Inspection on 08/06/06 for Flower Park Nursing Home

This inspection was carried out on 8th June 2006.

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 01/05/07

Flower Park Nursing Home 07/11/06

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 8th June 2006 09:10 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.V290533.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.V290533.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 NONE www.fshc.co.uk Four Seasons Health Care (England) Limited (wholly owned subsidiary of Four Seasons Health Care Ltd) David John Hutton 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.V290533.R01.S.doc Version 5.2 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). 13th October 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. The fees at Flower Park Care Home range from £395 - £460 free nursing care. Flower Park Nursing Home DS0000015860.V290533.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the homes first key inspection in the year 2005/06 it was unannounced and took place over three days starting on 12th June 2006 at 09.10 and finished at 17.00 then 13th June 2006 at 13.25 and finished at 17.00 and the final day 14th June 2006 at 09.15 and finished at 13.00 a total of 15 hours and 10 minutes was spent in the home. The home has also had a random inspection in this inspection year on 25th April 2006 this was to determine that staffing levels had been increased to meet the needs of the residents. As part of the inspection process the inspector spoke to 15 residents, 6 visitors, 1 visiting professional, 14 staff and the Manager were spoken to. A partial tour of the building took place, observing staff and practices. A number of records were examined these included medication, four service users care plans, menus, staff rotas, recruitment, service users finances and quality assurance systems. Feedback was given to the Manager when the visit was completed. What the service does well: What has improved since the last inspection? There has been a change in management at the home since the last inspection. The new manager commenced employment in January 2006 and was successfully registered with CSCI in May 2006. During this period the home has seen many changes in order to improve the service for the residents and the manager continues to make improvements. The majority of staff spoken to were extremely positive about the changes and realised they were for the better for the residents and staff. The needs of the service users are now being met, the inspector received positive comments from residents and visitors regarding the improvements in the home. Flower Park Nursing Home DS0000015860.V290533.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Flower Park Nursing Home DS0000015860.V290533.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.V290533.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply at Flower Park. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The assessments were out of date and lacked detail. EVIDENCE: The assessments were found to be out of date and did not reflect the individual’s needs. The assessments also lacked detail with many parts not even completed. This was evident in the four residents plans of care that were case tracked as part of the inspection process. It was therefore not clear what the needs of the residents were and if the home could meet these. Flower Park Nursing Home DS0000015860.V290533.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Care plans did not reflect resident’s needs. Medication records had improved although pain relief not always given. Service users are treated with respect and privacy is upheld. EVIDENCE: Four service users were case tracked looking at their plans of care to determine if their needs had been identified to enable to staff to properly meet their needs. During this process it was identified that the plans of care were poor the assessments were not fully completed were out of date and did not reflect the individuals needs. Flower Park Nursing Home DS0000015860.V290533.R01.S.doc Version 5.2 Page 10 The social history in the plans was poor with many not being completed and the majority had close contact with family and friend so a history could be obtained. One service user was registered blind yet this was not identified in the plan of care. Not all the service users needs were identified in the plans of care and they were confusing and complicated and very difficult to follow. Therefore not clear if residents needs were being met. Risk assessments were detailed on the same sheet as the problems and it was evident that not all staff under stood the difference and therefore risk assessments were not in place for many residents putting residents and staff at risk. This was discussed at length with the manager as all needs of service users need to be clearly identified and measures documented to meet these needs with good risk assessments in place and regular reviews. A new format for the plans of care is due to be released by Four Seasons a sample was looked at by the inspector and they appeared better with separate risk assessments, these need to be implemented. The requirement for the care plans to be improved and reflect service users needs has been identified in the last four reports and needs to be addressed urgently if this is not complied with by 1.9.06 CSCI will be considering enforcement action. The inspector spoke to staff and residents and most health care needs of service users were being met although they were not properly documented in the plans of care. Staff had a good understanding of the residents and their needs but carers stated they did not use the plans of care. Although it was observed on one of the inspection days that staff did not clean residents hands and faces after diner. Resident spoken to told the inspector that staff treated them with respect and always maintained privacy. Medication was assessed at this inspection as errors had previously been found all documentation was good with records of receipt, administration and disposal although not all medications disposed of were signed for. The controlled drugs were checked they were all accounted for although the records were confusing and could be made clearer. When case tracking and checking medication administration sheets it was clear that some residents were not always being given pain relief and no reason was documented. This needs to be assessed and if pain relief is not given it must be clearly documented why to ensure residents are not in any pain. Flower Park Nursing Home DS0000015860.V290533.R01.S.doc Version 5.2 Page 11 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, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Social and recreational activities are much improved. Meals could be better. EVIDENCE: The home has two activity co-ordinators, however one is leaving soon and the manager is trying to recruit a replacement. The activities have always been good on the downstairs unit but in the past have not been available to the residents on the upstairs unit, this is gradually improving and the social and recreational needs of some of the residents on the upstairs unit are being met the manager is aware this still needs to improve to include everyone to ensure all residents needs are met. Flower Park Nursing Home DS0000015860.V290533.R01.S.doc Version 5.2 Page 12 On the first day of inspection the cook walked out, a carer who often covers kitchen duties agreed to step in and take the job on permanently. A number of comments received form residents were regarding the food; that it could be better, a discussion with the new cook identified that she was aware of this and would work with the manager and residents to determine a new menu. This will therefore be looked at in detail at the next site visit. Flower Park Nursing Home DS0000015860.V290533.