Inspection on 15/11/05 for Euxton Park Care Home

This inspection was carried out on 15th November 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Euxton Park Care Home 19/08/08

Euxton Park Care Home 31/10/07

Euxton Park Care Home 23/05/06

Euxton Park Care Home 19/04/05

Euxton Park Care Home 09/11/04

Euxton Park Care Home 24/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Euxton Park Care Home Wigan Road Euxton Chorley Lancashire PR7 6DY Lead Inspector Anne Taylor Announced Inspection 15th November 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Euxton Park Care Home Address Wigan Road Euxton Chorley Lancashire PR7 6DY 01257 230022 01257 230385 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) Four Seasons Health Care (England) Limited (wholly owned subsidiary of Four Seasons Health Care Ltd) Ms Susan Margaret Jones Care Home 63 Category(ies) of Old age, not falling within any other category registration, with number (63), Physical disability (2), Terminally ill (2) of places Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 63 service users to include: Up to 63 service users in the category of OP (old age, not falling within any other category) Up to 2 service users in the category of PD (Physical Disability) Up to 2 service users in the category of TI (Terminally Ill) The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 19th April 2005 2. 3. Date of last inspection Brief Description of the Service: Euxton Park is situated on the edge of Chorley, in the village of Euxton. The home is situated within easy reach of the towns of Chorley and Leyland, is on a bus route and within easy reach of the railway network and the motorway. The company Four Seasons Health Care that operates a number of homes across the country owns Euxton Park. The home is purpose built and caters for a total of sixty-three people with either nursing or personal care needs. Of the sixty-three places two beds may be used for residents with physically disabilities and two places for residents that need care associated with a terminal illness, the remainder of places are for older people. At the time of inspection fifty-two people were living at the home. Accommodation is offered on two floors, which are served by a passenger lift. Each floor has communal lounges, dining room and access to a kitchen. There are a range of single and shared rooms, the majority of residents with nursing needs are located on the first floor and those needing only personal care on the ground floor. The home is set in extensive grounds with seating areas to the front and rear of the home which service users access as they wish. Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection that took place over one day in November 2005. The inspection involved discussion with the people who lived and worked at the home, examination of records, policies and procedures and a tour of the premises. An exceptionally large number of comment cards were received from residents and relatives. The feedback they provided has also been used in the production of this report. A pharmacy inspection was carried out shortly after the main inspection and a summary of the findings included in this report. As part of the inspection process the inspectors used “case tracking” as a means of assessing some of the National Minimum Standards. This process allows the inspector to focus on a small group of people living at the home. All records relating to these people are inspected along with the rooms they occupy in the home. They are invited to discuss their experience of the home with the inspector, however this is not to the exclusion of other people living at the home. Since the last inspection there have been three complaints investigated by the Commission for Social Care Inspection. The home took action to resolve the areas of concern. What the service does well: Strong Leadership and direction was provided by the manager, which ensured staff knew what was expected of them. The staff team worked well together and showed a good understanding of the needs of the people living at the home. The staff team received appropriate training and guidance that provided them with the knowledge and experience needed to care for this client group. Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: 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. Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 7 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 Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 8 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): 3 The pre admission procedure ensured that prospective residents could be involved in the process and their individual wants and needs properly assessed. EVIDENCE: Pre admission assessments carried out by the home and social workers involved prospective residents and or their relatives. This helped residents to know what sort of care they should expect to receive when they came to live at the home. When asked about the admission process one resident said, “My family came to look round and chose it, (the home) and someone came to see me and talk to me about it”. The manager said that she or another experienced nurse usually carried out pre admission assessments for prospective clients. This meant that both the home and any prospective resident could be sure that an appropriately trained person had done the assessments. Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 The care planning and risk assessment processes were thorough enough to ensure the needs of residents were properly identified. The provision of basic nursing and personal care was inconsistent so that individual needs were not consistently met. Procedures were in place to facilitate the safe handling of medicines, residents were supported to self-administer medication but record keeping must be improved. EVIDENCE: Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 10 Care records seen showed that each resident had a plan of care based on the pre admission assessment so that individual needs were identified and instructions for staff as to how those needs would be met were clear. The manager said that residents and / or their relatives were consulted about the care planning process and some plans had been signed by residents who were able to do so or by their relative. Care staff knew about the people they cared for, were able to discuss individual needs and made every effort to ensure the needs of the people they cared for were met. However, there was some inconsistency in the provision of care between the residential and nursing unit. Residents on the residential unit were seen to be comfortable and relaxed and told the inspector that they were happy living at Euxton Park. On the nursing unit, dependency levels were much higher and staff sometimes struggled to meet everyone’s needs. At the time of inspection a