Inspection on 21/04/08 for Gorton Parks Nursing Home

This inspection was carried out on 21st April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Gorton Parks Nursing Home 18/12/07

Gorton Parks Nursing Home 03/10/07

Gorton Parks Nursing Home 20/06/06

Gorton Parks Nursing Home 02/03/06

Gorton Parks Nursing Home 07/06/05

Gorton Parks Nursing Home 11/11/04

Gorton Parks Nursing Home 01/06/04

Gorton Parks Nursing Home 23/02/04

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

CARE HOMES FOR OLDER PEOPLE Gorton Parks Nursing Home 121 Taylor Street Gorton Manchester M18 8DF Lead Inspector Unannounced Inspection 09:20 21 and 22nd April 2008 st X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gorton Parks Nursing Home DS0000021678.V361489.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. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gorton Parks Nursing Home Address 121 Taylor Street Gorton Manchester M18 8DF 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) 0161 220 9243 0161 230 7439 www.bupa.com BUPA Care Homes (CFHCare) Ltd Manager post vacant Care Home 148 Category(ies) of Dementia - over 65 years of age (90), Old age, registration, with number not falling within any other category (43), of places Physical disability (15) Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of older people requiring nursing care at any one time shall not exceed 43 patients of either sex aged 60 years or over. There are three named service users requiring care by reason of physical disability. Should these service users no longer require the accommodation offered the places will revert to the category of old age (OP). This accommodation is in Sunny Brow and Debdale Houses. In addition a maximum of 12 places are designated for use as intermediate care beds for service users aged 55 and over requiring intensive rehabilitation by reason of physical disability following discharge from hospital care. The rooms are located in Debdale House and equipped with appropriate specialist facilities, equipment and staffing. The length of stay should not normally exceed 6 weeks. A maximum of 60 places in Delamere House and Melland House are registered for older people with dementia who require personal care only. A maximum number of 30 places in Abbey Hey House are registered for either sex aged 60 years or over for people with dementia assessed as requiring nursing care. Minimum nursing staffing levels as specified in the Staffing Notice issued under Section 13 of the Care Standards Act 2000 on 15 February 2006, will be maintained for Sunny Brow and Debdale Houses. The service provider will keep the needs of all service users living in Debdale House under continuing review and ensure that the numbers and skills of staff deployed in that unit are adequate to meet their differing assessed needs. All staff employed in Debdale House will be trained in techniques for rehabilitation as detailed in National Minimum Standard 6.3 (National Minimum Standards, Care Homes for Older People) and this training will be maintained on an ongoing basis. Minimum nursing staffing levels as specified in the Staffing Notice issued under Section 13 of The Care Standards Act 2000 on 15 February 2006, will be maintained in Abbey Hey House. All staff employed in Abbey Hey House must receive accredited training in dementia care by 31st March 2006 and this level of training will be maintained on an ongoing basis. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2. 3. 4. 5. 6. 7. 8. 9. 10. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 5 Date of last inspection 3rd March 2008 Brief Description of the Service: Gorton Parks Nursing Home is owned by BUPA Care Homes. The home is a purpose built building and consists of five, 30 bedded units. The home can provide accommodation for residents assessed as requiring intermediate care, nursing and personal care and Dementia care. Each unit is a single storey building with a lounge, dining area, a conservatory, a smoke room and a kitchenette. All bedrooms are single and all rooms provide a wash hand basin and a mirror. There are no en-suite facilities available. Accessible toilets and bathrooms, with aids and adaptations for those residents who are wheelchair users or with poor mobility are located near to bedrooms and living rooms. The home is located in the residential area of West Gorton in the North of Manchester. Local amenities, including a market, banks and shops are all within easy walking distance. Public transport is accessible. There are ample parking facilities at the front of the building. An administration building houses the main kitchen, hairdressing salon, laundry and offices. The charges for fees range from £373.54 to £639.73 per week. Additional charges are made for hairdressing, trips and newspapers. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This visit was undertaken as part of a key inspection, which includes an analysis of any information received by the Commission for Social Care Inspection in relation to this home prior to the site visit. Two regulatory inspectors and the pharmacist inspector carried out the inspection. The visit was unannounced and took place over the course of 12.5 hours on Tuesday, 22nd and Wednesday 23rd April 2008. During the course of the site visit time was spent talking to the manager, the responsible individual, day staff and residents to find out their views of the home. Time was spent examining records, documents, the resident’s files and staff recruitment records. Fees for accommodation range from £375-00 - £480-00. There are additional charges for hairdressing, newspapers and toiletries. What the service does well: Comments from people who use the service included “I wouldn’t move anywhere else”, “they look after me well” and “very pleasant”. Staff reported that the management team were “supportive and very helpful”. Residents said the food is “very tasty and there is always a choice”, “my family is made to feel welcome”, “I have everything I need here and nothing is too much trouble for the staff”. People are provided with sufficient information to make an informed decision about admission. Complaints are managed well and the service uses them to make improvements where necessary. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have their needs assessed and are given good information about the home in order to make an informed decision about moving in. EVIDENCE: 5 relatives commented in survey forms that the home gave them enough information to make decisions. One commented “the main sister is excellent she keeps me in the picture all the time”. We saw that there is an admissions procedure and that assessments are completed prior to anybody moving in. Once an individual comes to live there, a care plan is written based on these assessments. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 10 “This is a good home”, “the best I could of found” and “very pleasant” were some comments from people living at the home. Relatives and friends comments included “we are very happy” and “they have so many people to look after but the nursing care is good”. We saw that assessments are completed before admissions take place. Once an individual comes to live at the home, a care plan is written based on these assessments. We saw the ‘Quest’ individual assessment booklet in the care plans. This is completed by a unit manager and consists of a tick box system. Depending on the scores, the assessment document guides staff to which parts of the care plan/risk assessments need to be completed. This is carried out to make sure that they are able to meet people’s needs. They told us that Quest 2 is in the process of being introduced in line with the requirements of the Mental Capacity Act. They told us during the last inspection that for those residents who are referred through Care Management arrangements a copy of the Care Management Assessment is obtained before admission is arranged. The home provides 12 intermediate care places on Debdale house. This is to provide rehabilitation for people following discharge from hospital in preparation for their return home. There was a separate area off the main lounge with seating for around 6 people. They told us that a number of people admitted for intermediate care either stayed in their room or sat in the main lounge talking to the residents living on Delamere house. Appropriate facilities were in place for people receiving intermediate care to enable them to maximise their independence. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual needs are generally met by the home. Improvements are needed to the care planning process to ensure staff have detailed information in order to meet residents’ needs. EVIDENCE: It was pleasing to note some progress in care planning although there was scope for further improvement. Some did not give clear instructions to staff about how care should be provided and were not person centred. It was clear that staff were aware of the resident’s needs but this was not fully reflected in care plans. At the previous inspection requirements highlighted that they needed to improve the quality of the information in care plans. Although some improvements had been made further work was needed in this area. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 12 For example where it was identified that a resident needed assistance into and out of bed and dressing the care plan did not give any clear guidance to staff on what assistance was needed. The care plan for one resident stated they could become verbally aggressive if other residents ‘invade space’. Staff were to monitor mood and behaviour, record and report any changes and involve the relevant health professionals. The manager told us that this person’s behaviour was cyclical and appeared to change about every 6 weeks. However, this was not recorded in the care plan. Risk assessments are completed around areas such as falls, pressure areas and nutrition. We saw that these were generally well completed but they were generalised and could be more person centred. It is recommended that care plans, risk assessments and daily records be person centred and describe fully the care delivered to residents. We saw one resident on Delamere house dressed in soiled clothes and who had greasy hair and a strong body odour. When asked by the manager if they would like a bath the resident refused. This issue could have been approached in a more persuasive way. The resident’s care plan advised that night staff must remove the person’s clothes for cleaning so that they are not worn the following day. It also identified the need for assistance of 1 carer to wash and dress. There was no evidence in care plans of how assistance had been offered to this resident. One resident still did not have dentures although they told us that a dentist has been out and they were waiting a second visit. We asked them if the lack of dentures has had any affect on the residents weight. They told us this had not, but weight charts were not available on the care plan to evidence this. During the inspection the pharmacist inspector looked at how medication was handled on two units, Delemere and Abbey Hey. We found that most medicines were usually administered and recorded correctly. Regular and detailed checks on medicines continued to be carried out. These checks helped to show that most medicines could be accounted for and had been given as prescribed. The general standard of record keeping on both units was good. The records usually showed exactly how much medicine was in the home for each resident and there were usually accurate records of how much medicine was administered to each resident. If a dose of medicine had to be missed the reason for this was usually well recorded. If doses of medicines were changed or discontinued by the doctor, staff recorded this information clearly. When clear and accurate records of medicines are kept it helps to show that people are being given their medicines properly and their health is not at risk. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 13 In general most people were given their medicines properly and as prescribed. At the last inspection there were concerns that some people were not being given their medicines at suitable times. Staff told us that they were now making sure that medicines were given at the correct time by making sure that medicines rounds started earlier and making sure they were not interrupted during this time. However there are still some concerns that strict times of medicines rounds do not allow people to be given their medicines at times more suited to their life style. For example, one resident went to bed early every night and was prescribed an antidepressant at night time. Most nights this medicine was not given because the resident was asleep. This could seriously harm this resident’s health as this medicine should not be given intermittently. Most of the medicines were supplied in a Monitored Dose System, which helps the staff select the correct medicines in an organised way. We found that medicines supplied in this way were administered properly. Liquid medicines and some tablets cannot be supplied in the monitored dose system and we found that sometimes staff signed that they had administered these medicines but had not given them. We also found that very occasionally staff gave medicines which they did not sign for. It is important that all medicines are given properly and the records show exactly how much medicine residents have been given to make sure their health is not at risk. During the inspection we found that some residents could not be given their medicines as prescribed because their medicine had run out. It is very important that staff make sure that there is enough medicine in stock for each resident at all times. Residents’ health could be put at serious risk from harm if medicines cannot be given as prescribed. We also looked at how controlled drugs were recorded and stored. The records were generally accurate and storage was legal and safe. The manager told us that all staff had had recent medication training and we saw the competency assessment documents, which made sure they had understood the training and were handling medicines safely. Some staff had not been assessed as competent and were currently not administering medicines. More training sessions are being arranged in conjunction with the Primary Care Trust (PCT). The pharmacist from the PCT had worked with staff on Abbey Hey to help them improve the way medicines were handled on the unit. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A limited range of activities was provided. Meals and mealtimes were not always an enjoyable, social occasion for all of the service users. EVIDENCE: Visitors spoken to during the visit said they are encouraged to come and see their relative or friend and are always made to feel welcome. People spoken with said that they enjoyed the food offered with comments including “the food is good”, “very good”, “its cooked well” and “quite good”. One relative or friend commented that the “food is not always appropriate for his needs-I have to return meal and ask for another on occasion”. Menus were displayed in each house; this was in ordinary font and residents may benefit from this being in larger print. The meal on the day of visit was pea soup, fish fingers carrots and peas, poached fish or minced beef and kidney pie or assorted sandwiches. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 15 The sweet was rice pudding or ice cream. An afternoon snack of homemade buttered scone or fruit or yoghurt was on offer. Dinner was pork in mushroom sauce boiled potatoes and cauliflower. The home offers ‘Nite Bites’ during the evening; there are assorted sandwiches, cup-a-soup, cheese or spaghetti on toast and yoghurts. We observed the meal being served on Abbey Hey house where staff were helping residents to eat their meal. We saw that there was no conversation and both soup and main meal were brought out at the same time, the main meal cooling whilst the resident was eating the soup. We saw a number of missed opportunities where staff were with residents but did not positively chat or interact with them. This gave the impression of the mealtime being a task to have to get done rather than a pleasant social occasion. They should look at how mealtimes can be made a more positive occasion throughout the home and an opportunity for people to talk and interact. It was recommended that staff be encouraged to communicate with residents when carrying out tasks such as assisting residents with meals. We saw a list of dates for various parties on each house. One resident told us, “we get invited to the other houses when they have a party and they can come here when we have one”. When asked about activities one resident said “there’s bingo and they have just had a discussion group over there” and “there should be two activity people but there is only one at present so they are spreading themselves a bit thin”. Another resident said “I’d like to get out and about more but you can’t because there are not enough staff”. As stated previously we saw that care plans could be improved to include more information about social and emotional needs. This could be used to tailor and further improve the activities on offer at the home. One visitor said they are made to feel welcome and can visit at any time. Individuals spoken to said that they were able to have friends and family visit when they liked. One visitor said “my mum is 102 and they look after her really well, my niece takes care of her affairs so if there is a problem or she is not happy with anything she will tell them and they put it right”. One visitor said “mum was poorly a few weeks ago and I came down they said I could stay but I could not stay but the offer was there” and “.they are really good at letting us know if mum is ill they usually phone my niece as she lives closer and has a car”. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 16 One person commented in a survey form, “I phone my relative every day as well as visiting. For the past eight weeks the portable phone has not been in use which makes it very difficult for friends and family to phone, staff let me phone the office but this is not private and keeps an outside line occupied it has been reported every week”. We saw minutes of residents and relatives meetings but there was no evidence to show that issues raised had been acted upon. It is recommended that all records of meetings with residents, relatives and staff meetings record the agreed actions, date of completion and person responsible for action. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals are aware of how to make a complaint. Training in Abuse Awareness supports staff in protecting people living at the home. A more formal agreement should be developed relating to implications of the Mental Capacity Act. EVIDENCE: There are suitable procedures in place for dealing with complaints. The complaints policy and procedure is part of the guide for the people living there. We saw the complaint log and there had been 3 complaints since the last inspection. All but one had been resolved. The third was ongoing and a meeting with the complainant had been arranged for the 24/4/08. The home responded to complaints in an open manner. The service has internal policies and procedures for the Protection of Vulnerable Adults (POVA) and a copy of the Manchester multi agency policy and procedure for the protection of vulnerable adults was also seen to be available. There have been no recent allegations of abuse. Care staff at the home have training that teaches them how to recognise and report abuse. Staff spoken to were aware of the action to be taken in the event of an allegation of abuse. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 18 Behavioural charts were being maintained of any challenging behaviour but the agreed response to this is not fully detailed in the care plans. Cigarettes belonging to some residents were kept by staff and given out one at a time but there was no formal agreement of this restriction. One resident became aggressive when they could not access their cigarettes. Cigarettes were kept by staff but there was no formal agreement of this restriction and no direction as to how staff manage the residents behaviour. It is recommended that care plans fully reflect the agreed responses to aggressive behaviour in order to fully protect people. We also saw that where a resident is unable to sign and/or hold their own money the staff sign that they have received the money. However, they sign on the invoice where the resident should sign. There was no separate space for the staff to sign that they had received the money. We saw that staff requested money to purchase personal items for residents such as cigarettes, clothes, personal toiletries. They told us that staff often go out in their own time and buy these items. The purchase invoice and change are then returned to the administrator. There is no formal agreement between residents or their representatives that staff can access people’s monies to purchase personal items. A recommendation is made that a more formal agreement be developed in relation to the implementation of the Mental Capacity Act. Gorton Parks Nursing Home DS0000021678.V361489.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally kept clean and well maintained but would benefit from refurbishment or redecoration in some areas. EVIDENCE: Sanitising hand gel dispensers were provided at the entrance to each house to minimise the risk of infection. This was good practice and all containers were checked and found to be full. We saw that some of the resident’s bedrooms were personalised with photographs and ornaments. Some bedrooms were in need of refurbishment and the manager told us that a major refurbishment was due. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 20 The communal areas generally provide a comfortable and well-maintained living environment for residents. Melland and Delamere houses had a strong and unpleasant odour and did not provide a comfortable and clean living environment for residents, visitors or staff. The manager reported that the interior of the home was to be extensively remodelled in this financial year. This was to include redecoration, new furniture and carpets. We saw that there were satisfactory numbers of domestic staff to keep the home hygienic. The service should however look at replacing carpets if they cannot be kept clean and fresh. The requirement from the previous report about deep cleaning carpets or replacing them is reiterated in this report. People told us they were generally happy with the environment. Comments from individuals included “I like my room”, “it is very good here” and “I am happy with my room”. Gorton Parks Nursing Home DS0000021678.V361489.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home are protected well by the recruitment procedures. There is a staff training and development programme in place. EVIDENCE: One person said “staff are very reliable and responsible. Another said “staff always informed us of any changes in management”. Another said “ Staffing levels are not always consistent, this can lead to problems through out the running of the home”. One person said “When agency staff are in they do not know your relative as well as in house staff” and “again I am referring to agency staff I find that different people have a different way of handling patients some good some bad”. Staffing levels at the time of the visit appeared to be appropriate to meet the needs of the residents. However as previously stated interactions with residents were focussed on completing a task and involved little communication. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 22 We saw samples of new staff files for those staff that the home were currently in the process of employing but who had not yet started work at the home. The top part of the CRB disclosure was in the file but this did not contain the actual certificate number or the date of the certificate. They told us that BUPA Human Resource department do maintain a copy of the reference numbers and dates of staff CRB certificates. The manager stated that staff would not start working at the care home without obtaining a clear CRB certificate. It is recommended that the CRB disclosure numbers are recorded on individual staff files. They use a standard pro-forma reference request. The manager was not able to clarify how they knew that the reference actually came from a current/previous employer. It is recommended that references from current or previous employers be backed up with a company stamp or letterhead and confirmed with a telephone call to ensure they are genuine. The manager told us that the majority of interviews were carried out with 2 people on the panel, although she did tell us that occasionally she had completed interviews on her own. It was recommended that the home makes sure that there was always two people on an interview panel to ensure equal opportunities. Staff are offered a range of training in a number of topics such as manual handling, Fire Safety, the Mental Capacity Act and Protection of Vulnerable Adults. Updated training in dementia care is planned for all staff. An advisor has been working with the home to plan dementia care. There was a new unit manager on Delamere house and there have been improvements in care plans. Most have been reviewed but need further work to make sure they give clear detailed information to staff on what action they need to take to meet residents needs. Gorton Parks Nursing Home DS0000021678.V361489.