Inspection on 04/07/08 for Abington Park View

This inspection was carried out on 4th July 2008.

CSCI 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 28/04/09

Abington Park View 30/12/08

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Green Park Care Home Green Park Care Home 475 - 479 Wellingborough Road Northampton NN3 3HN Lead Inspector Sally Snelson Unannounced Inspection 4th July 2008 07:30 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.V367800.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.V367800.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Green Park Care Home Address Green Park Care Home 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 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.V367800.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. 9th October 2006 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 £493.00 and £556.50 per week based upon the dependency level. Green Park Care Home DS0000056079.V367800.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 0 star. This means the people who use this service experience poor 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. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. The inspection of Green Park was a key inspection, was unannounced and took place over six hours on 4th July 2008. As there were two inspectors, Sally Snelson lead inspector and Louise Trainor, this was equivalent to 12 inspecting hours. The manager, Francis Ashun, was present for the majority of the inspection. At the time of the inspection he had been in post approximately two months. Feedback was given to him throughout the inspection and at the end. During the inspection we tracked the care of two people who used the service (residents). This involved reading their records and comparing what was documented to what was provided. We also sampled other care files. In addition people who lived at the home, visitors 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. At the time of the inspection there were 21 people living at Green Park and 13 staff employed to care for them. There were a number of requirements made at the end of this inspection and a timescale was given in which the provider should do them. An improvement plan will be requested to detail how the manager and provider intend to do this. The inspector would like to thank all those involved in the inspection for their input and support. Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There have been a number of requirements made as a result of this inspection. Only one of the key standards was met, and if we do not see evidence of improvements at the next inspection we will need to take enforcement action. The proprietors and the manager of the home have been informed that they are the subject of a management review and the service has been included in our improvement strategy. Areas of particular concern are:There must be a Statement of Purpose and Service Users Guide that includes the information included in Regulation 4,5,Schedule1 and standard 1 of the National Minimum Standards. The format these documents are provided in must be considered. There must be evidence to demonstrate that the staff team at the home and on duty at any time have the necessary skills and training to meet the needs of the people admitted to the home. Care plans must be in place for all areas of care, they should be regularly reviewed and altered as necessary. Wherever possible people should be involved in their care plans and know what the include. Risk assessments must be completed regularly, dated and signed and the information gained from doing them used to influence the care provided. Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 7 Complete and accurate records must be kept of all medication administered, or not, together with a reason why the medicine was not given, in order to demonstrate that residents receive the medicines prescribed for them. Staff must devise an activity programme after consultation with the people living at the home that meets their interests. People living at the home must be offered choices about the way they spend their day, what they eat and what care is provided. People who use this service must be protected by the homes complaints procedure, and all records relating to investigations must be maintained in the home People who live in this home must be protected by appropriate referrals being made to the safeguarding team. The use of door wedges must be risk assessed through consultation with the fire safety authority. Staff must have the necessary experience, skills and qualifications to care for the people living at Green Park. People must only start work after a thorough recruitment process including the checks and references described in Schedule 2 of the national Minimum Standards. The home must ensure that having regard to the statement of purpose and the needs of the service users, the manager has qualifications, skills and experience necessary for managing the care home The Registered Provider must conduct monthly-unannounced Regulation 26 visits to the home and provide a written report of the visit to the registered manager. The home must complete quality assurance surveys and undertake and publish an analysis of them. All staff working at the home must be supervised at least six times a year. Staff must ensure that documents are kept up-to-date and dated and signed. This refers to the Statement of Purpose, the pre-admission assessment, care plans, risk assessments, There must be safe working practices in the home for the moving and handling of residents. Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 8 There must be regular checks of fire safety equipment in the home and other safety checks such as water temperatures and fridge temperatures. 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.V367800.R01.S.doc Version 5.2 Page 9 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.V367800.R01.S.doc Version 5.2 Page 10 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): 1,3,5,6. People who use this service experience poor quality outcomes in this area. The information given to people considering moving into Green Park was outof-date and inaccurate so did not give them a true impression of the home, however more recently any pre-admission visits and assessments had been done by a nurse to ensure that accurate information about the needs of a person was gained. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The Statement of Purpose and the Service Users Guide that was displayed in the home had not been updated as situations changed. For example the Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 11 documents did not reflect the current manager, suggested that there were two deputies and five nurses when in fact there were no deputies and four nurses. The documents listed the conditions that the service believed the staff team could care for, but did not include mental health or learning difficulties, (rightly so as none of the staff had the necessary training), but we came across one person living at the home with a learning disability and at least three people with a mental health condition. The manager now needs to check that the documents contain all the information required by standard 4 and 5, and schedule 1 of the National Minimum Standards, and that the information is written in sufficient detail to describe the service, and provides the evidence that the staff team have the necessary skills and qualifications to care for the people living at Green Park. Prior to the appointment of the new manager the Local Authority and the Primary care Trust(PCT) had become aware that people were being assessed, prior to admission to the home, by staff members who were not nurses. It is expected that people moving into a nursing home have nursing needs and therefore a nurse should assesses their needs. The new manager, who was not a nurse, ensured that he and a nurse now made these assessments. One of the files we looked at included a pre-admission assessment by a person with a nursing qualification. The assessments we looked at were in detail, but because they were not signed, or there were gaps in the information this standard was not met. We identified poor practice and omissions in staffs knowledge that suggested that people could not be confident that their needs would be met in Green Park. We were made aware that people were not routinely visiting the home prior to admission and that in some cases social workers were making decisions for them. One lady who had moved from another care home was disappointed that all her equipment and furniture from the old home would not fit into her new room and that some of the furniture she had used previously was not available. Green Park did not offer intermediate care. Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 12 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 People who use this service experience poor quality outcomes in this area. The compliance with the administration, safekeeping and disposal of medication, including controlled drugs, was such that people were at risk of not getting the correct medication. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The Msaada group had introduced new care planning documentation. It was therefore not possible to assess if care plans were being regularly reviewed. In files where the old care planning system was also in place, we noted that the plans had not always been reviewed monthly. One of the plans sampled had been completed in sufficient detail to ensure that staff would be able to provide a consistent level of care. The second plan, Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 13 for someone who had not been at the home very long, did not have the same detail and had some missing care areas, such as skin care and nutrition; an expectation for a person with a pressure sore. Nutritional screens had been completed without recording the individual’s weight. Where assessments had been completed these were not always dated and signed and it was not possible to show how they were being used, or how useful they would be. There was no signed bed rail agreement although one was being used and the person would have been able to agree or not. We saw no evidence that people had agreed their care plans with the staff, or that they had been written in a person-centred way. We were concerned that the family of a lady with full capacity had made decisions about her end-of life care and her ability to hold a key to her room. Where people appeared to not have capacity we did not see how this had been assessed. The manager was not familiar with the Mental Capacity Act. Throughout the inspection we witnessed poor moving and handling techniques. One staff member lifted a resident from a wheelchair to an armchair. Another member of staff then came and made her comfortable. A moving belt was used on a person who did not weight bear and another member of staff was overheard instructing a colleague how to use a moving belt. One staff member told us she had not had any moving and handling training ….see staffing section of this report for more detail. At the time of the inspection nine people had pressure areas, the tissue viability nurse was involved with some and staff were dressing and treating in between. We did not always see enough detail as to how staff should be caring for the wounds. One person we were case tracking had a hospital appointment at 10.40, despite her care plan stating that she should not be sitting on her pressure sore for more than one hour a day, she was up and sitting in a wheelchair awaiting the hospital transport when we arrived at 07.30. When the transport arrived it had not been booked for a wheelchair and could not take the lady without an escort. The lady became very distressed as she had a relative waiting for her at the hospital. We would have hoped that a member of staff could have accompanied her and caught a taxi back to avoid the distress she suffered, particularly as the home had failed to inform the transport of the need for the wheelchair. We looked at the medication charts for the people whose care we were tracking and for some others. We also looked at the medication policy for the home and the procedures used to ensure that medications were correctly received into the home, stored and administered. Medications were received into the home monthly and were administered via weekly cassettes. None of the medication were signed into the home so we were unable to reconcile any of the medications; something it is expected that Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 