Inspection on 19/08/08 for Euxton Park Care Home

This inspection was carried out on 19th August 2008.

CSCI found this care home to be providing an Adequate service.

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 31/10/07

Euxton Park Care Home 23/05/06

Euxton Park Care Home 15/11/05

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 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Euxton Park Care Home Wigan Road Euxton Chorley Lancashire PR7 6DY Lead Inspector Denise Upton Unannounced Inspection 09:00 19 August 2008 th 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.V371259.R03.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. Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Euxton Park Care Home Address Wigan Road Euxton Chorley Lancashire PR7 6DY 01257 230022 01257 230385 euxton.park@fshc.co.uk www.fshc.co.uk Four Seasons Health Care (England) Limited (wholly owned subsidiary of Four Seasons Health Care Ltd) Vacant Care Home 63 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) Category(ies) of Old age, not falling within any other category registration, with number (63), Physical disability (3) of places Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 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 3 service users in the category of PD (Physical Disability). Date of last inspection 31/10/07 Brief Description of the Service: Euxton Park Care Home is situated on the edge of Chorley, in the village of Euxton. The home is within easy reach of the towns of Chorley and Leyland, is located on a bus route and is in close proximity to the local railway and motorway networks. The home is purpose built and caters for a total of sixty-three people of either sex with either nursing or personal care needs. Of the sixty-three places three 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 the site visit, forty-nine people were living at the home. Accommodation is over two floors, served by a passenger lift. Each floor has communal lounges, dining room and access to a kitchen. There is a range of single bedroom accommodation. Residents with nursing needs are located on the first floor of the building and the majority of people requiring assistance with personal care are accommodated on the ground floor. The home is set in extensive grounds with seating areas to the front and rear of the home which residents can access as they wish. Visitors are made welcome but have now been asked to restrict visiting to between 9:00am and 9:00pm to enable staff to carry out their duties during the busy times of the day. Visitors can be entertained in the privacy of the residents individual bedroom accommodation or any communal area of the home. The current fees at Euxton Park Care Home range from £449.00 to £749.00 per week. Additional charges are also made for such items as hairdressing, private chiropody, personal toiletries, continence products and newspapers. Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced site visit took place over two separate mid-week days and in total lasted a period of approximately seventeen and quarter hours. The twenty-one core standards of the thirty-eight standards identified in the National Minimum Standard- Care Homes for Older People were assessed. A random inspection took place in May 2008. This is an inspection that only looks at certain specific areas where there have been concerns in the past. The report relating to this random inspection is held at the Commission for Social Care Inspection office and can be made available to enquirers on request. The requirements and recommendations identified at the last key inspection and more recent random inspection were also reassessed to establish what progress had been made. What the service does well: What has improved since the last inspection? The way medication is managed has been improved. This helps to make sure that people receive their prescribed medication at the specified time. Since the last inspection individual bedroom doors have been provided with a door lock. This ensures privacy for the occupant. In instances when a door lock Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 6 may not be appropriate, this is determined by a risk assessment outcome. A member of staff has a master key to ensure access in the event of an emergency. As recommended in the last inspection report, prospective residents are now informed in writing that their needs and requirements could be met at the home. There has been significant improvement in the way care plans have been developed however there is still room for improvement to make sure that all the needs and requirements of each resident are identified. 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. The summary of this inspection report can be made available in other formats on request. Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 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.V371259.R03.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 in-part & 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The Home’s Statement of Purpose and Service User Guide have been revised and amended but as yet, residents have not been provided with this updated information. Therefore prospective residents cannot be confident that the information verbally provided is accurate and up to date. There is a good system in place to assess the current needs and requirements of a prospective resident. This is to make sure that people are only admitted to the home if their individual requirements could be met. EVIDENCE: Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 9 The home’s Statement of Purpose and Service User Guide could not be evidenced at the time of the site visits. These two booklets are important because they tell residents, prospective residents, their relatives and any other interested parties about the facilities and services provided at the home. The booklets also give details about staffing at the home and the qualifications members of staff have achieved. By providing this written information, prospective residents and their relatives are in a better position to make an informed choice about living at Euxton Park. The home’s manager explained that further information is required before either booklet will be compliant with the information required. The manager also explained that the Home’s Service User Guide is a corporate Service User Guide that is not specific to Euxton Park. It is intended that this booklet will be available in an audio form to supplement the written information and help people with a visual disability access to the contents. It is understood that the Statement of Purpose is to be specific to the home and will be made available in large