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Inspection on 14/03/06 for Deer Park Nursing Home

Also see our care home review for Deer Park Nursing Home for more information

This inspection was carried out on 14th March 2006.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Deer Park Nursing Home continues to provide a good standard of personal and Nursing care to all residents including highly dependent residents and to those who are unable to express their needs. There is a dedicated and motivated staff group who ensure that Residents have all their needs met and ensure residents access a full variety of services. Residents spoken to were very happy living at the home and were full of praise for staff within the home. Residents and staff enjoy a genuinely caring relationship. Deer Park is a well organised home which has routines which are flexible depending on the needs, choice and requests of the residents. The staff group are actively involved in maintaining the standard of care and ensure they are `up to date` with the current trends and practices in health care by reading journals attending training and peer discussions. Staff within the home also foster positive relationships with other health care professionals who provide support, guidance and equipment to ensure the residents receive the best care. The home is situated in a rural community where many staff live and residents have lived. This provides a sense of community atmosphere inside the home as well as outside the home.The home is clean, tidy, and equipped to ensures Residents have a homely place to live and are helped to maintain as much independence as possible. Staff within the home ensure residents have the correct equipment for their needs.

What has improved since the last inspection?

The home have had a pharmacy inspection recently which has prompted a change in some policies at the home. The Manager also does spot checks on how staff complete medicine sheets this has reduced the numbers of errors that are made. The staff group have been divided into teams which indicate which group of residents they care for and which records they are responsible to complete. Each team has a registered nurse responsible for leading the care. New forms are used to assess the risk of falls and consent is now obtained for the use of bed rails. The Manager has continued to ensure training at the home is up to date and has accessed relevant courses for staff to attend. Some changes in the environment have been improved. Some carpets has been replaced and the dining room has been painted.

What the care home could do better:

There appeared to be two elements of management at the home. Both areas need improvements to improve the quality of life for residents at the home. Before residents are admitted, staff must improve the records they use to ensure all relevant information is gained prior to admission. Once admitted these records must be promptly transferred onto a care plan, maintained, correctly completed and kept under review. Registered Nurses should be reminded that the Nursing Midwifery Council guidance on record keeping states that the quality of record keeping is a reflection of their professional practice. Care staff must be reminded to think about how their actions and work patterns affect residents. This includes staff allowing residents to reply before entering their room. The high standard of education at the home should continue and subjects such as resident relationships and emotional needs could be discussed. The Manager should introduce systems that ensure all staff have had the necessary checks performed prior to employment.Quality checks and risk assessments must be introduced by the Provider as a priority. This would identify hazards and remove the risk from the living environment and work environment. Regular checks by the Provider would identify the issues raised at this inspection. These include unsafe flooring which has caused accidents, unsafe flooring which has not yet caused an accident, worn equipment, a poorly maintained environment and other areas which produce risk. The Provider must also support the measures taken by the care and nursing staff in the prevention of infection control. This is especially important as Deer Park receive more frail residents and the admission of residents with infections are becoming more common. Staff use gloves, aprons and alcohol gels and receive training but these measures must be supported by the presence of disinfecting sluices, adequate washing machines and replacement of worn baths and taps. The way the kitchen is managed and organised must also be addressed as a matter of priority. Recommendations made by the Environmental Health Office must be actioned. The kitchen must be managed in a way that improves food storage and hygiene. This management must include the way care staff are able to access the kitchen and use it as a short cut to the staff room.

