Inspection on 31/10/07 for Euxton Park Care Home

This inspection was carried out on 31st October 2007.

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 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Euxton Park Care Home Wigan Road Euxton Chorley Lancashire PR7 6DY Lead Inspector Denise Upton Unannounced Inspection 11:15 31 October 2007 st 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.V341034.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Euxton Park Care Home DS0000025559.V341034.R01.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) 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) Care Home 63 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.V341034.R01.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 23rd May 2006 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. Euxton Park is on a bus route and within easy reach of 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 inspection fifty-four 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 rooms, the majority of residents with nursing needs are located on the first floor of the building 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 residents can access as they wish. Visitors are welcome at any time of the resident’s choice and 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 £342 50 to £650.00 per week with an additional top up charge for those residents who are assisted in meeting residential care fees. Additional charges are also made for hairdressing, private chiropody, personal toiletries, continence products and newspapers. Information about the facilities and services provided can be found in the home’s Statement of Purpose and Service User Guide. Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place during the course of two mid-week days and in total spanned a period of approximately seventeen and a half hours. The lead inspector and a second inspector who was at the home for a slightly shorter period of time conducted the inspection. The twenty-one core standards of the thirty-eight standards identified in the National Minimum Standards-Care Homes For Older People were assessed along with an additional standard. A random inspection, looking at a specific number of issues, had taken place in June 2007 following concerns that had been raised. This was followed by two further random inspections undertaken by a Commission For Social Care pharmacist inspector looking specifically at medication practices within the home. Random inspections are conducted to look into particular areas of service provision and do not look at all the key national minimum standards. Reports relating to these visits in June and October 2007 are held at the CSCI office and will be made available to enquirers on request. The requirements and recommendations identified at the last key inspection and more recent random inspections were also reassessed to establish what progress had been made. We spoke with the home’s manager, the company’s regional manager, the deputy manager, the home’s administrator, two qualified members of staff, three care assistants, the cook on duty and the home’s handyman. In addition, individual discussion took place with nine people living at the home and four relatives who were visiting. A few other residents were briefly spoken with collectively in a communal area of the home. A number of records were also examined and a tour of the building took place that included communal areas of the home, the laundry and kitchen and some bedroom accommodation. Information was also gained from the Annual Quality Assurance Assessment completed by the previous manager of the home. Every year the registered person is asked to provide us with written information about the quality of the service they provide and to make an assessment of the quality of their service. This information, in part, has been used to focus our inspection activity and is included in this report. In addition, a number of residents and relatives/friends also completed a Commission for Social Care Inspection survey forms that helped to form an opinion as to whether resident’s needs and requirements were being met. Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 6 This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. What the service does well: What has improved since the last inspection? What they could do better: The system for medication practices must be improved to make sure that medication is administered and recorded correctly and that resident’s requirements are met in full. Individual care plans, that tell staff what each resident can do independently and what help or assistance may be required must be more detailed and cover all the needs and requirements of that person. The review of individual care plans, that is needed to make sure that the information recorded is up to date, Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 7 should include the resident where ever possible so they can have their say as to what help or assistance they feel they need. Some residents spoken with felt that the food provided was not as good as it had been. The manager is aware of this and taking steps to improve matters. Some staff have still not received first aid training, infection control training and food hygiene. This should be provided to ensure that staff are competent and well trained to do their job. 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.V341034.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is adequate. The home’s Statement of Purpose and Service User Guide are made available but do not always contain current, up to date information. Residents and prospective residents cannot therefore be confident that the written information provided is accurate in content. A new pre admission assessment tool has recently been introduced. This covers a wide range of topics to make sure that the current strengths and needs of a prospective resident could be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From discussion with the recently appointed manager of the home, it is understood that, as required in the recent random inspection reports, the home’s Statement of Purpose and Service User Guide have been revised and updated. However it was evident that the Statement of Purpose still contains Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 10 some inaccurate information and does not incorporate all of the required elements to ensure that residents, prospective residents and other stakeholders are provided with clear, accurate and up to date information in order to make informed choice. The manager explained that all residents are provided with an individual copy of the home’s Service User Guide. This booklet tells residents and prospective residents about the services and facilities provided and information about what they can expect when living at the home. Although the Service User Guide does generally contain more comprehensive information, some of the detail is ‘old’ and in need of updating to ensure that the information provided reflects current practice. For example, the outcomes of resident’s questionnaires were detailed in the Service User Guide but this related to surveys undertaken May 2004 rather than the outcomes of more recent resident questionnaires. It is understood that resident questionnaires were again provided several months ago and that the outcomes of this internal system for monitoring quality would be incorporated in the amended Service User Guide. It is essential that reference be made to Regulation 4 & 5 and Schedule 1 of the Care Homes Regulations 2001 and Standard 1 of the Care Homes for Older People, National Minimum Standards to ensure compliance. The information provided in the Service User Guide should be written in a language and suitable format that would be easily understood by people living at the home and made available in large print, on tape or by any another means that would ensure, as far as possible, that people are enabled to understand the content. It is understood that it is now company policy that the Service User Guide will be available on tape for all residents by the end of the year. These two documents should be reviewed and amended as required on at least an annual basis to ensure the information provided remains current. In order to ensure that residents are only admitted to Euxton