Inspection on 01/05/07 for Flower Park Nursing Home

This inspection was carried out on 1st May 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

Flower Park Nursing Home 09/10/07

Flower Park Nursing Home 07/11/06

Flower Park Nursing Home 08/06/06

Flower Park Nursing Home 13/10/05

Flower Park Nursing Home 11/05/05

Flower Park Nursing Home 09/03/05

Flower Park Nursing Home 19/10/04

Flower Park Nursing Home 15/12/03

Flower Park Nursing Home 20/05/03

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

CARE HOMES FOR OLDER PEOPLE Flower Park Nursing Home Rossington Street Denaby Doncaster South Yorkshire DN12 4BT Lead Inspector Sarah Powell Key Unannounced Inspection 1st May 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Flower Park Nursing Home DS0000015860.V330405.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. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Flower Park Nursing Home Address Rossington Street Denaby Doncaster South Yorkshire DN12 4BT 01709 863327 01709 860303 flower.park@fshc.co.uk www.fshc.co.uk Four Seasons Health Care (England) Limited (wholly owned subsidiary of Four Seasons Health Care Ltd) Post vacant Care Home 40 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 Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (24), Old age, not falling within any other category (16) Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The service may admit up to four persons between the age of 60 to 65 years within the category of Dementia (DE) and Mental Disorder (MD). One specific service user under the age of 65 (Mental Disorder), named on variation dated 22nd August 2006, may reside at the home. One specific service user under the age of 65 (Mental Disorder), named on variation dated 9th November 2006 may reside at the home. 7th November 2006 Date of last inspection Brief Description of the Service: Flower Park is a purpose built home situated in Denaby near Doncaster it is set in a residential area with shops, a market and other amenities nearby. The home is on two floors the upper floor is for service users with dementia and mental disorder years and has lift access, the ground floor accommodates nursing service users, Flower Park can accommodate up to forty service users. All rooms are single and the majority are en-suite with toilet and wash hand basin. The home has a suitable number of lounges, dining rooms, toilet and bathing facilities. The gardens are well maintained and easily accessible to the service users on the ground floor, access is limited for the service users on the first floor. The fees at Flower Park Care Home at the time of the inspection ranged from £410.00 - £470.00 free nursing care. (Nursing care bands are £40.00 low £83.00 medium and £133.00 high) for further clarification please contact the home. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection and took place over three days by a regulation inspector and a pharmacy inspector. The inspection began on 1st May 2007 at 9:00 am and finished at 3:30 pm this was both the regulation inspector and pharmacy inspector, on 2nd May the regulation inspector completed her inspection arriving at 2:00 pm and finished at 5:00 pm, on 4th May the pharmacy inspector completed the inspection and was at the home from 10:30 am to 12:30 pm. As part of the inspection process the inspectors spoke to 10 residents, 9 staff and 3 visitors. A tour of the building took place, observing environment, staff and care practices. A number of records were examined these included medication, two care plans, fluid charts, menus, staff rotas, recruitment and quality assurance systems. What the service does well: What has improved since the last inspection? What they could do better: Many areas have been identified in this report that require improvement to ensure service users needs are met. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 6 Care plans on the upstairs unit remain poor, service users needs are not clearly identified. Social and recreational activities still do not include all service users. The shower rooms were still in a poor state and have not been refurbished. The maintenance person had retired and had not been replaced and visitors had cut the lawns and collected the litter. The checks that the maintenance man had carried out had not been allocated to another person so had stopped. These checks were important to health and safety checks which safeguard the people who live at the home. The current position placed people living and working in the building at an unacceptable level of risk, which could easily have been avoided. This position again reflects the lack of management and leadership, which the home is suffering from. 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. Flower Park Nursing Home DS0000015860.V330405.R01.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 Flower Park Nursing Home DS0000015860.V330405.R01.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): 3, standard 6 is not applicable to this service. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The assessments lacked detail, which limited the actions of the care staff, in appropriately meeting the needs of the people living at the home. EVIDENCE: The assessments on the upstairs unit lacked detail and it was difficult to determine if the home could meet people’s needs from the assessments. The assessments on the downstairs unit had improved since the last inspection however they still needed more detail to ensure the home can meet the needs of the people who move into the home. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans did not clearly identify all needs and it was not clear if health care needs were fully met. There is a lack of a robust system within the care home for the recording and administration of medicines. This puts people at risk of not receiving medication as prescribed. There is a lack of a system in place to make sure medicines are kept safely. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 10 EVIDENCE: Two people were case tracked as part of the inspection process the plans on the downstairs unit had improved, they were detailed and comprehensive with risk assessments in place and the plans were reviewed. The plans on the upstairs unit still did not clearly identify needs. The person whose care plan was looked at had a pressure sore the wound assessment was not completed and their weight was not taken or recorded and some reviews were not carried out placing this person at potential risk. It was not clear from the care plans if all health care needs were being met lack of documentation would indicate that they were not being met. The inspector spoke to two Community Physiciatric Nurses that visit the home and they said that the mental health needs of the people who live at the home were not clearly identified and were not always met. The home care liaison team will visit the home regularly to try to improve this. The upstairs unit had a designated deputy in post and on the second day he was seen and he was aware of the need to improve the plans of care and had started making some improvements. Relatives and people who live in the home were spoken to they told the inspector that the staff maintained privacy and dignity. The report by the pharmacy inspector is included here in full to assist the provider and reader in identifying ongoing concerns. The reason for this visit was to undertake a pharmacist inspection of the service to look at arrangements within the home that support the safe handling of medicines. The inspection would also see if the previous requirements for medicine management had been met. The visit was over 2 days and lasted 7 hours and involved looking at medicine records, storage and administration. During the visit the inspector spoke to 3 people, the deputy manager and three senior nurses. Judgement: Quality in the management of medication is poor. This judgement has been made using available evidence including a visit to this service. There is a lack of a robust system within the care home for the recording and administration of medicines. This puts people at risk of not receiving medication as prescribed. There is a lack of a system in place to make sure medicines are kept safely. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 11 What they do well: • • • Forms are available to record details of medication prescribed as when required. This means staff have access to current medication instructions and can administer medicines correctly. A monthly audit system of medicines management has started. There is also a weekly audit undertaken by the nursing staff. This means there is a regular check on how medication is being managed. Support and encouragement is given to help people take their medication. This means that their medication is taken as prescribed. What has improved since the last inspection? • • Oxygen cylinders no longer in use have been returned to the pharmacy. People are asked privately if they want any medication prescribed as when required. This helps to maintain their dignity. What they could do better: • • • • The system for the recording of administration of medication is not consistent. This means there is a risk that people are not getting their medication as prescribed. The recording of the quantity of medication received into the home is not consistent. It is therefore difficult to trace medication received into the home and to confirm that the correct amount has been given. Medication carried over from the previous month is not recorded on to the MAR. This makes it hard to check if medication has been administered as prescribed. Secure storage of medication is not maintained. Medication not stored securely may go missing or be used by someone else. This puts people at risk of not receiving their medication as prescribed and on time. Findings: Record Keeping • • The current and previous months MAR charts were looked at for both floors. There is no list of staff signatures in the MAR chart folders. This means it would be difficult to identify who was involved if an error in administration was to occur. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 12 • • • • • • • There are identification sheets attached to the MAR charts used on the first floor. These sheets have each person’s name and photograph on and information on any problems the person may have with taking medicines. The list of problems for 2 people highlighted that medication could be hidden in food or drink. This is known as covert administration and should only take place after a detailed assessment and multidisciplinary team agreement has taken place. The inspector looked in the care plans for both and found no evidence that this approach had been taken. On speaking to the nurse on duty the inspector was informed that both people had taken their medication that morning without any problems. On the second day of the inspection the inspector found that the direction to hide the medication had been removed from both forms. The recording of medicine administration on the first floor is irregular. There were some gaps on the MAR. To demonstrate that people are getting their medication as prescribed the MAR chart should record every administration. The quantity of medication carried over from the previous month is not recorded. This makes it difficult to track how much medication has been administered. There is inconsistency in the recording of medication prescribed as one or two. It is important to record the amount given to provide clear information on how a person’s treatment is responding if a review was to occur. Handwritten entries need to include the quantity supplied, the date of entry, the signature of the person making the entry and a witness signature where possible. Similar requirements are needed for a change of dose or cancelled medicines. Details of the person authorising the change should also be included. This makes sure that there is an accurate record of any changes or new medicines. Medication that had been discontinued or a dose changed the previous month was listed on the new MAR. The pharmacy should be advised when medication has been stopped or changed to make sure the most up to date chart is in use. There is a form attached to each MAR chart detailing medication prescribed as when required. This form details the reason for the medication, how often to give and any special instructions. This is an example of good practice as it provides clear information to staff to make sure a person’s medication is given correctly. However not all medications prescribed as when required are listed on the form. Good practice such as this should be followed by all staff to make sure there is consistency. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 13 • • • • A weekly medication audit form is attached to each person’s chart. This form is completed by a member of the nursing staff and provides information on errors in record keeping. This is an example of good practice as staff can regularly check each other’s compliance with the policies and procedures in the home. Feedback can then be given to staff on a regular basis. The code ‘F’ is sometimes used to record no administration but there is no clear reason written on the chart. This means it is difficult to know why a person has not had their medication as prescribed. A clear record of why medication has not been given would also help the prescriber when reviewing a course of treatment. Entries for antibiotic medication did not have a record of the quantity received. This made if difficult to confirm if the course had been completed as prescribed. An accurate record of disposed medicines is kept. Administration • • The morning round was observed. Encouragement and support is given to help people take their medication. On entering the dining room the inspector observed that the medicine trolley was open whilst the nurse in charge was administering medicines. The medicines trolley must be locked at all times when not in use to make sure that medicines remain securely stored. There is a notice on the medicine trolley asking people to not disturb the person doing the round. This is an example of good practice as it helps to prevent errors occurring. • An audit of current stock and records showed that some medication had been signed for but not given whilst others had been given but not recorded. Medication for three people had not been administered because there was no stock available at the time. One person prescribed a diuretic was without the medication for 6 days. Regular checks on stock levels of medication should be performed to make sure that people do not go without. If medication is not given this may have an affect on a person’s medical condition. There was confusion whether one person prescribed a variety of medicines had been given them. The monitored dosage systems had medication taken out of the second week of the cycle or from 2 days at the end. The dates on the pharmacy labels where different to those for other supplies. The inspector checked with the pharmacy when the supplies had been made. The dates provided indicated that the period between supplies was greater than the 28 day cycle. There was poor record keeping of the dates received and the quantity. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 14 The MAR charts indicated that administration had taken place over this period but the poor recording of supply meant that it was difficult to clarify that this person had got the medication as prescribed. The inspector was informed that the GP prescribing for this person had recently been changed and the regular monthly cycle was not in line with other people. The nurse in charge had identified this and was working with the surgery to make sure the next cycle was correct. The inspector was advised that the person receives a weekly visit from a community nurse who had not reported any problems. It is important that a complete record of medication received in to the home is made, so that in the event of a query on medicines administration an accurate check can be made. If a person has a change of GP or a change to medication there should be a system in place to make sure enough supply of medication is obtained and that the regular monthly supply is correct. Storage The storage facilities for both floors were looked at. • A separate, lockable room is used for storing medication on both floors. The medication trolleys are chained to the wall. On entering the room on the first floor the inspector found the room unlocked and the cupboard containing the trolley and other medicines open. It is the responsibility of the provider to make sure medication is stored securely at all times. Leaving doors and cupboards unlocked means there is a risk that medication may be removed. There are fridges in both rooms that are clean, locked and appropriate for use. Fridge temperatures are checked and recorded daily. A tube of cream was found in the upstairs fridge without a lid. This means that there is a risk that bacteria may get into the cream and make it unsafe to use. Medicines where found with no pharmacy label. Only medication that has been prescribed for that person and labelled with their names should be administered. Medication was found in the trolley that was no longer listed on the MAR. Only medication that is currently in use and listed on the MAR should be stored in the trolley to reduce the risk of inappropriate administration. This medication must be disposed of. There was a bottle of liquid Metformin in the trolley that must be used within one month of opening; this bottle did not have a date of opening on. Medicines must only be used in accordance with the manufacturers directions including dates of opening to make sure that the medicines are safe to take. There was a large amount of depot injections in stock. The dose was for one ampoule every four weeks yet there where 19 ampoules in stock. It is important to regularly check the stock of medication especially before ordering the monthly prescriptions. This is to prevent problems of excess stock. DS0000015860.V330405.R01.S.doc Version 5.2 Page 15 • • • • • Flower Park Nursing Home Controlled drugs • The controlled drugs cabinet and register meet the legal requirements. Other • A monthly audit of medicines management has started. This includes checking the accuracy of the MAR chart entries. A copy of the results of the audit is placed at the front of each MAR folder. As a result of the audit the staff are informed of how well they are performing and poor areas of performance that need addressing. However the last audit was in February 2007. It is important that audits such as this are regularly performed to make sure staff are updated on how well they are performing and to identify any areas of concern. 