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Inspection on 13/10/05 for Flower Park Nursing Home

Also see our care home review for Flower Park Nursing Home for more information

This inspection was carried out on 13th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff team on the downstairs unit work very well together providing good quality care for the service users although there is not always enough staff on duty to meet the needs of service users. Many service users and relatives commented that the staff worked very hard but were short staffed. The standard of cleanliness throughout the home was good with many service users and visitors commenting on the standards of cleanliness.

What has improved since the last inspection?

The home manager has carried out a training audit to determine what training is required for each member of staff and has organised training courses to ensure staff are up to date this is ongoing and much improved as training for all staff was out of date.

What the care home could do better:

The home has had many staff leave since the last inspection the new RMN on the upstairs unit has left and many carers who had worked at the home for years, this had made staff morale very low. There is no continuity of staffleadership on the upstairs unit and no staff with appropriate qualifications to meet the needs of the service users. Staff levels in the units is not consistant with the needs of service users. Staff on the downstairs unit have no available time to socialise with residents and staff on the upstairs unit have time but choose not to do so. The home does not meet the needs of the service users in regard to leisure, social activities and interests. The home only provides 9 hours for an activities co-ordinator, which from feedback received from staff, relatives and service users, is inadequate. The staff started to review the care plans to ensure they reflected the needs of each individual however, this has not continued.