Park Care Home if their requirements can be met, the home’s manager or deputy manager undertakes a pre admission assessment of current strengths and needs to determine if the level of care and support required can be provided at the home. This is coupled with an invitation for the prospective resident and/or their family to undertake an introductory visit to the home to assess the accommodation for themselves, meet staff and existing residents in order to make informed choice about living at the home. The pre admission assessment carried out by the home’s manager or deputy manager, is in some instances, further supplemented by information made available from professional assessments undertaken by Care Managers or through hospital discharge Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 11 information. This combined information is then collated and provides a basis for the initial care plan. The Dependency Assessment Rating Tool (DART) used to record the outcome of the pre admission assessment covers various areas including daily life skills, mental health, multi agency input, and social care needs. However on the completed pre admission assessments of two recently admitted residents, no reference was made to recording information relating to cultural or religious needs or specific requests to ensure that any individual requirements could be met at the home. The DART assessment comprises of a scoring system against a set of dependency statements with space for comments. Although initially completed prior to admission, the information is built on following admission and reviewed regularly to update the needs assessment. For existing residents the DART tool is also being used to transfer information from previous documents. However on at least one of the DART assessments with regard to a recently admitted resident, it was impossible to tell what information had been gained pre admission to decide if needs could be met and what information was post admission as the information had not been dated when written. It is strongly recommended that all entries in respect of resident’s files be signed and dated by the person completing the record. This is necessary to ensure that the person recording the information takes ownership of the record and to confirm accuracy as to the content. Although raised as a requirement in the last random inspection report, it was noted that newly admitted residents have still not been provided with written information prior to admission in order to confirm that the home could meet their current individual assessed needs and requirements. There is a requirement that each prospective resident must have it confirmed in writing, that having taken account of the outcome of the pre admission assessment, that the care home can meet the individual needs of the prospective resident in respect of their health and welfare. The manager stated that in future, all prospective residents would be provided with this written information prior to admission. Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 12 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. Care plans are in place but are often limited in content and therefore do not always give staff the information they need to provide a consistent service. The health care needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. The medication in this home is better managed but people using the service are still not provided with a robust, consistent and accurate medication administration system. This could potentially place residents at risk and affect their health and well-being. Personal support is generally offered in a way that promotes and protects resident’s privacy and dignity however this is not always consistently applied. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 13 During the course of the site visits, the care of four people living at the home was ‘case tracked’. (Two from the nursing unit and two from the residential care unit). Several other care plans were also seen in order to triangulate evidence or clarify an issue. DART assessments were seen on all plans evidenced. However information recorded was not all dated therefore it was unclear if all the information was current and up to date. All included personal and contact details, three included a photograph of the resident, one did not. One care plan seen had not been completed until two days after admission. Care plans evidenced predominantly focused on medical and personal care tasks rather than being holistic in content. Very little direction was given to staff in the care plans about individual strengths and how these should be promoted. Nothing was seen about religious or cultural care requirements and very little about individual social care needs and how these were to be met. Even when psychological or emotional needs had been identified in the DART assessment this was not necessarily followed through to the care plan. The quality of the care plans seen was variable. In the main the care plans seen did give adequate and in some cases good information about medical and personal care interventions. The DART assessment sometimes also contained some information about what a particular resident likes for example, a specific soap and baby talc. However information from the DART is not always transferred to the care plan in order to direct staff as to what is action is required to address an issue or instruction as to how the task is to be completed. This is necessary to ensure consistency. In respect of one resident there were very individual directions to staff on how to attend to personal care needs. However, although the movement section of the care plan included information about bathing and showering, the assessment indicated that this resident was bed bound. Updated DART and review notes provided additional information about a nutritional supplement but the updated information had not been reflected in the care plan. This same resident has a sensory impairment and although some individual directions were provided about this resident liked listening to certain C.D’s nothing was written about how staff should approach this resident or introduce themselves or the importance of describing items etc. The section on the care plan in respect of dressings wounds was completely out of date and did not reflect current requirements. The mental health section of the DART indicated that this resident was disoriented but had some insight however the record does not say into what. There was a score recorded of 2 for depression but no further comment made. Obsessive-compulsive behaviour was also recorded but then not elaborated on in order to advise or guide staff on how to respond. Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 14 Risk assessments were in place. There was a monthly evaluation of scores record but this had not been completed monthly, the most recent dates being 03/06/07, 05/08/07 and 04/10/07. A new plan was in place with regard to moving and handling. The falls risk assessment indicated a high risk but did not seem to take into account that this resident was bed bound. There was no evidence to confirm that the care plan had been discussed with the resident and/or relatives and the daily notes completed in respect of this resident were very brief statements that did not give any sense of the person. With regard to another resident, the medical history indicated a long-term mental health condition however there was no mention on the assessment and care plan about mental illness or how this person was affected by it. From discussion with a member of staff it was confirmed that this person continues to exhibit symptoms of the diagnosed mental illness but the directions to staff about how to respond to this issue was completely inadequate and require an urgent review and update. The last recorded review in respect of this resident had taken place in March 2007. There was no evidence that further routine monthly reviews had been undertaken and the plan did not fully reflect current strengths and needs or personal situation. Some of the directions on the care plan were inadequate or irrelevant as no need had been identified and gave no real meaningful direction to staff. This must be addressed and the care plan reviewed and updated. The care plan of a resident recently admitted for a period