3 care plans were looked at. A record is kept of current medication and visits from health care professionals. A record of tests requested is kept but there is no record of results. Sometimes the results are recorded on either the progress or monthly record sheets. To make sure there is a complete record of medical tests performed all information should be on the same form. Staff will then have access to up to date information. • The ordering of prescriptions is the responsibility of the nurses in charge. The prescriptions are sent directly to the pharmacy without the nurses checking what has been issued. The inspector advised that the prescriptions are sent for checking by the nurses before going to the pharmacy. This is to make sure that any changes from the previous month are on the new prescriptions, to check for missing items on the prescriptions and to inform the pharmacy of items on the prescriptions that were not requested and therefore helping to reduce excess stock. The checking of prescriptions is an important part of the management of medication. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 16 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 and 15 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Social and recreational interests were not met, contact with family and friends was maintained. People have lack of choice in control over their lives. EVIDENCE: The home had employed a new activities co-ordinator but unfortunately she had taken time off and the home was without one. Many people spoken to told the inspector that activities had decreased in the home and there was also lack of entertainment coming into the home and no outings. They said that the new activity co-ordinator was nice but had not worked much. Visitors spoken to said they were always made welcome by staff and could visit at any time, they said staff were always pleasant and polite. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 17 The people who live at the home were not always able to exercise their choices, on the day of the inspection two people wanted to go out for a walk and kept asking the staff to take them out this was not accommodated, they both continuously walked up and down the corridors and would not settle. There was adequate numbers of staff on duty to allow the service users to go out for a walk, however staff in charge did not consider allowing care staff to take the people out for a walk, this again is lack of management direction and leadership. Lunch was observed by the inspector, a choice of different sandwiches were offered and then a pudding. The cooked meal was in the evening many service users told the inspector that they did not like the food and did not like having sandwiches at lunchtime. They only had cereal for breakfast and by 12.30 pm were very hungry and sandwiches were not enough. The evening meal was at 4.30 pm and the inspector was told that no supper was offered. The Area Director told the inspector that a new menu was to be introduced and this should be addressed. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 18 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 and 18 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Adult protection referrals are still being received. The home has a good complaints procedure. The people living at the home are not protected by the systems in place because they are poorly applied. EVIDENCE: The home has a good comprehensive complaints procedure, which is displayed, in the entrance hall. All service users spoken to were aware of this, but all stated if they had any concerns would go straight to the deputy manager or a member of staff. There is one ongoing complaint that the home and Doncaster council are dealing with. A number of adult protection referrals are still ongoing and being dealt with through the multidisciplinary strategy meetings to ensure service users are protected. An admissions embargo is placed on the home by Doncaster Council. Staff had received training in adult protection but it is not clear if they are aware of the importance as referrals are still being made regarding staff behaviour and an incident between two people who live at the home was not reported, placing people in the home at risk from abuse. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 19 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 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment is mostly well maintained and kept clean, however the outside gardens were not well maintained for the people living in the home to use. EVIDENCE: The standard of cleanliness observed during the inspection was to a good standard and a cleaning schedule had been implemented to ensure standards were maintained providing a clean environment for the people who live at the home. The domestics had hand held baskets to take the cleaning fluids into rooms with them safeguarding the people in the home. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 20 Two rooms had a foul odour, new floor covering had been requested but were still to be fitted this was outstanding from the last inspection, the showers were also still to be refurbished also a requirement from the last inspection. Other environmental improvements had been made new dining chairs had been provided which the people who live at the home told the inspector they were much better. New bedding and pillows had also been provided and bedrooms were well maintained for the people living in them. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 21 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 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The number of staff on duty meets people’s needs, however recreational needs were not being met. Training had improved. Recruitment does not protect the people who live at the home. EVIDENCE: The staffing numbers on duty could meet the needs of the people in the home. However the recreational and social needs were not being met as the activities co-ordinator was not at work and care staff were not being instructed to meet these needs. Staff training had been carried out since the last inspection and all mandatory training had taken place and a large number of staff had attended. Records were seen and it was fire training that a number of staff still required. The deputy manager organised the training however she was not available to discuss the future training programme. Records/information was not made available to the inspector to confirm what training if any was planned. Staff spoken to told the inspector that a lot of training had been organised recently and most staff had attended and were booked on other courses in the future. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 22 A number of staff recruitment files were seen no references were in the files no evidence of induction training and no terms and conditions this does not safeguard the people who live in the home. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 23 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 and 38 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home does not have a manager and health and safety of the people who live at the home is not promoted or protected. EVIDENCE: The home manager has moved to another home in the company and Flower Park does not have a manager, two unit managers have been appointed but neither were on duty on the day of the inspection. A bank nurse was on the upstairs unit and it was her first shift for many months at the home. There did not appear to be anyone taking overall management of the home on the day of the inspection. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 24 The inspector discussed this with the area manager following the inspection and the company intend to put an acting manager in post two to three days a week until a permanent manager is appointed. Staff morale was very low due to the changes occurring in the home many fear the home will close. Communication from the area management could improve this situation. Some quality monitoring is taking place but not all had occurred due to the home being without a manager and a maintenance person. People spoken to in the home were very confused and did not fully understand what was happening in the home as the manager left very suddenly, many told the inspector there was a lack of communication. Service users financial interests continued to be safeguarded, the systems had improved and good records maintained. The maintenance person had retired the previous month and no one had been nominated to carry out his duties. No health and safety checks were being carried out, water temperatures had not been monitored, fire checks has ceased and the gardening had been left. One relative told the inspector she regularly goes round the garden and picks up litter, as it looks dreadful. Relatives had also organised for the grass to be cut. The current arrangements are inadequate and unsatisfactory for the people living at the home and the staff. The levels of anxiety among people living at the home and working at the home are having a negative and unsettling impact on all involved. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 Requirement All service users must have a plan of care that reflects their needs. (Old timescales of 1/1/06, 1/3/06, 1/4/06 & 04/02/07). All service users must have a detailed assessment in their plans of care. (Old timescale of 04/02/07) All health care needs must be identified and met. (old timescale 04/02/07) All service users social and recreational needs must be met. (old timescale 04/02/07) People must be given a choice regarding all aspects of their life in Flower Park. People’s views regarding meals and times must be obtained and sufficient food must be offered and available. Timescale for action 01/08/07 2. OP3 14 01/08/07 3. OP8 12 01/08/07 4. OP12 16 01/08/07 5. OP14 12 01/08/07 6. OP15 12 01/08/07 Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 27 7. OP18 13 Measures must be in place to safeguard people who live in the home. The shower rooms must be upgraded to meet people’s needs. Recruitment procedures must be followed to protect people in the home by obtaining references. The mandatory training must be continued and all staff must receive training to enable them to carry out their jobs. 01/08/07 8. OP19 23 01/08/07 9. OP29 19 01/08/07 10. OP30 12 01/08/07 11. OP31 8 There must be a competent 01/08/07 manager to run the home so that the home is well managed for the people who live there. The quality monitoring systems must be carried out to ensure the home is run in the best interests of the service users. All health and safety checks must be carried out in the home to ensure the people who live there are safe. A system must be in place to make sure there is enough stock of medication. This means every person receives their medication as prescribed. Medication must be stored securely at all times. This means that people are receiving their medication safely. 01/08/07 12. OP33 24 13. OP38 23 & 13 01/08/07 14. OP9 13 01/08/07 15. OP9 13 01/08/07 Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 28 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 OP9 OP9 Good Practice Recommendations The quantity of medication carried over from the previous months MAR should be recorded on the current MAR. A system should be put in place to inform the pharmacy of medicines that are not required on the monthly prescriptions to reduce excess stock. Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Flower Park Nursing Home DS0000015860.V330405.R01.S.doc Version 5.2 Page 30 - 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. 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