print. The Service User Guide should give residents accommodated at Euxton Park specific details about the home including a description of the individual accommodation and communal space provided, the views of people living at that home and the qualification of the manager and staff working at the home. It is difficult to see how this could be achieved with a corporate Service User Guide and consideration must be given to revising this document to ensure that the information provided is specific to Euxton Park. It is also recommended that both booklets be provided in large print and made available in an audio format to ensure that as many people as possible have direct access to the information. Residents are only admitted to Euxton Park Care Home if their needs and requirements could be met at the home. A senior member of staff routinely visits all prospective residents prior to admission to undertake an assessment of current strengths and needs in order to determine the level of care and support required. To supplement this, further information is sometimes made available from professional assessments undertaken by Care Managers or through hospital discharge information. The Dependency Assessment Rating Tool (DART) is used to record the outcome of the pre admission assessment and covers a range of needs and requirements. It was noted that as recommended in the last inspection report, staff are now signing and dating entries to take ownership of the accuracy of the recording. Although physical and personal care needs were recorded in more detail, sometimes there was little recorded about the holistic needs of the individual or their wants and wishes. Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 10 It was confirmed that as identified in the last inspection report, all prospective residents now receive written confirmation prior to admission confirming that their needs and requirements could be met at Euxton Park Care Home. Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Generally care plans are now far more detailed to provide staff with the information they require to ensure a consistent service, however some care plans do not always highlight or address changed needs. The health care needs of residents are well met and people are treated with dignity and respect. This promotes a feeling of confidence that any health care needs would be quickly assessed. EVIDENCE: Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 12 Each person has a written plan of care and in total, five of these were viewed that included residents in both units. There has been considerable improvement in the detail of the care and support that each resident requires, recorded in their individual care plan. Care plans are significantly more person centred and individualised and in the main provide good information to direct staff as to how an objective was to be achieved. There are a variety of risk assessments in place personal to the individual that can include, ulcer risk assessment, MUST risk assessment, oral risk assessment, falls risk assessment, moving and handling risk assessment, nutrition risk assessment, and pain assessment chart. There is also evidence of monthly reviews taking place. However there is still room for further improvement. Generally speaking there was a clear audit of information identified in the DART assessment document that was followed through to the care plan. However there are still occasions when identified needs/risks are not recorded or strategies in place to minimise behaviour/risks. This seems to be especially so if the risk has changed after admission. For example, it was clearly recorded that one resident has shortterm memory loss and dementia. Daily diary notes identified that this person had experienced numerous episodes of agitation and confusion and was ‘wandersome’. There was no care plan or risk assessment developed to direct staff how to respond to the period of agitation and confusion. The effects of the dementia for this person had not been assessed, recorded, reviewed or managed in a planned way that provided consistency for the resident and direction for staff. With regard to another resident it was again recorded in the daily dairy notes that this person also had periods when she was ‘very agitated’. Again there was little direction for staff to follow when this behaviour was evident. One carer had recorded that this resident was ‘moody’ but did not specify what she had meant by this. It is important that care staff explain what they mean when completing records to avoid any confusion of meaning. Care plans in respect of social activities, religious needs and eating and drinking generally contained only limited information that could have been improved by providing a more rounded picture of the holistic needs and requirements of the individual. A social needs assessment completed on 28/07/08 in respect of a resident with regard to religion, simply stated, ‘television’. It could only be assumed that this person enjoyed religious programmes on the television. There was no indication as to how this activity was to be provided or if the resident needed assistance to watch religious programmes on the television. It was therefore difficult to evaluate how staff had ensured that the resident had access to religious television programmes. Another social activities care plan evidenced highlighted social activities as shower, hair, nails, dining room – talking, son visits and all activities. Except for showering, there was no indication of where/when or how frequently or if Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 13 staff assistance was required to access these activities. Later observation of the progress report did show that this resident did enjoy varied social activities at the home but the care plan did not reflect this. Another social activities care plan indicated family visits, hair, nails, shower as activities. Whilst there may be some social activity in terms of chatting with a carer when assisting with hair, showering and nails there was nothing to indicate if any other social activities had been considered or offered or if the resident had chosen not to become involved. There was little written in the DART document about dietary preferences. One recording said, “Good appetite, likes tea and coffee but prefers tea mostly” There was no indication of any dietary preferences or needs. Whilst it is acknowledged that the catering manager does speak with newly admitted residents, the prospective resident needs to be sure that their individual dietary preferences are understood and reassured that there dietary wants or needs could be provided. All needs and requirements in respect of