CARE HOMES FOR OLDER PEOPLE Flower Park Nursing Home Flower Park Rossington Street Denaby Doncaster South Yorkshire DN12 4BT Lead Inspector Sarah Powell Unannounced Inspection 13th October 2005 11:50 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.V253760.R02.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Flower Park Nursing Home Address Flower Park Rossington Street Denaby Doncaster South Yorkshire DN12 4BT 01709 863327 01709 860303 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Four Seasons Health Care (England) Limited (wholly owned subsidiary of Four Seasons Health Care Ltd) Alison Commins Care Home 40 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.V253760.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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). 16th September 2005 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 over 65 years and has lift access, the ground floor accommodates nursing service users over 65 years. 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. Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the homes second inspection in the year 2005/2006 the home has also had two additional visits between the inspections three of these visits/inspection have resulted in the necessity to serve an immediate requirement details of these are contained within this report. The additional visits have been to check on compliance with the requirements, immediate notices, investigate an adult protection issue and a complaint. This inspection took place over two days the inspection commenced at 11.50 and finished at 16.15 on 13th October 2005 and a second day was arranged for 1st November 2005 this commenced at 07.45 and finished at 15.30. 11 Service users, 10 staff and 6 representatives were spoken to. A full tour of the building took place to look at environmental standards, observing staff and practices; time was also spent in the office looking at policies, procedures, staff files, training records and other paper work. What the service does well: What has improved since the last inspection? What they could do better: The home has had many staff leave since the last inspection the new RMN on the upstairs unit has left and many carers who had worked at the home for years, this had made staff morale very low. There is no continuity of staff Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 6 leadership on the upstairs unit and no staff with appropriate qualifications to meet the needs of the service users. Staff levels in the units is not consistant with the needs of service users. Staff on the downstairs unit have no available time to socialise with residents and staff on the upstairs unit have time but choose not to do so. The home does not meet the needs of the service users in regard to leisure, social activities and interests. The home only provides 9 hours for an activities co-ordinator, which from feedback received from staff, relatives and service users, is inadequate. The staff started to review the care plans to ensure they reflected the needs of each individual however, this has not continued. 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. Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&4 Contracts are being issued to service users. The home is not able to meet the needs of the service users. EVIDENCE: The home has received copies of the new contracts for service users these are to be sent to the relatives to be signed. The manager is aware of the need to use advocacy services if required to ensure the service users best interests are safeguarded. The home does not have the appropriately qualified staff on the upstairs unit to meet the needs of the service users as the permanent RMN has left having only been at the home two months the only other RMN is only on the bank. Care plans were poor and did not clearly set out service users needs and were not reviewed so was impossible to determine if a specialist services were required in order to meet the service users needs. Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 9 The staff collectively did not have all the skills to deliver the services of care which the home offers to provide as the home provides care for service users with mental health problems and have no appropriately trained member of staff to meet these needs. Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&9 Health care needs were not properly documented or met and medication was badly managed. EVIDENCE: Each service users has a plan of care at the inspection in May this year the staff had commenced reviewing and updating the plans of care as this had been a previous requirement. This process has not progressed and the care plans remain poor with service users needs not identified, plans out of date, evaluations not carried out, no care plans to monitor mental health and assessments out of date making it impossible for staff to meet the needs of the service users. The Inspector and the Regulatory manager who joined the inspector for part of the inspection looked at medication. The medication records were in a mess particularly the records kept for controlled drugs it showed that a large number of tablets were unaccounted for and this was raised with the manager. An immediate requirement was issued to carry out a full audit. Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 11 The home and senior management gave this matter the attention it required and carried out a full audit and it was unable to determine where the drugs have gone. This is a very serious incident as the outcome determines that a large number of tablets are unaccounted for. We understand from the homes response that they will continue to monitor the situation closely to ensure this does not occur again and to ensure staff are retrained if it is determined necessary in order to safeguard service users. It may also be necessary to inform the police of the missing drugs. The disposal bins were full to overflowing and need collecting, the disposal records were not signed for, the systems need to be reviewed and amended to ensure safety. Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 & 15 Recreational needs are not met service users choice is limited. An appealing balanced diet is provided for service users. EVIDENCE: Previous requirements and an immediate requirement has been to increase the activity hours to ensure service users leisure and recreational needs are met this was agreed in the last action plan that they would be increased to 20 hours however the manager informed the inspector that she was unable to advertise the post so service users were still not having these needs met. Staff stated they do not have the time to meet care needs as well as social needs as staffing numbers have been reduced. The service users commented that the care staff tried very hard to entertain them when the activities co-ordinator was not working but it was usually impossible as they were very busy. The comments from relatives were very similar and many said, “there is a lack of stimulation especially on the upstairs unit”. The service users are unable to exercise personal autonomy and choice as the staff are so busy there has to be a set routine with set times even taking service users to the toilet. Staff told the inspector they did not like this but it was the only way they could meet all service users basic health care needs with the staff that were on duty. The two days the inspector observed the staff it was obvious they were very stretched and not meeting service users needs. Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 13 The diet provided is wholesome and nutritious service users said, “the food is lovely”. There was a menu which was changed regularly a choice was available at every meal. It was observed on both inspection days that meals took a long time many service users needed assistance with eating and due to this some service users waited a long time for their meals as there was only two staff on duty the quality of the meals therefore deteriorated and were sometimes cold when some service users were given the assistance they required. The inspector spoke to two relatives who came into the home most days to feed their relatives, as they were aware staff did not have the time. On relative told the inspector they were concerned their relative was not getting enough food as they were very slow eating and took a lot of persuasion to get them to eat and staff did not have this time to spend with one service users when there were 15 others on the unit. Service users needs regarding meals were not being met. Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Complaints are taken seriously, however service users are not always protected. EVIDENCE: The home has received three complaints since the last inspection these were dealt with following the homes complaints procedure, which is clear, accessible, comprehensive and clearly states timescales to be followed to ensure complaints are taken seriously and acted upon. During the inspection two members of staff told the inspector that an incident had been reported to the manager regarding verbal abuse this had apparently not been followed through putting service users at risk. An immediate notice was served following this the manager investigated the allegation following the procedure in order to safeguard services users. Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 21, 23, 24, 25 & 26 The environmental standards meet the requirements of the standards however two of the bathrooms are unusable. EVIDENCE: During this inspection a full tour of the building took place, two bathrooms are being used as store rooms and are unusable as bathrooms and one other bathroom has had the assisted hoist removed as it was unsafe this is limiting choice for service users. The bathrooms need to be re-instated and find alternative accommodation for storage. The outdoor space is safe and accessible however the service users in the upstairs unit can only go in the garden accommompanied by staff as access is downstairs and through the other unit so service users on the upstairs unit do not access the garden. Many service users on the upstairs unit would benefit from access to the gardens so this needs to be reviewed in order that service users needs are met. The standard of cleanliness observed throughout the building was excellent however it was observed that the home still doesn’t have a sluicing disinfector Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 16 this was a previous requirement and the action plan stated it would be provided but as yet this has not happened and the manager is not aware of any timescales. Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 The numbers and skill mix of staff do not meet the service users needs. EVIDENCE: Following the first day inspection an immediate requirement was served to increase the staff numbers on duty on the downstairs unit this has not been instigated. During the two days of the inspection it was observed that the staff on the downstairs unit were extremely busy struggling to meet the needs of the service users. It was not until late morning that the final service user was up and dressed this was not always their choice it was due to lack of staff. Midmorning drinks were sometimes not given due to lack of time and breakfast was not served until 9.45 with some service users sat waiting since 7.30. However staff on the upstairs unit were observed sitting around ignoring requests from service users to go to the toilet, all taking breaks together, two carers were observed sat at service users dining tables eating fish and chips leaving no one looking after the service users. Staffing needs to be reviewed on each unit to ensure service users needs are met. The inspector received comments from relatives regarding staff on the upstairs unit that when they visit they are just sat with their feet up, yet comments received from relatives and service users on the downstairs unit all said “staff work very hard and are always very busy”. Night staff were also spoken to during the second days inspection they told the inspector that with the staff on duty it is difficult to cover both floors safely Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 18 from approx 5.30 am until the night shift finished at 8am as service users started to wake and want to get up. They also told the inspector that a large amount of accidents occurred during these times as three members of staff can not observe both floors and assist in service users rooms so service users were at risk. The inspector looked at the accident book and common times for accident was early morning but also early evening when staff are also stretched when service users that requesting to go to bed. These appear to be peak times and staffing should be adjusted accordingly to ensure service users needs are met. Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 Financial interests of the service users are safeguarded. EVIDENCE: The homes administrator looks after money for some service users who are unable to maintain their own money. These records were seen written records of all transaction were maintained all receipts kept and the money was kept in a bank account, which is available at any reasonable time for the service users to access. Regular audits are carried out on service users money to ensure financial interests of service users are safeguarded. Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X 2 1 X 3 3 3 2 STAFFING Standard No Score 27 1 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X X Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP12 Regulation 16 Requirement Ensure social, cultural, religious and recreational needs of service users are met. (old timescale of 1 June 2005). The home should provide a sluicing disinfector (old timescale od 1.8.05) Ensure the numbers and skill mix of staff on duty meet all the service users needs (old timescale of 1.7.05 and immediate requirement served on 13.10.95) Ensure service users needs are met by ensuring all specialist services are offered. Ensure all service users have a plan of care that reflects their needs. Ensure all medication is recorded, administered and disposed of correctly. Ensure service users are given choices. Ensure all allegation of abuse are followed up promptly (this was an immediate requirement issued on 13.10.05). Ensure all service users have DS0000015860.V253760.R02.S.doc Timescale for action 01/01/06 2. 3. OP26 OP27 13 18 01/01/06 01/01/06 4. 5. 6. 7. 8. OP4 OP7 OP9 OP14 OP18 12 15 17 12 12 01/01/06 01/01/06 01/01/06 01/01/06 01/01/06 9. OP20 23 01/01/06 Page 22 Flower Park Nursing Home Version 5.0 10. OP21 23 access to the outside space. Ensure all the bathrooms used as 01/01/06 storerooms are re-instated as usable bathrooms. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Flower Park Nursing Home DS0000015860.V253760.R02.S.doc Version 5.0 Page 24 - 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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