CARE HOMES FOR OLDER PEOPLE Deer Park Nursing Home Rydon Road Holsworthy North Devon EX22 6HZ Lead Inspector Adele Adams. Inspection performed by Clare Medlock Unannounced Inspection 14th March 2006 10:00 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.V264143.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 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 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.V264143.R01.S.doc Version 5.1 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 10th October 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, speech and language therapy and audiology. Care staff undertake activities with residents in the afternoons and there is also visiting entertainment from time to time. The service has a minibus which is used for hospital appointments, transporting day care Service Users and conducting twice weekly trips. Visitors are welcome into the home at any time. 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 homely and comfortable atmosphere. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place between 9.30 and 4pm on Tuesday 14th March 2006. It found that the overall quality of personal and Nursing care provided was good. This inspection consisted of speaking with Service Users (Who have requested to be called Residents), family, staff and management within the home. A full tour of the premises was conducted. Care records, policies and procedures and other records were inspected. Five of the Residents, two relatives, and five staff were spoken to. Not all standards were inspected on this occasion. It is therefore recommended that the reader obtains previous inspection reports to gain a full picture of events at the home. What the service does well: Deer Park Nursing Home continues to provide a good standard of personal and Nursing care to all residents including highly dependent residents and to those who are unable to express their needs. There is a dedicated and motivated staff group who ensure that Residents have all their needs met and ensure residents access a full variety of services. Residents spoken to were very happy living at the home and were full of praise for staff within the home. Residents and staff enjoy a genuinely caring relationship. Deer Park is a well organised home which has routines which are flexible depending on the needs, choice and requests of the residents. The staff group are actively involved in maintaining the standard of care and ensure they are ‘up to date’ with the current trends and practices in health care by reading journals attending training and peer discussions. Staff within the home also foster positive relationships with other health care professionals who provide support, guidance and equipment to ensure the residents receive the best care. The home is situated in a rural community where many staff live and residents have lived. This provides a sense of community atmosphere inside the home as well as outside the home. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 6 The home is clean, tidy, and equipped to ensures Residents have a homely place to live and are helped to maintain as much independence as possible. Staff within the home ensure residents have the correct equipment for their needs. What has improved since the last inspection? What they could do better: There appeared to be two elements of management at the home. Both areas need improvements to improve the quality of life for residents at the home. Before residents are admitted, staff must improve the records they use to ensure all relevant information is gained prior to admission. Once admitted these records must be promptly transferred onto a care plan, maintained, correctly completed and kept under review. Registered Nurses should be reminded that the Nursing Midwifery Council guidance on record keeping states that the quality of record keeping is a reflection of their professional practice. Care staff must be reminded to think about how their actions and work patterns affect residents. This includes staff allowing residents to reply before entering their room. The high standard of education at the home should continue and subjects such as resident relationships and emotional needs could be discussed. The Manager should introduce systems that ensure all staff have had the necessary checks performed prior to employment. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 7 Quality checks and risk assessments must be introduced by the Provider as a priority. This would identify hazards and remove the risk from the living environment and work environment. Regular checks by the Provider would identify the issues raised at this inspection. These include unsafe flooring which has caused accidents, unsafe flooring which has not yet caused an accident, worn equipment, a poorly maintained environment and other areas which produce risk. The Provider must also support the measures taken by the care and nursing staff in the prevention of infection control. This is especially important as Deer Park receive more frail residents and the admission of residents with infections are becoming more common. Staff use gloves, aprons and alcohol gels and receive training but these measures must be supported by the presence of disinfecting sluices, adequate washing machines and replacement of worn baths and taps. The way the kitchen is managed and organised must also be addressed as a matter of priority. Recommendations made by the Environmental Health Office must be actioned. The kitchen must be managed in a way that improves food storage and hygiene. This management must include the way care staff are able to access the kitchen and use it as a short cut to the staff room. 