social, religious, dietary and cultural, requirements should form part of the formal care plan in order to inform and direct staff as to the holistic needs of the whole person. If care is taken to complete in full all sections of the DART assessment and outcomes were followed through to the care plan, a comprehensive overview of the needs and requirements of each person would be available and care plans would be significantly improved. There appeared to be some inconsistency between care staff in accessing and reading care plans. One carer spoken with said she never looked at care plans because she had no time and was ‘always rushing round’. This was also stated by a senior member of staff on the nursing unit when they said, that care staff do not have time to read care plans. Another carer spoken with also said she did not read dairy entries and frequently relied on other people to pass any information on. However other carers in a different unit said they did access and read care plans especially if they needed to know something and also commented that the unit manager was excellent in passing information on. It is recommended that all care staff be encouraged to read care plans and daily diary entries to ensure they have up to date information about any changes that may have been agreed. A number of Commission for Social Care Inspection (CSCI) surveys were returned from residents and relatives that helped to form an opinion as to whether people living at the home were satisfied with the level of care and support provided. A number of residents were also spoken with individually during the course of the site visit. The views of the residents and the majority of staff spoken with and the comments written on some of the surveys did not give a consistent account of living at the home. A number of resident and relative surveys were very negative however the writers remained anonymous and indicated they did not want to speak with the inspector. CSCI has not Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 14 received any recent complaints from relatives or residents since the last inspection. Again there was a discrepancy in the views of staff. In one unit staff stated that they did not have enough time to attend to the assessed needs of residents accommodated in this unit. Whilst acknowledging that the basic care was always provided, staff were concerned that they did not have time to address the social or emotional needs of residents or give the one to one support or having time to just talk with residents. On the other unit, the staff were much more positive saying they did have time to attend to all the assessed needs of residents including sitting and chatting with residents especially at weekends. One carer said, “The quality of care is good we do get time to spend with them (residents)”. A resident spoken with said that the carers were caring and that she did not have to wait a long time for the call bell to be responded to. A relative said of her father that, “Staff go out of their way to engage with him socially” and “as far as I can tell the staff seem very competent and almost all of them are very positive and encouraging”. However another relative said that the care home usually met the needs of their relative but that this was dependent on fluctuating staff levels. The same person went on to say, “If the home was able to be fully staffed and people weren’t put under all the extra pressure expected of them because of understaffing it would probably run quite well”. The manager was made aware of all the comments received but stated she was confident that staffing levels were adequate for the assessed needs for all residents accommodated in both units. However the home’s manager is concerned about some of the comments and confirmed that staffing levels are always kept under constant review. Responses in the CSCI surveys completed by people living at the home confirmed that medical support is provided when required. There was good evidence to confirm that the health care needs of residents are well met. All care plans evidenced showed contact with other health care professionals. This shows that the home is proactive in seeking medical attention for residents as and when required. One resident confirmed this when she said that staff were, “Good at getting the doctor out if you are not well”. Euxton Park Care Home continues to have available a corporate policy and procedure for the administration and recording of medication that staff with responsibility for the administration of medication are required to adhere to. Unit managers, senior carers and senior night carers have all received appropriate medication training to ensure they have the skills and abilities to administer prescribed medication to residents. There has been some improvement to the way medication is managed. This is partly the result of regular monitoring of medication practices. Introducing Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 15 regular medication audits and additional staff training. Generally the medication administration records evidenced were clear and well completed. There was however the occasional dose omission without explanation. The unit manager explained that the medication had been taken out of the medication cassette and given to the resident but the medicine administration record had not been signed. This suggests that not all staff are consistently signing the drug administration record immediately after the medication has been administered. On some occasions staff have to make a handwritten entry onto the medication record and it would help to reduce the chance of any error if this was always checked and signed by two people. Medication information leaflets are available that give good give information about how the medication should be given and details of possible side affects. Short life medication is dated on opening to ensure that medication past its ‘use by’ date is not administered. Records are kept of drugs received into the home and for disposal to ensure a clear audit trail. The administration and recording of controlled drugs was accurate. A unit manager confirmed that residents who require their medication at a specific time, for example 30 minutes before food, always received this medication at the time prescribed, however on occasions the administration of routine medication are sometimes delayed especially when only one qualified member of staff is on duty and unscheduled events occur such as a resident becoming ill or doctor or other medical person visiting. It is important that residents do receive their medication at regular intervals as prescribed. If the time span between the administration of medication is shortened, there