of short term care was more informative and covered all needs identified during the assessment. Directions for staff on the assistance required and how tasks should be completed were satisfactory. However the daily notes made several references to this resident being confused and unsettled but the care plan did not address this. In this instance, the original care plan should have been reviewed and updated to provide staff with clear directions of the strategies to be adopted when the resident was confused and unsettled. This would help to ensure that staff responded to this issue in an appropriate and consistent way. With regard to a further resident, comments on the ‘daily life skills’ that was updated on 11/10/07 showed a marked deterioration in daily living skills but scores on the DART remained the same. This gave conflicting information. For example the review showed that this resident became incontinent when in hospital but there was nothing to show whether/how staff were assisting the resident to regain continence. The care plan had not been updated in respect of social needs and abilities. The care plan still indicates that this person is sociable and joins in everything but the review notes show that encouragement is now required. There was nothing on the care plan regarding a number of issues identified at assessment such as communication, and how a specific disability affected her daily life or what staff needed to do to assist this Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 15 resident regarding this issue. Some risk assessments had been reviewed but there was no evidence to confirm that all had. The DART indicated that this person is resistive during moving and handling techniques but the care plan did not specify what staff should do in this situation. Again the daily notes completed by staff were brief. One record was that “pads changed as needed” but did not state how often this was and the care plan did not state how often or when it should be changed, therefore staff could be providing inconsistent care. A number of very brief, recent incident records were evidenced relating to aggressive behaviour towards staff but there was no plan of how this was to be addressed. One care plan contained some brief directions that included ‘refer to stoma nurse as necessary’. A member of the nursing staff team confirmed that this resident sees the stoma nurse regularly who provided some special wipes and powder (not on care plan). The care plan is still in date but needs more specific directions, for example to define ‘as necessary’. All assessments and care plans should be automatically reviewed and updated as required on at least a monthly basis or more frequently if required. The formal review of the care plan should be undertaken in direct consultation with the resident when ever possible. Alternatively, and with the prior consent of the resident, a relative could be invited to the review in order to express their view as to the content of the care plan and whether they felt this would fulfil their relative’s requirements. Alternatively the amended care plan could be discussed with the relative when they visit. Failure to do this could mean that care plans and risk assessments are staff directed rather than fully involving the resident in the decisions taken relating to their strengths, needs and requirements. Several residents spoken with individually did not have any knowledge of their individual care plan but expressed an interest in seeing it and having it explained to them or being provided with an individual copy of their own care plan. This would help residents to gain some understand what staff do and why they do it and provide opportunity for residents to decide if the directions on the care plan are practiced on a day to day basis. The comments made by residents would also assist in the monthly review process. One resident spoken with said that “I have never seen a care plan and know nothing about it or any review. I have never been asked about it but would like to be asked what I think about what help I need.” Likewise a relative wrote on Commission for Social Care relative surveys in response to the question ‘How do you think the care home can improve’ said, “Regular (possibly 6-8 weeks) more formal meetings to review care plans/progress/strategies for care/handling plans and “A family service plan or person centred plan for each resident to be created on admission” and “More involvement with physio/occupational therapist to devise therapeutic handling Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 16 plan”. These comments suggest that neither residents nor relatives are routinely involved when devising care plans or undertaking reviews. As identified in Standard 7.6 of the National Minimum Standards, Care Home’s for Older People, care plans should be drawn up with the involvement of the resident, recorded in a style accessible to the resident and agreed and signed by the resident wherever capable and/or representative (if any). Residents spoken with were however in the main satisfied with the care they receive. One resident spoken with said that “they look after us well enough but it’s not the same as home”. Another person said, “I am a doctor’s daughter and doctor’s wife and I have never been fussed over as much as I am now”. Another person said “They are very good with us, get very good care and I can’t complain about that”. A relative also passed comment that “staff carry out their tasks very well” and that “staff are perceptive about mum’s problems-generally speaking they are alert and aware of needs and I am happy with the care”. Another relative wrote on a Commission for Social Care Inspection survey form that, “Most of the carers give mother good care and support. She has built a good relationship with some of the staff. All cope with her physical needs now. Sometimes she needs more reassurance and emotional support than she is given”. A further comment on another survey form was also similar when stating, “Care home meets the physical needs of my relative but not the emotional needs as consistently” Although it appears that relatives felt that physical and personal care needs are addressed to the resident’s satisfaction, there is some concern that emotional and psychological needs are not met as well. It is important that the assessed emotional and psychological needs and requirements of residents are given as much emphasis and direction on the care plan as physical care needs in order to provide a holistic approach to addressing strengths and needs. Since the last inspection, staff have made some improvements to assessment and care planning. There is a new senior management team in place who are working with staff to further develop care planning in order to encompass all strengths and needs including psychological, emotional, social, religious and cultural needs and requirements. 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. There was no concern about referrals for medical assessment or intervention been requested late or inappropriately. Advise from other professionals was usually but not always incorporated into the care plan. The recording of advice given should be consistently applied to ensure accurate detail is recorded that cannot be misunderstood. Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 17 At present one resident who is diabetic but not assessed as requiring nursing care has weekly blood glucose monitoring undertaken by registered nurses employed at the home. This should not be happening, any resident not assessed a requiring nursing accommodation should have their nursing requirements met by the Community District Nursing Team. The deputy manager is aware of this. There is some provision for district nurses to delegate some invasive procedures for none qualified staff to undertake. However the district nurse must ensure that the person(s) undertaking the procedure are appropriately trained. The district nurse must provide monitoring and oversight as in these instances the district nurse retains overall responsibility to ensure that the procedure is carried out correctly and at the right time. The district nurse should also sign to confirm that the person(s) carrying out the procedure are competent to do so. In all other situations any procedures that require the input of a qualified nurse should be referred to the Community District Nursing Team. A resident spoken with confirmed that his medical needs were well met and said, “It’s alright-it took me a time to get settled but I’m contented enough. I can’t stand I occasionally have physio-they move me on a hoist-always use that. I had eczema but they put cream on it and it’s smashing now. They are on their toes.” Euxton Park Care Home has available a corporate policy and procedure for the administration and recording of medication that staff are required to adhere to. A Commission for Social Care Inspection Pharmacist Inspector carried out two recent random inspections at the home following concerns about medication practices. The Pharmacist Inspector has advised the home of the findings of these random inspections independently of this report. Although some improvements have been made, this is an area that still requires ongoing attention to ensure that medication practices are robust and consistently applied. This is to make sure that residents are well protected and that medication is provided as prescribed. The manager explained that additional safety measures have been put into place including a daily medication audit. However at present this does not include checking the remaining stock. The deputy manager said that she would introduce a random audit of this to provide a more robust system of auditing. An external enforcement agency is to attend a staff meeting and talk to staff about accountability with regard to medication. All staff with responsibility for the administration and recording of medication have recently received medication retraining. However during the course of the site visit, some inadequate medication practices were observed. In one instance medication had been given to a resident in a pot while having lunch. This resident does not normally take the Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 18 medication until after lunch. An agency worker did not know the normal routines of the resident and took the medication away before the resident had taken it. It was the resident herself that alerted staff that she had not taken her medication. The member of staff was advised that it was not good practice to leave medication unattended and that part of the administration policy was to watch residents taking medication. In some instances there was some discrepancy in the amount of medication available against what the medication record indicated should be left. In another instance the medication administration record (MAR) and the assessment and review notes contained differing information. On one MAR sheet it was indicated that a supplement was given four times a day but only twice on the food and fluid chart. There should be consistency of information on both of the charts used to ensure an accurate record is maintained. There was confusing information observed in another instance that appeared to be the result of poor record keeping and information not updated. The administration and recording of controlled drugs was accurate and the majority of ‘when required’ medication had a criteria list to indicate when the medication should be given. This helps to ensure that consistency and provides clear guidance to staff. However in once instance, a resident was prescribed morphine for breakthrough pain however this had not been written onto the MAR chart. Any person administrating medication, particularly agency nurses would not have known about the prescription and the resident may not have had his pain adequately controlled. There was good direction on one plan that described signs of behaviour that indicated ‘when required’ medication should be given. It was observed that special instructions with regard to give with/after food was clearly highlighted on the MAR and the manager explained that an additional early morning medication round has now been introduced to make sure that residents received all their medication as prescribed. The home has policies and procedures 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. In the main residents spoken with felt that in practice their privacy and dignity was well respected with one resident saying, “If anyone wants to come in they knock before they enter”. Another resident explained that he sometimes “closed the bedroom door and have private space. They always knock-not just a cursory knock” Members of staff spoken with also gave some good examples of how resident’s privacy and dignity is promoted within the home. Staff were seen to be speaking politely and respectfully with residents and were seen to knock on bedroom doors before entering. However some improvements could be made to ensure that privacy, dignity and confidentially are better maintained. Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 19 Although residents usually see their General Practitioner (G.P.) in their bedroom accommodation, it was observed that during an evening meal period, one resident was wheeled into the communal reception area of the home where the consultation with his G.P. took place. Whilst it is acknowledged that no resident, relatives or other visitors were present in the area at the time, the resident should have been automatically taken to his room when the G.P. visited. Another resident said, “Any problems I tell them in the morning and they get the doctor. I usually come to my room-only once been seen in the dining room.” One resident spoken with described how she felt her dignity had been compromised when she had had to wait “a very long time” for staff to assist her to the toilet. This had caused the resident great distress and embarrassment. There should be sufficient staff on duty at all times to prevent this sort of embarrassment from occurring. It was noted that various notices were on display in individual bedroom accommodation that generally contained information for staff. Some of this information was highly personal about the needs and requirements of the occupant. Other notices were about bed rails, named nurse and the name of the resident, moving and handling needs and the use of aqueous cream instead of soap. Not all bedroom doors have locks provided, some people were very poorly and in bed with the bedroom door open. This made any notices visible to anybody passing including other residents and visitors to the home. Staff should always be mindful that information personal to the resident, whether this is verbal or written, is confidential and should always be treated as such. Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 20 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. Residents are encouraged to keep in regular contact with family and friends in order to maintain family and friendship links. The routines of daily living are kept flexible to enable people living at the home to, as far as possible, live the lifestyle of their choice. Dietary needs of residents, including catering for special dietary needs, are catered for but this does not always meet with residents taste and choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Several residents spoken with confirmed they are able to exercise choice in there every day lives and choose to do what they want to do and when they want to do it. One resident said “I go out with the activity person and can go out myself around the grounds as long as I tell someone. I have plenty of choice. I have a tablet at 7:00am so I choose to get up then. If I was out they would keep my lunch for me. People can go to bed whatever time they want. It Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 21 usually goes quiet around 11:00pm. Not a lot of rules-just for safety-they are predominant now”. Social relationships are encouraged either through family/friends visiting at a time of the residents choice or social stimulation in the wider community. A notice is displayed in the reception area of the home to confirm that visits to resident’s is unrestricted but there was a polite request to avoid mealtimes if possible. One resident spoken with explained that her daughter visits four times a week and her son also visits regularly. Both are “made welcome”. Relatives were greeted by staff and offered a drink. One relative visiting at lunchtime was offered a meal. It appeared that there was a good relationship between staff and visitors that helps