number of residents needed assistance with their meals. Some meals had been left at the side of residents awaiting a staff member to help them and another resident was attempting to eat their meal with out help. Staff said that they didn’t feel they have enough time to spend with the residents. Comment cards received from relatives contained mixed comments and highlighted a number of concerns about the care provided on the nursing unit. Relatives indicated that the reason for this was insufficient staff (please see standard 27 of this report). Comments were very detailed and included, “Since my relative has been moved to the nursing unit, overall care has improved immensely”, There are more bed bound residents in the home (nursing unit) and you often find no jug of water for days, no midmorning or afternoon cup of tea as staff do not have the time”. And “Downstairs (residential unit) mid morning and mid afternoon drinks are served religiously and with biscuits. I have yet to see biscuits available upstairs on the nursing unit and have never seen drinks served mid morning. Upstairs fresh drinking water is often missing yet downstairs it is always present Records showed that people living at the home had access to health care services according to individual need. Risk assessments that enabled health care to be provided safely were in place so staff were confident about this part of their job and residents able to feel safe when being assisted with personal care needs or receiving nursing care. The risk assessment for the use of bedrails had been improved since the last inspection so that it reflected advice given by the medical devices agency. Three residents were supported to administer some of their medication but written assessment of safe self-administration had not been completed for one resident. Qualified nurses or trained carers administered all other medicines. Medicines were crushed for administration to two residents but this was not detailed in their care plans, and evidence of GP and pharmacist advice was not Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 11 recorded. GP and pharmaceutical advice must be sought and recorded before crushing medicines. The pre-printed medication administration records (MAR) were generally up-todate, but handwritten entries were not signed, independently checked and countersigned. One handwritten record examined did not include complete dosage instructions. The medication receipt entries were generally missing on handwritten MAR. All medication records including those for receipts and for self-administration must be complete, clear, accurate and up-to-date. The medication storage was orderly and secure but the refrigerator temperature was not recorded. It was noted that eye drops are not dated on first opening, this is recommended to help ensure they are not used for extended periods. New arrangements have been made for the disposal of medicines; the procedures need to be updated to reflect this change. Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: The above standards were not assessed at this inspection as they were fully assessed at the last inspection. However, the recommendations made at the last inspection were discussed with the registered manager. The requirement in relation to standard 12 and the recommendations in relation to standards 12 and 15 remain outstanding and have therefore been included in the requirements and recommendations made in this report. Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The home had an accessible complaints procedure, which ensured that all complaints would be acknowledged and investigated. The home had a robust procedures in place to safe guard service users from abuse and harm. EVIDENCE: A complaints policy and procedure was in place and included in the service user guide given to each resident on or just before they came to live at the home. Residents spoken to say that they had no complaints but knew whom they could speak to if they had any concerns. Staff were able to discuss how they would respond if a resident complained to them and realised how important it was to make sure residents felt able to raise concerns and be sure they were listened to. Comments cards received from relatives showed that a significant number of them not were aware of the procedure to follow if they wished to make a complaint. At the time of inspection there was a copy of the complaints procedure in the entrance foyer and all residents had a service users guide in their room. The home should make sure that relatives or representatives of people living at the home are made aware of the complaints procedure. Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 14 The home had an adult abuse policy and whistle blowing policy, in addition to a copy of guidance issued by the department of health. Discussion with staff showed that they were aware of the above documentation and were quite clear about what they would do if an allegation or suspicion of abuse came to their attention. The manager was aware of her responsibilities in relation to protecting people living at the home and making sure staff were appropriately trained to recognise and act upon any signs of possible abuse. Induction training records for new staff included information and guidance about abuse so that all new staff were familiar with the subject and how to respond to any allegation or suspicion of abuse. Staff confirmed that they received regular updates so that they continued to be made aware of the need to protect the people they care for. Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 15 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): EVIDENCE: The above standards were not assessed at this inspection as they were fully assessed at the last inspection. However, the one requirement and two recommendations made at the last inspection were discussed with the manager. The requirement to fit radiator guards in all areas of the home had been addressed. One recommendation in relation to ensuring that the premises comply with the Water Supply (Water Fittings Regulations 1999) remains outstanding and has therefore been included in the recommendations made in this report. Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Staffing levels in the home did not ensure that the needs of residents were consistently met. The recruitment procedure for overseas staff was not thorough enough to ensure the protection of service users. Relevant training was provided for staff so that they were able to do a competent job. EVIDENCE: Staffing rotas were kept that showed the number and skill mix of staff on duty at any given time and the capacity in which staff were employed. At the time of inspection the residential unit was sufficiently staffed and the needs of residents met. However, staffing levels on the nursing unit were not sufficient to fully meet the needs of the people accommodated there. (Please see standard 8 of this report). Comment cards from relatives indicated that they felt that there was not enough staff on the nursing unit and this was adversely affecting the standard of care. Comments included, “I do not feel that there are enough staff on duty upstairs, which results in my friend having to wait for assistance”, “The main problem as always is the lack of staff on duty” and “staff always seem to be busy and call bells are often allowed to ring for prolonged periods”. Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 17 Care records, observation and discussion with staff on the nursing unit showed that the dependency needs of residents on this unit were high. Staffing levels must be sufficient to ensure the needs of residents are fully met and based on an assessment of need and dependency. The Commission for Social Care Inspection will be contacting the registered provider separately about this matter. A random sample of staff files were seen, which showed that a thorough recruitment process was in place, which took into account the need to protect residents. However the registered person must ensure that CRB clearance is obtained for all overseas workers that come to live in this country. Staff talked about how they had been recruited and confirmed that they had received a statement of terms and conditions of employment and a job description so that they knew what their responsibilities were and what was expected of them. A training matrix had been developed that clearly showed what training, had been undertaken by staff. Certificates were kept on individual files that confirmed the training courses they had attended. Staff were provided with mandatory training and other more specialised training such as catheter care and wound care, which equipped them with the necessary skills to carry out their role confidently and competently. Six staff had an NVQ Level 2 qualification and 2 staff were working towards the qualification. The registered manager was aware of the need to ensure 50 of the staff has an NVQ qualification. Staff spoken to said that training opportunities were good and that regular training courses were held for fire safety, moving and handling and other health and safety topics so that they were kept up to date about safe working practices. Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 18 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, 33 Residents lived in a home that is managed by a responsible person who is fit to be in charge and able to meet the demands of their role. An improved Quality assurance system had recently been implemented that if acted upon should help make sure the home is run in the best interests of the people living there. EVIDENCE: Records showed that the registered manager is a first level registered nurse who has experience of running and managing a care home for this client group. The manager was studying for a recognised management qualification, which she hoped to complete in the very near future. Discussion with staff showed that the manager provided leadership and direction so that every one knew what their role was and what was expected of them. Residents spoken to Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 19 say that they regularly saw the manager and would contact her of they had any problems or concerns. An external quality assurance consultancy had recently carried out an accredited external quality assessment and was waiting for the report at the time of inspection. The consultancy team had conducted a survey of service users, relatives and staff requesting feedback on the service provided and how the home supported the quality of life of residents. The manager said that the results would be used to produce a development plan. The plan would include proposed developments in respect of the facilities and services within the home and, staffing and training issues. The home should ensure that any feedback from the survey of residents and relatives is used to improve the service provided if indicated. The findings of the assessment should also be made available to residents and their relatives. Policies and Procedures were reviewed and updated regularly by the parent company and reflected changes in legislation and good practice advice. The area manager had visited the home monthly and carried out an internal audit that met the requirements of Regulation 26 of the Care Home Regulations 2001. Copies of the audit had been submitted to the Commission for Social Care Inspection. Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 20 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X x STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X X X X Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard OP8 OP9 OP9 Regulation 24(1) (a) (b) 13(2) 13(2) Requirement A system for reviewing and improving the quality of care provided must be established. GP and pharmaceutical advice must be sought and recorded before crushing medicines. All medication records including those for receipts and for selfadministration must be complete, clear, accurate and up-to-date. Service users must be consulted about the programme of activities available to them at the home. (Timescale of 30th June 2005 not met). Dependency levels of residents must be reviewed and staffing levels determined accordingly to ensure identified needs are consistently met. The registered person must ensure that all new staff are confirmed in post following completion of a satisfactory CRB disclosure. Timescale for action 31/01/06 31/12/05 31/12/05 4 OP12 16(2)(m) (n) 28/02/06 5 OP8OP27 18(1) 31/12/05 6 OP29 19(1) Schedule 2 31/01/06 Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 22 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 OP9 OP9 OP16 OP26 OP28 OP31 Good Practice Recommendations It is recommended that prescribed eye drops be dated when first opened to help make sure that they are not used for extended periods. The home’s procedure for the disposal of medicines should be update to reflect recent changes in legislation. It is recommended that the registered person makes sure that a copy of the complaints procedure is given to residents and relatives. The registered person should be able to demonstrate that the premises are compliant with the Water supply (Water Fittings) Regulations 1999. It is recommended that fifty per cent of care staff are qualified to NVQ Level 2. The registered manager should obtain a relevant training qualification. Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Chorley Local Office Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW 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 Euxton Park Care Home DS0000025559.V251975.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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