is potential for residents to be harmed. Medication is securely stored when not in use. However it was noted that the medication storage room in the downstairs unit was very hot with a recorded temperature of 28 . The properties of some medications can alter if the medication becomes too warm. The management team are aware of this and an air conditioning unit has been provided in the short term. Alternative methods of keeping the room cool are being investigated. Euxton Park Care Home continues to have policies and procedures in place to guide and direct staff to ensure the privacy and dignity of residents is maintained. These topics are also covered during induction and National Vocational Qualification (NVQ) training. Staff were seen to be respectful of residents and were mindful of respecting privacy and dignity. During the lunchtime period, members of staff were observed assisting residents who remained in bed, to eat their meal in a quiet and sensitive way, so as not to cause embarrassment to the individual concerned. It was noted that information posters directed at staff are still visible in resident’s bedroom accommodation although one of the posters is now placed Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 16 at the back of the bedroom door. Another poster relating to bed rails remains on the wall by the bed. It is important that privacy of information is maintained and is not visible to any other person including visitors to the home. Care must be taken to ensure that notices for staff do not infringe or compromise privacy. Euxton Park Care Home DS0000025559.V371259.R03.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 adequate This judgement has been made using available evidence including a visit to this service. Residents are encouraged to maintain contact with their family and friends to ensure these relationships are sustained. Residents do not always experience a lifestyle that satisfies their social or recreational interests and needs. Dietary needs of people who live at the home are well catered for with a balanced and varied selection of food available that meets individual taste and choice. EVIDENCE: At the time of the site visits the atmosphere in the home was relaxed. This helps to create an environment where residents feel comfortable. Visitors are welcome to visit the home at any reasonable time and could visit residents in Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 18 the privacy of their own individual bedroom. One visitor spoken to on the day of the site visit said he visited his wife very frequently, felt comfortable visiting the home and that staff were approachable. Recently relatives and friends have been asked to restrict visiting the home during the busy periods of the day especially early morning and later in the evening when the needs of residents are high and staff are occupied in providing a substantial amount of personal care. A number of resident and relative meetings have taken place recently to help explain why this request has been made. The more restricted visiting times did not seen to be an issue for the small number of residents spoken with during the site visits. However this matter was mentioned on a small number of anonymous resident and relative surveys. Discussion with the recently appointed activities coordinator confirmed that some group activities do take place. However this appeared to be restricted to a narrow range of residents. The activities coordinator said she had spoken with each resident individually to find out what activities they would enjoy. At present there is bingo each Thursday and occasionally on another day, generally seven or eight people attend. There is a film show each Tuesday that is watched by up to ten people and approximately up to six residents enjoy crafts such as card making, knitting blanket squares and drawing and colouring. There is also on occasions some music but the activities coordinator said that not many people attended. In addition three quarters of an hour per week is spent playing drafts with one resident and half an hour per week is spent playing dominoes with another resident. The activities coordinator also said that she tried to give everybody five minutes a day especially those in bed and those who did not like group activities and some people with dementia that could not join group activities. A record of residents who enjoy each activity is maintained but in general the same group of people attend. This leaves a substantial number of people living at the home with little opportunity for structured social interaction. It is understood that a summer fair has taken place and some entertainment has been arranged for the Christmas period including a carol service and outside entertainment. The activities coordinator stated that male residents were not interested in group activities and that people in bed did not want to do anything ‘until well’. As previously stated, the DART assessment document and care plans provide very limited information about social interests/hobbies and how positive social care outcomes could be achieved for residents living at the home. The coordinator stated she had never seen a care plan so had no idea what residents had previously enjoyed and no direction of what social activities could be considered or introduced. Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 19 One resident spoken with said she did enjoy the activities provided and that the activities coordinator was “ a very nice lady”. This resident particularly enjoyed arts and crafts, bingo and occasional quizzes but stated she was “not a film buff”. However another anonymous resident stated on a survey that “The activities lady does not provide anything I am interested in and she has not asked what I like. She is content to play bingo or knit squares. I do not consider hairdressing or nails is an activity. I want someone to engage me in new opportunities – the days are long and boring when I don’t have visitors, my eyesight is poor so I cannot read”. A good social care activities programme should be introduced that takes into account the needs and requirements of all residents. Specific activities could be introduced that would attract more male residents to attend such as a newspaper discussion group or a gardening group (including in door gardening). A range of more mentally challenging activities could be introduced that may attract more male residents to attend. Attention should also be given to providing activities for people with specific needs such as those with a sensory impairment, dementia or those who spend the majority of time in bed but who may enjoy a mentally stimulating activity that they could do on their