to create trust. A variety of social activities are arranged ‘in-house’. There is a designated activities coordinator. The activities programme is displayed in the entrance area of the home however the activities coordinator explained that the programme is flexible and in the main residents decide what activity they would like to do each day. During the course of the site visit a Halloween party was taking place that was enjoyed by all those who attended. On admission the activities organiser stated that she visits newly admitted residents to find out what they enjoy doing and to provide information about the activities already available. Time would be spent in introducing different activities currently not provided such as painting if this was what the new resident enjoyed. Quizzes, ball games, armchair exercise and one to one nail care are enjoyed and a knitting group is to be set up as some residents enjoy knitting. A book-reading group is also enjoyed that helps to promote discussion and debate amongst residents. It is understood that outings are also arranged to places of interest including walks to the local pub. A relative commented that, “usually plenty of activities, activities organiser works like a Trojan, every one is catered for. Arranged for them to go out-to the lights. She gets them out”. In the nursing unit where people are more dependent the activities coordinator explained that she visited a number of residents who were in bed each day sometimes just to talk and stroke their hand. This could last anything from a few minutes to an hour depending on what the resident wanted. The activities organiser also said that she spent time with residents who were sensory impaired and tried to provide suitable activities of their choice. A member of staff spoken with also explained that routines within the home are now a lot more flexible with staff spending time sitting down with residents and chatting informally. This supplements the time spent with residents by the activities coordinator. Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 22 Although on some DART assessments, social interests were identified this was not followed through to the care plan to detail how the need was to be addressed. Residents’ care plans evidenced also did not include detail regarding any specific cultural or religious needs. However a Minister from a local church visited the home during the course of the site visit to conduct a communion service for residents who wished to participate and a resident spoken with said “I had communion last week which was very nice. I am a Catholic and it makes me feel better”. All needs and requirements in respect of social, religious and cultural, requirements should form part of the formal care plan in order inform and direct staff as to the holistic needs of the whole person. All residents at Euxton Park Care Home are encouraged to maintain control of their own financial affairs for as long as they wish to and have capacity to do so. However in reality, the majority of resident’s are assisted in this task by a family member or external advocate. Details of advocacy services are made available for resident/relatives to access if and when they choose. From observation and discussion, it was clear that residents are encouraged to bring some of their own possessions with them into the home to make their individual bedroom feel homely and more familiar. One resident spoken with in her bedroom said she was pleased to have familiar things around her including a musical keyboard for playing tunes. Comments from residents regarding meals and meal times was mixed. Whilst one resident said, “Meals are very nice I chose braised steak today. They have plenty of vegetables everyday – a decent choice. In the evening I have soup or cheese on toast. They always ask if I am alright or need help when I am eating” and another person said, “The food is usually OK. If you were to write down the menu it is nutritionally balanced but the cooking varies” and “Foods alright-get plenty for me”. Other residents were however more critical of the meals served of late. Comments ranged from, “The meals are alright but I would expect better” and “Food could be improved we lost our cook-she retired I think-it’s not been the same since” and “I had a dry and curled up pork chop today-I could not eat it” and “I have not enjoyed the food over the last few months, potatoes slimy and wet, very disappointing. I sometimes feel hungry because of the food. My family bring me a food to have in my bedroom. There is not much fresh vegetables. I would like fresh fruit for dessert rather than that instant whip stuff, it’s like food you give to children”. Clearly the expectations of certain resident’s in relation to the quality and quantity of the food served are compromised. Some residents are clearly not enjoying the food provided. A relative also commented that there “had been some problems with the food. Were only very small portions but it seems a bit better that’s one of the things that needs checking. The manager stated she was aware of the dissatisfaction of some residents regarding the meals served and was taking steps to address this issue. Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 23 The cook on duty confirmed that written information is provided to kitchen staff about any specialist dietary needs at the time of admission. There is a four weekly rotating menu that has recently been updated. A vegetarian option is now available at each meal. A carer talks with each individual resident on a daily basis about the menu for the main meal for the following day to enable residents to select their choice. For the evening meal, a variety of food is sent to the dining rooms and care staff asks each resident when they would like to eat from the choice provided. If a resident did not want something from the foods provided and alternative of choice would be offered. Refreshments are served at various times during the day to supplement the main meals. The dining rooms were attractively arranged with full place settings. Alternatively, residents could have their meals in their rooms if they wished. Equipment was available to help residents to maintain their independence and staff were observed in the main giving assistance to residents in a sensitive manner. However on at least one occasion staff were heard shouting to each other across the dining room. This did not create a calm and relaxed environment for people to enjoy their meal. On another occasion a carer wheeled a resident into the dining room, left him in the middle of the floor without a word, went away, came back and then continued to wheel the resident to a table. The resident was given no indication of why he had been left unattended in the middle of the dining room or if anybody was going to assist him to the dining table. This could clearly have been avoided if the carer had conveyed the actions he was to take with the resident rather than the resident being left bemused. Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 24 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. The arrangements in place for handling complaints ensure that people feel confident that their complaints will be listened to and taken seriously. Adult protection measures are in place in order to help ensure that people living at the home will be protected at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a detailed corporate complaints procedure, which is made available to all residents on their admission and incorporated in the home’s Statement of Purpose and Service User Guide and in communal areas of the home Any complaint received is documented and investigated with a written outcome of the investigation findings provided to the complainant. On the documents seen, although the method of investigation was detailed in the letter to the complainant, this was not evident on the complaint/investigation form. It is recommended that the method(s) of investigation is included on the complaint/investigation form to provide clear detail of how the complaint was investigated. Since the random inspection, that took place in June 2007, staff training in respect of complaints has been included in the induction training programme provided to all newly appointed staff and is also documented in the