CARE HOMES FOR OLDER PEOPLE
Deer Park Nursing Home Rydon Road Holsworthy North Devon EX22 6HZ Lead Inspector
Clare Medlock Key Unannounced Inspection 18th July 2007 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.V339403.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.V339403.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 with nursing 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.V339403.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.V339403.R01.S.doc Version 5.2 Page 5 Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced. The visit to the home took place on Wednesday 18th July 2007 and started at 9.45am. We looked at records, care plans and other documents. We spoke with the business manager, provider and other staff at the home. We spoke with two people in detail and more, briefly in passing. We looked around all areas used by the people who live at the home, a few bedrooms and kitchen and storage areas. We spoke with people living at the home. We spent a period of time in the lounge watching how staff interact with the people who use the service. Three people were ‘Case tracked’ This is where the records and care of selected people were looked at in detail to check if their individual needs are being met. The registered manager had also sent the Commission for Social Care Inspection an annual quality assurance assessment. The details of this well completed document were used for this inspection. We did not send questionnaires for this inspection because of the short time between inspections. The registered person/registered manager was not at the home inspection. The Provider was present for a short time and manager was present for part of the inspection. It was agreed from the inspection would be given to the business manager by day after visiting the home. on the day of the business that feedback telephone the What the service does well:
Deer Park Nursing Home continues to provide a good level of personal and nursing care to highly dependent people and to those who are unable to express their needs. People are able to wear their own clothes, be called by their chosen name and bring personal items to decorate their rooms. People living at the home say staff are kind and more like friends. When staff provide care this is done in a caring and respectful way. Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 7 Nursing and personal care provided at the home is generally good. Staff at the home access a range of services including, General Practitioner, District Nurse, dentist, community psychiatric nurse, optician, chiropodist, out patient appointments and other NHS Services. The home has many adaptations to help people keep as independent as possible and ensure they are able to access all parts of the building. The home is situated in a rural community where many staff live and people moving to the home have lived. This provides a sense of community atmosphere inside the home as well as outside the home. Relatives and visitors have access to the home at all times and are welcomed by staff. The people living at the home enjoy the varied activities programme and enjoy the standard of food provided. The team of nursing staff and nursing care is managed well at the home. The registered manager promotes learning in the home, which means that many nurses and carers have further qualifications and have attended courses, which means their practice is up to date. What has improved since the last inspection?
Assessments performed on people before they have moved into the home are beginning to improve. The Care planning system and records kept on people living at the home has dramatically improved since the last inspection. Basic care is planned and reviewed. Charts are used to monitor trends in weight, blood sugar and other health needs. This means that any concerns can be picked up early and reported. The improvements in care planning means that registered nurses are responsible for the overall care and review of a small group of people. This means that people living at the home and their families have someone specific to liaise with and also means that care records are reviewed more frequently. The homely remedies list has been agreed practitioner) and means that basic medication recording of medication has also improved. This medicines have been missed, rather than leaving by the local GP (General can be given promptly. The means that staff explain why a gap. Staff now have access to more hoists and there have been fewer breakdowns. This means care is not delayed because of lack of equipment and also means that where care is given people are transferred in a safe way.
Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 8 Kitchen management at the home has also improved. Foodstuffs are labelled and covered when being stored in the fridge. Staff are no longer allowed access to the kitchen and have tea and coffee making facilities in the staff room. This means reducing access to the kitchen where food is prepared helps to prevent the spread of infection. Kitchen units have recommendations. been replaced according to Environmental Health Areas in the home have also been repaired. A boiler cupboard has been painted and treated to remove mould and a washing machine used to wash soiled linen has been repaired. The home has also obtained a vehicle to allow wheelchair/scooter access, which is used for hospital appointments and individual journeys. What they could do better:
The management systems within the home are unclear and managed very differently within the home. Nursing care, staff management and day-to-day running of the home, is effectively managed by the registered person/registered manager. However, who is responsible for the environment and safety of the building is not clear at Deer Park. The health and safety of the building and environment must be improved as a matter of priority. The registered manager must be aware that her registration with the Commission for Social Care Inspection mean she is responsible for meeting the requirements of the Care Standards act and it’s associated regulations. She must make sure that everyone living at the home, visiting the home and working at the home are safe at all times. She must ensure that precautions are in place to prevent and detect fires. Exits must be clear. Fire doors must not be propped or wedged open. Fire doors must be effective and fire escapes must be well maintained. Risk assessments for fire escapes and equipment should be maintained and available. When ensuring the environment is a safe place to live, work and visit, the registered manager must make sure: Creases in carpets are be removed to prevent people tripping. Corridors should be well lit and cleaning chemicals must not be left in communal areas where vulnerable people are present. Staff should be aware that their work practices have the potential to place people at risk. Footplates must be used on wheelchairs at all times to prevent accidents and discomfort. Adapted equipment should only be used when it has been fully
Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 9 discussed and documented. Failure could mean that the person is being restrained without consent or approval from the person, their relative or health care professionals. The use of bed rails must also follow careful care planning, safety checks and risk assessment. The Registered manager must ensure all areas of the home are clean and free from dirt. This should include the food storage rooms and laundry rooms being hygienic. Food storage containers should be clean and an awareness of who is responsible for maintaining such roles should be clear. By ensuring the environment is hygienic will prevent the spread of infection. Although the standard of record keeping and care planning is improving at the home there are still improvements to be made. Assessments performed on people who may move into the home must clearly show what individual needs people have. The staff responsible for performing the assessments must realise these documents will form the basis of the care plan. Therefore entries such as ‘may need help’ or ‘requires assistance’ does not explain what level of assistance is needed and may mean that information is not passed on or may be missed. Staff must consider the words used in records to avoid misunderstanding. Staff must continue with the way they interact with people who use the service. This ensures people are treated with kindness and respect. Staff must ensure this interaction is for all persons living at the home, not just for those who need regular help. Training programmes must continue at the home, but the registered manager must make sure that training changes the way staff work. The Registered manager must ensure that as well as staff receiving POVA (Protection of vulnerable adult) training they also become aware of what can be seen as abuse, how to prevent it and how to correctly report any allegations in the absence of the registered manager. The management of the home must be improved. Records must be available for inspection at all times, not just when the registered manager is at the home. The registered manager must look at ways of ensuring the environment is well maintained at all times and not just addressed when a problem arises. Quality assurance processes must be introduced and should not just focus on the care provided. 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
Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 10 be made available in other formats on request. Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 11 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.V339403.R01.S.doc Version 5.2 Page 12 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): Standard 3 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s management do not always obtain enough detailed information on a person prior to admission, and do not use the assessment for care planning. This means that staff may not have the detailed information needed to care for the people living at the home appropriately. EVIDENCE: The people living at Deer Park all have an assessment performed before moving into the home regardless of who is funding their care. The team of registered nurses and the registered manager perform these. The quality of assessments has improved greatly since the last inspection but the detail obtained is not enough to accurately form the basis for planning the
Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 13 care people need. Entries such as ‘needs help’ and ‘requires assistance’ does not show the level of help or assistance needed or how that will be provided. Staff at the home said that information on the person coming to the home is sometimes difficult to obtain in one visit so they also get details from hospital staff, GP, relatives and social workers. The staff use a standard assessment tool that contains all the recommended questions and prompts for staff to ask people who wish to come to Deer Park Nursing Home. Staff ensure health care specialists are consulted regarding the specific needs of people living at the home. Registered Nurses are appointed as link nurses for advice regarding issues such as continence care, nutrition and tissue viability. On the day of inspection healthcare specialists had come to the home to give educational talks to staff to ensure staff provide the best care to people living at the home. One member of staff told us that she had attended an optician course where she learnt about diseases of the eye, how to care for glasses and perform emergency repairs. Another member of staff said training was good at the home and there was ‘always some course or other to go on’. Posters in the home display a variety of training sessions for staff to attend. Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 14 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): Standards 7,8, parts of 9, 10 and parts of 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Improved care planning system is now beginning to reflect the care provided at the home. EVIDENCE: People living at the home on the day of inspection appeared well cared for with the finer details of care being given (Appropriate foot wear, glasses on, hearing aids in and clean nails). Those being cared for in bed looked warm comfortable and pain free. We were told that staff at the home were ‘very kind’ and ‘more like friends than staff’. One person told us that she had been at the home for a long time and that staff were always there at a touch of the bell. Other comments were: ‘wonderful’, ‘couldn’t be better’ and ‘smashing’.
Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 15 One person said the staff were always working so hard and could not do enough for you. There has been a review of care plans at the home. Each person now has an A4 ring binder with sections on assessments, care plans, and communication. Staff told us the new system had been in place for a month and was working well but taking a while to get used to. Care staff use a daily diary, which was used by registered nurses to get an overview of what care had been given and was needed. The daily sheets were also used by cleaning staff to check when the persons room was free to be cleaned. Discussion was used about the terminology used on these records, which could be misunderstood by people or their families. Discussion was also held about care staff having access to write in care plans. Each person at the home has a named nurse who is responsible for updating records and liaising with the person or their family regarding specific issues. Each care plan contained pre admission assessments, admission assessments, correspondence, daily records, multidisciplinary notes and health monitoring records. Health monitoring sheets (e.g. weight charts) now show changes in the persons condition is not always recorded in a way that shows trends or changes in condition. All care plans seen had been reviewed and were well completed. Social assessments were not all completed but staff told us that they gave these to the family to complete. Some care plans did not clearly explain what care was given and the reasons. Explanation from staff was clear but this specific detail was not written in the care plans. This lack of detail could result in communication not being passed on or could result in a lack of evidence that care had been given. Generally, however, care plans were well written and clear for basic care needs such as mobility, personal hygiene, continence care, nutrition and pain relief. Some staff at the home are ‘specialist link nurses’ for areas such as continence care and tissue viability. They ensure they have up to date skills and knowledge to pass on to staff in the home. Where needs of people are specific staff get advice for other health care professionals. Examples include a multiple sclerosis specialist nurse, community psychiatric nurse, GP’s, chiropodists, speech and language therapist, community nurses, and optometrist. When people need to visit health care professionals they are taken to out patient appointments or clinics by staff at the home. The business manager explained that the home has purchased a mobility vehicle to take people for appointments outside of the home. We spoke with people living at the home and they told us that staff gave out their medicines on time and were good at sorting out any problems. A new list of homely remedies has been sent by the local doctors surgery. During the
Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 16 inspection health care professionals were adjusting medication for a person at the home. This change was correctly recorded on the MAR (Medication administration record) sheet. The medications handed out at lunch were administered correctly. Care staff said they are not asked to give out medicines. Prescribed creams and lotions are used and signed to show that they had been administered. Any refusal of medication or omissions of medicines was clearly explained on the MAR sheet by registered nurses. The general storage, ordering and disposal of medicines was not inspected at this visit. However it was noticed that some medication had been left in a room that had been vacant for two days and a visitor leaving a person for respite care had left the new box of medication within the entrance hall. Once alerted, the registered nurse took the medication to a place of safety. People living at the home said staff were very kind and caring. They said staff knock on the door before coming into their room. One person said they were not sure but they were very deaf and did not mind. One care plan was seen for a person who had died at the home. This record was able to show that the person was provided with pain relief, given good care and saw the doctor when needed. The care plan also showed that family members were informed of the person’s deteriorating condition and they were asked about being present during the last moments of life. The care plan also showed that the requests made before death were followed. Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home enjoy a variety of activities and the contact they keep with friends and families. They have choice over their lives and enjoy the meals. EVIDENCE: We spent a period of time ‘sitting in the lounge area’. During this time we noted how staff interacted with people living at the home. We watched how the mood of a person was affected when they communicated with staff, visitors, and other people living at the home or took part in activities. The majority of interactions between staff and people living at the home were positive. Staff gave comfort to the people. People were generally respected, and treated with genuine kindness. Staff explained what was going to happen and staff did not rush the person who was being cared for. However, one person was not spoken too for one and a half hours, by either staff or the other people in the lounge. The person was quiet and self- contained. When
Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 18 the staff spoke with her she enjoyed the interaction and responded by smiles and nods. Following lunch the atmosphere continued to be relaxed and engaging. Some people were receiving visitors, others were watching a film and some were chatting among themselves. A group of approximately 6 people were going out on a mini bus trip to a nearby town on a mystery trip, which was to include a picnic. The business manager told us that the activities programme is ongoing and includes singers, dancing dogs, skittles in the lounge and visits from local ministers of religious denominations. We spoke with people living at the home and they said the staff were very kind. One person said most requests are listened to. Another person said they had asked for staff uniforms to be changed before but this had been ignored. They stated that they would prefer female staff to wear tunics and trousers to protect staff dignity when providing care, however this request had been ignored. People living at the home are able to see friends and family when they chose and can see them in their room or the communal areas. All feedback received regarding food was complimentary. Roast Pork was served on the day of inspection, which looked appetising and people said was very good. There are two sittings, one for the people that need help. These people were being assisted with their meals were helped in a sensitive unhurried manner. Food that was pureed was served in an attractive manner with different textures and colours to help the appetite. One persons’ care plan showed that she had gained weight since moving to the home. One person said the food had always been good at the home. Food storage cupboards were well stocked with fresh, frozen and dried foodstuffs. Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 19 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): Standard 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Despite training and policies that are in place, the lack of understanding of what restraint is, and unclear knowledge of how all staff should report allegations of abuse could place people at risk. EVIDENCE: Staff at the home were unable to access the complaints register in the absence of the registered manager. The Commission for Social Care Inspection have not received any complaints about Deer park since January 2007. People spoken to said they would speak with registered manager if they have any complaints or the nurses if it were ‘niggles’ The knowledge and practice regarding vulnerable adult procedures is inconsistent within the home. We noted that local vulnerable adult policies and guides were available within the entrance hall. Staff also told us that they had watched a training video on the recognition and prevention of abuse in the elderly. Further discussion revealed that staff that had received the training were still unclear of how to correctly report allegations of abuse if the registered manager was not present at the home. There appeared to be a general lack of understanding for staff to link the training video and local safeguarding adults procedures. At previous visits to the home the registered manager has had a very good knowledge of vulnerable adults procedures.
Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 20 Despite training and policies being available staff were unaware of some equipment used at the home could be classed as restraint if not clearly explained in care plans and assessed. Staff were unaware that misuse of some equipment could be seen as abuse. A specific issue was highlighted at inspection. Staff gave assurances that care plans would detail why the practices were given. People spoken to said they feel safe living at the home. Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 21 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): Standard 19,20,21, parts of 22 parts of 23, parts of 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Areas of the environment which people have regular access to are safe and hygienic, however service areas are not safe and hygienic. 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.V339403.R01.S.doc Version 5.2 Page 22 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 were not inspected on this visit. The home provides an environment that meets the specific needs of the people who live there. The home is comfortable, and has a programme to improve the decoration, fixtures and fittings. There has been slippage of timescales and maintenance tends to be reactive rather than proactive. People who use service have personalised their room by bringing in pictures ornaments and small pieces of furniture. Staff said there are now some weekend cleaners who come on a Saturday and bank holidays. The communal areas of the home appeared generally clean and tidy. People living at the home said their rooms were always clean. When people leave a room it is redecorated and a new carpet is fitted when necessary. Most rooms are for single occupancy and some rooms have adjoining doors if two people wanted to share accommodation. The majority of rooms have ensuite facilities with extra adapted bathrooms available. Toilets around the building are accessible and clearly marked, however when observing people in the lounge it was noted that the inspector could hear communication between staff and people in the toilets. There are adaptations and equipment in the home to help people gain their independence. Ramps, lifts grab rails and call bells are present in all areas. Storage space is provided throughout the home. Larger equipment such as hoists and wheelchairs are stored in corridors and under stairwells. One hoist was stored in front of a fire exit. Hoists and lifting equipment were in use on the day of inspection. Staff said that hoists are managed more effectively with fewer breakdowns. People needing nursing care are not always cared for in ‘adjustable nursing beds’ The business manager stated that these were being introduced gradually. In the mean time, staff are at risk of caring for people in non-adjustable beds. Staff said there were more hoists available. Staff were using wheelchairs without footplates until this was highlighted. All areas of the home appeared well lit with the exception of a corridor that links one side of the building with the other. This was pointed out to the business manager that the dark corridor would be a hazard for those with restricted sight.
Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 23 All radiators seen had individual controls on but radiator guards are not adequate. Records to show whether these radiators are low temperature surfaces were not inspected on this occasion. The areas of the home that people have access to were generally clean and tidy. However, the laundry room floor had dirt, debris and dust present. The kitchen storage rooms had dirty shelves; floor and storage containers and freezers were rusty and had dirty seals. Some commode frames were rusty, although not as many as at the previous inspection. A new sink unit was present in the kitchen. Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 24 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): Parts of 27 and parts of 28 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The numbers of staff are adequate and their regular training means that a team of skilled staff cares for people. EVIDENCE: All comments received from people living at the home were positive. Relationships between staff and people generally appeared warm and genuine. The staff group is stable and duty records showed that staffing numbers are constant at the home with more staff being available at peak times of the day. One person said that sometimes they had to wait but staff came as quickly as they could. One person said if you ring at night they come quickly. Staff files, training records and induction records could not be inspected because of the absence of registered manager. Staff spoken to said the registered manager encourages training. One member of staff had just completed an NVQ 2 (formal qualification) and is going to do NVQ3. Another member of staff said that she had been on an ‘optician’ course and found this very useful.
Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 25 Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 26 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, parts of 35, and 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People are placed at risk because the management of the environment and health and safety aspects of the home are poor. EVIDENCE: The manager is aware of the needs of people living at the home and has developed a group of staff who are generally competent and knowledgeable to care for the people who use the service. When the manager is present the home runs smoothly, however in the absence of the manager, processes are not in place or robust enough to ensure
Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 27 the smooth running of the business and protection of people living at the home. Registered nurses are able to continue with the care of people living at the home, but they lack understanding of the more complex management roles. Access to records is limited in the absence of the manager. Management of the home appeared fragmented with many staff not knowing what the roles of other staff were. It was not clear who was responsible for the health and safety management of the home. There is a lack of systems in place that ensures the health and safety of people is continually addressed. Action has been reactive rather than looking ahead to anticipate problems before they arise. Some requirements have been repeated at this inspection for similar issues. There are not clear quality assurance systems for the environment and health and safety issues. Staff said the registered manager continually makes sure people living at the home are happy and have anything they need. However there are no regular checks to ensure people are safe at the home at all times. There are no environment audits or health and safety checks performed. It was not clear in the home where this responsibility lay. Areas of the home were ‘tired’ and in places unsafe. Some practices were dangerous but had become accepted as part of the normal practice of the home. There was lack of evidence that money had been invested in the home apart from adhoc redecoration of rooms. Carpets in corridors were stained and had creases, which could cause trip hazards for staff and people at the home. A fire exit to the rear of the property was made of wood, which was crumbly, old and potentially unsafe. Freezers for food storage were rusty with dirty seals. One fire exit was blocked because of poor storage and another fire door not sealed due to overgrown plants being trapped. This fire door had a hook to hold it open as the building kept overheating through lack of airflow, which in turn set off fire alarms. Door wedges were being used for food storage cupboards, although no wedges were seen in communal areas. A corridor was very dark which could cause a hazard if a person had reduced eyesight. The business manager explained that light bulbs had been removed on instruction of the fire authority but a solution not found. Some equipment remained dirty and rusty. Footplates for wheelchairs were re attached after prompting at the inspection. Some areas of the home were unclean. The laundry floor and food storage room were covered in debris, dust and stains. COSHH (Control of Substances hazardous to health) products were on display in one bathroom and used feeding solution and syringes (no needles) were left in a vacant room.
Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 28 Accidents in the home had been generally well reported but one omission was noted from the night before the inspection. Risk assessments for the environment were not produced at the inspection and were not used for those needing bed rails. This was discussed with the registered nurses on duty. A specific risk assessment was discussed for a fire escape at the rear of the property. The Provider gave assurances that this would be done rather than removing a stair gate. There was no clear evidence that the registered person has organised a business plan for the home to address those areas that need updating and repair. Areas of the home need attention to provide a safe environment for people to live and work in. The management of ‘personal monies’ (money held for people living at the home) has improved. Two signatures are obtained for each transaction made. This not only protects the person living at the home but also helps protect staff making errors. Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 29 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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 3 2 3 3 2 1 1 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 3 X 1 1 Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 30 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 manager/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 Timescale for action The registered manager shall not 01/11/07 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 The registered manager shall 01/11/07 make arrangements for the safekeeping of medicines received into the care home. Requirement 2. OP9 13 3. OP16 22(3) 01/11/07 Not inspected due to lack of access to records: The registered manager shall supply to the Commission at its request a statement containing a summary of the complaints made during the preceding twelve months and the action that was taken in response. 4. OP18 13(7) The Registered manager must
DS0000026711.V339403.R01.S.doc 01/11/07
Page 31 Deer Park Nursing Home Version 5.2 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 The Registered manager must ensure that despite training all staff are aware of how to correctly report allegations of abuse. The Registered manager must ensure all areas that people have access to in the home are well lit and do not provide a hazard for those with restricted vision. The registered manager must ensure all areas of the home are clean and tidy. This must include the food storage cupboards, freezers, food storage containers and the laundry room The Registered manager must introduce a system to review the quality of the service and the safety of the home. 5. OP18 13(6) 01/11/07 6. OP25 23(2p) 01/11/07 7. OP26 16(2j) 01/11/07 8. OP33 24 01/11/07 9. OP37 17(3b) 10. OP38 13(4a) The Registered manager must 01/11/07 ensure that records kept at the home are available for inspection at all times. The registered manager must 01/11/07 ensure all parts of the home are free from hazards by ensuring COSHH (Control of Substances hazardous to health) products are not on display And The registered manager must ensure all areas of the home are
DS0000026711.V339403.R01.S.doc Version 5.2 Page 32 Deer Park Nursing Home 11. OP38 13 (4b) 12. OP38 23(2c) 16(2j) safe. This must include ensuring all creases are removed from the carpets The registered manager must 01/11/07 introduce systems to ensure staff do not transport people in wheelchairs with no footplates The Registered manager must 01/11/07 ensure they seek advice of the suitability of the rusty freezer with dirty seals from Environmental health The Registered manager must ensure all accidents are recorded 01/11/07 13. OP38 Schedule 4 (12) 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. 3. 4. 5. 6. Refer to Standard OP7 OP12 OP12 OP21 OP25 OP26 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. 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 Provider should consider requests from people living at the home that staff should be able to wear trousers. 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 ensure all staff are aware of who’s responsibility it is to perform cleaning duties within the home. Deer Park Nursing Home DS0000026711.V339403.R01.S.doc Version 5.2 Page 33 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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