own. The manager at Euxton Park is aware that the range of activities offered and sustaining the social well being of residents is an area that needs to be developed further in order to meet residents individual expectations and requirements. People living at the home are encouraged to maintain control of their own financial affairs for as long as they wished to be or assisted in this task by their family or advocate. Information regarding the local advocacy service is made available to enable residents and/or relatives to access independently if they so wish. From observation of some individual bedroom accommodation, it was clearly evident that people are encouraged to bring some of their own possessions with them into the home to make their individual bedroom feel more homely and comfortable. Generally people living at Euxton Park were satisfied with the meals provided. However there were some comments especially on the surveys, that this can vary as to who was doing the cooking on any particular day. One resident commented on a survey that, “When the cook is here, it is good but oh – sometimes a little variation would be appreciated”. A relative commented that the “Food provided by the home is very good most of the time” and some residents who completed a survey said they always enjoyed the food served”. Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 20 Discussion with the catering manager confirmed that there is four week rotating menu and that discussion with residents takes place periodically to find out what foods people living at the home would like introduced on the menu. The menu is changed at about four monthly intervals and incorporates where possible the suggestions that residents have made. The catering manager also explained that she spoke with residents on a daily basis about the menu choice of the day. When a new resident is admitted the catering manager visits to introduce herself to the new person and to talk about their likes/dislikes or any special dietary needs, that is then recorded. Diet information sheet are readily available and the catering manager gave a good account of how to help residents with specific dietary needs to try different ways of eating foods. If a resident had not eaten for any reason this was questioned and an alternative offered. As much food as possible is home made including pies, casserole, meatballs, cakes etc and fresh fruit and vegetables are served daily. A fruit platter is served mid morning rather than cakes and biscuits as people often become too full to eat their main meal. The catering manager considered there was a sufficient budget made available but this was partly because of all the homemade foods served at mealtimes. The catering manager also considered that there was a good team working in the kitchen and felt confident that the all meals served were nutritious and of a similar standard. Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has developed a satisfactory complaints system and adult abuse policy and procedures for the protection of residents. The majority of staff have now been provided with formal adult abuse training that helps to protect residents. EVIDENCE: Euxton Park has a comprehensive, corporate complaints policy in place, which includes all of the required detail and outlined the steps that could be taken if a resident was unhappy with the service provided. The procedure making a complaint is to be included in the recently amended statement of Purpose and Service User Guide. Residents spoken with and those who completed a survey all said that they knew how to make a complaint but one person said that they “Can make a complaint to the appropriate person, but have never seen a copy of the complaint procedure”. It is important that the newly amended Service Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 22 User Guide is provided to residents as soon as possible with the information about complaints verbally reinforced where appropriate. The AQAA indicated that over the last twelve months 19 complaints had been received. The home’s manager investigated these complaints using the company’s corporate complaint procedure. Eight of these complaints were upheld. Over the last twelve months three adult safeguarding referrals were made. A multi agency approach was involved in determining how the investigation should be conducted and the home fully cooperated in the matter. As a result of this the home has made some changes to minimise the risk of any further allegation being made and to ensure that improvements are maintained. Generally residents spoken with felt that they were listened to however one relative commented on a survey, “On occasions my mother has had a problem. If my mother says something they ignore her comments or requests. If however she tells me and then I say something, it is only then that they take notice”. This is clearly inadequate and staff should be mindful of listening to what residents are saying and where appropriate act on it. There is a policy and procedure in place for dealing with allegations of abuse and the staff-training matrix indicated that all care staff have now received this important training except for new employees. Adult protection training will be provided for these people in due course. A member of staff spoken with was clear as to what she should do if an allegation was abuse was made to her. As recommended in the last inspection report, the adult protection procedure should be kept under regular review and provide explicit information about who takes the lead and when to contact each authority. Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is very good and provides residents with an attractive, homely and well-maintained place to live EVIDENCE: The layout of the home remains the same and continues to provide residents with opportunity to access all areas. There are two passenger lifts for ease of access throughout the building. A number of bedrooms are provided with an en-suite facility and all are comfortably furnished and personalised to reflect the needs and wishes of the occupant. The majority of bedrooms have been Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 24 refurbished and it is policy that when an un-refurbished bedroom becomes vacant, the room is updated that includes provision of new furniture, carpet, curtains and a flat screen television. Residents are encouraged to take into the home personal items such as pictures and ornaments to make their bedroom more homely. Communal areas of the home remain spacious, well decorated and furnished and consist of a dining room on each floor and a variety of comfortable lounges. This means that residents have a choice of place to sit quietly, meet