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.V264143.R01.S.doc Version 5.1 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.V264143.R01.S.doc Version 5.1 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): 1,2,3,4 and 5 Residents and their families are given sufficient knowledge to decide whether Deer Park is the right place for them to be. The staff group do not always obtain detailed information on residents prior to them coming to the home. EVIDENCE: A Statement of Purpose and Service User Guide were produced at this inspection. Both documents contained all the necessary information needed. This helps Residents and their families decide whether Deer park Nursing Home is the right place for them to be. Discussion with staff and the Manager confirmed health care specialists are consulted with specific needs of Residents. Registered Nurses are appointed as link nurses for advice regarding issues such as continence care, nutrition and tissue viability. Healthcare Representatives come to the home to give Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 10 educational talks to staff and the Manager ensures all staff attend sufficient training to ensure health care needs are met. During the inspection the Manager explained that more Service Users with Palliative care needs are being admitted to the home and training is accessed by the local hospices. Specialist records being introduced for this purpose have been accepted by the home but uptake from General Practitioners has been slow. Discussion with the Manager confirmed that information regarding potential residents is obtained prior to admission. This is done by speaking with the resident, their families and other health care professionals. The Manager stated that if possible this is done by visiting the residents in hospital but where this is not possible information is obtained verbally prior to admission. Records and care plans confirmed that written information is obtained from Healthcare professionals but the assessment tool used by the home does not include all information required for the standard. This may result in inaccurate or insufficient knowledge being obtained. Residents spoken to said they were able to decide whether to move into the home. One resident said she used to come to the home for respite and decided she wanted to come to Deer Park. Another resident said he was given an option of two homes but knew straight away that Deer Park was the right home because the staff were so friendly and the home felt more homely. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 11 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,Minor elements of 9. 10 and 11. Residents health care needs are met at the home but the way this is planned and recorded is inadequate. The way staff protect the privacy of residents is inadequate in some ways EVIDENCE: All Residents seen on the day of inspection looked very well cared for with the finer details of care attended to. Examples included nail, hair and eye care. Very frail residents and those being cared for in bed appeared warm, pain free and well cared for. Records and discussion with Residents confirmed that NHS services are accessed and that staff contact the General Practitioner and other multi disciplinary health care professionals promptly. Discussion with the Manager and staff at the home confirmed good working relationships and lines of communication are held between the home and health care professionals. Domiciliary services are also held at the home. These include chiropody, optician and dental services. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 12 Four residents were asked about the care they received. All spoken to thought that the care they receive is very good. Residents said that staff are very kind, sensitive and respectful. Residents said they receive their medication on time and are able to report their concerns to the nursing staff who in turn contact health care professionals or provide appropriate care. Five Care Plans were inspected on this occasion. Four of these care plans demonstrated how Residents have their needs planned and met. However one resident had not had a care plan formulated after two weeks of admission and the remaining four Care Plans seen were not up to date. Some records had not been signed or dated. One Care Plan had not been reviewed since April 2005, although daily entries had been recorded. Observation confirmed that staff knock on Residents doors prior to entering, but observation confirmed that staff do not always wait for a reply before entering. Observation confirmed that staff prevent entry when care was being given to protect their privacy. Thank You cards and letters received by the home since the last inspection read: “Heartfelt Thanks from myself and our family for the wonderful care mother received. You can be proud of all your staff for creating such a family atmosphere for mum.” And “I know it’s been expressed many times by my family and by me but a heartfelt thank you to you all for the care, support and sheer professionalism you have given to my mother and to us all over the past two years……I know that your care was infinitely superior…….It’s the little things that count, the hugs, the smiles, the offers of tea and coffee that made the experience bearable. Your outstanding professionalism at all levels is exemplary and a beacon of good team work.” The Management of the medication system was not closely inspected on this occasion although the Manager stated that she had been performing spot checks on medication administration records (MAR) and informing staff when omissions or errors were spotted. Three MAR sheets were inspected on this occasion. No errors were seen. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 13 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): 12,13,14 and 15. Links with the community and families and friends is supported well at the home. Residents are helped to exercise choice over their lives. Residents enjoy the well presented food provided EVIDENCE: The Visitors book and discussion with residents confirmed that visitors are welcomed at the home at any time and residents are able to go out with families and friends. On the day of inspection a relative was taking his family member out to an appointment. Residents stated that they enjoy going out with family and friends, and enjoy the events put on at the home and especially like the organised bus trips. One resident said she prefers to stay in her room and does not go down to the activities through choice. One resident said she likes the trips to the local pub. Activities mentioned at the inspection included bingo, connect four, art classes, video sessions, religious services, chair aerobics, 1:1 sessions, talking books for the blind, the library and seasonal