CARE HOMES FOR OLDER PEOPLE
Deer Park Nursing Home Rydon Road Holsworthy North Devon EX22 6HZ Lead Inspector
Jo Walsh Unannounced Inspection 13th November 2007 10:30 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.V350321.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. Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 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 deerpark@rydonroad.fsbusiness.co.uk Mr Andrew Gordon Orchard Mrs 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.V350321.R01.S.doc Version 5.2 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 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. People who use the service are provided with care that is overseen by qualified nurses. There is also access to other health services and people are escorted to attend hospital appointments when necessary. Additional health service personnel that visit the home include, the chiropodist, dentist, speech and language therapist and an audiologist. Care staff undertake activities with people at the home in the afternoons. There are regular bus trips and visiting entertainment from time to time. The minibus is also used for hospital appointments and transporting people using the day care facility. Visitors are welcome into the home at any time. Meals are cooked on site and a doctor visits the home weekly. There is a ‘ trolley - shop’ and a hairdresser comes to the home twice a week. Although the home is large, it does have a homely and comfortable atmosphere. Fees vary and range from £ 481 to £ 550. Extra costs are charged. These include: Hairdresser £4-£18, Chiropody £7 per visit, Toiletries- At cost, Newspapers and Magazines- At cost with no delivery charge. The Statement of Purpose, Service User Guide and recent inspection reports can be found in the entrance hall to the home or from the Registered manager. Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 5 Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was completed by two regulation inspectors on a weekday in November and lasted for approximately 6 hours. The registered manager was available throughout the inspection, and time was also spent talking to the staff group, including nursing staff, care staff, catering and administration staff. We also spoke to two visiting relatives on the day. Their views and opinions have helped to inform the inspection process. Prior to this inspection being completed surveys were sent to people who live at the home and to a selection of staff. 17 were returned form the people who live at the home and 2 returned from staff members. Their comments are included in this report. We case tracked four people who live at the home. This means we looked at all records relating to the individual, asked staff about what their understanding of individuals needs are, and talked to the individual about their experiences of living at Deer Park. What the service does well:
Each person has a plan of care that gives staff information to enable them to provide consistent care. People we spoke to said ‘’I am settling in very well, the girls are all very nice, they help me with getting up and I like it here.’’ Surveys returned showed that people who live there were generally satisfied with the care and support provided. 17 surveys were returned and all said they always or usually receive the care they needed. A good range and choice of meals is provided and individual likes and dislikes are taken into consideration. People appeared to be satisfied with the meals provided. People who need support to eat their meals are given support in a relaxed and respectful way. The home is purpose built and provides good communal space that it warm, clean and homely. The staff group are trained and experienced and appear to know individuals needs and wishes. They provide a reasonable level of personal care in a way that respects individuals’ privacy and dignity. Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
Assessments of people who are planning to move into Deer Park must improve to include more detail of the individuals care and support needs so that staff can plan for their care before they arrive. Plans of care have improved, but could be made better by including more detail of individuals social needs and preferences and as detailing their preferred daily routines. This would ensure that social needs could be better planned for and staff could provide care and support in a person centred way. Ideally plans of care should be developed and reviewed with the individual concerned and/or their family members, this would help to ensure care and support is provided in a way the individual prefers and wishes. The systems for the safe administration and storage of medication were poor, putting people at risk. The home needs to provide a more regular activities programme that suits the needs and wishes of the people who live there. A week prior to this inspection taking place a person who had only been at the home for one day was scalded by being immersed in a hot bath. This incident was referred to a safe guarding adults protection meeting. This is where the home, CSCI, health care professionals and funding authorities meet to discuss how and why this incident has happened and what measures will need to be
Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 8 put in place to ensure that other people who receive care form the home are not subject to the same sort of risk again. Despite clear directions about how these risks should be minimised, the home failed to comply. This resulted in water temperatures being checked during this inspection and found to be above 50 degrees C. This temperature will scald, and we asked that immediate action be taken. We are disappointed in the way the home has dealt with this recent incident. The registered manager had failed to record that any temperature checks had been made on hot water outlets since the incident. We are also concerned that despite being told that having the room where the boiler and thermostatic valve should be kept locked to prevent anyone tempering with it, no action was taken. There is no record of what disciplinary actions have been implemented since the incident and no training needs identified. We have concluded that the home has not taken this incident seriously and have therefore placed people at further risk. Since this inspection the home have written to the Commission to confirm that regulators have been fitted to both baths and they are doing daily checks on the hot water outlets. This incident will be further investigated by The Health and safety Executive and the home could be subject to prosecution if improvements are not made to ensure people are safe. Since we visited the home, a further incident has been reported by a health care professional and this has been referred to the safeguarding adult protection team too. This is with regard to a person who received short-term respite care at the home (one week) and returned home with a pressure sore alleged to have happened at Deer Park. This incident is ongoing at the time of writing this report and is currently undergoing a formal police investigation. The laundry floor must be replaced so that all parts of it are fully washable, this will help with infection control. The seal around the sink in the kitchen must be replaced, as this could compromise having a clean environment. The registered manager needs to have a system in place whereby she can clearly identify who and what training needs to be updated, so this can be planned for. Systems need to be in place to evidence that the management team work together to ensure that areas identified as needing improvements, are clearly budgeted for. This includes staff training to ensure that all staff has updated skills to do their job effectively and safely. The home needs to look at how they can ensure that adequate staffing is on shift at all times, so that if staff are off sick, care and support is not compromised. Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 9 The review of quality of care should include the views of staff and visiting health care professionals to the home. The results of any surveys should be made available to the people in the home and a copy sent to CSCI. 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. Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 10 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.V350321.R01.S.doc Version 5.2 Page 11 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): 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some improvements are needed to ensure that individuals’ needs are fully assessed prior to them moving in, so that the home can be sure all needs can be met EVIDENCE: The assessment information of the newest people was looked at and discussed with the registered manager. The assessments contain the basic information about personal and health care needs, but does not give sufficient details about how staff should provide the care. For example on the section on mobility for one person said need assistance, but did not fully explain how staff should support the person, whether one carer or two were needed for assisting with mobilising. There was only scant reference to what sort of equipment the staff would need to ensure safe moving and handling. We were also concerned about the terminology used in assessments. Statements like ‘’non compliant’’ and ‘’needs feeding’’ are subjective and do Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 12 not give sufficient details to help staff understand how best to support the individual. The registered manager explained that they have a further assessment form that is completed on the first day the individual arrives at the home. The form for this was divided up into more detailed sections and if completed fully should give a good picture of how care and support needs to be provided. One of the files examined that held information about someone who had recently come into the home (over a week), did not have a completed assessment form in. This meant that this person needs had not been fully assessed and staff did not have the information they needed to meet this person needs. We said that this level of detail needs to be obtained at the initial assessment so that when a new person arrives at the home, the staff have already been able to plan for their care and support. The registered manager agreed to look at using the more comprehensive assessment form for her initial assessments of people in the future. Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 13 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): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Plans of care and medicine procedures are not robust and so do not protect the people who live at Deer Park. EVIDENCE: People who live at Deer Park said ‘’I am settling in very well, the girls are all very nice, they help me with getting up and I like it here.’’ Tow visiting relatives spoken to said they were happy with the care and support their relatives received at Deer Park, one commented ‘’ I have been coming here for 9 years and it’s always been good.’’ Four plans of care were looked at in some detail. Whilst they give a basic picture of individuals’ personal and health care needs, improvements are needed to ensure that all risks are identified and what actions are in place to reduce these risks. For example there are no risks assessments on hot water outlets and the risk of scalding. This should be done as a matter of urgency as there has been a recent incident of someone being scalded by hot water.
Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 14 One person’s plan of care had their weight recorded but no date was put on this. The individual concerned had been admitted in early October and was previously known to us from another care home. They look to have lost weight and this should be monitored more closely, with dates of when the weight was done. The information held on individual files did not give the information needed for staff to care for people safely or meet peoples’ needs. Care plans were not consistently completed and changes to peoples needs were not recorded. For example one person had bruising that was described as “extensive” and due to the use of a hoist. Despite members of staff raising their concerns about the use of the hoist it had not been included in the care plan and no action had been taken to ensure that the correct equipment was used. In addition, assessments for the use of bed rails had not been completed and the use of a recliner chair had not been recorded in the care plan. Bed rails and reclining chairs could be forms of restraint. The reasons for their use needs to be clearly assessed and recorded to ensure that people are not restrained. Or if this kind of restraint is necessary that it is for the health and safety of the person being cared for. The use of chairs and ‘restraint, was also highlighted at the last inspection. The systems for the safe administration and storage of medication were poor. This puts people at risk. For example one persons medication had been removed from sealed containers. This meant that staff could not account for medication, they could not be sure if the person had taken the medication, if it had been disposed or if stolen. In addition the poor monitoring and recording of the use of prescribed creams meant that some staff were using creams that were not prescribed. This meant that the person being cared for had inconsistent care that affected their wellbeing. Medication including creams should only be used as prescribed for that person. It was not clear in the records examined, if the people living at the home or their advocates, family or friends had been consistently involved in their assessments and care planning. Some good practice was observed during the inspection that would indicate that individuals are treated with respect and dignity. During the meal time people were being assisted to eat their meals in a relaxed and unhurried manner. Staff were observed to knock on bedroom doors before entering and Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 15 some staff were seen to talk to individuals in a caring and supportive way, ensuring they got down to their eye level to communicate. One complaint has been received by the Commission from a health care professional regarding a pressure sore that was alleged to have occurred whilst a person was living at the home on short-term (one week) respite care basis (see Standard 18). Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 16 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A limited range of activities is offered to people who live at Deer Park. Improvements are needed to ensure that staff know and understand individuals’ social needs and personal preferences, to help them give individuals more choice and control over their lives. EVIDENCE: Currently the home offers a limited range of activities, which includes a bingo session once a week, a trip out in the homes minibus for up to 12 people once a week and occasional entertainers to provide music sessions. One carer did say that when time permits they try to instigate activities such as ball games and will spend time with individuals one to one chatting. One person who lives at Deer park said they really enjoyed it when staff talked to them, but that they always appeared busy and so could not sit with them for long. Some care staff spoken to said that they are extremely busy attending to individuals’ personal care and on occasion they are short staffed, so that there are only three carers and one nurse on duty. This does not allow for staff to plan or achieve any sort of regular activities for people, and staffing levels
Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 17 need to be reviewed if the home are to ensure that they are fully meeting all needs and not just basic care needs. On they day of the of the inspection we did not see any activities take place, and observed people sitting in lounge areas for long periods of time without any meaningful engagement, other than staff offering them refreshments. The registered manager said that they are about to employ someone who will have responsibility for organising activities for people. This will help to improve the lack of stimulation people are currently experiencing. Initial assessments and plans of care should be more detailed to include what people have enjoyed doing the past and what sorts of activities they may like to participate in. This would give a base line for an activities coordinator to plan a more person centred activities programme. It would be good practice to have a visible notice board in the main lounge that gave people information about what date and day it was, who is on duty and what the menu was for the day. This could also be used to tell people what activities are being offered each day. One person spoken to said they were able to make choices about when they got up, and where they spent their day. Many of the people who live at the home are only able to make limited choices about their lives, but including a section in plans of care about preferred routines for getting up and going to bed, would help staff to provide care and support in a way that individuals wish and prefer. The home offers a good range and choice of meals to people. The catering staff explained that they have written details of individuals’ likes and dislikes and can plan menus around these. They can also cater for special diets such as low sugar for diabetes. People are given a written menu on their breakfast tray each morning to make choices for the following days lunchtime and evening meals. Having a menu board up would help people to remember what the choices were for that day as they may not have remembered from the previous day when they were asked to make a choice. The main meal of the day is served at lunchtime with two sittings. We observed the mealtime to be relaxed and unhurried, and staff were supporting people to eat their meals in a caring and respectful way. Two people told us the meals were very good and they enjoyed them. Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 18 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): 16.18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at Deer Park can be confident that their concerns will be listened to and acted upon. Systems are in place to protect people from abuse. EVIDENCE: The home has a stated complaints procedure, which is included in the homes information that they give to all people who move into the home. The last complaint recorded by the home was in October 2006, and records show this appeared to have been dealt with in a timely fashion, with all issues investigated satisfactorily. The Commission received a complaint shortly after the inspection. This concerned a person who had come to Deer Park for respite care and had allegedly got a pressure area whilst being in the care of the home. This will be followed up with Deer Park, and may be the subject of a safe guarding adults protection meeting. This is where the home, CSCI, health care professionals and funding authorities meet to discuss how and why this incident has happened and what measures will need to be put in place to ensure that other people who receive care form the home are not subject to the same sort of risk again. (see standard 8) Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 19 Three staff spoken to were able to say what may constitute abuse and what should be done if they suspect abuse is happening. All said they had received training in this and would be confident to report any issues of concern. This is an improvement from the previous key inspection. We looked at staff files and were satisfied that appropriate checks were being completed to ensure that people who work in the home are suitable to work with vulnerable adults. Good systems are in place to ensure that individuals’ finances are protected. The administration staff keep good records and there is a clear audit trail for individuals monies. Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 20 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): 19,25,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Deer Park provides people with a clean and hygienic environment, but improvements are needed to ensure that all parts of the home are safe and risks to health and safety are identified and minimised. EVIDENCE: Deer Park Nursing Home is a purpose built care home situated on the edge of Holsworthy, a market town in North Devon. It is a purpose built care home arranged over two floors. There is a spacious lobby / entrance hallway which is furnished to provide a pleasant and comfortable seating area for visitors and people living at the home. There are several lounge areas and a conservatory area, which has level access to the garden. Grounds were seen to be well maintained and enjoyed by people sitting outside during the fine weather. Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 21 The home employs a maintenance man three days a week and use outside contractors for specialist services, such as maintaining the hoist, bath, lift, electrics, emergency lighting and the call bell system. Maintenance records for these are detailed in information we ask the home to provide on an annual basis (Annual quality assurance assessment). Since the last inspection carpets have been replaced to ensure that they are no longer a trip hazard for people. Lighting in a corridor has been improved, which was also highlighted form the last inspection. The kitchen storerooms were clean, but there are broken seals around the kitchen washbasins, which could compromise through cleaning of this area, and should be addressed. The registered manager and general manager are now completing monthly audits of the environment and some records. This should help to improve the maintenance of the home being proactive instead of reactive. We are however very concerned that records in respect of checking hot water temperatures were last recorded on the 22/10/07, despite the fact that a person was scalded by being immersed in hot water on 07/11/07. We spent a significant amount of time checking water temperatures round the building, due to the fact there had been a serious scalding incident. We found that hot water was above 50 degrees C in both communal bathrooms and some of the en suite facilities. This places people at risk from scalding and we asked that immediate action be taken to reduce this risk. The registered manager immediately called the plumber who reset the thermostatic valves that are placed just off the boiler. Following the inspection a letter was sent to Deer Park highlighting the risks we had identified and explaining what actions were needed to reduce these risks. The home have responded and have now had thermostatic valves fitted to both baths and they sat they are doing daily checks on hot water outlets. The laundry floor needs to be replaced in order that all parts of it are fully washable. This will help with infection control. Clean laundry should not be stored in areas where dirty laundry is being loaded for washing. The mop heads were looking very old and worn and should be replaced. This is the sort of issues monthly quality audits by the home should be picking up. Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 22 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff group are experienced, sufficiently trained and supported to ensure the needs of the people who live at the home are well met most of the time. EVIDENCE: The staffing levels appear sufficient to meet the current needs of the people who live there. Some staff did say that sometimes at weekends they were short staffed, so that there were only 6 carers and 2 qualified nurses on duty. Staff said that this is sometimes because of sickness, but the home does not have a bank of staff they can call on in an emergency and do not use agency staff. The management of the home needs to consider how they can address staff shortages so that peoples care and support is not compromised. Staff spoken to said that they have opportunities for training and they had covered most of the health and safety courses. There is no clear system in place that would alert the registered manager that this key training needs to be updated. We discussed ways in which this could be achieved so that she could ensure people were in safe hands at all times. The home had a basic induction for new staff employed in the home and the manager said that a more detailed induction was completed. We were unable to look at more detailed induction records as the manager said that the staff kept them until they were completed.
Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 23 Staff files, were examined, which had a range of documents in, including application forms and contracts of employment, police checks and references for new staff, that had been consistently completed. The manager had developed clear processes, to enable them to check that all documents were in place, before starting a new member of staff at the home. Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 24 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): 31,33,35,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who live at Deer Park cannot be assured their health safety and welfare is always fully protected. EVIDENCE: The registered manager is experienced and qualified to run the home. Staff spoken to said she was on the whole she was a good manager, however there still seems to be confusion over the management arrangements of the home. One care staff member said that the general manager was the overall manager of the home. It has been made clear to the registered manager that she is responsible for the health and safety management of the home, as well as overseeing care and support services. The registered manager does not hold any budgets for maintaining a safe environment and this could compromise her role to do this
Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 25 effectively. Systems need to be in place to evidence that the management team work together to ensure that areas identified as needing improvements, are clearly budgeted for. This includes staff training to ensure that all staff has updated skills to do their job effectively and safely. The registered manager uses questionnaires to get the views of the people who live at the home. She discussed ways in which she had used this information to improve services offered, menu changes for example. The results of any surveys should be made into a report and be available for people who live at the home to see. Copies of such reports should be sent to CSCI. We discussed extending the quality assurance system to include surveys to staff, families and visiting health care professionals. This would give further input into the review of quality of care and services provided. The registered manager and general manager have also begun monthly audits on the environment, and we have already mentioned in previous sections of the report, how this could be improved. A recent incident in which a person was scalded had been poorly managed and not followed up so that people continued to be unsafe. The registered manager had failed to record that any temperature checks had been made on hot water outlets since the incident. We are also concerned that despite being told that having the room where the boiler and thermostatic valve should be kept locked to prevent anyone tempering with it, no action was taken. There is no record of what disciplinary actions have been implemented since the incident and no training needs identified. We have concluded that the home has not taken this incident seriously and have therefore placed people at further risk. This incident will be further investigated by The Health and safety Executive and the home could be subject to prosecution if improvements are not made to ensure people are safe. We checked the records and actual monies held for three people and found the system to be robust, with a good audit trail. This means that individuals’ finances are safeguarded. Deer Park Nursing Home DS0000026711.V350321.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 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 X X X X X 1 2 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 2 X 2 X 3 X X 1 Deer Park Nursing Home DS0000026711.V350321.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. Standard OP3 Regulation 14 Requirement The registered manager shall not provide accommodation for a person at the care home, unless the needs of the person coming to the home have been thoroughly assessed and clearly shows what the needs of the person include( previous date set for compliance 01/11/07) Individuals plans of care must detail fully all personal and health care needs, with clear instructions to staff as to how this is to be achieved safely and consistently. The registered manager must ensure that medication is safely, administered, recorded and stored. Staff must be aware at all times of what medication is administered and ensure that medication is accounted for. Staff must use prescribed medication that includes the use of prescribed creams.
Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 28 Timescale for action 01/01/08 2 OP7 15 30/12/07 3 OP9 13 30/11/07 4. OP18 13(7) The Registered manager must ensure: People at the home are not subject to restraint unless it is planned and the only method agreed which protects the person. The methods used must be detailed in care plans The methods used must be risk assessed This relates to the use of a tilted chair for one named person and the use of bed rails in the home (previous date set for compliance 1/11/07) 01/01/08 5. OP26 13 (3) The registered manager must ensure that the laundry floor covering is replaced so it is all fully washable. The seal in the kitchen around the sink must be replaced. The Registered manager must introduce a system to review the quality of the service and the safety of the home. The Registered manager must ensure that records kept at the home are available for inspection at all times. (this was not inspected or checked as the manager was available during this inspection) The registered manager must risk assess all individuals in respect of risks to scalding from all hot water outlets. Where significant risks are identified, tell us how they intend to reduce these risks. You are required to forward us copies of these risk assessments.
DS0000026711.V350321.R01.S.doc 30/01/08 6. OP33 24 01/12/07 7 OP37 17(3b) 01/12/07 8. OP38 13 (4b) 01/12/07 Deer Park Nursing Home Version 5.2 Page 29 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 The Registered manager should ensure terminology in assessments and care plans cannot be misleading or misinterpreted and clearly explains what care is needed. Plans of care should contain more detail about individuals’ social history, their preferred routines, and where possible should be shared and developed with the individual and/or their family. The Registered manager should ensure all persons are treated equally and are not ignored when they do not demand attention from staff or are quiet. The home should provide a regular programme of activities that suits the needs of people who live there. The Provider should consider requests from people living at the home that staff should be able to wear trousers. (This was not inspected on this occasion) The Provider should consider ways of providing privacy for the toilets situated by the lounge. The Provider should provide evidence that radiators are low surface temperature and provide risk assessments for those that are not covered. The registered manager should develop a system that helps to easily identify when training in health and safety needs updating so that it can be planned for. 2. OP7 3. OP12 4. 5. OP12 OP12 6. 7. OP21 OP25 8. OP38 Deer Park Nursing Home DS0000026711.V350321.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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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