with family and friends or be actively engaged with other residents. The fixtures and fittings are of a high quality, well maintained and well adapted to meet the wishes of the current residents. This purpose build accommodation has been designed to accommodate residents with a variety of needs and requirements. One of the units, predominately provides accommodation for older people who require nursing care, whilst the downstairs unit provides care and support to less dependent residents who require assistance with personal care. There is a choice of bathing facilities, both assisted and unassisted showers and baths and there are a number of toilets placed strategically around the home. The grounds are accessible, safe, provided with seating areas, very well maintained and offers a pleasant area for residents and visitors to enjoy. Residents spoken with were again all pleased with their bedroom accommodation and the communal space provided. The majority of residents that completed a survey confirmed that the home was always or usually fresh and clean and a relative commented on a survey that “It is a very pleasant, well furnished environment which could be a very happy one” Another relative said, “On the whole residents are well cared for. It is a pleasant environment with a core team of dedicated staff who do a thankless job”. As recommended in the last inspection report, the door to resident’s individual bedroom accommodation has been provided with an appropriate lock to ensure the privacy and dignity of the resident. In occasional instances when a lock may not be appropriate, this will be determined through the outcome of a formal risk assessment and reviewed on a regular basis. A master key is available for staff to access the bedroom in an emergency. Laundry facilities are sited in an area that does not intrude on residents accommodated. Equipment is appropriate to fulfil the needs of the home and the area is easily cleanable. There is a recommendation that all care staff receive infection control training. The training matrix indicated that a substantial number of staff have yet to receive this training. It is important that staff have clear, up to date training that is put into practice to ensure that Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 25 good and effective infection control measures are in place. Sluicing facilities and a sluicing disinfector are provided. Since the last inspection, a new system of colour coded laundry bags has been introduced in each of the units. This has ensured that only infected linen is placed in red coded bags and resident’s personal clothing is placed in another colour-coded bag for each unit. This has decreased the possibility of resident’s clothing going missing and helped to make sure that suitable linen and clothing is washed together. Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate Improvements have been made in order to ensure a stable staff group, however currently there is still some reliance on agency staff There is a good match of permanent members of staff who demonstrated an understanding of their roles The standard of vetting and recruitment practices are good with appropriate checks being carried out to protect residents. Induction training is compliant with ‘Skills For Care’ induction training standards and provided to newly appointed care staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager stated she was confident that current staffing levels were sufficient to meet the assessed needs and requirements of each individual Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 27 resident. This had been determined by a full needs analysis conducted by another manager who was unfamiliar with Euxton Park. It is understood that there is also ongoing reassessment of staffing numbers based on the daily manager’s report, weekly risk monitoring report and also staff verbal reports. The views of staff spoken with were mixed with staff on one unit saying there were sufficient staff on duty to ensure residents needs and requirements were addressed and staff saying on the other unit that they were very stretched and not able to fulfil all needs. A number of relatives and staff that completed the surveys also had concerns about the number of staff on duty especially on the nursing unit. One relative said that, “My mother is very happy at Euxton Park. Her only complaints are when she has to wait long to go on the commode and similarly taken off”. Another relative said, “Sometimes my father has to wait to be put to bed. He does not like waiting. The staff on duty work very hard getting people into bed as quickly as possible and will tell him how long they’ll be before they get to him. I just feel that they could do with an extra help at these times”. A third relative said. “Staff at times appear to be over worked resulting in none essential tasks being left (and example of this being lunch time plate and leftovers being left for hours on end in my mothers room and tea/refreshments being missed morning or afternoon”. This same person went on to say that, “Short staffed in the nursing unit. There appears to be the same amount of staff both in residential unit as in the nursing unit, with the same amount of residents in each. Obviously the nursing unit has a high number of high dependency residents”. A care member of staff spoken with in the nursing unit, whilst acknowledging that basic care was always provided but said staff are very rushed and there was no time for social, or emotional support or one to one quality time with residents. Another carer said of the same unit, that dependency needs did not seem to be taken into account when staffing numbers were determined and a third carer said people were having to wait longer for their buzzer to be answered and that more staff were needed. Staff working on the other unit gave a different account. On this unit staff told us that they did have enough time to attend to the assessed needs of residents including spending time talking to residents, with one carer saying that she enjoyed working at the home and had no complaints at all. Another carer working on this unit felt that the quality of care was good and that she did get time to spend with residents. This same person commented that “the way staff are with residents is very good, the whole package is good, we provide stimulation at the weekends with activities or just sitting and chatting with residents”. Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 28 There were clear discrepancies in the way relatives and staff perceives the adequacy of current staffing levels on each unit. It is essential that staffing levels be kept under constant review, especially in the nursing unit where concerns regarding staffing levels have been highlighted. The ability by staff to address the holistic needs and requirements of each individual resident within a reasonable time scale that is acceptable to the resident is crucial in determining adequate staffing levels through the 24 hour period. There continues to be some dependency on the use of agency staff. This is managed by the same agency workers, where ever possible, visiting the home in order to provide some continuity of care for residents. From information on the training matrix, 50 of the care staff team, that includes agency or bank staff, has now achieved at minimum a National Vocational Qualification (NVQ) Level 2 qualification in care. In addition, several members of staff have also achieved a Level 3 of this award. A carer spoken with explained that she was currently undertaking an NVQ qualification which she was enjoying. By encouraging staff to undertake this important training, carers will be better equipped to provide a consistent service and a good level of care for residents accommodated. In addition, a variety of other training is offered including specialist professional training specific to the trained nurses employed in the home. The company has a corporate recruitment policy and procedure that is followed. Since the last site visit several new members of staff have been appointed. The files of two of these people were viewed and were found to contain all the documentation to confirm that the correct recruitment procedures had taken place to ensure that residents were protected. Discussion with a recently appointed staff confirmed that the formal recruitment process had been completed before she had commenced employment at the home. This included an interview, obtaining satisfactory references and obtaining a POVA First and CRB clearance. There was evidence of ‘Skills for Care’ common induction standard training being available and the training matrix indicated that all care staff had received this training. This ensures that newly appointed care staff have the necessary basic skills to provide an adequate service. It was pointed out however by one of the unit managers, that generally the induction training programme cannot be provided with the recommended six week of employment because of time restraints. It was observed that one member of staff that had commenced employment at the home five months previously, had still not completed this basic training. Staff should complete formal induction training as soon as possible to ensure they have the skills and abilities to perform their duties satisfactorily. Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, & 38. Standard 37 was assessed in part. Quality in this outcome area is adequate The home regularly reviews aspects of its performance through a programme of self-review and consultations, which include seeking the views of residents, staff and other stakeholders. Financial procedures in respect of residents’ monies and the safekeeping of valuables are robust to protect the interests of people accommodated. Systems are in place to ensure as far as possible the health and safety of people living at the home, staff and visitors. However all staff must be provided with essential health and safety training. This judgement has been made using available evidence including a visit to this service. Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 30 EVIDENCE: Euxton Park care home has not had a registered manager for some considerable period of time. However the current manager is experienced and qualified and is about to submit an application to the Commission for Social Care Inspection (CSCI) for consideration to be registered. The home’s manager will have to demonstrate that she has the experience, skills and qualifications to manage a care home for older people in order to be registered with the Commission for Social Care Inspection. Euxton Park has a number of quality assurance systems in place to monitor the level of service being provided for its residents, which includes gathering the views of residents and relatives and keeping them informed about events being organised by the home. The company provide anonymous resident questionnaires on a regular basis. The last one was completed in February 2008. Following an audit of the information received, the manager at the home is then expected to ensure resident and relatives are informed of the outcome of the company surveys by post. It is uncertain if this actually happened at Euxton Park on this last occasion. An external manager visits the home on at least a monthly basis and a full home review audit takes place on a bi monthly basis looking at all aspects of care provision including care plans and medication. In addition, there are daily staff meetings in each department, a monthly head of department meeting, monthly unit meetings and full staff team meetings are planned every two months. Resident/relative meeting have been taking place on a monthly basis of late, however it is anticipated that this will be reduced to a meeting every two months. Residents that are admitted for a period of respite care are also provided with a questionnaire when they returned home to capture the thoughts of their experience of staying at the home for a short period of time. This helps to inform the internal quality audit and bring about changes for the benefit of residents. The home also has a RDB accreditation that is only awarded when a certain standard has been achieved. Resident’s financial interests continue to be safeguarded by the financial procedures adopted by the home. People living at Euxton Park are, wherever possible, encouraged to remain financially independent or assisted in this task by a family member or independent advocate. When the home does retain any monies or valuables in respect of a resident, this is appropriately recorded and Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 31 secure facilities are provided for the safe keeping of monies and valuables held on behalf of the individual. A monthly reclamation audit trail is completed and the company also undertake an announced and unannounced audit once a year and also random ‘safe’ checks in order to protect residents with monies or valuables held in safekeeping. Whenever a resident is unable to sign the record of their personal expenditure a second member of staff signs the document to confirm the transaction is accurately recorded. Residents/relatives are provided with a monthly written account of monies spent/deposited in safekeeping. Euxton Park Care Home continues to have available a variety of policies and procedures to ensure the health, safety and welfare of residents, visitors