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Complaints are taken seriously and residents are protected from abuse. EVIDENCE: The home has a good comprehensive complaints procedure, which is displayed, in the entrance hall. All relatives spoken to were aware of this but all stated if they had any concerns would go straight to the manager or a member of staff. The home has received 2 complaints, which were dealt with appropriately by the manager and resolved within the agreed timescales. CSCI received a number of concerns regarding bedrails and the change in the homes policy this is currently being resolved by the manager and Four Seasons and the outcome will be discussed with the relatives, residents and CSCI to protect residents. Due to the change in management a number of adult protection issues have been identified these have been dealt with appropriately to protect the residents in Flower Park. Staff spoken to by the inspector were aware of the homes adult protection policy what it meant and how to report an incident ensuring residents are protected. Flower Park Nursing Home DS0000015860.V290533.R01.S.doc Version 5.2 Page 14 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): 19 & 26. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the visit to this service. Standard of cleanliness is excellent and residents live in a safe well-maintained environment. EVIDENCE: As part of the site visit a partial tour of the building was carried out and the standard of cleanliness throughout was excellent. The home has carried out a large number of environmental improvements over the last five months and it has much improved. Relatives and residents all commented to the inspector on the improvements and how much better the home looked. At the time of the inspection the improvements were still ongoing with the upstairs lounge and dining areas being re-painted to ensure residents live in a well maintained environment. Flower Park Nursing Home DS0000015860.V290533.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a good skill mix of staff. The recruitment procedure protects service users. Staff training is not up to date. EVIDENCE: There has been a number of staff changes in the home since the last inspection. There is a new Registered Manager a Registered Mental Nurse is now employed on the upstairs unit and two new bank Registered nurses so the home does not have to use agency staff. The skill mix meets the needs of the residents. The homes recruitment procedure is very good since the new manager has been in post. A number of staff files were looked at by the inspector and were very good, well organised and contained all the required information protecting the residents. Staff training was looked at all staff require mandatory training the only courses up to date were Protection of vulnerable adult and moving and handling. This was discussed with the manager and was to be addressed to ensure all staff are appropriately trained to meet the needs of the residents. Flower Park Nursing Home DS0000015860.V290533.R01.S.doc Version 5.2 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home is well run by the manager. Quality monitoring systems need improving. Not all service users financial interests are safeguarded. Health and safety is promoted. EVIDENCE: The manager has taken a poor performing home and is making changes to improve the service for the residents. Most staff are embracing the changes as a positive move and are working with the Manager these staff told the inspector that the new manager has made great improvements, he listens to problems and concerns and tries to resolve them. Staff also said the carers now work together as a team ensuring residents needs are met. Flower Park Nursing Home DS0000015860.V290533.R01.S.doc Version 5.2 Page 17 However, following discussions with staff the inspector felt that some staff were reluctant to move forward with the changes thinking they are not a good thing for the home, so some staff moral was fairly low at the time of the visit due to the staff differences. Some staff said they felt undervalued and Unappreciated. During interviews with all staff they told the inspector that some confidential management issues were being disclosed and confidential issues were common knowledge with all staff. The staff discussed the items with the inspector and they were issues that should have been confidential. The issues were discussed with the manager, as staff were now reluctant to talk to the manager openly as they thought it might be told to all staff. The manager agreed to act on this as a matter of urgency and was going to talk to all staff to try to resolve the issues to improve the relationship between staff. Quality monitoring systems are re-commencing with residents meeting now taking place and staff meetings. Regular audit are carried out to ensure standards are maintained within the home. The quality monitoring questionnaires that are sent to residents and relatives have not yet been recommenced the manager is aware this needs to happen and it will be addressed to ensure residents views are listened to and acted on. Service users money was checked during the inspection records were good however some residents had gone into the red and as the money is in one joint account they have actually borrowed other residents money. The account is also interest bearing so they money borrowed will not get any interest. The homes Administrator is aware of the need to rectify this and was at the time of the inspection trying to rectify the problems. When the problems are resolved it was agreed the CSCI inspector would be informed. This needs to be rectified urgently to safeguard all residents’ money. The home has a good health and safety policy, however staff training is not up to date and these needs to be addressed to ensure service users safety. The maintenance records for gas safety, electrical safety certificates, Pat testing, legionella and safe environment including equipment and machinery were available and up to date at the time of the inspection. The risk assessments on safe working practices were not available, however the manager is aware these need to be drawn up and has instigated this process to promote safety of staff, visitors and residents. Flower Park Nursing Home DS0000015860.V290533.R01.S.doc Version 5.2 Page 18 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 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 1 X X 2 Flower Park Nursing Home DS0000015860.V290533.R01.S.doc Version 5.2 Page 19 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 Ensure all service users have a plan of care that reflects their needs. (Old timescales of 1.1.06, 1.3.06 & 1.4.06). Ensure that all service users have a detailed assessment in their plans of care. Ensure the new plans of care are implemented. Ensure all health care needs are identified and met. Ensure that pain relief is always offered and recorded properly if it is refused. Ensure all service users social and recreational needs are met. A new menu must be devised with consultation with service users and the new cook. Ensure all mandatory training is updated for all staff. Timescale for action 01/09/06 2. OP3 14 01/09/06 3. 4. 5. OP7 OP8 OP9 15 12 13 01/09/06 01/09/06 01/08/06 6. 7. OP12 OP15 16 16 01/09/06 01/09/06 8. OP30 18 01/10/06 Flower Park Nursing Home DS0000015860.V290533.R01.S.doc Version 5.2 Page 20 9. OP33 24 Implement all quality monitoring systems to ensure the home is run in the best interests of the service users. Rectify the financial irregularities regarding residents’ money. Ensure the risk assessments for safe working practices are drawn up. 01/09/06 10. 11. OP35 OP38 16 23 01/08/06 01/09/06 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.V290533.R01.S.doc Version 5.2 Page 21 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.V290533.R01.S.doc Version 5.2 Page 22 - 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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