events. All five residents spoken to said the food at the home was very good. Residents stated that they are able to have drinks in the middle of the night and have plenty of food provided. Discussion with the Manager confirmed that menus are operated on a four week cycle and changed according to feedback Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 14 from residents. Meals seen on the day of inspection appeared appetising and were served in a variety of ways to suite the needs of residents. Residents that were being assisted with meals were done so in an unhurried sensitive manner. Residents spoken to said they liked living at the home and were able to have appropriate friendships with other residents. Specific examples were given which were being managed and dealt with in appropriate ways. Discussion with the Manager confirmed visitors to residents are not prevented unless instructed by the resident. Although in recent months a total ban on residents and restriction of movements within the home was introduced to prevent the spread of an infection which was affecting staff and residents. The Manager stated this worked well as the infection was contained within a short time frame. The Manager received no complaints regarding this. Discussion with the Manager and residents confirmed that choice and decisions are supported by staff at the home in an appropriate way. It was suggested that although the Manager and senior staff do this it may be useful to perform teaching sessions for staff to understand why it is important for residents to be supported in making choices. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 15 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): 16,17 and 18. Deer Park’s complaints procedure allows Residents, Relatives and staff to be confident that their concerns are listened to, taken seriously or acted upon. Staff knowledge, training and policies within the home inform staff how to identify and report adult protection allegations. EVIDENCE: A complaints procedure is displayed within the home, Service User Guide and Statement of Purpose. This includes contact details and timescales. A complaints register is kept within the office areas and details action taken and follow up information. The Commission for Social Care Inspection has received one anonymous complaint since the last inspection. This was given to the home to investigate. None of the elements were upheld and observation at the inspection confirmed the home had acted appropriately and come to the correct decision. All residents spoken to were happy about the care they receive at the home. All residents spoken to said staff were kind and polite. Residents said they could complain to the Matron or staff and things get sorted straight away. Three staff were spoken to. All three staff said if they suspected an abuse they would report it to the Matron or Provider. Staff knew who to report any allegations to if they concerned the Manager or Provider or what to do if the Manager and Provider did not take any action. All staff stated that they had Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 16 received Adult Protection training. Observation confirmed that a training video was being shown at the home during the afternoon of the inspection. Residents said they were able to vote at previous inspections and were taken to the local polling stations by friends, family and the homes mini bus. Records confirmed that residents who have bed rails in use now have a risk assessment and consent by family or the residents themselves to say this is appropriate. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 17 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): 19,20,21,22,23,24,and,26 Deer Park generally provides residents with a clean and tidy home. However some areas in the environment are poorly managed and presented which have a potential to place residents and staff at risk. EVIDENCE: 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 Residents. Some areas of the home had been redecorated. The dining room had a clean fresh appearance. The home employ a maintenance man three days a week and use outside contractors for specialist services. Despite this areas of the home were seen to be poorly maintained. Toilet frames were rusty however the Manager and Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 18 business Manager confirmed that new ones have been ordered. An area of flooring by a kitchen door was damaged and provided a hazard. Observation throughout the inspection confirmed that staff were able to freely enter the kitchen and use it as a ‘shortcut’ to the staff room. The kitchen was seen by a visiting Environmental Health Inspector on the day of inspection who stated that kitchen management was poor and management of food hygiene was inadequate. Feedback was given to the Business Manager by the Environmental Health Officer. The boilers were being replaced by a visiting plumber. One boiler was housed in a cupboard within the staff room. The walls of this cupboard were seen to be stained with black mould. Staff were seen to enter the kitchen and help themselves to refreshments and no facilities were available within the staff room. A tour of the home confirmed residents enjoy a homely environment and a choice of communal or private space. Grounds were seen to be attractive and well maintained and residents stated that they enjoy sitting outside during fine weather. The majority of rooms have ensuite shower facilities. The Staff stated that these are rarely used as residents continue to enjoy their baths. A tour of the building confirmed that the bath on the ground floor was damaged by the hoist which is used. This damage has increased and caused rust marks and unsightly stained. This has been addressed at previous inspections but no action has been taken. Taps on this bath were stained with lime scale which looks unsightly but also provides an infection control risk. Toilets were located within residents rooms and within close proximity to communal spaces. One toilet did not have a sign indicating it’s purpose. This has not been acted upon despite being a previous recommendation. Service Users have access to all areas of the home by the use of ramps, lifts and grab rails. Hoists and lifting equipment were in use on the day of inspection. Six mechanical hoists and two manual hoists were seen on the day of inspection. The home is purpose built, therefore has doorways and corridors wide enough to enable wheelchair users to independently propel them selves independently. Call bell systems were located within the home and staff were seen and heard to respond to these promptly. Three Residents stated that they did not have to wait long for bells to be answered. Residents were asked if the call bell was too loud? All three residents said they had not had a problem with this. The home had many storage areas for aids and equipment. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 19 A tour of the building confirmed Residents rooms were suitable for their needs. Furniture, lighting and flooring was generally of good quality. Each Residents room contained necessary equipment including personal items to reflect their choice and taste. The premises appeared clean and free from offensive odours. Laundry facilities were situated to the rear of the property. Staff spoken to confirmed that all laundry, including foul laundry, is washed on the premises. Residents spoken to said if clothes are labelled then the system works well and they do not have to wait long for clothes to be washed. There was no evidence to show that clothes are washed and a minimum of 65oC for not less than 10 minutes. A tour of the building confirmed that despite Deer Park providing Nursing Care the home do not have disinfecting sluices. This has been addressed at previous inspections and has not been actioned. This therefore will be come a requirement. Staff are provided with gloves, aprons and disinfecting gel to reduce the spread of infection. Staff are given adequate training and written policies on infection control but environmental changes are now needed to support these care practices especially as Deer Park receive more frail residents and infections are becoming more common. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 20 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): 27,28,29 and 30 Residents at Deer Park are cared for by a suitable number of staff. EVIDENCE: Residents and staff spoken to on the day of inspection thought that generally there are enough members of staff on duty. Residents said that holidays or sickness sometimes mean that staff are away but that staff work hard to make sure everything is done. Off Duty confirmed that staffing levels have been stable for the last few weeks. The Manager confirmed that adverts are placed to find new staff but this is a careful process to ensure the staff are right for the home. The Manager stated that a twilight carer has been tested and is proving useful. Residents said they receive their medicines on time, get up when they chose and never feel rushed by staff. Domestic, administration staff and kitchen staff are employed to support the running of the home. There were two trained staff on duty. The Manager was supernumerary, there were 9 care staff in addition to ancillary staff. Staff spoken to said staffing was a problem a while ago when staff were affected by a vomiting illness that was affecting staff and residents at the home. Six staff files were inspected on this occasion. Three of the files were not complete. Missing documents included Nursing Midwifery Council PIN checks, forms of Identification, application forms and references. This must be addressed as a matter of urgency. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 21 Staff at the home said the Manager was exceptional at supporting training and encouraging care staff to do NVQ Training. The Manager said that many staff were also doing NVQ 3 training. Induction records confirmed that the Manager uses a recognised induction programme and has used this to encourage staff who are reluctant to embark on NVQ training. Staff said if they see a training course they are interested in the Manager will help ensure this is supported. Staff all confirmed they receive free training at least three times a year. All staff spoken to were up to date with their mandatory training. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 22 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,Elements of 33, Elements of 34, 35, 36,37 and 38. The Management at Deer Park is good in some ways but not others. EVIDENCE: The Registered Manager is a first level Registered Nurse who is currently undertaking a Registered Managers Award qualification. The Manager stated that she and the staff undertake periodic training and ensure as a team they are up to date with the current trends and practices. There are clear lines of Management within the home. Staff said they always go to the Manager with problems although there is a business Manager and Provider who are also approachable. Contact details are available in the home. Both the Business Manager and Registered Manager were seen to operate an ‘open door policy’ ensuring staff, residents and relatives are able to contact them freely. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 23 Staff, residents and relatives all said that the Manager was very supportive and ensured requests and concerns were listened to immediately. Staff said meetings are held but information is shared on a daily basis during the report sessions. Staff said the Manager was respected as she was firm but fair and wasn’t afraid to roll her sleeves up and ‘pitch in’. Staff said the Manager supported development within the home and ensured training was a priority. Residents said they have not filled in questionnaires about life at the home but things get sorted out straight away rather than letting them become a problem. Insurance certificates were displayed within the home and showed that Deer Park have adequate insurance cover. There were no business plans requested at this inspection. Supervision of care staff is performed regularly both formally and informally with records kept of supervision sessions. Peer supervision is also held as part of the report process. Some records within the home were well maintained, accurate and up to date. Others were inadequate and have been reported in other areas of this report. Records of maintenance of some equipment