14 managers do regularly to ensure that staff are administering medications correctly. The manger told us that he had noted that staff sometimes ran out of medications before the next order was due and he was proposing to keep a book of what medications came into the home. We overheard staff telling one resident that they could not have their cream applied until after the pharmacy delivery later that day. One of the people we were case tracking did not have their breakfast (out of choice) until late. We noted that although his morning medications had not been given the nurse had signed the Medication Administration (MAR) chart to indicate that they had been given, including signing for a drug that he regularly refused to state it had been refused again that day. When we asked why she did not have an answer except that he always refused this particular drug. At 11am this person had not been given a controlled drug that was used for pain control, and administered twice a day, because there was no other staff member free to witness this. Another resident had been visited the day before by the McMillan nurse, who suggested a particular medication was stopped; this had not happened, although staff knew it should have. This person’s medication record was also confusing. She had been discharged from hospital on 70 mg of MST (a morphine based pain killer), to be taken twice a day. The hospital dispensed two weeks supply by giving the home 56 30mg tablets and 28 10mg tablets. The medication chart had been written by the staff at the home to suggest that one 30mg and one 10mg tablet be given twice a day, so in effect the person was only written up for 40 mg of the drug twice a day. Staff however had been giving 70mg. This was a positive outcome for the person, but indicated that the nurses were not following the guideline set by their registering body that stated that had to give the correct dose to the correct person etc. Only two months earlier the Primary Care Trust (PCT) and the Local Authority had looked into a case where a person was given the wrong medication for pain relief. We would have expected that this concern would have identified the need for more training of staff, better auditing by management, and more care by staff. We were able to reconcile the controlled drugs although it was not easy to find our way around the controlled drug book as the index page had not been updated and an entry we were looking at for the day of the inspection had no date. We also noted that someone did not have the prescribed pain control one evening but the MAR chart and the daily record did not indicate if it was a planned omission or a mistake. There were medications in the medication fridge that were out of date, and that did not have written on them the date they were opened, despite having ‘a use by * days from opening’ label on them. We also noted out-of date creams in a person’s own bathroom. Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 15 We therefore left an immediate requirement that the procedures and practices for administering medications in the home were reviewed. We saw people being spoken to appropriately and heard preferred names being used. However the manager did tell us that sometimes clothes were given to the home to be given to people if needed, but as this was not recorded it could be considered that people were not always wearing their own clothes. One of the inspectors sat next to a resident who needed an insulin injection before her breakfast. The nurse arrived to do this, and at no time asked the resident if she minded it being done in front of the inspector and other residents in the home, it involved lifting her top to expose her abdomen. Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 16 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 poor quality outcomes in this area. Some activities were provided but there was nothing to suggest that they were what residents wanted to do, or how the activities benefited them as little consideration was given to people’s individuality. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Individual care plans included very little detail about any past hobbies or interests a person had had and what they would like to do, so it was not possible to link them to the few activities provided. We asked two residents sitting together about the activities in the home, one told us, ‘ I sit here all day, I live here, I can’t join in anything because of my disability’. Another who had been at the home about two weeks said, “I joined in a game when a lady came. We had to pick a letter, can’t remember what we did then”. Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 17 Another resident we visited in their bedroom said, “I read and do puzzles”, I have not seen anyone doing physio or activities. Another who was cared for in bed but being quite positive about the care he received told us, “the worst part is boredom, you never see anyone.” The manager told us that he had identified a member of the care staff to do some training around suitable activities. Green Park did not have any visitors from the community other than a priest who could offer Holy Communion. The manager was currently exploring churches and choirs who might make visits to the home. There was a whiteboard in the lounge with a list of activities but we did not see how these related to the day. When we arrived at the home at 07:30 hours the TV was on a music channel, it was then changed to a shopping channel and only later was it showing a soap opera. The manager told us one person monopolised the TV remote, but did not say how this was being managed. We saw visitors coming into the home when they wanted and being greeted by the staff. Visitors had a number of areas in which they could meet with their relatives, including communal areas or their bedroom. Throughout the inspection we saw little opportunity for the people using the service to make choices. One lady told us, I go to bed when the staff are ready. This morning they woke me up when I was in a deep sleep. When asked why she had to be woken she relied “they have to get all the work done”. As it was only 08.00am we did not feel that it was necessary for her to have been woken. We noted the following comment in a care plan, **enjoys cigarette, particularly after meals. This