Inspection on 28/04/09 for Abington Park View

This inspection was carried out on 28th April 2009.

CQC found this care home to be providing an Poor service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Abington Park View 27/10/09

Abington Park View 30/12/08

Abington Park View 04/07/08

Abington Park View 09/10/06

Abington Park View 10/10/05

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Green Park Care Home 475 - 479 Wellingborough Road Northampton NN3 3HN Lead Inspector Rajshree Mistry & Kathy Jones Key Unannounced Inspection 09:00 28 & 29th April 2009 th DS0000056079.V375207.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Green Park Care Home Address 475 - 479 Wellingborough Road Northampton NN3 3HN 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) 01604 719888 01604 472892 greenpark@msaada.co.uk Msaada Care Limited Mrs Maureen Elaine Keet Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22), Physical disability (5), Physical disability of places over 65 years of age (10) Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No person falling within the category older persons (OP) can be admitted where there are 22 persons of category older persons (OP) already in the home No person falling within the category/combined categories physical disability (PD)/physical disability persons over the age of 65 (PD(E)) may be accommodated in the home where there are 10 persons of category/combined categories PD/PD(E) already in the home. The home may accommodate 5 service users who fall within the category physical disability (PD). No person under the age of 50 years of age and who falls within the physical disability (PD) category can be admitted in the home. Total number of service users in the home must not exceed 22. To be able to admit the person who is named in the variation application dated 11th August 2005 and who is under the age of 50 years. 30th December 2008 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Green Park Nursing Home is a registered care home with nursing, providing care to people over the age of 65 years. In addition, the care home can care for up to 10 people who have a physical disability. Green Park Nursing Home is situated in a residential area and opposite the large park. It is on a main road approximately two miles from the town centre. There is good public transport and local facilities. All bedrooms have en-suite facilities and there is a passenger lift giving access to all areas. There are a variety of communal areas including a lounge and a dining room on the ground floor and a lounge on the first floor. The Quality Development Manager for Msaada Care Limited provided us with the fees charged. These range from £373.76 per week to £566.60 per week, which excludes personal expenditure such as hairdressing, chiropody, personal toiletries and newspapers. The fees are determined upon individual assessment of needs and requirements. People considering using Green Park Nursing Home are encouraged to contact the home directly. The full details about the home and any specific Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 5 requirements can be obtained from the home in the form of the ‘Statement of Purpose’ and the ‘Service User Guide’. The latest inspection report from the Care Quality Commission is available at the home or can be accessed via the CQC website: www.cqc.org.uk Green Park Care Home DS0000056079.V375207.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 no star – poor service. This means the people who use this service experience poor quality outcomes. ‘We’ as it appears throughout this inspection report refers to ‘The Care Quality Commission’ (CQC). This key inspection of Green Park Nursing Home started with the review of the last key inspection report dated 30th December 2008 and the findings from a further random visit to the service on 5th March 2009. We looked at the information we have about the management of Green Park Nursing Home that included concerns and the complaints. The Annual Quality Assurance Assessment (AQAA) is a self-assessment tool, which is to be completed by the home to reflect their assessment of standards at Green Park Nursing Home. We did not receive the AQAA as we carried out this inspection earlier, in light of a number of serious issues being managed through a ‘safeguarding alert’. This means that people are at risk or suspected to be at risk from abuse, harm and/or neglect. The concerns were raised by a number of lead agencies: Fire Service, Primary Care Trust, Northamptonshire County Council and Environmental Health Authority. We visited Green Park Nursing Home on 28th April 2009, starting at 9am and finishing at 7.30pm. We returned on 29th April 2009 for the second day of inspection, starting at 9.30am and finishing at 7.30pm. The Operations Manager and the Quality Development Manager for Msaada Care Limited assisted us during the inspection of the home. The main method of inspecting we used was ‘case tracking’. This means looking at the range of care and support needs people receive with consideration to their individual health, cultural and diversity needs. We did this by selecting four people; all having a range of health and personal care needs and included a person that was new to the home. We spoke with the people we case tracked, other people living at the home and some visiting relatives. We looked at their care records to establish what their needs were and how these were met. We made observations on both days of the staff and their conduct with the people living at the home. We looked at the living environment including some private bedrooms. We spoke with the staff on duty: registered nurses, carers, the cleaner and the cook. We looked at the staff recruitment and training records. We spoke with the senior management team representing the company of Msaada Care Limited. We looked at the records that demonstrate the management of the home. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 7 As part of case tracking we looked at how the issues raised in the safeguarding alert affected them with regards to the health and personal care needs and their quality of life experienced. Throughout both days, we shared our concerns, observations and findings with the Responsible Individual (owner) and the Operations Manager representing Msaada Care Limited. In some instances, immediate actions were required to ensure the immediate risks to people’s health, safety and well-being were addressed. After the site visit to the home, we sent out surveys to people using the service, which included surveys for relatives. However, none were received at the time of writing this inspection report. We sent out surveys to health care professionals such as General Practitioner, District Nurse and Tissue Viability Nurse, of which none were returned. We did contact the Tissue Viability Nurse after the sending out the surveys and spoke with them to gather their views about the standards of care people received. The comments received are included in the body of this inspection report. We also sent out surveys to staff working at the home. However, none were returned at the time of writing this inspection report. The Care Quality Commission has a focus on Equality and Diversity and issues relating to these are included throughout the main body of this inspection report. What the service does well: Green Park Nursing Home is a residential care home with nursing situated in a residential area. It is a large home and all the bedrooms have en-suite facilities. Some people have lived at the home for a number of years. People that are more mobile are satisfied with the care they receive, the quality of life they experience and their level of independence. Some of the comments we received from the people using the service included: “She’s very good” “I stay in bed and watch TV all day and all night” The relatives we spoke with were generally happy with the care provided by the staff; felt the care staff were polite and kept them informed. They made the following comments: “Happy with the care provided to …” “The carers are very attentive” Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 8 “Informed by staff of ….’s well-being, such as recently becoming more forgetful. Very happy with the spacious bedroom with en-suite toilet facility” Our observations and findings from the site visit concluded that the majority of staff at Green Park Nursing Home are dedicated, caring and attentive. The interaction of staff with the people using the service promoted their well-being. What has improved since the last inspection? What they could do better: Green Park Nursing Home must make significant improvements in all areas to ensure people’s health and safety. Whilst the home addressed the immediate risks that we identified there must be better management and continuous monitoring of the quality of care people receive and safety in the home. Improvement must be made to the assessment and care planning processes to ensure people’s health and personal care needs are known and are met. There must be regular monitoring of people’s health needs and timely access and advice must be sought from health care professionals. The management systems, storage, recording and administration of medication must be robust. People must have their medicines available to them all at time to ensure people health and well-being. There must be a varied choice of social and leisure activities that stimulate and suit people’s interests. Consideration must be made to ensure people being cared for in bed have the same opportunities to participate in social, leisure and stimulating activities. Green Park Nursing Home must make sure the home environment is safe and free from hazards and risks to people using the service. This includes ensuring the bedrooms and bathrooms have sufficient space where people need to use equipment and ensuring people have the correct equipment in place that is in good working order. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 9 Green Park Nursing Home must comply with the Fire Service and Environmental Health Authority regulations at all times. Staff recruitment must be robust to ensure pre-employment checks are carried out before employment commences. There must be a robust induction programme for all staff including agency and bank staff to protect the people using the service. Staff must have training in safeguarding procedures, health and safety to protect people using the service. There must be a planned training programme and regular staff supervision to ensure staff skills and competency is maintained in line with current best practice. Staffing levels must ensure people’s needs are met safely and timely at all times. Management and record keeping must improve to ensure accurate and up to date information is maintained. The systems of communication between staff and management must be effective and comprehensive to ensure people’s needs are met. Green Park Nursing Home must improve leadership and have robust management systems to oversee the staffing, care practices and compliance with regulations. The following comments were received from the people we spoke with and the Tissue Viability Nurse: “It would be nice if someone came in to talk to me like you have” “Some of the carers are very good but not the night nurse – she doesn’t want to touch you” “Wasn’t aware that you (CQC) had raised the need for me (Tissue Viability Nurse) to look at ….. wounds” “Carers seem to be consistent but the trained nurses are bank or agency nurse, which does affect the care” If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 10 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 Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 is not applicable. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service do not in all instances have a comprehensive assessment of their needs undertaken, this can affect the care they receive. EVIDENCE: We wanted to find out what information people receive about Green Park Nursing Home. We read the home’s ‘Statement of Purpose’ and the ‘Service User Guide’. The aims and objectives for the home is set out, the type of health and personal care needs that would be met by registered nurses and carers. This information tells people the range of services offered and the quality of service they can expect. It sets out the type of accommodation and facilities offered including meals and social opportunities. The information details the key policies and procedures such as the admission process, the complaints procedure, fire and evacuation procedure. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 12 The Statement of Purpose and the Service User Guide can be made available in alternative formats. However, it needs to be updated. For example, it still refers to the manager that no longer works at the home. Therefore, people may be making decisions about using Green Park Nursing Home, based on out of date information, which may affect their well-being if the home is not able to meet their needs. We wanted to find out how people chose the home. People we case tracked said they visited the home or that their relatives visited the home before they moved in. One person we case tracked told us they were moved to the home directly from the hospital and assumed it was chosen for them. A visiting relative told us that they looked at the home at short notice before agreeing for their relative to be moved into the home. We wanted to find out what was involved in the assessment and admission process. We read the care files for the people we case tracked. We found there was a hospital transfer/discharge letter detailing the person’s health needs. We read the assessment completed for the newest person at the home. The information recorded about the person’s needs was minimal with regards to health and personal care, medical history, mobility, continence and communication. For example, there was no reference as to why the person needed to be ‘nursed in bed’ or how the diabetes was managed. There were comments such as “nursing staff to ensure annual eye-tests”; “to be nursed upright position” and “to monitor the insulin regime check blood sugar levels, catheter and pressure area”. The information provided in the hospital ‘transfer/discharge’ letter was not included in the assessment process and therefore, key information was omitted. This could result in their health and personal care needs not being met. We spoke with the people we case tracked, some who were nursed in bed, to find out what their needs were and how they were met, as there was minimal information in their assessment. We asked the registered nurse on duty why some people were being nursed in bed but she was unable to tell us without referring to the care files. One gentleman said in front of the bank registered nurse they were nursed in bed, “because I can’t walk”. This demonstrates that the bank registered nurse in charge was not aware of people’s general needs, even though they work at the home on a regular basis as a bank nurse. We read the assessment records completed for people that have been living at the home for a number of years. The assessment was comprehensive detailing a full medical history, health problems, disability, treatments and any specialist equipment required. It also detailed their preferences, likes, dislikes and social interests, which reflected the person and their lifestyle. There was an audit check that showed actions to be taken such as bed rail assessment and to contact the dietician. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 13 In some files we found assessments of risk, for moving and handling and use of bed rails and bumpers. However, there were no bumpers or padding found on the bed rails in the person’s bedroom, whose records we checked. This showed that whilst some risk assessments were carried out, safety measures were not acted upon. We concluded from reading the assessments for the people we case tracked that there are inconsistencies in practice, which is dependent upon the person assessing. There is no system in place to manage any follow-up actions required such as contacting the dietician. This demonstrated that the assessment process is not robust and key information about the person in not included. The person responsible for conducting the assessment of needs lacks training and competency to protect and promote people’s health and wellbeing. This highlights the lack of management and monitoring in place to oversee the admission and assessment process consistently that ensures people’s health and safety. Staff we spoke with told us they are told about any new people moving into the home as part of the handover meetings between staff. We looked at the handover sheet, which had the names of people living at the home and comments such as ‘ok’ next to them. This highlighted that staff were not aware of people health and well-being on a daily basis, as demonstrated earlier from our conversation with the bank registered nurse. Therefore, a greater risk is placed on the people using the service as the home regularly uses bank or agency nurses and communication is between staff is poor. We raised the issue of the quality and the content of the handover meeting with the Operations Manager and the Quality and Development Manager. We gave them examples of our findings from the discussion with the people we case tracked and what we had read in the care files compounded by the home using bank and agency staff. The Quality and Development Manager drafted a new ‘handover sheet’ with the names of the people using the service and prompts to ensure key information was communicated to all the staff. For example, the one person was returning home from the hospital and staff would need to know if there are any changes to their needs. The staff we spoke with on the second day with regards to the quality of the handover found the information shared was comprehensive about people using the service. This demonstrated how the quality of good information can improve the service people receive as staff are more aware. Green Park Nursing Home does not provide intermediate care. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s health and personal care needs are not met safely due to poor care planning, monitoring, communication and management of risks. EVIDENCE: We wanted to find out how individual’s health and care needs were met by the home, as there were a number of serious concerns raised through the safeguarding alert. The Quality & Development Manager initially told us that everyone living at the home required ‘nursing care’. We identified four people to case track after speaking with them and making observations. We read the care files containing the care plans and records to show how their health and personal care needs were met. The care files contained lots of information but was not structured to enable us to find information quickly. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 15 The care plans were not ‘person centred’, which means focused from the person’s point of view, personalised to their lifestyle and did not give clear guidance for staff to follow. There were individual care plans written for each need such as safety, moving and handling, eating and drinking, personal care and elimination that includes catheter care. This meant some people had more than 10 individual care plans. The care plans such as eating and drinking were not linked with diabetes care plan, nutrition plan or elimination plan. We saw assessments of risks but the safety measures were not reflected in the care planning or how it people’s safety was ensured. For example, there was a note to refer to the dietician and to use bumpers / padding on bed rails. However, the records did not demonstrate that a dietician had been consulted and bed rails still did not have bumpers/padding in place even though it was identified in the risk assessment. We found a number of serious issues that potentially placed the people we were case tracked at risk. Some of the issues supported the concerns raised in the safeguarding alert. We immediately brought these issues to the attention of the nurse in charge and the Operations Manager to address to remove the immediate risks to people. These included: • • Height of the mattress causing risk of falling over the bed rails and out of the bed. Of the two mattresses used on the bed, one was removed and made safe. The ‘power fail’ light was switched ‘on’, on the unit for the air mattress and was set to the maximum. There was no information as to what the setting for the air mattress should be even though weight records were kept. Having raised this, the air mattress was replaced and set in accordance with the person’s weight. Loose ‘bed rails’ that could place people at risk of ‘entrapment’, which means trapping themselves into the gap or in the bed rail itself. The risk assessments clearly stated to use bed rail bumpers/padding for one person we case tracked. Clearly no action had been taken. Having raised this, padding was secured where there were identified risks to people. We found a hoist on the ground floor that was ‘out of order’. We established the number of hoists in the building on each floor to sufficiently meet people’s needs. Having raised this, the Quality Development Manager confirmed a hoist has been brought over from the sister home, as it was surplus to requirement. The repair to the ‘out of order’ hoist was scheduled for 11th May 2009. Two people raised issues with regards to catheter care. One person told us they have to tell the staff to empty the catheter bag on a regular basis. This further demonstrates lack of care planning, monitoring, and thus not meeting needs. Another person’s care file showed they did have use a catheter and on four consecutive months there were repeated problems. On the last occasion, 7th April 2009, there is a record made by the nurse on duty, stating that the District Nurse was contacted. There was no evidence DS0000056079.V375207.R01.S.doc Version 5.2 Page 16 • • • Green Park Care Home of the District Nurse or the General Practitioner having visited. The person told us, they did not know what was happening, and often finds themselves in a wet bed at night. This shows there was no care planning for nightly checks, hence staff not carrying out the checks to meet needs at night. Having raised this, the General Practitioner was contacted. This further demonstrates lack of management and monitoring. We concluded that health and personal care needs are constantly met in a reactive way, placing people at risk. Management of staff, care planning and the on going monitoring of health needs is poor, placing people at risk. This highlights that the service is not managed and there is no clinical directive to ensure health care needs are monitored and met safely. (Also refer to section: ‘Environment’, ‘Staffing’ and ‘Management and Administration’). We wanted to find out what health care support people received, such as General Practitioner and Dietician visits, as referred to in care files. On the first day of our visit we saw the Chiropodist was visiting. They said they had not been to the home since 2nd February 2009, which indicates no regular visits are arranged to meet needs that affects their well-being. They told us that they still had not received a list of names of the people at the home having requested this information a number of times. This further supports the lack of management in the home. We looked at records for two people relating to the care of wounds and found that specialist advice had been received from a Tissue Viability Nurse on 3rd April 2009. Records relating to the assessment, care planning and evaluation of the wounds were poorly organised making it difficult to ascertain the current condition of wounds. We found in one case the wound had actually healed, though this was not apparent from initial review of the records. We spoke with an agency nurse about wound care for one person and she told us that she had dressed wounds on the person’s feet. We had seen a record relating to a pressure ulcer on the person’s buttock. The nurse had not been aware of this, highlighting the inadequacy of the recording and communication systems in meeting people’s needs. We asked the nurse to check this person for wounds as a carer said they thought this person might have another sore. We also raised this with the Operations Manager. After the site visit to the home, we were informed and received copies of the records demonstrating that the Tissue Viability Nurse had re-visited two people in need of wound care. A new system for handing over information between shifts, which includes the presence of any pressure ulcers or wounds, was implemented during the inspection. We spoke with the Tissue Viability Nurse on the telephone to ascertain their views with regards to health care specifically wound and pressure area care. They told us they were not aware of the need to visit a person with a pressure sore as no contact had been made by the home. They said: Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 17 “Since the change of staffing there has been problems, mainly after … leaving and a nurse going on maternity leave” “Things have been chaotic at the service” “Wasn’t aware that you (CQC) had raised the need for us (Tissue Viability Nurse) to look at … wounds. .. wound condition is much better” “Carers seem to be consistent but the trained nurses are bank or agency nurse, which does affect the care” “We know they are taking steps to improve things” We wanted to know what information staff have about people’s needs. We saw that staff did not refer to the care plans at any time unless they were making an entry in the daily report. On the first day we saw care staff receiving little direction or guidance from the nurse on duty. However on the second day of our visit, the agency nurse was seen giving guidance and deploying the care staff to tend to people. The care staff we spoke with demonstrated a good understanding of people health and personal care needs. Most of the care staff were permanent and showed they had a good rapport and relationship with the people living at the home. Three people were seen complimenting staff when they entered the bedroom to bring them a drink or check that they were comfortable. Comments received included “she’s very good”. We observed that two nurses (a bank nurse and an agency nurse) that were on duty over the two days also demonstrated an awareness of people’s health care needs. They were seen referring to the care file and talking with the staff on duty with regards to people’s health. Whilst this demonstrated some nurses were pro-active, communication still remains an issue, as the nurse on duty in the afternoon on the first day said: “There’s nothing in the diary” “….. use to write down information on dressings” “No one told me about the transfer of ….. to …...” “Had to call ….. about transfer, especially about medication had to read the care plan to do the discharge letter” One nurse who came with us to see two people caused us concern. One gentleman wanted to see the General Practitioner (GP) with concerns about his hands and the nurse gave the diagnosis to us instead of the gentleman. The nurse made no reference to when the GP would be contacted. A gentleman Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 18 told us they find it difficult to eat solid food and preferred soups. However, the care file reflected neither the preferred meals or any advice sought from health professional such as a Dietician. On another occasion the same bank nurse who works regularly in the home was unable to tell us about a person’s needs in relation to wound care without referring to the care file. This demonstrated that the nurse in charge failed to respond to the request made by a gentleman, showed no respect by not responding to them and did not know about people’s health needs without referring to the care file. This further supported our findings with regards to communication, the quality of information and the lack of management in the home. We shared our findings with the Operations Manager and the Quality Development Manager. Whilst they demonstrated by responding quickly to address the serious issues we identified, we expressed our concerns regarding the lack of clinical and management of the home to ensure people’s health and care needs were met safely. We spoke with a care assistant who was organising a bath/shower rota, as there had been no system in place to ensure that people were able to have regular baths and showers. The majority of people have been reliant on bed baths. As detailed in the environment section we do have some concerns about the adequacy of the bathing facilities in relation to meeting the needs of some people using Green Park Nursing Home. It is important that appropriate equipment and arrangements are in place to meet people’s personal care needs. On the first day of inspection one person told us that they were in pain, we reported this to the nurse on duty. We found later that the person’s medication had recently been reviewed and there had been a change of pain relieving medication. There was a document titled ‘behavioural pain assessment’ and a care plan, which talked about liaising with the GP and a relative. However, there was no evidence of any monitoring of the effectiveness of the pain relief in controlling the person’s pain and no record of the complaints of pain. On the second day of inspection a gentleman told us that he was in pain and that his painkillers ran out yesterday. We went to check this with the nurse on duty and found that arrangements were being made for a member of staff to collect the prescription from the pharmacist. The painkillers were collected and administered late morning. However, we found that this medication had also run out the previous week. An emergency prescription had been obtained via the out of hour’s GP service, which had again been allowed to run out without more medication being obtained. The Operations Manager confirmed that he would carry out a full investigation as to how the medication had been allowed to run out on two occasions and put in place systems to ensure it did not happen again. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 19 A sample check of people’s medication and medication records identified that although the records contained some entries with the code ‘o/s’ (out of stock) according to stock levels there should have been sufficient stock. There was no further explanation within the records as to why the medication was not given. We did however find that medication is stored in a medication trolley, different cupboards in the main office and also in a locked cupboard near the manager’s office. This practice increases the risk of an agency or a bank nurse not finding medication. We looked at the medication for a person who had recently been admitted from another care home. Medication received at Green Park Nursing Home had not been checked or recorded on admission. The medication administration record from the other home showed medication received. However, this was what had been received at the previous home. More medication had also been received from the pharmacist supplying Green Park Nursing Home. It is important that there is a clear audit trail with records kept of all medication received, administered and disposed of. This helps to identify any discrepancies and should also alert staff to any medication where there may be insufficient to last until the next supply is received. On the second day of inspection an agency nurse who was working for the second time in the home administered medication. We observed that she was thorough in checking medication was administered to the correct people, checking with staff and also with the person receiving the medication. Some medication records had photographs, which provided a further check. However, these were not in place for the more recent admissions to the home. The nurse had a pleasant manner and unhurried manner with people and provided them with any necessary assistance with medication. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 20 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are no planned activities reflective of people’s interests. This inhibits individual rights to choose how to live. EVIDENCE: We wanted to find out how people spend their day and how staff support people with their preferred daily routines and interests. This would demonstrate the quality of lifestyle experienced by people using the service. The ‘Service User Guide’ lists all the activities offered at Green Park Nursing Home, which includes board games, music and videos, singing entertainment, life story books, religious services in-house, shopping and days out’. During our visit over two days we saw most people were sat in the lounge on the ground floor, watching television or talking or watching staff and people in the lounge, for most of the day. Some people were sat in the dining room after having a late breakfast, which showed people’s preferred morning routines were promoted. Although there was a lounge on the first floor, this was not Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 21 used. Some people were seen asking staff to take them out onto the patio at the rear of the home, to sit in the sunshine. Some people remained in their bedroom, as they were being nursed in bed or preferred to watch television in the privacy of their bedroom. We spoke with one person who was being nursed in bed. They told us that they use to sit in the armchair in the bedroom, which is no longer there. They told us being hoisted was painful. The comments they made indicated that staff do not spend time with people who are being nursed in bed unless staff were tending to their need. The comments received from the people we spoke with were: “I stay in bed and watch TV all day and all night” “It would be nice if someone came in to talk to me like you have” “Some of the carers are very good but not the night nurse – she doesn’t want to touch you” We noted that there was no programme of activities displayed in the home to show what activities are on offer so people can choose to participate. This contradicted the information provided in the ‘Service User Guide’. In the afternoon, some staff were seen spending time with one or two people in the lounge; talking and doing an activity with their hands to promote flexibility. However, at no time did we see staff spending one-to-one time with people that were being nursed in bed. This was clearly not possible as there were no additional staff on duty to promote activities for the people living at the home. This supported the comments we received from people being nursed in bed. We saw a number of people living at the home receive visitors. Three visiting relatives told us that they were generally ‘quite happy with the care provided to their relatives living at the home’. People were not restricted as to when family and friends could visit. One relative was seen staying for lunch, which showed that people were encouraged to have their relatives join them for a meal. The comments received included: “Happy with the care provided to …” “The carers are very attentive” “Informed by staff of ……’s well being, such as recently becoming more forgetful. Very happy with the spacious bedroom with en-suite toilet facility” The care plans read for the people we case tracked contained a mixture of information. Some had details of people’s family and social interests, whilst others did not. The staff we spoke with were positive with regards to making people feel comfortable and spending time talking with them. However, if staff Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 22 had more information as to people’s social interests and hobbies, activities could be tailored to suit them, providing there were sufficient numbers of staff. This would stimulate people and promote people’s wellbeing. Throughout our visit we saw staff were encouraging people to make choices and decisions about their lifestyle and daily routines. Two people were seen asking the staff to take them out onto the patio after lunch. Staff were seen addressing people by their preferred names and speaking with them in a respectful manner. This showed people were valued, respected and treated as individuals. We wanted to find out what the quality and choice of meals were offered to people. We saw people were able to have breakfast later in the morning. The majority of people had their meals in the dining room, where the radio was playing. Some people preferred to eat their meals in the lounge or in the privacy of their bedrooms. We spoke with a gentleman who has his meal in his bedroom. They said they prefer to have soup, to avoid the food being brought back up. The care file read had no information with regards to the person’s eating preferences, difficulties or advice sought from the health professionals such as a Dietician. The lack of attention, information and support to address the food and eating issue could affect the person’s health and well-being. (Refer to section: ‘Personal Care and Health’) There were bowls of fresh fruit on the dining tables and people were seen helping themselves to the fruit. People were regularly being offered hot and cold drinks throughout the day. We saw staff assisting people with their meals in a discreet and sensitive manner. We saw people were provided with special cutlery to promote their independence and some people asked staff to cut up their meals into bite size pieces. People said they enjoyed the choice of meals, which suited their dietary needs such as sugar free meals for people with diabetes. Meal times were unhurried and a pleasant experience most of the time. We saw some people stopped talking and put down their cutlery when the platform lift was being used. The noise of the platform lift that is situated in the dining room affects people’s well-being, resulting in people not talking. We brought this to the attention of the Operations Manager with regards to how the noise affects people especially at mealtimes. This was an issue raised at the last inspection and clearly had not been addressed. (Also refer to sections: ‘Environment’ and ‘Management and Administration’). We were made aware that the Environmental Health Officer had inspected the home recently and made a number of requirements to comply with regulations. The issues related to the kitchen, storage of food items and hygiene practices. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 23 The Operations Manager told us that as a result of the issues raised the ‘Facilities Manager’ is also overseeing the management of the kitchen. We wanted to find out what skills and training the cook has to make sure people have healthy and nutritious meals and the actions taken to respond to the concerns raised by the Environmental Health Officer. The cook showed us that food items in the kitchen cupboards and the fridges are now labelled and dated. They showed us that they now completed the ‘safer food better business’, folder recommended by the Environmental Health Officer. The cook was required to record comments for each day. The notes made were brief and there missing entries on the days when the cook was not working. This demonstrated that there was no system of checks or monitoring of the records and practices in the kitchen. We brought this to the attention of the Operations Manager, which further demonstrated the lack of management of the home. (Also refer to sections: ‘Staffing’ and ‘Management and Administration’). Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 24 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are not protected due to poor management, staff competency, systems and procedures. EVIDENCE: We wanted to find out if people were aware of how to make a complaint and what the process was. We read the complaints procedure that is included in the ‘Service User Guide’, given to people when they move to the home. The complaints procedure clearly set out how people can complain and the process if they remain unhappy. The Quality Development Manager told us they now deal with all the complaints in the absence of a manager for the home. This showed arrangement was in place for a member of the management team to address all complaints received about the home. Four people using the service told us they were confident to tell the staff if there was a problem or that they had a complaint. The visiting relatives told us they were aware of the complaints procedures and were confident to express concerns to the nurse on duty. This demonstrated people felt confident and able to express concerns, directly or with the support of their relative. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 25 We read the complaints log and noted Green Park Nursing Home had received five complaints. All the complaints were investigated and responded to satisfactorily. Records of the complaints investigation were kept to demonstrate actions taken and any changes in practice to improve the provision of care. The people we case tracked said they felt safe and secure at the home. A number of people using the service and visiting relatives complimented the staff that helped them. This showed people generally felt safe and cared for at the home. We were advised of the safeguarding adult referral since 28th March 2009, following the Fire Service’s inspection of the home. In addition, the Environmental Health Officer inspected the home and identified further serious issues. The local Primary Care Trust and the Northamptonshire County Council carried out their own monitoring visits and identified poor practices, unsafe equipment in use, issues with regards to staffing and the management of the home. This placed people using the service at risk of their health safety and well-being. As part of our inspection of Green Park Nursing Home, we looked at the issues raised to assess if people were at risk. We spoke with staff on duty, assessed how people’s health and care needs were met through case tracking. In addition, we tested the knowledge of staff, their practice and procedures followed with regards to health and safety. We raised a number of serious issues as we identified them throughout the inspection of the service, which placed people at risk and is documented within this inspection report. Whilst the Operations Manager addressed the immediate risks, it highlighted that there is a lack of management that includes ‘clinical input from a trained nurse that ensures the health and safety of the people using the service and the staff. During our inspection of the service we noted that a few requirements made from the previous inspection were still not fully addressed. We expressed the seriousness of our findings and ongoing assessment of the home to the Responsible Individual (owner) and the Operations Manager, highlighting how people using the service were not protected or safe. The Operations Manager continues to work with Social Services and Primary Care Trust to address the issues raised in the safeguarding alert. Regulating bodies such as Environmental Health Authority and the Fire Service have set requirements for the home to comply with regulations. These will be monitored and assessed as part of the safeguarding alert, to protect the health, safety and well-being of the people using the service. (Refer to sections; Personal Care and Health’ and ‘Management and Administration’). Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 26 We wanted to find out if staff at the home, knew how to deal with allegations made by people living at the home with regards to abuse. Staff we spoke with demonstrated a good understanding of the types of abuse and were confident to report concerns to the person in charge. However, the newest member of staff in post for 2 weeks was unsure how they would deal with any allegations. This demonstrated some individual members of staff protected people, as we already identified poor communication between staff, recording, staff competency and the training for agency and bank staff is not robust. (Refer to sections: ‘Staffing’ and ‘Management and Administration’) We looked at the staff training records. Whilst the staff we spoke with excluding the newest member of staff were aware of the procedures that they would follow, the training records did not demonstrate whether staff had or had not received training. (Also refer to section on ‘Staffing’) Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 23, 24, 25 and 26. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s health and safety is placed at risk due to equipment and premises not being safe or suitable for them. EVIDENCE: There were a number of issues raised through the safeguarding alert with regards to the living environment, which includes the fitness of equipment, hygiene and infection control practices. The home is accessible for people who use walking aids or wheelchairs. There is a passenger lift at the centre of the home and a platform lift situated in the dining room. The platform lift in the dining room was loud and affected people using the dining room. People stopped talking, as they could not be heard. This Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 28 impacts on the quality of life people experience and could affect their wellbeing. We brought this to the attention of the Operations Manager as the platform lift was identified as an issue at the last inspection of the service and remains outstanding. The Operations Manager confirmed and demonstrated that window restrictors have been installed to all the windows. This was a requirement made at the last inspection. With regards to the radiator guards identified at the last inspection, these have been made safe and confirmed as part of the home’s routine maintenance. We looked at the bedrooms for the people we case tracked with permission to assess to see if it was suitable for their needs. All the bedrooms had en-suite toilet and shower rooms. The bedrooms were personalised with pictures and photographs. People told us they liked their bedrooms. We identified a number of issues of health and safety relating to bedrails and air mattresses, which are detailed in the ‘Personal and Health Care section of this inspection report. Whilst the Operations Manager made the immediate risk safe there must be a system of ongoing monitoring and assessments. We identified two bedrooms where there was insufficient space to assist the person safely using a hoist. We brought this to the attention of the Operations Manager, highlighting the risk to individual being helped and the two staff. As a result of our concerns an alternative bedroom was identified in discussion and agreement with the individual and their relative. This demonstrates our ongoing concerns, the lack of monitoring and management of the home and the need to ensure people’s needs and required equipment and space is carefully considered prior to admission. Some people needed the use of a hoist to help with transferring them from the bed to a chair. We observed two staff using a hoist to transfer a lady from the wheelchair into the armchair. This was done safely, staff talking to each other and with the lady and maintained her dignity throughout. We saw that there were at least one or two hoists on each floor available for use. We found a hoist in the bathroom on the ground floor, which had a Parker bath. The Parker bath is a special bath used by people with limited or no mobility who would need to be hoisted in and out of the bath. The hoist was ‘out of order’. We measured the space available to use, by two staff using a hoist and transferring the person safely from the wheelchair into the Parker bath. We concluded that there was insufficient space to safely hoist the person into the bath and would compromise their safety, privacy and dignity. We raised our concerns with the Operations Manager and the Quality Development Manager. They confirmed that the hoist was booked for repair on 11th May 2009 and another hoist was brought in from the sister home within the group, as it was not needed. We also advised that movement and handling Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 29 assessments should be carried out for bathing and showering, taking into account the size, design and layout of the rooms. We asked people who we case tracked how their personal care needs with regards to bathing were met. One person told us they have regular beds baths, whilst another said they use the en-suite shower. We saw staff wearing protective clothing such as gloves and aprons when assisting people with their personal care or handling food. We saw that people had gloves and aprons in their bedrooms and specific laundry bags in use to prevent the spread of infection. This was an issue identified through the safeguarding alert and our observations showed practices had improved. All areas of the home were generally clean. We saw the cleaner moving from one bedroom to the next with cleaning products, mop and bucket of dirty water. This practice increases the spread of infection, such as MRSA, as the dirty water is not discarded and used to clean other bedrooms. We spoke with the cleaner with regards to their knowledge, understanding and training in health and safety and infection control. The cleaner demonstrated a lack of knowledge and awareness of safe practices with regards to infection control. We brought this to the attention of the Operations Manager, highlighting the increased risk spreading infection and lack of management. The people we spoke with during the site visit to the home told us they were happy with the laundry arrangements. People said they had their clothes washed, pressed and returned to them. We saw people had their own laundry bags for soiled clothing and where required appropriate laundry bags were provided to prevent the risk or spread of infection. This showed best and safe practice was followed to protect people’s health and safety. We looked at the staff rota and noted that staff on duty at night were required to do people’s laundry. We assessed this in light of a recent incident whereby the Fire Service was called out at night. We concluded that people were at risk at night. We raised this issue with the Operations Manager regarding staffing levels especially at night and in case of a fire or an emergency. As a result, we were advised that the home would be advertising for a laundry person and care staff would not be required to undertake laundry duties at night. On the second day of inspection, we saw a noticed displayed on the laundry room door informing all staff that ‘laundry tasks must not be carried out at night’. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 30 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels, recruitment and training is not robust to meet people’s needs safely. EVIDENCE: We had received some concerns with regards to staffing and staffing levels through the safeguarding alert. We wanted to find out whether the numbers of registered nurses and carers ensure people’s health and personal care needs are met. We observed there was a registered nurse and a number of care staff working in the day. People sitting in the lounge and the dining room were complimentary of the care staff and one particular registered nurse. We observed staff had a good relationship with the people using the service, addressing people by their preferred names and smiling, which had a positive reaction from people that were being helped. We looked at the staff rota for the week. The rota was unclear as to the staff working and the number of changes were made. We established from speaking with the staff on duty and then the Operations Manager the numbers of staff on duty per day. At present there is a registered nurse (bank or agency) on at all times, supported with 4 carers in the day, 3 in the afternoon and 2 at Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 31 nights. Additionally, there is the cook and the cleaner. It was unclear how the staffing levels were determined, as people’s needs and dependency levels are not known, without further assessments being undertaken. Therefore, staffing levels at present may not safely meet people’s needs, especially where there are a number of people being nursed in bed, compounded by the size and the layout of the home. We wanted to know if staff had clear roles and responsibilities. We were aware of the lack of clinical management to meet people’s needs, which was raised through the safeguarding alert. Staff told us that they are sometimes told what areas they are responsible for but that would be dependent upon the nurse in charge. Our findings during the inspection detailed in the ‘Personal and Health Care’ sections, highlighted the significant risk to people due to lack of clinical support. Although the Operations Manager is managing the service in the absence of a manager, they do not have the clinical expertise. We raised our concerns with the Responsible Individual (owner) and the Operations Manager to address. The Responsible Individual confirmed that a registered nurse from the local hospital would provide the ‘clinical expertise’ for 3 weeks, initially to support the Operations Manager. (Refer to the section on ‘Management and Administration’). We wanted to find out if the staff recruitment, induction and training protected and promoted people’s health, safety and well-being. We looked at the recruitment process for three members of staff and found some shortfalls. We found that criminal record bureau clearances had been obtained for all three. However, although references had been obtained it was not clear in some cases that these had been provided by an ‘employer’. Entitlement documents for working in this country for one person were out of date. The Operations Manager confirmed that relevant documents would be obtained before this person returned to work. A thorough recruitment process is important in helping to protect and safeguard people who use the service. Records relating to staff induction training, training and supervision were patchy. We did not find any induction records or records of recent training. We were informed that some recent training has taken place (April 2009), however training certificates have not yet been received. This training included: fire safety, infection control and food hygiene. We discussed the need for induction training for agency staff as well as for permanent staff. This is particularly important in the case of agency or bank nurses who may well find themselves left in charge. We spoke with the registered nurses on duty over the two days. We established that the registered nurses were mainly bank or agency nurses, some who had worked at the home for a number of years. This highlighted that some registered nurses even though had worked at the home for a number of years did not know the people using the service or their needs. This Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 32 supports our findings with regards to lack of management and clinical management to ensure people’s needs are met safely. (Also refer to section: ‘Personal Care and Health’) We spoke with a number of carers, some who had been working at the home for a number of years and a new carer. The carers in post for a number of years said they receive regular training and quoted the training undertaken. These included moving and handling, health and safety, safeguarding adults and were due to attend infection control training. They told us that they do not have supervision meetings. We spoke with the newest carer with regards to her role and the training completed, she said, “still getting familiar with the residents – only 2 weeks into post”. However, the Quality Development Manager told us that there were no new staff employed at the home, which contradicted our findings, demonstrating lack of management awareness. We wanted to find out what induction training is provided to agency and bank staff. One bank nurse described the fire evacuation procedure that would be followed. They stated people being nursed in bed would be removed from their bedroom on a fire blanket and brought downstairs by 6 staff. We read the fire evacuation procedure and found it lacked detail and clear guidance for staff to follow. This example highlighted a number of issues, which places people at risk, especially as 6 staff are not always on duty, lack of training, management and information with regards to procedures. This contradicted the information in the Statement of Purpose, stating staff are aware of the fire procedure. Although the fire evacuation procedure was updated and communicated with all the staff in the first instance to remove the immediate risk to people using the service, it highlight again the lack of management and monitoring of the service. (Refer to section: ‘Management and Administration’). We already raised the issue of the quality of handovers and communication between staff in the ‘Choice of Home’ section. As a result the Quality Development Manager developed a new handover sheet and the quality of information shared between staff was improved. We concluded that the clinical management and staffing of the home must improve from staff recruitment; induction and training to ensure staff skills and knowledge ensure people’s needs are met safely and are protected. This supports the concerns raised through the safeguarding alert highlighting the risk to people using the service. We expressed our concerns and findings with the Responsible Individual (owner) and the Operations Manager, as once again we had to intervene to ensure immediate risks were removed to ensure people’s health and safety. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 33 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is not robust and in some key areas fails to recognise, protect or promote people’s health, safety and well-being, leaving people and staff at risk. EVIDENCE: We wanted to find out how the management of Green Park Nursing Home affects the people using the service. The concerns raised through the safeguarding alert indicated lack of management of the service. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 34 The acting manager for Green Park Nursing Home left prior to our inspection of the home. However, the qualifications and experience of the acting manager remain in the ‘statement of purpose’ and the service user guide’. People we spoke with talked about the acting manager with regards to being able to raise concerns or issues that they may have had with them. The Responsible Individual (owner) told us the Operations Manager is now responsible for the day-to-day management of the service until a manager is recruited. The home has recruited a deputy manager although the start date is not confirmed. Throughout the inspection of the home, we raised a number of serious issues, which placed people at risk. Whilst the Operations Manager and the Quality Development Manager addressed the immediate risks, this highlighted the people were not safe and their needs were not met promptly. Care staff were caring and responsive to people’s requests and showed initiative. However, staff had told us they do not always have clear roles and responsibilities, which is dependent upon the ‘nurse in charge’. We found some registered nurses lack knowledge, skills to manage, assess and respond to health needs of people living at the home. It was evident that there is no robust system of management or monitoring in place to ensure people’s needs are met safely. This highlights that staffing levels and management of staff is not effective and places people at risk or ongoing risks. Our findings during the inspection of the service detailed throughout this inspection report and the concerns raised through the safeguarding alert demonstrates a lacks leadership; management and clinical expertise to ensure people’s health and personal care needs are met. In addition, a few requirements set at the last inspection of the service remain outstanding or incomplete. We expressed our concerns with the Responsible Individual and the Operations Manager. As a result, the Responsible Individual confirmed to us in writing that the Operations Manager is responsible for the day-to-day management of the service. In addition to the existing staffing, a registered nurse has been identified to provide the ‘clinical expertise’ until 26th May 2009. The Operations Manager has given assurance that they will continue to submit weekly staff rotas to us and we would be notified of the ‘clinical expertise’ after 26th May 2009. We wanted to know whether people have the opportunity to learn about the changes within the home that would affect them such as the ‘Residents & Relatives Meetings’. The ‘Service User Guide’, stated there are ‘monthly house meetings takes place in order to discuss with the residents the general day-today running of the home. However, we saw no evidence of these meetings taking place. We were made aware that a ‘Residents & Relatives Meeting had been arranged by Social Services for 30th April 2009 and that people were aware of this. This demonstrates people are not kept informed or consulted Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 35 about changes within the service that could be beneficial to them and shows practice is not as stated in the Service User Guide. We wanted to know whether Green Park Nursing Home has a quality assurance process for people using the service and their relatives to comment on the quality of care and services they receive. At the last inspection of the service there was a requirement made for the home to develop a quality assurance process. We found no evidence of this process being put into place. The Quality Development Manager confirmed there is a quality assurance process for all the services within Msaada Care Limited. The Responsible Individual confirmed that a quality assurance exercise would be carried out by 1st June 2009. We advised the Responsible Individual and the Operations Manager that a report should be produced detailing the findings from the quality assurance and how the service intends to improve. This report should be made available to the people using the service, their relatives, other interested parties and a copy made available to the Care Quality Commission. We wanted to know what internal systems are in place to assess the quality of the service people received. The Responsible Individual or their representative is required to conduct monthly visits to assess the service. The Quality Development Manager told us that they took responsibility for conducting the monthly visits and has remained working at the home since the acting manager left. They showed us the monthly visit reports dated: 23.07.08 and 24.11.08, which identified a number of shortfalls and respective action plans. We were told that although formal monthly visits were not being conducted, they were addressing the significant issues raised by Environmental Health Authority, Fire Service, Primary Care Trusts and Northamptonshire County Council. Whilst the home was addressing the concerns through action plans and presence of management, it further demonstrates people were placed at risk. The home must re-start the monthly visits and produce reports of their findings, action plans and evidence of monitoring and the management of the home. Copies of the monthly visits reports must be available for the purpose of inspection. We wanted to find out how people are supported to manage their money. People we spoke with said they managed their own money. The ‘Service User Guide’ states people have the right to manage their own finance. We established speaking to the Quality Development Manager that the home does not manage people’s money, where possible family are encouraged to take responsibility. The statement of purpose states “All staff receive supervision and support from their line manager” and “This will take the form of formal supervisions every 8 weeks, information supervisions as required and an annual appraisal”. We found a record for one member of staff having a supervision session in December 2008. However, there were no records of any supervision sessions for a member of staff who had been employed for four years. The Operations Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 36 Manager acknowledged the importance of supervision in monitoring staff competence and identifying training needs. The records relating to the people using the service are not kept up to date; reflective of changes in care needs, details of health care support and recording. The information in the care files are not in good order or easily accessible to staff providing the care. People using the service and their relatives should be made aware of their records and they should be involved in care planning to ensure their care needs and preference of support, are met by staff. We were made aware through the safeguarding alert a number of serious issues. In addition, the Fire Service and Environmental Health Officer imposed regulatory requirements on the home to address within set timescales to ensure compliance. These included fire training, fire evacuation procedures and equipment, safe storage of food items and hygiene practices. This contradicted the information in the Statement of Purpose and the Service User Guide, which stated ‘fire procedures are in place’. The Operations Manager informed us that fire evacuation equipment had been ordered and staff training planned providing the equipment is delivered at the home at prior to the training. This showed to steps were being taken to address the shortfalls but highlights the service was not equipped or safe in the first instance. During our inspection of the home we identified a number of serious issues with regards to health and safety, which we raised with the Operations Manager. These are detailed throughout this report and include: • Staff described to us an unsafe fire evacuation procedure and the fire procedure was not clear. Having raised this with the Operations Manager we also sought advice from the Fire Service. The fire procedure was revised and staff were informed. We identified risks to people using the service. These included the risk of entrapment where bed rails were used. The ‘power failure’ light was switched ‘on’, on the unit for the air mattress. Risk of people falling over and out of bed as the bed was too high. All of these were addressed immediately to prevent people using the service being at risk We identified people were using bedrooms that were not suitable for them with regards to health and safety and the need to use moving and handling equipment safely. Skills and competency of staff. One person could not take their painkillers on two occasions as the medication had run out. Inconsistencies in practice of registered nurses and failure to seek advice and treatment from health care professionals due to poor communication • • • • • Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 37 • • and management. For example, issues relating to wound and pressure care management and catheter care. Poor infection control practices followed by some staff. Lack of robust recruitment processes, induction, training and supervision of staff. (Refer to the following sections: ‘Personal and Health Care’, ‘Daily Living and Social Activities’, ‘Environment’ and ‘Staffing’) The information we received through the safeguarding alert indicated there was a lack of evidence to show regular testing and servicing of equipment. We viewed records that showed Portable Appliance Test (PAT) tests were carried out. During our inspection of the service we saw hoists were labelled detailing the date they were last serviced and respective documents in the health and safety file. We were unable to view the records relating to the emergency lighting, fire alarm checks and the inspection of the fire safety equipment as the copies were held at head office and the office copies were sent to Northamptonshire County Council, upon their request. However, following the site visit we received copies that demonstrated these checks had been carried out. We are aware that the Fire Service and the Environmental Health Officer have scheduled further inspections; the home must comply with the regulations to ensure the health, safety and well-being of the people using the service and the staff. The evidence gathered from the site visit and reviewing of records, showed the home must make significant improvements to ensure compliance with health and safety and to ensure the home is ‘fit for purpose’, to care for the people using the service. The contents within this inspection report demonstrates the management and leadership of the service must improve. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 38 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 1 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X X 1 1 X X 1 STAFFING Standard No Score 27 1 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 1 1 Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 39 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Requirement The statement of purpose and the service user guide must be kept up to date, contain accurate information about the home, services offered, staffing, training and the management of the home. To ensure people have current information about the home and make informed decisions about using the service that meets their needs. The person responsible for assessing the needs of the people must be suitably qualified or trained to ensure details of the care needs are obtained fully to ensure the health and care needs can be met. This is to ensure the individual care needs are identified and can be met safely. Care plans must be comprehensive reflecting all aspects of health and personal care and include assessments of risk. Consideration should be DS0000056079.V375207.R01.S.doc Timescale for action 09/09/09 2 OP3 14 14/07/09 3 OP7 15(1) 15/06/09 Green Park Care Home Version 5.2 Page 40 made as to how the person wishes their care to be carried out and their preferred daily routines. This would ensure care needs can be met safely, risks minimised and staff promote people’s health, safety and wellbeing. Care plans must be kept under review and updated, when changes have been identified and in consultation with the person and their relatives. This would ensure changing care needs are known and care be met safely. There must be ongoing assessment of equipment used to meet people’s health and personal care needs to ensure it is fit for purpose and where necessary assessment of risk to be carried out. This includes: • Safe use of bed rails and height of the mattress; • Safe and correct use of air mattresses. This would ensure people are safe from risk and harm that promotes their wellbeing. The must be timely access, advice and treatment sought from health care professional. This would ensure people’s health care needs are met timely. Records relating to the assessments, care planning and evaluation of wounds must be organised in such a way as to enable information about the current condition and required treatment for wounds to be DS0000056079.V375207.R01.S.doc 4 OP7 15(2) 15/06/09 5 OP8 13(4), 14 30/06/09 6 OP8 13(1) 29/05/09 7 OP8 12(1) 15/06/09 Green Park Care Home Version 5.2 Page 41 accessed easily. This is to help ensure people receive the treatment they need. The effectiveness of pain relief, particularly where changes have occurred must be monitored to ensure people’s pain is managed appropriately. This would ensure health needs are monitored to promote people’s well-being. The non-availability and lack of accessibility of medicines by staff must be avoided at all times. This would ensure people receive their medication(s) on time that promotes their health and well-being. Full and accurate records for the receipt of medicines into the home must be completed at all times. This is to ensure medicines can be accounted for at all times and records demonstrate medicines have been administered as prescribed safeguarding people’s health and well-being. Staff must ensure people’s privacy and dignity is maintained with regards to continence management. This includes promptly emptying the catheter bags and monitoring. This would ensure people’s dignity is maintained at all times their wellbeing promoted. To make sure people are consulted about their social interests and activities to be DS0000056079.V375207.R01.S.doc 8 OP8 12 (1) 29/05/09 9 OP9 12(1) 29/05/09 10 OP9 13(2) 29/05/09 11 OP10 12(4) 13(4) 15/06/09 12 OP12 16(2)(n) 15/08/09 Green Park Care Home Version 5.2 Page 42 arranged by the home. To put into place a range of social and leisure activities that stimulate people and to ensure activities are suitable for people being cared for in bed. This would ensure people have the opportunity to participate in activities of interests that are stimulating and promotes wellbeing. All staff employed by the home to receive training in safeguarding adults to demonstrate staff to understand their roles and responsibility in protecting and supporting individuals in their care in line with current procedures. 13 OP18 13(6), 18(1) 15/06/09 14 OP22 23(2)(c) (n) This would ensure people are protected from harm, risk and abuse by trained staff. The equipment used by the 15/06/09 people using the service to must be kept in good working order and fit for purpose. This includes the loud/noisy platform lift and hoist. This would ensure people have access to aids, adaptations and equipment that promotes their health, safety and wellbeing. The size, design and layout of the bedroom and bathroom must be assessed; by carrying out a written assessment and risk assessment to ensure it is suitable for people’s needs. 15 OP23 23(2)(f) 30/06/09 16 OP26 13(3)(4) This would ensure people’s health and safety is promoted at all times. All staff including cleaners must 15/06/09 be trained in infection control and follow the best hygiene DS0000056079.V375207.R01.S.doc Version 5.2 Page 43 Green Park Care Home practices. This would ensure people are not at risk of cross or spread of infection that promotes their health, safety and well-being. The staffing levels must be sufficient to meet the assessed needs of people living at the home and reviewed regularly to ensure staffing levels continue to meet people’s needs. This would ensure people’s health, safety and well-being is promoted and maintained. Staff must be recruited with satisfactory pre-employment checks and records must be kept to evidence recruitment procedures are robust. This would ensure people are protected and safeguarded by staff recruitment processes. The home must appoint a manager that is qualified, and/or has clinical expertise, competent and experienced to run the care home with nursing and meet its stated purpose, aims and objectives. 17 OP27 18(1)(2) 15/06/09 18 OP29 17(2)(3) 30/06/09 19 OP31 8(1) 9(1)(2) 30/06/09 20 OP31 26 This would ensure the people benefit from a managed service that promotes their health, safety and well-being. 29/05/09 The registered person or their representative must conduct the monthly visits and produce a report detailing the findings and action plan to address issues and shortfalls with timescales to ensure the health, safety and well-being of people. A copy of the Regulation 26 reports must be made available Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 44 to the CQC. This would ensure the home is managed and the needs or people are met safely. There must be an effective quality monitoring and quality assurance systems introduced to enable people using the service and their representatives to comment on the quality of the service including the quality of nursing, they receive. This must be conducted at regular intervals and make a copy of the report available. This would enable the service to be assessed against the aims, objectives and the statement of purpose to demonstrate whether expectations of the service are met and to identify areas of improvement. This is a repeated and outstanding requirement made at the last inspection dated 30.12.08. Timescale: 01.04.09. The registered person must ensure that staff receive regular supervision that ensures people receive care from staff that are competent. This would demonstrate and ensure the staff team are trained in accordance with current best practice to ensure the health, wellbeing and safety of people protects people. The registered person must ensure the records relating to the people using the service must be kept up to date and in good order, including the care DS0000056079.V375207.R01.S.doc 21 OP33 24 15/08/09 22 OP36 13(5)(6) & 18(1)(2) 15/08/09 23 OP37 17 15/06/09 Green Park Care Home Version 5.2 Page 45 plan and the care files. The individual and where appropriate their advocate and main carers should be consulted and made aware. This would ensure people’s health and care needs are known and what support they receive. The home must comply with the regulatory requirements set by the Fire Service to ensure the home is fit for purpose. This would ensure the people using the service are protected by good systems, safe equipment and staff trained in the correct procedures in line with current best practice. The home must comply with the regulatory requirements set by the Environmental Health Authority to ensure the home is fit for purpose. This would ensure the people using the service are protected by good systems, safe equipment and staff trained in the correct procedures in line with current best practice. 24 OP38 OP15 16(2)(j) 23(2)(4) (5) 29/05/09 25 OP38 OP15 16(2)(j) 23(2)(4) (5) 14/07/09 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 OP9 Good Practice Recommendations There should be consideration for the use of pain assessment tool for people with dementia or mental DS0000056079.V375207.R01.S.doc Version 5.2 Page 46 Green Park Care Home 2 3 4 5 OP9 OP12 OP33 OP29 6 OP30 health. There should be consideration to having a photograph of the person on the medication records sheet. The programme of activities should be planned, displayed and accessible to people to choose to participate. The home should ensure residents and relatives meetings take place as stated in the service user guide. It is recommended that the home’s induction programme is reviewed and updated, considering the Skills for Care training, which promotes the current best practice to ensure staff have the right basic skills and training to support the people living at the home. It is recommended that there is a robust planned training programme for all the staff to maintain their skills and practice in line with current best practice and guidance. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 47 Care Quality Commission East Midlands Region Citygate Gallowgate Tyne and Wear NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastmidlands@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Green Park Care Home DS0000056079.V375207.R01.S.doc Version 5.2 Page 48 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!