and members of staff. At the time of inspection, various records, maintenance records and certificates relating to equipment and instillations were examined and found to be up to date and in good order. It is understood that new environmental risk assessments are in the process of completion although this is still work in progress until the task is completed. This will help keep people safe and remove any avoidable risks. All staff are expected to undertake a variety of mandatory health and safety training, however the staff-training matrix indicated that some staff have not received all of this required training. All but the newest members of staff have received manual handling training and there is a rolling programme of manual handling refresher training on going. A number of care staff have completed the “First Aid at Work” course to equipment them with the skills to provide immediate first aid in the event of an emergency. In calculating the number of staff with this qualification required to be on duty at any one time, this should be determined by a risk assessment. The risk assessment should take in to account, the needs of service users, how likely it is that first aid will be needed and what kind of first aid is likely to be needed. The layout of the premises where the care is provided will also need to be taken into account. A large establishment with people accommodated on more than one floor may require more first aid cover than a smaller single story building. Although staff that has completed their induction training will have received a very limited amount of fire safety training as part of the induction-training course, not all staff have received more in-depth fire safety training and not all staff have received basic food handling training. The manager did explain that a lot of training booklets have been given to staff but the staff training matrix indicated that a substantial number of staff have yet to complete this training. Likewise only a minority of staff have received infection control training. The manager explained that every Wednesday has now been designated as a training event and it was company policy that all staff will have received all health and safety training by the end of the year. Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 32 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 2 2 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 6 Requirement The revision and update of the statement of purpose and service user guide must be completed as soon as possible. The service user guide must be specific to Euxton Park and provided to all residents and prospective residents. The registered person must notify the commission and residents of any such revision within 28 days. (Time scale of 22/05/08 not met). The registered person must ensure that the home is conducted with due regard for any disability of service users. Residents with any sensory impairment must have access to the same information about the service and facilities available as other residents. (Time scale of 22/05/08 not met at the time of the site visit) All care plans must be holistic in content to identify all needs and requirements. (Time scale of 22/05/08 not met) DS0000025559.V371259.R03.S.doc Timescale for action 30/11/08 2. OP1 12 (4) 30/11/08 3. OP7 15 30/11/08 Euxton Park Care Home Version 5.2 Page 34 4. OP38 18(1)(c) Arrangements must be made for care and ancillary staff to have adequate training in infection control. (Previous timescale 22/05/08) 31/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations It is recommended that the recently revised Statement of Purpose and Service User Guide should also be provided in large print and on audiotape to ensure that as many people as possible have direct access to the information. Religious, cultural, dietary and social care needs and preferences should be detailed on the DART assessment on order to make a judgement whether assessed needs and requirements could be met. Care plans should address all the assessed needs and requirements identified on the DART assessment. Risk assessments should always be conducted when a risk has been identified that is kept under regular review. Specific care plans and risk assessments should always be provided whenever a need is identified. This includes changes that have become apparent sometime following admission. Care plans should provide specific and detailed information about any religious, cultural, dietary or social care needs and how these are to be addressed. All staff should be encouraged to read care plans and daily diary notes and not rely solely on verbal information sharing. The drug administration record should be signed immediately after the medication is administered. All hand written entries in the drug administration record should be signed and countersigned to ensure accuracy. The medication storage areas must be maintained at an acceptable temperature. Confidentially of information should be maintained at all times within the home. This applies to notices for staff in DS0000025559.V371259.R03.S.doc Version 5.2 Page 35 2. OP3 3. OP7 4. OP7 5. 6. 7 OP7 OP7 OP9 8 9. OP9 OP10 Euxton Park Care Home 10. OP12 11. 12. OP16 OP27 13. 14 15 16. OP27 OP30 OP31 OP38 resident’s bedroom accommodation. The range of social activities provided should be extended to incorporate the interests of all residents. This is especially so for people who remain in bed, people with dementia and people with other special needs. Staff should always listen and act on what residents are saying. The number of staff on duty should be kept under constant review to ensure that the needs and requirements of all residents can be addressed within a reasonable timescale that is acceptable to residents. The use of Agency staff should be kept to the minimum so that residents receive care from a consistent and stable team of staff. Recently appointed care staff should complete ‘Skills for Care’ induction training within the first six weeks of employment or as soon as possible after this. An application to register the home’s manager should be submitted to CSCI as soon as possible. All staff should complete all mandatory health and safety training that includes food hygiene training, fire safety training and infection control training. A first aid risk assessment to determine the number of staff required to be on duty at any one time with a first aid qualification, should be in place. Euxton Park Care Home DS0000025559.V371259.R03.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 © 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.V371259.R03.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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