person told us, “I haven’t had a smoke since I have been here, I do miss it”, and we saw nothing as to why this was the case. There was a piano and a computer for the use of residents, but staff said they were not used. There was no choice of menu and the cook told us that she did not ask people what they wanted for a meal, but would make them a salad if they did not like what was on offer. However from three residents suggested that if they did not like what was on their plate they could leave it but would not necessarily be offered an alterative. The cook had been in post less than a week, she told us and we saw that she had a large stock of food. This was reassuring, as in January 2008 a complaint about the lack of food in the home had been made. At breakfast we saw people being given cereals or toast, and heard staff telling the cook what the individual wanted. We felt sometimes it would have been appropriate to check it was still what the person wanted. For example, it was Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 18 a hot day, and those that liked hot milk on cereal may, if asked, may have chosen to have cold milk on this occasion. At lunchtime the meal was fish in sauce and mashed potato. There were no condiments on the table for people to add to their plate. One lady who was gradually being introduced to thicker food had fish finger and mashed potato. The lady opposite asked for the same, this was bought out of the kitchen by the carer who was using a fork to mash the fish finger into a pile of potato as she came towards her. This meal did not look at all appetising when put in from of the resident. There was no sauce with this meal. We noted that there was fresh fruit and drinks in the kitchen and in the dining room. One resident who had all his meals in bed told us, I don’t really enjoy my meals as I can not get in a comfy position. At the time of the inspection there was a water problem affecting the whole area of Northampton and as a consequence the home were storing at least 150 2 litre bottles of water in the dining room. Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 19 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 poor quality outcomes in this area. There was no evidence to indicate that complaints were appropriately investigated in this home, and the manager lacked understanding of the safeguarding reporting processes, so that people living in this home may not be protected. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The visitor’s book at the entrance to the home was being used appropriately. A number of thank you letters were displayed in the home, however when we asked to see the complaints file, it was empty despite the manager telling us, and recording in the AQAA, that there had been two complaints made to the home since he took up post. We were therefore unable to establish how the complaint had been investigated and responded to. Prior to this inspection there had been an allegation regarding the treatment of a resident from a family member. This had been made to the Local Authority but the home had not reported this matter to us, and when this was discussed with the manager, he was unable to demonstrate any understanding of the Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 20 local protocols and procedures that are in place to protect people in care homes. We were concerned that we found accident forms that had not been completed correctly, including one where a person had trapped their leg in the bedrails and gone on to be diagnosed with a dislocated hip as a result. Again we had not been informed of this incident under Regulation 37 and the manager had not considered reporting it under Riddor (part of the Health and Safety Executive) Further sampling of the accident record indicated that we should have been informed of some of then under Regulation 37. We did not see any evidence that staff had received training on Safeguarding Vulnerable Adults (SOVA). Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 21 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): 19,26 People who use this service experience adequate quality outcomes in this area. Generally the home provided a physical environment that met the specific needs of the people who live there. However if people were cared for in their bedroom they could be socially isolated. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We made a limited tour of the building, but it was apparent that people were able to personalise their rooms with items of furniture and ornaments from their home. We also noted that the furniture and furnishings were of a good quality and were clean. Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 22 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.) The toilet in this room was operational, and still being used, the room was also used to store wheelchairs. We counted six chairs in the room; this could be a trip hazard for people, as well as confusing for anyone with dementia looking to use a toilet. At 09:45 we noted the toilet in the entrance hall of the home was blocked and dirty. We were concerned about the number of people that chose to remain in the bedrooms during the day. One person told us that she has to stay in her room because “they don’t have the staff to take me downstairs. My wheelchair doesn’t fit in the lift”. We noted that the long windows on the stairs were open and were not restricted and as one care record referred to a persons ‘recent suicidal ideation’ we felt this was very dangerous. None of the windows in bedrooms or on landings were restricted. At the last inspection it was reported, ‘It was noted that door wedges were seen to be habitually used throughout the home, it was explained by the acting manager that for residents who spend long periods within their bedrooms there was a need for the doors to be open, to reduce the risk of become isolated and to ensure that staff could closely monitor the residents safety. However within the residents care plans and within the fire risk assessment there was no record of a risk assessment being carried in this area. The registered provider should consult with the fire safety authority to address this safety area’. We did not see any evidence that this was being addressed and noted staff kicking out the door wedges that were being used, suggesting they knew it was wrong. There was a large timber decked patio area to the rear and the side of the building and there was outdoor seating available. The garden at the front of the building had shingle covering it. The outside area was not all tidy as plants were dead in flowerpots, probably from the previous year and weeds were up around the edge of the decking and between the shingles. We did not see any evidence of the garden areas being used by the people living at the home even though it was a hot day but we were told it was well used. While sitting in communal 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. Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 23 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. This service had poor recruitment procedures. Staff were appointed and started working without important documentation being received and this could put the people living at Green Park at risk. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: On duty at the start of the inspection were a nurse and four carers and a cook. Although this was sufficient to meet the care needs of the 21 people living at the home we were concerned that staff were working excessive hours. For example there were only four nurses and 9 carers to cover the day and night shifts. There must always be a nurse on duty in care home that provides nursing and four nurses working full time covers 150 hours of the necessary 168 hours needed to cover a week. The extra 18 hours is manageable between four staff but does not allow for leave or sickness. The manager told us that staff were sometimes deployed from a another home in the Msaada group, but agency staff were not used. Staff spoken did not mind extra hours. All of the staff, with the exception of the manager were female, the manager Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 24 told us that some of the people living at the home had not liked it when a male was employed. However we did not see any documentation to support that people were asked about their preferences for the gender of the person providing their care. The personal files of four staff were examined during this inspection. The recruitment processes in this home were ‘disjointed’ and the manager was unaware of processes he should be following to protect the residents from employing someone who was not suitable to work with vulnerable people. We were told head office took responsibility for recruitment. One carer did not have documentation to support Home Office permission to work in the UK and although she and the manager said she had received a letter permitting her to continue working, it was not on file and there was nothing to state if it was indefinite or for a fixed period. We looked at the file of the cook who had started work that week. She had previously worked in a local care home but did not have reference from the home, instead she had two references from the same place of employment that she had worked in sometime ago. One of the referees admitted to having been made redundant from this place. She had not been checked by Criminal Record Bureau, so did not have a POVA first. Another file did not have a current Criminal Record Bureau check, but one for another place of employment. The manager told us that head office were responsible for checking recruitment, but head office were not able to locate some of the missing documentation and it is the manager responsibility to be sure he is employing people with the necessary skills and experience and clear checks to work with vulnerable people. One carer who had started work with the company as a cleaner did not evidence of the induction training she had completed for the new role. We therefore left an immediate requirement that the procedures and practices for recruitment were reviewed immediately. The manager was not aware of what training staff had had, or needed, or needed to update, and we saw very little evidence in staff files that staff had much training. We looked for evidence of moving and handling training for the staff on duty, as we had witnessed poor practices. One file had a certificate from 2007 but another had supervision notes dated 09.07.07 that identified moving and handling as a training need, but no evidence that training had been given. The manager told us that staff had full induction training but we did not see any evidence on file, indicating that someone had signed them off as able to perform certain tasks before they did so independently. Including the nurses less than (required by 2005) 50 of the care staff had a NVQ qualification to level 2 or above. Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 25 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): 31,33,36,36,37,38 People who use this service experience poor quality outcomes in this area. Lack of records indicated that the manager lacked understanding, knowledge and control of some of the main components involved in the running this home and the protection of the people living there. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager was not a nurse, he had a certificate in managing care but not the Registered Managers Award. If there is a non-nurse managing a nursing home the manager must be able to identify a clinical lead, and as a Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 26 consequence the home was considering appointing a deputy who was a nurse. At the time of this inspection none of this nurses had been given this responsibility. The manager had worked for the company in the past and told us that he had been managing another home and had worked at the head office, but was committed to making a change. He had been at Green Park approximately two months and staff, who had seen a lot of managers come and go recently, had not formed an opinion of his management style. He appeared to have good relationships with the residents and made a point of speaking to them all when he came on duty. The manager told us that there was no quality assurance system in place and that supervision had lapsed under the previous manager and he had yet to restart it. We would have hoped that this would have been a priority in order to get to know the staff team. We did not look at monies held in the home as the manager told us they were muddled as people had been borrowing