is undertaken it was found that not all staff had evidence of CRB checks, and there was no evidence of the POVA First check being undertaken prior to commencement of employment at the home. This issue was discussed with the Registered Manager and a member of staff, and on the second day of the inspection visit the Inspector was told that action was being taken to enable the Registered Responsible Person to register and enable them to carry out POVA First Checks. A requirement was made under the appropriate standard. At the previous inspection visit the home had an induction programme and the Registered Manager and Deputy Manager said that they were in the process of updating this. This is ongoing. Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 18 Staff training has been extensive during the last twelve months with staff undertaking courses in for example Fire Training, Diabetes, Health and Safety, First Aid, Medication, and Infection Control. The Registered Manager said that three members of the care staff have completed the NVQ Level 3, two members of the care staff are currently undertaking the NVQ Level 2 and three members of the care staff are undertaking NVQ Level 3. Following discussion it was recommended that the Cook undertake the Intermediate Food Hygiene Course. It was ascertained that Supervision is undertaken with written records kept although the Registered Manager stated that this was not always on a two monthly basis as stated in the National Minimum Standards - Standard 36. A recommendation was made in relation to this standard. Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42,43 The Registered Manager has a clear vision for the home that, she has effectively communicated to the service users, staff and stakeholders. The Registered Manager is supported well by senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. Service Users benefit from a well run home. Service Users rights and best interests are safeguarded by the homes record keeping, policies and procedures. The health, safety and welfare of Service Users are promoted and mainly protected. Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 20 EVIDENCE: The Registered Manager has many years experience and the necessary qualifications for running the home. She has a good relationship with staff, and Service Users, promoting an inclusive supportive management style. The Registered Manager was observed communicating a clear sense of direction, and she spoke with understanding of service user needs. The organisation makes a commitment to equal opportunities, and is currently applying for Investors in People certification. The home is financially viable and the Inspector was able to speak to the administrator for the home who spoke about the ongoing work and changes being made to systems. The home has the required public liability insurance cover. It was unclear as to whether the electrical certificate for the home was still current, and the Registered Manager agreed to take action in relation to this issue. A requirement was made under the appropriate Standard. Although a number of monthly Regulation 26 visits had been undertaken with written records a copy of which have been sent to the Commission. It was found at the home that the last recorded visit was in August this year. It was found that the Registered Responsible Person usually visits the home at the weekend and does not at that time see the Registered Manager and is therefore unable to provide the required supervision for the Registered Manager. The Inspector was told that communication with the Registered Responsible Person is usually made by regular telephone calls. A requirement was made under the appropriate standard. Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X 3 X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 4 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Deer Park Care Centre Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 2 2 DS0000023393.V267855.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 7,9,18,19 Timescale for action The registered person operates a 22/11/05 thorough recruitment procedure – POVA First Check and CRB checks The registered manager ensures 22/11/05 so far as is reasonably practicable the health, safety and welfare of service users and staff – Provide an ap0propriate electrical certificate for the home The Responsible Person to carry 22/11/05 out regular Regulation 26 visits with written records kept and a copy of monthly report to be sent to the Commission Requirement 2 YA42 12(1)(a) 3 YA43 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA32 YA36 Good Practice Recommendations The cook to undertake the Intermediate Food Hygiene Course Staff receive the support and supervision they need to carry out their jobs DS0000023393.V267855.R01.S.doc Version 5.0 Page 23 Deer Park Care Centre Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Deer Park Care Centre DS0000023393.V267855.R01.S.doc Version 5.0 Page 24 - 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. 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