was seen on the day of inspection. These included hoist servicing, lift servicing, emergency lighting, and electrical equipment. During the inspection the fire alarm was activated. Staff were seen to appropriately respond to this alarm before it was confirmed that the detector had been triggered by some maintenance work. The Management of Health and Safety is well managed in some areas but not managed in others. The Manager ensures staff are up to date with mandatory Training for staff and provides policy guidance and some equipment for the safety of those that live and work at Deer Park. There are first aid boxes and Health and Safety Executive posters and information. Accident and incident records are well maintained but some events could be prevented by simple practices such as not storing shampoos and other cosmetic products in communal areas and removing risks that have caused accidents. During the inspection it was noted that a member of staff was injured when they tripped over uneven flooring in the lift area. Observation confirmed the flooring in the lift had become unsafe. An immediate requirement was issued during the inspection to make this safe. However correct risk assessments would have prevented this occurrence. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 24 The Management of the kitchen area was insufficient which is reported on in standard 19. This shortfall also has the potential to place staff at risk of injury within the work environment. Areas within the home require constant review and upkeep to ensure hazards are removed. The step at the back of the kitchen was unsafe and needs to be replaced to reduce risk of injury. Fire escapes were all seen to be clear on the day of inspection. However at the rear of the property a fire escape was guarded by a stair gate. The height of this gate was questioned and a suggestion to put in a full height gate was discussed. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 X 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 1 3 1 3 3 3 x 1 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 2 3 2 1 Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 26 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 OP7 Regulation 15(2b) Requirement Existing requirement carried forward. The Manager must ensure that the Service User Plan is: o Reviewed by staff in the home at least once a month and updated to reflect changing needs. o Completed to include date and signatures. The Manager must ensure all staff give residents time to respond after knocking on doors before entering. The Provider must replace/repair to damaged bath and unsightly taps on the ground floor The Provider must: o introduce Management systems of the kitchen. o Adhere and act on recommendations made by the environmental health department o Act on the recommendation set at the last inspectionThe registered manager ensures safe working practices including: Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 27 Timescale for action 01/05/06 2 OP12 12(2) 01/05/06 3 4 OP19 OP19 23(2b) 16(2j) 01/09/06 01/05/06 • Food hygiene: correct storage of food to avoid food poisoning, including labelling and dating of stored food. 01/04/06 5 OP38OP19 23(2b) 13(4a) 6 7 OP38OP19 OP21 13(4a) 23(2b) 23(2c) 8 OP26 13(3) 9 OP26 23(2k) 13(3) 10 OP26 13(3) 11 OP29 Schedule 2 This relates to food storage. The Provider must remove the uneven flooring in the lift area(Immediate Requirement done at inspection) and replace with a non slip flooring material The Provider must make safe the area of flooring at the rear of the kitchen and back corridor Existing recommendation not actioned: 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 Provider must ensure the spread of infection is reduced by: o Providing evidence that the washing machines are able to wash foul laundry at 65oC for no less than 10 minutes. And provide a sluice washing machine if this can not be done. The Provider must ensure the spread of infection is reduced by: o Providing disinfecting sluices on each floor of the home. The Provider must ensure the spread of infection is reduced by: o Preventing entry to the kitchen by non kitchen staff. The Manager must ensure staff do not work at the home unless all information is obtained. This DS0000026711.V264143.R01.S.doc 01/05/06 01/05/06 01/09/06 14/03/07 01/05/07 01/05/06 Deer Park Nursing Home Version 5.1 Page 28 12 OP38 13(4c) information must include: o Proof of Identity o Two written references o Documentary evidence of qualification (Nursing Midwifery Council PIN number, statement of entry and copy of Nursing Midwifery Council card) Products such as shampoos and other cosmetic products must not be left in communal areas 01/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP3 OP14 Good Practice Recommendations The Manager should ensure the pre assessment tool contains all information listed in standard 3. The Manager should consider informing staff of how appropriate relationships can be facilitated within a home and the importance of allowing residents make decisions and choices about their lives. The Manager should obtain a copy of the food standard agency guidance recommended by the Environmental Health Office (Safer Food, better business) Existing recommendation to be discussed at next inspection. 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. The Provider should continue with: o The supply and replacement of toilet frames. o The repair of the boiler cupboard in the staff room The Manager should ensure Service Users personal money is handled in a way that protects the resident and staff. It is recommended that: o Receipts of all transactions made are kept o Two signatures are obtained on each transaction The Provider and Manager should consider putting an DS0000026711.V264143.R01.S.doc Version 5.1 Page 29 3 4 OP19 OP19 5 6 OP19 OP35 7 OP38 Deer Park Nursing Home alternative gate on the top floor rear fire exit. Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 30 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. Extracts may not be used or reproduced without the express permission of CSCI Deer Park Nursing Home DS0000026711.V264143.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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