Inspection on 30/12/08 for Abington Park View

This inspection was carried out on 30th December 2008.

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

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

Other inspections for this house

Abington Park View 27/10/09

Abington Park View 28/04/09

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 27/02/2009.

CARE HOMES FOR OLDER PEOPLE Green Park Care Home 475 - 479 Wellingborough Road Northampton NN3 3HN Lead Inspector Sally Snelson Unannounced Inspection 30th December 2008 07:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Green Park Care Home DS0000056079.V373565.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 Vacant 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.V373565.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. 4th July 2008 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Green Park registered in January 2005 is a care home that provides nursing care, generally to people over the age of 65 years. In addition he home can care for up to 10 people who have a physical disability, and there is the provision for one person under the age of 65 to live at the home. 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 lounges and a dining room; the first floor lounge has pleasant views over the local park that is opposite the home. The home is situated in a residential area and is on a main road approximately two miles form the town centre. There is good public transport and local facilities. Fees are between £449.00 and £556.50 per week based upon the dependency level. Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out in accordance with the Commission for Social Care Inspection’s (CSCI) policy and methodologies, which requires review of the key standards for the provision of a care home for older people that takes account of residents’ views and information received about the service since the last inspection. The inspection started at 07.15am on 30th December 2008; at this time staff were changing from the night to day shift. Rona Davis, the manager, was present for the majority of the inspection. Feedback was given throughout the inspection, and at the end. During the inspection the care of three people who use the service (residents) was case tracked in detail. This involved reading their records and comparing what was documented to what was provided. Since the last inspection there had been two random inspections of the home to check compliance and information from these inspections will also be included in this report. In addition to sampling files, people who lived at the home and staff were spoken to, and their opinions sought. Any comments received from staff or residents about their views of the home, plus all the information gathered on the day was used to form a judgement about the service. The inspector would like to thank all those involved in the inspection for their input and support. What the service does well: The general environment of the home was warm, clean and tidy and the communal rooms were tastefully decorated for Christmas. The manager was regularly auditing the care files and had an eleven-page audit tool that she checked the documentation against. The plans that we looked at had been signed by a family member and had appropriate permission for bed rails etc. The new care files included information about the persons Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 6 past life and staff were working with those residents who wanted to, to complete a life history. Throughout the inspection we saw resident’s being treated with respect and dignity at all times. We saw evidence that people using the service had been asked about their preference for the gender of the staff that cared for them and that this had been recorded. The home had a complaints policy that was available to residents and their families. The manager told us that there had not been any complaints made about or to the home since she had been in post. She was able to discuss how she would deal with a complaint and she had a file for any associated documentation. What has improved since the last inspection? Following the last inspection, and the requirement made for the Statement of Purpose and Service users Guide to be reviewed, we were sent updated copies. These documents included all the required information and described the type of nursing needs the home could manage We looked at three case files, two in detail, and one in less detail. Since the last inspection the manager had re-written all the care plans. They had been written in such a way that it was apparent to staff that the person using the service must be offered choices wherever possible. Case files also included risk assessments. At the last key inspection on the 4th July 2008 we were very concerned about the medication systems and left an immediate requirement that the medication systems were improved. At this inspection we noted improvements. An activity programme had been introduced in an effort to stimulate the people living at Green Park. There had been a variety of outsider entertainers invited into the home, for music sessions, sing-a-longs etc. Door wedges were no longer in use, and some doors had been fitted with doorguards, a devise that automatically closed the door in the event of a fire. Recruitment practices were improved and a new human resource manager was ensuring peoples safety by making more changes to the recruitment processes. A member of the management team was conducting monthly-unannounced Regulation 26 visits to the home and providing a written report of the visit to the manager. Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6 People who use this service experience good quality outcomes in this area. The service is aware of the need to assess prospective residents, and ensure that people using the service have sufficient information to make an informed choice, before an admission is agreed. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Following the last inspection, and the requirement made for the Statement of Purpose and Service users Guide to be reviewed, we were sent updated copies. These documents included all the required information and described the type of nursing needs the home could manage. Both documents would benefit from being dated so that it was obvious to the reader if it were current. The complaints procedure in both documents needs to be reviewed to ensure Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 10 that it does not include an advocacy service for the parents of a child with a learning disability. The documents informed the reader that they were available in other formats including larger print, Braille and other languages. During the inspection the manager informed us that she had taken photographs of areas of the home, to use in the next edition of the Service Users Guide, to make it personal. We also received a copy of the revised contract. Following the last inspection the Local Authority put an block on admissions. Due to the continuing embargo, there had been no admissions to the home, so we were unable to assess standard 2 or 3 fully, but we did see a copy of a contract and a preadmission tool that the manager had designed to use when making the decision as to if the home could meet the needs of a prospective resident. The staff team’s ability to meet the needs of the current group of residents will be discussed in the staffing section of this report. The home did not offer intermediate care. Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 People who use this service experience adequate quality outcomes in this area. Care plans had been written in sufficient detail to ensure that those living at Green Park should receive continuity of care. However if the care plans were not correctly altered as care needs changed this would not happen. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked at three case files, two in detail, and one in less detail. Since the last inspection the manager had re-written all the care plans. They had been written in such a way that it was apparent to staff that the person using the service must be offered choices wherever possible. On the whole care plans had been reviewed monthly and the appropriate changes made, but we did note that where care needs had altered between the monthly reviews these instructions had not been clearly transposed in the care plan and could lead to Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 12 confusion. For example one resident with a pressure sore was having the sore dressed on alternate days. Following a visit by the tissue viability nurse (TVN) the frequency of the dressing was altered to daily. The nurse on duty had recorded the visit by the TVN and the new instruction in the multi-disciplinary care notes, but had not altered the care plan. We were able to ascertain that the dressing was being done daily, but only by checking other documents including the daily notes and the handover sheets. It is not acceptable that staff should need to refer to a number of different documents to confirm care needs, especially when good quality care plans have been written and only need to be kept updated. This is particularly concerning because of the home’s reliance on agency nurses to cover shifts. The manager was regularly auditing the care files and had an eleven-page audit tool that she checked the documentation against. It was apparent that the manager was using the care planning system correctly and had written most of the plans, but that the nurses were less able and had to be supervised by the manager. In addition to the care plans being re-written the new manager had tidied the care files and ensured that all the documents relating to one activity of daily living was in one place. For example with the care plan for eating and drinking was a nutritional risk assessment, the document that recorded the residents weights a malnutrition assessment tool (MUST). The plans that we looked at had been signed by a family member and had appropriate permission for bed rails etc. We saw that health professionals, including GP’s, physiotherapists and community opticians were requested to visit as necessary. We were disappointed to learn that the home were having trouble sourcing a GP surgery who wanted to take responsibility for the home. We noted that the manager had written to each family requesting their permission to change their relatives GP if necessary on their behalf. During the inspection we overheard a nurse requesting a visit from a GP, but the request had to come from the manager before the GP agreed to visit. One resident who had been nursed in bed for many months, had been supplied with the correct equipment to enable him to use a wheelchair. This had resulted him being able to go outside and to have a cigarette, which had pleased him. The home now had five hoists distributed across the three floors and each resident had been assessed for the correct sling to be used with the hoist. Residents were supplied with their own slide sheets for use during moving and handling. At the last key inspection on the 4th July 2008 we were very concerned about the medication systems and left an immediate requirement that the medication systems were improved. As the medications were delivered monthly we needed to leave at least 28 days before carrying out a compliance visit to Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 13 check the medications. We did a random inspection on 5th August and we were shown a revised medication policy and told that it had become apparent that a new medication system was necessary so a new pharmacy provider had been sought. We therefore returned 26th September 2008 and we reported that ‘the procedures for the administration of medication had improved and staff were much more vigilant about the process. A new supplying pharmacist had been sought and as a consequence the Medication Administration Records (MAR) charts were printed for each month and much easier for staff to follow. A new medication trolley had been purchased and the new manager was working with staff to ensure that correct procedures were followed.’ During this inspection we checked the Medication Administration Record (MAR) sheets for all of the residents. Medications were appropriately stored in a locked trolley or fridge. Monthly deliveries had been appropriately signed into the home, and as a consequence it was possible to reconcile all of the medications (whether provided in a blister pack or not). Staff used omission codes correctly and recorded the reason for any omissions on the reverse of the MAR chart. Controlled drugs (CD’s) were stored appropriately and all administrations had been recorded accurately with two signatures in the CD register. However we did witness the agency nurse who administered the medication leaving the dining room before ensuring that the residents had taken the medication she had given them. This resulted in us stopping one resident trying to ‘give away’ her medication. We also found a tablet on the floor. Throughout the inspection we saw resident’s being treated with respect and dignity at all times. We saw evidence that people using the service had been asked about their preference for the gender of the staff that cared for them and that this had been recorded. Each file we sampled had a care plan for the end of life. These were be being built upon as more information was gathered from families. Care must be taken that any advanced decisions are supported by the documentation defined by the Mental Capacity Act. Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People who use this service experience good quality outcomes in this area. An activity programme had been introduced in an effort to stimulate the people living at Green Park. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The new manager had introduced an activity programme that detailed at least one activity for every morning and one for every afternoon. This was to be used as a guide and if people wanted to do other things that was acceptable. The manager had not appointed an activity co-ordinator, but encouraged all the staff to join in activities; she had had to change the mind-sets of some of the staff that were task orientated. We saw evidence that games and equipment had been purchased to facilitate the activities. The manager’s husband volunteered in the home, and he encouraged activities, he also ran a trolley shop and would do shopping for residents. Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 15 The new care files included information about the persons past life and staff were working with those residents who wanted to complete a life history. Following an activity a record was kept of the activity, and how the person using the service had enjoyed it. A local religious leader comes into the home monthly. Ways of taking a resident to her preferred place of worship were being explored. There had been a variety of outsider entertainers invited into the home, for music sessions, sing-a-longs etc. Following the entertainment the residents were asked for their opinions and those they enjoyed would be invited again. However many of the people we spoke to said that they liked to watch the TV and to be left alone, rather than joining in communal activities. They did appreciate one to one time and general activities such as reading articles from the newspaper. The Manager had plans for the piano and the computer in the dining room to be used for, or by, the residents. Visitors were welcomed in the home and offered drinks on arrival. We spoke to one husband who regularly visited over lunchtime and had a meal with his wife. He praised the food and the changes under the new manager. We noted that mealtimes were a social occasion, and people were encouraged to eat in the dining room. The dining tables looked attractive with linen clothes, condiments and printed menus. A selection of hot and cold drinks were offered at mealtimes and during the day. The manager had revised the menus. On the day of the inspection people had the choice of beef casserole with fresh vegetables and mashed potatoes or omelette and chips. This was followed by fruit crumble and custard, or fresh fruit salad. At breakfast time people were offered their breakfast from when the cook arrived at 8.30am, and we saw the last person having their breakfast (out of choice) at 11.30am. Before the cook arrived carers made cups of tea for people as they got up. At breakfast people were given a choice of a variety of cereals and fresh fruit and toast. The kitchen was clean and tidy and the cook recorded daily fridge temperatures. The fridge and cooker were clean and open food, bottles and jars had the date on which they had been opened recorded on them. There was a sufficient supply of food in the home including fresh fruit and vegetables. Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People who use this service experience adequate quality outcomes in this area. Staff had an understanding of how to protect people from abuse, but there was little evidence of them having training, and some practices in the home, mainly the poor staffing levels, could put people at risk. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home had a complaints policy that was available to residents and their families. The manager was not aware that there had not been any complaints made about or to the home since she had been in post. She was able to discuss how she would deal with a complaint and she had a file for any associated documentation. Following the last key inspection we were able to report in the subsequent random inspection, ‘We have received Regulation 37 notifications (care home must report to us notifications of death, illness and other events) appropriately and the manager has been available to support the various inspections, audits and investigations that have taken place.’ This has continued and the manager correctly reports incidents in the home under Regulation 37. However Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 17 professional visitors to the home have had to alert the safeguarding team to some unexplained injuries and some incidents that had not been identified by the staff. For example pressure sores that were not healing and unexplained injury. At the last inspection we did not see any evidence that staff understood their responsibilities to protect people from abuse (SOVA). The manager was aware that staff did not have certificates to support any training they had had as they were using video teaching material. However staff were able to tell us how they would deal with certain incidents, and the manager had a good understanding of SOVA and was available to staff, even when not on duty. The manager was sourcing a certificated training through the local council, which would link with the council’s policy on the safeguarding of older people. We were concerned that the homes telephone system defaulted to the fax machine if it was not answered promptly. This could put people at risk. Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,25,26 People who use this service experience poor quality outcomes in this area. Some areas of the home had been made comfortable and pleasant, but this was spoilt by a number of details, which detracted from the otherwise homely environment. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The general environment of the home was warm, clean and tidy and the communal rooms were tastefully decorated for Christmas. Some of the carpets were stained but we were told that the owner had identified this, and was arranging for the carpets to be cleaned. Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 19 We met maintenance contractors, who were a subsidiary of the company that owned Green Park, and were responsible for the upkeep of the home. We were disappointed, that despite having been told about a number of necessary ‘jobs’, some of these remained outstanding. For example three bedrooms had portable electric heaters in them, as the radiators were not working. There were also some radiators that were not working in bedrooms that were not currently occupied. We were concerned that there was no documented risk assessment for the practice of using portable heaters, although we were aware that consideration had been given to making the situation as safe as possible. We also noted that some curtains were partially off the curtain rails in bedrooms and communal rooms. The maintenance man showed us the list he had been given and said, these were outstanding jobs that he had not got around to yet. The manager told us that where curtains had been put back on rails, because there was no end ‘stoppers’, some had come off again. We therefore believe that the manager has done all she can to address these shortfalls, and it is now the responsibility of the company providing the maintenance. At the last inspection we reported ‘All of the bedrooms had en-suite facilities but some were more appropriate for the needs of the person using the room than others. A bath had been removed from a first floor bathroom and was to be replaced. (At the time of the inspection there was no bath in the home.)’ This was still the situation although a new parker bath had been ordered and delivered and was in the dining room awaiting connection. As the inspection was concluding the plumbers were arriving to connect the bath. We were told that the parker bath had been successfully installed and that the hoist could be used with it, but that many of the exsisting resident were reluctant to change their ways and use the bath. We also reported ‘While sitting in communal areas with residents we were aware of how noisy the room became intermittently. The nurse call system was extremely loud and intrusive throughout the home and the lift that came down the steps into the dining room made a loud mechanical noise.’ At the time of this inspection the home had not taken any steps to change this situation. There had been concerns raised by the fire authority about the storage of certain equipment close to the loft space in the home. The Local Authority had insisted that the risk must be reduced, by having a third member of staff on duty at night. The service had responded by having a member of the administrative staff live-in the ‘bungalow’ attached to the home, who could be called upon in no emergency. The manager told us that the fire brigade had said to the home’s maintenance team that the risk was now reduced, but there was nothing in writing. A further inspection by the fire officer was planned for early in the New Year. It had been identified that a number of the windows in the home were locked and could not be opened, and that other windows that should be restricted could open fully. The later had been addressed by putting chains on the Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 20 window, but these had proved not to be substantial enough and more secure window restrictors were to be fitted. Keys were found for the widows that would not open and it was planned that a window key would be kept in each room. The home had been in the habit of using door wedges to keep communal and bedroom doors open. The company had surveyed those residents who wished to have their bedroom doors open at night about the possibility of them contributing towards a doorguard, which would shut electronically in the event of a fire. Since this discussion with the residents the home had purchased in full enough doorguards for the bedroom doors of those people who requested to have their bedroom doors open at night and were purchasing more for other doors. We did not witness doors being kept open by wedges. Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People who use this service experience poor quality outcomes in this area. The staff team appeared to be committed to providing care, but the number of staff on the duty rota meant that those staff employed were working long hours, and there was a reliance on bank and agency staff. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We arrived at the home at 7:15am. The day staff had arrived at 7:00am and the staff were handing over from one shift to the next. On duty overnight there had been one nurse and one carer. The carer was able to leave at 7.15 am, but the nurse had to remain on duty, as an agency nurse was taking over from her, had phoned to say that she would be late and because of child care problems. The off duty identified that three carers were due to support the agency nurse. Also on duty was the manager, herself a nurse, who was supernumerary. It became apparent that only two of the carers had arrived on duty. The third carer was phoned and reported being sick and unable to come on duty. Staff contacted another member of the staff who was available for work and agreed to come in. We also noted that the cook who was due to start work at 8.30 am did not arrive until 8.45 am. She was reliant on a bus, Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 22 and because of it being a holiday period the bus had not arrived. We did however note that the cleaner, seeing this shortfall, put on a white coat and went to work in the kitchen. The staff on duty should be commended for the commitment to the residents and their resourcefulness, but it was concerning to us that the staff team was so small that these absences impacted on the staff tram so much. For example, the night nurse working extra time had worked for six out of seven nights and the carers that were offering to do extra shifts had worked a number of hours already. The carer who came in for the extra shift was on a 20-hour contract as he was a student, but was allowed to work additional hours during his holiday. However this meant that had the same situation arisen the next week he would not be available. All of the staff reported being happy to do additional hours. Particularly concerning was the trained nurse situation, with only two trained nurses providing permanent cover day and night. Therefore it was necessary for staff who worked on the bank, or staff who were employed by an agency, to provide cover. The agency staff were ‘block booked’ to provide consistent care for the residents. The home employed additional staff to cook and clean. The home employed one male carer and there was documentation to support that staff were asked about their preferences as to the gender of the staff who provided their care. The manager had enrolled all the permanent care staff onto a NVQ course. Some staff were completing NVQ level2 and others NVQ level3 in care. The manager had enrolled to do NVQ level 4, part of the requirement if she is to be considered as the registered manager. Following the last key inspection we left an immediate requirement that the procedures and practices for recruitment were reviewed immediately. This was because vital pieces of information relating to peoples suitability to work in the care sector were missing. Within the set timescale the management had been able to produce the documentation that was missing from individual personnel files. Two of the three staff files that we sampled contained fully completed application forms, appropriate references, induction checklists and training records and certificates. Criminal Record Bureau (CRB) checks had been carried out on all staff, and home office paperwork was present where required. The third file was not on the premises. We were told that the file was at head office and we were provided with the missing information as soon as possible. The company had recently appointed a new human resource manager who was checking the details of all the staff files. The manager had identified the training needs of the staff team and was accessing the appropriate training. To ‘bridge the immediate gap’ videos had been sourced for people to watch about a variety of care subjects. The manager told us that she was aware of the staff teams qualifications and experience and that she would not expect to offer accommodation to people who the staff team could not provide care to. She was aware that people Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 23 living at Green Park had secondary conditions such as mental health problems, dementia and learning disabilities which staff must be aware of. Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37,38 People who use this service experience adequate quality outcomes in this area. The manager had a vision for the home, but a lack of resources, particularly staff, prevent her from achieving this vision in all areas. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Following the last inspection the previous manager resigned from the post and went to work elsewhere within the organisation. The home appointed a new manager, Rona Davis, who is a nurse with a number of years experience of Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 25 caring for older people. Mrs Davis appears to be committed to the role and prepared to work extremely hard to ensure the care and safety of the residents. We are concerned that without support from a larger staff team, and the organisation, she will not be able to sustain this indefinitely. The staff team were having staff meetings and the manager met regularly with staff to ensure that they were kept up-to-date with any new procedures that had been introduced. A member of the management of Msaada visited monthly to carry out a Regulation 26 visit and prepare a report of the visit. The manager told us that visitors would come to her ‘as and when’, and that she had an open door policy. However there was not any formal system for audit quality. The manager had introduced a number of informal audits to ensure good practices. Records for these were available at inspection. The manager was aware of the need for formal supervision, but had rightfully prioritised other changes first. When the manager had taken over the home she had been concerned about the processes for the home holding small amounts of money on behalf of residents. Changes had been made, and we sampled six accounts for which the records and funds all corresponded correctly. The money was stored in individual pouches in a locked silver case, in a locked cupboard. Staff had access to the cupboard, but only the manager had access to the safe therefore staff must ensure that the cupboard remains locked at all times as the case is portable. This system means that resident could not access money in the manager’s absence. We discussed with the manager the types of occasions that people would want money, and it appeared that the home only held small amounts of money for people to use on the ‘trolley’ shop, for the hairdresser or the chiropodist. The latter two were paid from petty cash by the manager who subsequently billed the individual and the trolley shop was currently run by the managers husband in his capacity as a volunteer to the home, so was a planned activity. The manager was encouraging those people who could to hold the small amounts of money they needed for the trolley shop, in order to maintain their independence. Since the manager had been in post and had established a pattern for herself and the staff she had introduced staff supervision sessions. These were established and we saw record that covered personal, care and training aspects of the role. If this continues, it is anticipated that at the next inspection this standard will be met as we will be confident that staff will be ‘on track’ to have six sessions per year. On the whole there had been a marked improvement in the records kept in and by the home. For example care plans were written in more detail and records of money held by the home were appropriate. However it was not always possible to easily ascertain when a dressing had been changed without reading the daily notes, the handover sheets, and the care plans, as there was no consistency in where staff recorded episodes of care. This could result in care Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 26 being missed, or repeated, and could be dangerous. We were advised that a member of the local authority monitoring team and the Primary care Trust (PCT) visited the home after us and were concerned that assessments had not always resulted in the correct equipment being provided. For example, they discovered documents completed to assess a person at risk of getting a pressure sore, indicating that a certain type of mattress was necessary, but this had not been put in place. There findings were to be discussed with the manager, as she was not available when they visited. We looked at a variety of health and safety documentation. Fire alarm call points were tested weekly, and the type and position of fire extinguishers were listed on a log and checked monthly. The last fire drill was recorded on the 14/11/08 and emergency lighting was checked weekly. Radiators were checked monthly and as already commented upon those that were not working had been identified to the company on the 10/10/08 and were still not fixed although heat was provided via portable heaters that had been PAT tested. The manager confirmed that there were no associated risk assessments for using this type of heater in a bedroom of an elderly frail person. Hoists, water temperatures and the safety of bed rails were also all checked and recorded monthly. We were disappointed with the time it takes the company’s maintenance contractors to respond to a job. For example an electric light bulb had been reported a not working during the second week of December, and this was still not replaced. As already mentioned the fire brigade had been concerned about the risk of fire in the loft space. We were told that the maintenance team had spoken to the fire authority, which said that due to the dividers in the loft it is as safe as possible. The fire officer is due to visit on the 07/01/09 to confirm this and put it in writing. Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 x 2 X X X 1 3 STAFFING Standard No Score 27 1 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 2 2 2 Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 14(2)(b) Requirement Staff must ensure that service users care plans are altered as care needs change, in order to ensure that current, correct care is delivered at all times. Staff must ensure that they ensure a service user has taken the medication they have administered, before signing the administration record. Staff must have training on the identification of the various forms of abuse. They must also be aware of the procedures for reporting abuse correctly. Maintenance ‘jobs’ must be carried out in a timely fashion and priority must be given to those areas that put people at risk. There must be evidence that the home is compliant with the requirements of the local fire service. Consideration must be given to the noise from the lift and the call system. This was a recommendation following the last inspection. DS0000056079.V373565.R01.S.doc Timescale for action 01/02/09 2 OP9 13(2) 01/02/09 3 OP18 13(6), 18(1) 01/03/09 4 OP19 23 01/02/09 5 OP19 23 01/02/09 6 OP19 23 01/04/09 Green Park Care Home Version 5.2 Page 29 7 8 9 OP25 OP25 OP27 23 23 18(1)(a) 10 OP29 19, Schedule 2. 18(1)(a) 11 OP30 12 OP33 24(1) The radiators that have been identified as faulty must be repaired. Window must be correctly restricted to prevent accidents. The home must employ enough staff to care for the people using the service and have sufficient time off duty. The home (as well as the head office) must have files that indicate that staff had been correctly recruited. The manager must ensure that the staff team have the necessary experience and qualifications to met the assessed needs of the people using the service. The home must complete quality assurance surveys and undertake and publish an analysis of them. 16/01/09 16/01/09 01/02/09 14/02/09 01/04/09 01/04/09 13 OP38 23(4) This requirement is repeated The home must have the 07/01/09 documentation to indicate that the fire authority is not concerned about risk, or take the necessary steps to prevent the risk. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP18 OP11 Good Practice Recommendations The complaints procedure should not include information that is not relevant to the service. End of life plans that include directions for the end of life (especially if these are the wishes of a family member), DS0000056079.V373565.R01.S.doc Version 5.2 Page 30 Green Park Care Home 3 4 OP16 OP31 should be in line with the Mental Capacity Act. The complaints procedure should be accurate and relevant to the service. The manager should apply to us to become the registered manager. Green Park Care Home DS0000056079.V373565.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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