staff Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 25 handbook. This will help staff to recognise when a complaint has been made and what to do with the information to make sure that the complaint is investigated. It is important that all staff respond consistently when a complaint has been made, record the information accurately and inform the management team to insure that the complaint is recorded and investigated. Comments received from residents and relatives confirmed that they were aware of how to make a complaint and felt these would be listened to and acted upon. One resident said, “I feel quite safe with them (staff)” Another residents said “I can’t think of anything I couldn’t speak to someone about. I had some problems with the laundry but I think they are getting it sorted out”. A relative commented, “If it’s a minor thing will speak to the person concerned and they usually sort it out. Will bring things up at the meeting”. There is a policy and procedure in place for dealing with allegations of abuse. This policy and procedure should be kept under regular review and provide explicit information about who takes the lead and when to contact each authority. The management team and staff spoken with had an understanding of the procedures to be followed in the event of any allegations or suspicion of abuse or neglect. Since the last key inspection one adult abuse allegation has been made. This was thoroughly investigated using the multi agency adult abuse protocols. As a result of this the home has made some improvements. The improvements made must be sustained and build upon to provide a continuing improving service. Evidence was seen that all staff would have received adult protection training or retraining within a few days of the site visit. This training provides guidance in relation to recognising abusive practices and how to deal with this issue. It is important that all staff has understanding of the local protocols and be clear about what they can do and must not do if an allegation of abuse is made to them. One qualified member of staff spoken with who potentially could be left in charge of the home gave some inaccurate information about their role if an allegation of abuse was made. It is important that once adult abuse training has been completed, the management team make sure that staff is clear about their responsibilities and the action to be taken. Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 26 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. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents at Euxton Park Care Home live in comfortable, bright, welcoming and well-maintained accommodation. The layout of the home provides residents with opportunity to move freely round the building and access all areas with ease. 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 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 Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 27 items such as pictures and ornaments to make their bedroom more homely. Communal areas are 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. There is a passenger lift for ease of access throughout the building. The fixtures and fittings are of a high quality, well maintained and well adapted to meet the wishes of the current residents. 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 ongoing problem with the heating system has now been resolved, hot water is now freely available at all times. Staff and residents spoken with both confirmed this. 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 all pleased with their bedroom accommodation and the communal space provided. One person said, “They say my room is beautiful-I can’t see it, my bed is comfy. Another person said “It’s a beautiful place and lovely gardens-go out in the summer. I have a room with a viewwatch people taking their dogs out.” However one relative felt that the “bedroom could be cleaned a bit more” and that there has been a drop in cleaning standards over the last few months. Since the last random inspection in June 2007, some improvement was noted in maintaining a hygienic environment and in infection control standards. This must be maintained. Staff were seen to be using protective gloves and aprons and disposable wipes were available. At the time of the site visit the home was clean, tidy and free from offensive odours. It was noted that a number of individual bedroom doors have not as yet been provided with an appropriate lock to ensure privacy for the occupant. It is understood that residents were asked if they would like a lock on their bedroom door and all but one resident declined. Never the less there is an expectation that all bedroom doors in resident accommodation be routinely provided with a suitable lock with the resident retaining the key. It is recommended that when a bedroom becomes vacant, a suitable lock be fitted before a new resident occupies the room. In instances when a lock may not be appropriate, this should be determined through the outcome of a formal risk assessment and reviewed on a regular basis. Likewise, if an existing resident refuses to have a lock fitted to their bedroom door this should be clearly recorded and regularly reviewed. Of the four care plans evidenced of the people who were ‘case tracked’, three of the care plans contained a bedroom assessment incorporating a checklist of equipment, furniture and safety measures for example window restrictors and Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 28 radiator guards. However there was no obvious indication of the action taken to address any concerns highlighted and no evidence of review. In one instance the assessment showed that some contents of the bedroom caused concern regarding the fire risk assessment but there was nothing to show how this had been addressed. There was no separate fire risk assessment on the care plan. It is recommended that whenever a concern is identified following a bedroom assessment, that a risk assessment in routinely undertaken and the action taken to address the matter clearly recorded. 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. Discussion with the designated laundry assistant confirmed that the system in the laundry has been tightened up and there are less incidents of clothing being misplaced. As identified in the Annual Quality Assurance Assessment completed by the then registered manager at the home, only eleven members of staff have received infection control training. The present manager confirmed that only a minority of staff have received up to date infection control training. It is understood that qualified members were recently provided with an infection control, training workbook. Once these have been completed, returned and assessed, other staff will be provided with the same training. It is important that staff have clear, up to date training that is put into practice to ensure that good and effective infection control measures are in place. Sluicing facilities and a sluicing disinfector are provided. Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 29 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. Although the situation is improving, there has recently been a high level of staff turnover and dependency on agency staff. This does not always provided a consistent service. The arrangements for National Vocational Qualification (NVQ) training in care are improving with a further number of staff achieving this qualification. This helps to provide a good quality of care that is consistently applied. There is a structured process for the recruitment of staff that includes obtaining satisfactory references and clearances in order to protect people living at the home. Induction training is compliant with ‘Skills For Care’ induction training standards and provided to newly appointed care staff within the first six weeks of employment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observation of the staff rotas showed that the home is staffed with a suitable skill mix of staff. Additional staff are on duty at peak times of activity and all night staff have waking watch responsibility. In the main residents had Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 30 confidence in the staff that care for them and were generally satisfied with the overall standard of care received. However there was disquiet from a