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, 35,36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements are meeting the needs of the service, and the quality of the service is improving. EVIDENCE: The manager has a number of years experience of running a care service for older people. Comments from staff about the management of the home included “good” and “the manager is approachable. The manager has showed a good understanding of the areas of weakness and there is a good capacity for the service to improve. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 24 The manager told us that surveys are sent to relatives or friends. They told us that the responses are analysed and a Service Improvement Plan generated. The manager stated that they only received the 2007 result in Feb 2008 and so had not yet been able to develop a plan of action. Regular audits are carried to monitor areas such as accident reports, staff training and Health and Safety. The home acts as appointee for one resident only the remainder either have a relative or the purchasing local authority as the appointee. In addition some residents have Court of Protection orders and named third parties are in control of these residents finances. The administrator stated that interest was earned on the account and distributed to residents. We saw samples of resident’s financial records. Money is withdrawn each week from the BUPA account and an invoice made up that is taken with the cash to the resident where they sign that they have received the money. A recommendation is made that the home develop a formal agreement between residents or their representatives, that staff can access people’s monies to purchase personal items. A senior financial administrator from BUPA audited the resident’s financial records on a regular basis and a yearly audit is carried out independently of all the home’s finances. The management were aware of the Mental Capacity Act 2005 and its implications in relation to helping residents to make decisions that affect their lives. It is recommended that the home’s policies, procedures and working practices be reviewed to reflect the implications of the Mental capacity Act 2005. A system for staff supervision is in place but needs development to make sure that all staff receive this on a regular basis. It is recommended that those staff responsible for providing supervision receive appropriate training. It is also recommended that a system of assessing staff competence following training events is introduced There is a quality assurance auditing system for care plans and personal best this looks at customer care. The manager has made application to be registered with the commission. Gorton Parks Nursing Home DS0000021678.V361489.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 3 X X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 2 X 3 Gorton Parks Nursing Home DS0000021678.V361489.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 OP9 Regulation 15 Requirement Care plans must contain sufficient detail on all aspects of the person’s care needs to enable staff to offer appropriate support. Medicines must be available and offered for administration as prescribed to ensure the health and well being of people at the service. Not met from 31/12/07, this timescale still applies. Timescale for action 20/06/08 2. OP9 13(2) 21/04/08 3. OP26 13 (4)(a)(c) 23(2)(d) 4. OP36 18 (2) The time medicines are offered to residents must take into account the direction of the medicines and or the personal preferences of the residents. Medicines should be offered at the right and best time for residents to ensure their heath is not placed at risk. Not met from 28/01/08 and 7/02/08 The home must be kept clean 20/06/08 and satisfactory standards of hygiene maintained. Where carpets have an odour these must be cleaned to improve the living environment for residents. All staff must receive appropriate 20/06/08 DS0000021678.V361489.R01.S.doc Version 5.2 Page 27 Gorton Parks Nursing Home supervision on a regular basis. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that care plans, risk assessments and daily records should be person centred and describe fully the care delivered to residents. It is recommended that staff are encouraged to communicate with residents when carrying out tasks such as assisting residents with meals and personal care. It is recommended that all records of meetings with residents, relatives and staff meetings record the agreed actions, date of completion and person responsible for action. It is recommended that care plans fully reflect the action to be taken by staff in response to aggressive behaviours. It is recommended that a more formal agreement be developed in relation to the implementation of the Mental Capacity Act and restrictions on residents holding their own cigarettes. It is recommended that the CRB disclosure numbers are recorded on individual staff files. It is recommended that references from current or previous employers be backed up with a company stamp or letterhead and confirmed with a telephone call to ensure they are genuine. It is recommended that two people be on the interview panel to ensure equal opportunities. It is recommended that a system of assessing staff competence following training events be introduced. It is recommended that training in supervision skills be provided to those staff with supervisory responsibilities. DS0000021678.V361489.R01.S.doc Version 5.2 Page 28 2. OP7 3 OP14 4. 5. OP18 OP18 6. 7. OP29 OP29 8. 9. 10. OP29 OP30 OP30 Gorton Parks Nursing Home 11. OP35 12. OP35 It is recommended that the home develop a formal agreement between residents or their representatives, that staff can access people’s personal monies to purchase personal items. It is recommended that the return of change to the administrator must be signed and recorded. Gorton Parks Nursing Home DS0000021678.V361489.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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. 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