Inspection on 10/10/05 for Deer Park Nursing Home

This inspection was carried out on 10th October 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Deer Park Nursing Home 22/05/08

Deer Park Nursing Home 13/11/07

Deer Park Nursing Home 18/07/07

Deer Park Nursing Home 31/01/07

Deer Park Nursing Home 14/03/06

Deer Park Nursing Home 04/03/05

Deer Park Nursing Home 07/09/04

Deer Park Nursing Home 08/03/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Deer Park Nursing Home Rydon Road Holsworthy North Devon EX22 6HZ Lead Inspector Adele Adams Unannounced Inspection 10th October 2005 09:20 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 Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Deer Park Nursing Home Address Rydon Road Holsworthy North Devon EX22 6HZ 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) 01409 254444 01409 254448 Mr Andrew Gordon Orchard Ruth Hatcher Care Home 56 Category(ies) of Old age, not falling within any other category registration, with number (56), Physical disability (56) of places Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Registered for 56 - Adult/Elderly General Nursing Care Registered for 3 Elderly Residents Date of last inspection 4th March 2005 Brief Description of the Service: Deer Park Nursing Home is a purpose built care home situated on the edge of Holsworthy, a market town in North Devon. The home is privately owned; the Registered Manager is a qualified nurse and oversees the day-to-day management of the service. The service is currently registered to provide care for 56 people. Residents are provided with care that is overseen by qualified nurses, residents also have access to other health services and are escorted to attend hospital appointments when necessary. Additional health services that visit the home include, chiropody, dental treatment and audiology. Care staff undertake activities such as Bingo with residents in the afternoons and there is also visiting entertainment from time to time. The service has a minibus, meals are cooked on site and a doctor visits the home weekly. In addition there is a weekly ‘ trolley – shop’ and a hairdresser comes to the home twice a week. Although the home is large, it does have comfortable atmosphere and visitors are welcome at any time. Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection has introduced “Key Standards “ to be inspected over each inspection year. Therefore, unless it is felt necessary by the inspector, some standards will not be inspected. To obtain a full picture of the home it is recommended that previous reports also be taken into consideration. This inspection was unannounced and began at 9:20 a.m. on 10th October 2005 and ended at 14:55. On the day of inspection, there were 50 residents living at the home. The inspector toured the home, met residents, observed staff and residents together, read documentation and resident records and spoke with residents, staff and the manager individually in order to gather information necessary for this inspection, previous inspection reports also informed this inspection. The manager and staff were welcoming, and contributed positively to the inspection; there were no relatives / visitors available for the inspector to speak with this occasion. What the service does well: This inspection found that resident records are comprehensive and well written and clearly show the needs of residents and how these needs are met. There are good risk assessments in place for both residents and the environment, which shows that the home are committed to the health and safety of both the residents and staff at Deer Park. The home is good at encouraging residents’ independence and residents who feel recognised as individuals with different but equally important needs value this. Each resident’s need for privacy, dignity and respect is recognised, understood and is a high priority for staff at Deer Park. The manager stated that the home supports the training and updating of staff, which ensures care practice is up to date and that residents receive care from well-informed staff. Staff told the inspector that they feel well-supported working at Deer Park and really enjoy working with the residents. The manager feels that one of the home’s strengths is its ‘homely’ focus and that each resident’s individuality is recognised and effort is made to encourage residents to continue to make choices and decisions about their lives. Residents told the inspector that they are pleased to be at Deer Park, that it is ‘a home from home’ that they are well cared for by staff that they trust and this helps them feel safe and secure. Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: This inspection found that improvements are needed in the following areas: The residents plan should be reviewed by staff in the home at least once a month and updated to reflect any changing needs. The recording of residents’ prescribed medication and the record of medication given to residents needs to improve. Uniform could be improved - this is important for both residents and staff privacy and dignity. A request has been made for all staff to wear trousers and tunics as the dresses worn by female staff are sometimes revealing – the owner and manager are aware of this and a decision is awaited. The consent /permission of residents or someone acting on their behalf must be clearly recorded to show their involvement, choice and agreement in making the decision – particularly when a decision is made to use equipment such as cot sides. Some areas of the home are beginning to show signs of wear and tear and could be improved. Infection control practices should be improved. Noise levels in the home could be improved by reducing the volume of the calls bells, which are very loud and remain at the same level at night. Although somewhat improved since the last inspection, some improvements to food storage remain. Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 7 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 Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 8 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 Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 9 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): x Standard 3 will be inspected at the next inspection. EVIDENCE: Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The recording of residents’ prescribed medication and the record of medication administration needs to improve. Each resident’s need for privacy, dignity and respect is recognised, understood and is a high priority for staff at Deer Park. EVIDENCE: The inspector spoke with staff, the manager and residents individually, read residents records including care plans and medication administration records. The inspector read x 3 residents records in depth and looked at a further 2 residents records. The care plans are well written being individual to each resident showing personal preferences, likes and dislikes, and are easy to follow, the monthly review had unfortunately lapsed but had clearly been taking place prior to August on a monthly basis, residents confirmed they are aware of their care plans and do discuss them with staff. The inspector noted that the care plans in residents’ rooms were not the same as those held in the office – this was discussed with the matron, who is to look into this. Residents confirmed that they have access to services such as chiropody, dentist and optician and the staff spoken with also confirmed this, residents told the inspector they can access a doctor when they need to and that a doctor visits the home weekly, the manager and staff also advised the inspector of this. Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 11 Residents medication administration records were inspected following the recommendation made at the previous inspection, gaps in recording were brought to the attention of the manager as was the need for all hand written prescriptions to be signed by 2 members of staff – demonstrating that one has checked the entry of the other and found it to be correct – advice was sought from the pharmacy inspector during the inspection in relation to this. Staff described how they make sure that residents privacy is respected and how they make sure this happens when involved with supporting residents with their personal care needs, residents spoken with told the inspector that they are treated with respect and their dignity is important to staff– one resident did feel it would be more appropriate for female staff to wear trousers – the owner and manager are aware of this and a decision is awaited. Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 14 Residents at Deer Park do exercise choice and control over their lives and are able to maintain contact with family, friends and the local community. EVIDENCE: The inspector spoke with staff, read residents records and spoke with residents, both staff and residents described how they are supported and encouraged to make choices and gave examples of this – the residents care plans also highlight the preferences of residents. Residents and staff confirmed that visitors are welcome at the home and talked with the inspector about why this is important. The staff and residents described the activities that staff make available and involve residents in if they wish to take part. The inspector and residents explained how their needs as individual are met. The inspector saw the activities programme which is displayed in the reception hallway and on the afternoon of the inspection a small choir visited the home and sang in the lounge. Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 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): 18 The reasons for and the residents consent for the use of equipment such as cot sides was not recorded thus did not demonstrate this intervention is not a method of restraint. Cot sides pose a significant health and safety risk and clear risk assessments and supporting documentation is vital. EVIDENCE: The inspector noted that cot sides were in use when touring the home – the resident’s records were checked and no record of how this decision had been made or by who was available and there was also no record of consent from either the resident, a representative acting on the residents behalf or evidence of a multi agency meeting where a decision had been taken. This was discussed with the manager who advised that on arrival at the home the resident had requested the use of cot sides – the manager recognises the importance of documenting this type of information and is to look into this matter. The residents spoken with told the inspector that they feel safe and well cared for and feel the staff at Deer Park are trustworthy and feel able to talk to them about any concerns. Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 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, 21 and 26 Deer Park generally provides residents with a clean, safe and pleasant home but some changes could improve this. EVIDENCE: The inspector toured the home and spoke with residents, staff and the manager about the environment. Residents like their rooms and feel overall the home is clean and tidy, staff share the same view as residents. The home and the grounds are spacious and homely, however the carpet in the entrance is now looking tired and faded and the carpet in the hallway on the lower floor has stretched in places, there are now areas of ‘bumpy’ carpet that could pose a risk to people walking with frames, people in wheelchairs and staff moving equipment such as hoists. During the tour of the home the inspector made several observations that were raised with the manager for improvement, these included; soiled towels and linen on the carpet outside 2 residents rooms, an empty breakfast tray on the floor outside a residents room, stained/ dirty sinks in sluice room and residents bathroom, missing sign from toilet door to toilet next to the residents downstairs lounge and no sluicing facility to wash bedpans. A light fitting was Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 15 missing in the upper floor bathroom and the downstairs bathroom feels cold/ clinical. The residents and staff feel the call bells are excessively loud – the inspector found this also – the manager has already had the volume level reduced and is unsure if this can be further reduced but will find out. Residents’ rooms are individual in that residents have their own belongings around them; the inspector saw one room had been decorated before the arrival of the resident. The laundry was visited and found to be satisfactory. Care staff told the inspector that they are made aware of infection control procedures and practice and that the infection control department provides information as necessary, each member of staff carries individual anti bacterial hand gel and antibacterial hand gel is available at readily accessible points throughout the home. Staff confirmed they are provided with protective aprons and gloves as necessary. Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 16 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 Residents at Deer Park are cared for by a suitable number of staff. EVIDENCE: The inspector read the staffing rota and discussed staffing levels with residents, staff and the manager. Residents felt that the staff are busy but manage to care in an unhurried manner and feel the staff put effort into spending time with residents in the afternoons. Staff feel that generally staffing levels are satisfactory other than when there is staff sickness or staff holidays. The shift patterns have recently altered and the manager advised the inspector that she has recently introduced a ‘twilight’ shift from 5p.m. until 10pm. Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 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, 32 and 38 The manager runs Deer Park Nursing home effectively putting residents needs first. There is an open atmosphere from which all benefit. Although somewhat improved, some improvements to food storage remain. EVIDENCE: The Registered Manager of the home remains the same, observation of staff and residents and discussion with residents, staff and the manager and reading of documentation in the home all demonstrated that the home continues to be well managed and that there is an open approach which residents and staff find beneficial. Residents and staff were complimentary about the manager – staff feel ’well supported’, value the regular staff meetings and said that the manager is ‘approachable and always makes herself available’. Residents feel they can talk to the manager ‘about anything’ and one resident said ‘ She’s lovely – she makes it like a home from home’. Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 18 During the tour of the home, the inspector noted some improvements in the storage of food, however although some foods were labelled and dated other food was not – the manager observed this with the inspector. This will be revisited at the next inspection along with food hygiene training and the recording of fridge temperatures. Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 X 18 2 2 x 2 x x x x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x x x x x 2 Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 20 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard 7 9 Good Practice Recommendations The service user plan is reviewed by staff in the home at least once a month and updated to reflect changing needs. The registered person shall make arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received in the care home. This refers to gaps found on the medication administration records for some service users in relation to recording medication received at the home. 3 18 The reasons for the use of equipment such as cot sides must be clearly recorded to show that the individual or a representative has been involved in the decision making process and has given their consent. Renewal of the fabric and decoration of the premises should be routinely maintained. This refers to the carpets on the lower floor, the stained DS0000026711.V255027.R01.S.doc Version 5.0 Page 21 4 19 Deer Park Nursing Home 5 6 19 21 7 26 sinks and enamel ware and, missing light fitting in the upstairs residents bathroom. The home meets needs in a comfortable and homely way. This refers to the calls bells, which are excessively loud, and intrusive both day and night. There are accessible clearly marked toilets close to lounge and dining areas. This refers to the missing sign on the ‘male’ toilet door next to the lounge. The premises are clean, hygienic and free from offensive odours and systems are in place to control the spread of infection. This refers to soiled towels on the carpet outside 2 residents rooms and stained sinks and enamelware in bathrooms and sluice. This also refers to the home not having a sluicing facility either on the first or ground floor. The registered manager ensures safe working practices including: • Food hygiene: correct storage of food to avoid food poisoning, including labelling and dating of stored food. 8 38 This relates to food storage. Deer Park Nursing Home DS0000026711.V255027.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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