number of residents and relatives spoken with about the number of staff on duty at any one time and the length of time residents sometimes had to wait for assistance. Residents commented that, “sometimes short of carers, we are today. Means we have to wait” and “Carers are nice but always short-a lot of sickness-we have to wait a very long times for things” and “Very patient staff, anytime you ask anything, no problem. Sometimes have to wait if they are short, I use my buzzer”. Other residents spoken with also reported that sometimes they had to wait a very long time for staff assistance when they pressed their buzzer. Two residents said that this had caused them a great deal of distress. Clearly outcomes for some people living at the home were at times compromised with staff response times being too long to provide a good service. Relatives also voiced concerns about the number of staff on duty with one relative saying, “They could improve by employing more staff, they are living to an extent on goodwill and too many agency staff” and “ Not always enough staff on sometimes they are very pushed. Staff always pleasant. There have been some new staff” and “ Main complaint is staff shortages. Too many agency staff-they don’t know the patients needs”. Some staff also felt that at times staffing had not been as good as it could be. One qualified member of staff reported that things had sometimes been really bad that was compounded by the need to use agency staff. However this person felt that the appointment of the deputy manager had made a big difference. From discussion with the manager it is understood that staffing numbers have been increased of late and vacant posts are in the process of being filled. This will reduce the dependency on agency staff. There does not appear however to be any formal system for determining staffing levels against residents dependency needs and requirements. Given that a significant number of residents and relatives spoken with considered insufficient staffing to be an reoccurring issue in addressing needs within an reasonable and realistic time scale, the number of staff on duty at any time should be kept under constant review with outcomes acted upon. Since the last inspection further members of the care staff team have achieved a nationally recognised qualification in care. Currently 15 of the 27 members of the care staff team have achieved at minimum a National Vocational Qualification (NVQ) Level 2 in care. Although currently no further NVQ training is taking place, four members of staff are on a waiting list to commence NVQ Level 2 and a further two members of staff are on a waiting list to commence Level 3 of this award. On carer spoken with explained that he had been working at the home for an extended period of time and although he had Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 31 expressed a wish to undertake an NVQ qualification in order to extend his skills and knowledge, he was still waiting to be offered a place. However evidence was seen that individual training needs had been identified and the some relevant training courses arranged to ensure that a well-trained and competent staff team is caring for residents. Euxton Park Care Home has in place a structured, corporate recruitment policy and procedure that help protect residents. Since the last inspection, some new members of staff have been appointed. From observation of four recently appointed staff member’s personnel file, it was evident that the recruitment policy and procedures had been followed. This included an application form, health questionnaire, formal interview, references and a Criminal Records Bureau (CRB) clearance had been obtained prior to the applicant actually taking up post at the home. However the CRB clearances were not available for inspection. This situation occurred because some false information was provided. The organisation and home’s manager were aware of this prior to the site visit taking place and have taken action to ensure that the correct procedures are undertaken in the future. All newly appointed staff are provided with induction training appropriate to their role. This includes different induction training for qualified staff, experienced care staff, inexperienced care staff and ancillary staff. Appropriate staff also receives induction training that is compliant with the ‘Skills for Care’ common induction standards for care staff. In the main the interaction observed between staff and those living at the home was warm, friendly and comfortable which helped to make residents feel happy, safe and secure. There was generally a good rapport between residents and staff that helped to create a supportive and caring environment. One person spoken with said, “Staff on the whole are very good”. Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 32 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, 36 & 38. Standard 37 in part Quality in this outcome area is adequate. The manager has an understanding of the areas in which the home needs to improve. Some planning had taken place as to how this was to be resourced and managed. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 33 A new manager has very recently been appointed at Euxton Park Care Home. This person is a registered nurse who has successfully completed a Batchelor of Science Honours Degree in nursing studies and the Registered Managers Award. The new manager is also experienced in running a care home for older people. It is anticipated that an application will be submitted to the Commission for Social Care Inspection in the near future in order for this person to be assessed for the post of registered manager at the home. Staff and residents talked with all spoke very highly of the new manager and considered her to be approachable, supportive and ‘good’ at what she was doing. A member of staff said that since the new manager has been appointed the staff group are more supportive of each other and now get on together much better for the benefit of residents. A resident said “Matron’s very good at making appointments for me”. Since the random inspection in June 2007, the external managers of the home have been making very regular visits to Euxton Park in order to monitor and review progress of the action plan designed to improve standards. It is understood that this close monitoring will continue for some time until all elements of the action plan have been addressed. Recently residents were asked to complete a survey outlining their views of the home. This survey covered a number of topics. The outcomes of this survey have been evaluated, analysed and recorded. The management team have now arranged a meeting to feedback this information to residents and their relatives. The external management team have also devised an Action Plan to address some of the issues raised. From discussion with the manager it was confirmed that consideration is being given to developing staff surveys to enable staff to formally ‘have their say’ about what they think about the running of the home and the current practices in place. Consideration could also be given to developing specific survey for other stakeholders such as Opticians, General Practitioners, District Nurses the hairdresser or anybody else that has an interest in the home. This would all help to inform the internal quality audit. Staff spoken with confirmed that formal staff meetings are now starting to take place on a more regular basis and resident/relative meetings are schedules to take place approximately every three months. Resident’s financial interests are 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 secure facilities are provided for the safe keeping of monies and valuables held on behalf of the individual. Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 34 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. In the recent past formal one to one staff supervision had been allowed to lapse, however this has recently been re-introduced for all staff. Two members of staff have recently undertaken leadership and supervision training to make sure they are equipped to formally supervise staff. Informal day-to-day staff supervision is on-going as part of the normal management role. Formal one to one staff supervision for qualified and care staff should take place at least six times a year and cover at minimum all aspects of practice, philosophy of care in the home and career development needs. Though there has been some improvement in record keeping this is an area that could be further improved. A relative was spoken with described an incident regarding safety relating to her husband. The brief daily records of this event gave a very different account of the relative’s concerns and anxieties and did not reflect a true account of events. The manager said she had not been made aware of the incident. It is essential that all records maintained are accurate and detailed to alert concerns and prompt any further actions required to ensure safety. Euxton Park Care Home ensures safe working practices are maintained through observing policies and procedures and staff training in respect of health and safety issues. Since the random inspection in June 2007, all staff have either received up to date manual handling training or are about to receive this training. All staff have now completed fire training except very new starters who will receive this training in due course. Less progress has been made however in ensuring all staff have received other health and safety training. The staff- training matrix showed that to date only a limited number of staff have undertaken food hygiene training and infection control training. It is understood that a food hygiene workbook and an infection control workbook are available and that staff will be expected to undertake this training. There is an ‘in-house’ trainer to provide health and safety training but only about 20 of the staff group have received this training up to now. At present only a limited number of care staff have received first aid training. This is a requirement. From discussion with the regional manager it is understood that this training again will be provided but not date has been arranged for the training to take place. Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 35 It was noted that the fire action notices posted in corridors instruct staff to evacuate where as the fire instructions in the entrance lounge instruct staff to carry out the Four Seasons fire routine. There seemed to be some discrepancies between the two. It is recommended that all fire instructions are re-examined to make sure they give the same instruction and that staff are clear about what they should do in the event of a fire. Maintenance records were available to confirm that various routine health and safety checks are maintained on a daily, weekly and monthly basis to the internal and external environment of the home. It was also noted that equipment is regularly serviced. Discussion with the maintenance person confirmed that all residents that require bed rails have now been provided with a profiling bed and the manager completes a bed rail audit on a regular basis the outcome of which is sent to the Regional Manager. Bed rail risk assessments are in place. In addition, risk assessments are available in respect of fire, health and safety issues that are regularly reviewed. Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 36 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 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 3 X 3 X 3 2 2 2 Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 37 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 Timescale for action 31/12/07 2. OP1 12 (4) 3 OP3 14(1)(d) The statement of purpose and service user guide must be kept under review and where appropriate revised to ensure the information provided remains current. The registered person must notify the commission and residents of any such revision within 28 days. (Time scale of 11/10/07 not met) 31/12/07 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 11/10/07 not met at the time of the site visit) The prospective resident must be 15/12/07 informed in writing that the home can meet their needs before they are admitted. This is so that they can be confident that they will be given the right care. (Previous timescale 11/10/07 not met) DS0000025559.V341034.R01.S.doc Version 5.2 Euxton Park Care Home Page 38 4. OP7 15 5 OP9 13(2) 6. OP9 13(2) 7. OP9 13(2) 8. OP38 18(1)(c) 9 OP38 13(4) Wherever possible the care plan must be drawn up and reviewed with the involvement of the resident or a representative. All care plans must be holistic in content to identify all needs and requirements. Care plans and risk assessments must be formally reviewed on at least a monthly basis. Medicines must be given to residents as prescribed and at the right time in relation to food intake. Receiving medicines at the wrong dose, wrong time or not all can seriously affect the health and well being of residents. (Not fully met previous timescale 30/07/07). Records of medicines received into the home and disposed of must be accurate to help checks take place to show that medicines are being given to residents correctly. (Not fully met previous timescale 30/07/07 as records of receipt still require improvement). All prescribed medication must be entered on the MAR sheet to ensure staff have the required information. Arrangements must be made for care and ancillary staff to have adequate training in infection control. (Not assessed at this inspection previous timescale 22/06/07) All care staff must receive basis first aid training. 31/12/07 31/10/07 31/10/07 15/12/07 28/02/08 28/02/08 Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 39 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP7 Good Practice Recommendations Religious and cultural needs and preferences should be detailed on the DART assessment. All recordings on the DART assessment should be signed and dated. 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. The Community District Nursing Team should always provide any nursing tasks required for residents that are not assessed as requiring nursing accommodation. Staff should not leave medication unattended on a dining table. Staff administering medication should watch the resident actually taking their prescribed medication. There should be consistency of information on the fluid and food chart and the MAR sheet. The daily medication should include a check of the remaining medication to ensure the correct amount of medication has been given/medication record is correct. Consultation between a resident and their G.P. should only take place in the privacy of their individual bedroom. Confidentially of information should be maintained at all times within the home. This applies to notices in bedroom accommodation. The meals served should be well-cooked and meet residents taste and choice. Staff should always convey their proposed actions to residents before transferring in a wheelchair. It is recommended that the method of investigation be identified on the complaint/investigation form. All staff should be competent to recognise a complaint and be aware of and follow the action required. The Adult Protection policy and procedure should be kept under review to ensure it is complaint with local protocols. The management team should make sure that staff have a clear understanding of their role and responsibility if an allegation is made. All individual bedroom accommodation should be provided with an appropriate lock with the resident retaining the key unless the risk assessment suggests otherwise. DS0000025559.V341034.R01.S.doc Version 5.2 Page 40 3. 4 5 6 7. OP8 OP9 OP9 OP9 OP10 8. OP15 9 OP16 10 OP18 11 OP19 Euxton Park Care Home 12 13 OP19 OP27 14 15. 16 OP27 OP37 OP38 Whenever a bedroom assessment highlights concerns, a formal risk assessment should be routinely undertaken and the action taken recorded. 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. All records completed should be an accurate reflection of what is actually happening so that they give a true account of events that have taken place. All staff that prepare, cook or serve food should be provided with food hygiene training. All staff that have not done so should be provided with health & safety training. It is recommended that the fire notices in the building are reviewed to ensure that they contain the same information, Euxton Park Care Home DS0000025559.V341034.R01.S.doc Version 5.2 Page 41 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.V341034.R01.S.doc Version 5.2 Page 42 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!