money from his petty cash and it needed to be paid back. We advised him that he needed to ask families for the relatives personal allowances and if they did not give it to them and the person was unable to have something that they needed because of the lack of money, then it should be reported under SOVA. As alluded to throughout this report documentation was not well kept and the manager was not recording and reporting all that needed to be. Staff must also be mindful that if they are recording information they must act on it. For example a fluid chart that indicated that the output was drastically reduced from the input had no action against it. Regularly fire checks that should have been carried out weekly had been recorded monthly. The manager said safety checks had been the responsibility of the handyman but he had yet to ask someone else to do it. There were no hot water checks and we were told that they were not being done. The manager was not aware of the temperature that water should be recorded at when leaving an outlet. We did not see evidence of any fire drills or emergency lighting checks. No fridge or freezer temperatures had been recorded since 19th May 2008. The cook told us that she probed food before it was served and checked it was the right temperature but did not record the finding. Green Park Care Home DS0000056079.V367800.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 2 X 2 1 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 1 1 1 1 Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? no 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 4,5,sched ule 2 Requirement There must be a Statement of Purpose and Service Users Guide that includes the information included in Regulation 4,5,Schedule1 and standard 1 of the National Minimum Standards. The format these documents are provided in must be considered. There must be evidence to demonstrate that the staff team at the home and on duty at any time have the necessary skills and training to meet the needs of the people admitted to the home. Timescale for action 01/09/08 2 OP4 18(1) 01/09/08 3 OP7 15(1)(2) This requirement relates to people who are admitted to the home with conditions that the staff team do not demonstrate that they have the experience to care for. Care plans must be in place for 01/09/08 all areas of care, they should be regularly reviewed and altered as necessary. Wherever possible people should be involved in their care plans and know what the include. DS0000056079.V367800.R01.S.doc Version 5.2 Page 29 Green Park Care Home 4 OP8 12(1) 5 OP9 13(2) 17 (1)(a) 6 OP12 16(2)(n) 7 OP14 12(2) 8 OP16 22 9 OP18 13(6) 37 13 (4)(c) 10 OP19 Risk assessments must be completed regularly, dated and signed and the information gained from doing them used to influence the care provided. Complete and accurate records must be kept of all medication administered, or not, together with a reason why the medicine was not given, in order to demonstrate that residents receive the medicines prescribed for them. An immediate requirement notice was served. Staff must devise an activity programme after consultation with the people living at the home that meets their interests. People living at the home must be offered choices about the way they spend their day, what they eat and what care is provided. People who use this service must be protected by the homes complaints procedure, and all records relating to investigations must be maintained in the home. People who live in this home must be protected by appropriate referrals being made to the safeguarding team. The use of door wedges must be risk assessed through consultation with the fire safety authority. This standard had been partly met but is re-stated with a revised timescale. 01/09/08 12/07/08 01/09/08 01/09/08 01/08/08 01/08/08 01/08/08 11 OP27 OP30 18(1) 12 OP29 19 Schedule 2 Staff must have the necessary 01/09/08 experience, skills and qualifications to care for the people living at Green Park. People must only start work after 12/07/08 a thorough recruitment process including the checks and DS0000056079.V367800.R01.S.doc Version 5.2 Page 30 Green Park Care Home references described in Schedule 2 of the national Minimum Standards. An immediate requirement notice was served. The home must ensure that having regard to the statement of purpose and the needs of the service users, the manager has qualifications, skills and experience necessary for managing the care home. The Registered Provider must conduct monthly-unannounced Regulation 26 visits to the home and provide a written report of the visit to the registered manager. This requirement is re-stated. The home must complete quality assurance surveys and undertake and publish an analysis of them. All staff working at the home must be supervised at least six times a year. Staff must ensure that documents are kept up-to-date and dated and signed. This refers to the Statement of Purpose, the pre-admission assessment, care plans, risk assessments, There must be safe working practices in the home for the moving and handling of residents. There must be regular checks of fire safety equipment in the home. 13 OP31 10(1) 01/09/08 14 OP33 26 01/09/08 15 OP33 24 (1) 01/09/08 16 17 OP36 OP37 18(2) 17 01/09/08 01/09/08 18 OP38 13(5) 01/08/08 19 OP38 23(4) 01/08/08 Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 31 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 3 4 5 6 Refer to Standard OP5 OP10 OP15 OP19 OP27 OP28 Good Practice Recommendations People should have the opportunity to visit the home before making a decision to move in. People’s privacy and dignity should be considered at all times. This relates to an insulin injection being administered in front of others. Meals should be appetising and people should be offered a choice. Consideration should be given to the noise from the lift and the call system. There should be enough staff employed to allow staff to take holidays and have time off. Staff should be encouraged and supported to complete NVQ training. Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG 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. Extracts may not be used or reproduced without the express permission of CSCI Green Park Care Home DS0000056079.V367800.R01.S.doc Version 5.2 Page 33 - 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!