Inspection on 16/05/06 for Holly Park

This inspection was carried out on 16th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Holly Park 12/11/08

Holly Park 13/11/07

Holly Park 09/01/07

Holly Park 02/11/05

Holly Park 28/06/05

Holly Park 22/02/05

Holly Park 06/01/05

Holly Park 16/12/04

Holly Park 30/09/04

Holly Park 29/06/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Holly Park Clayton Lane Clayton Bradford BD14 6BB Lead Inspector Chris Levi Unannounced Inspection 16th May 2006 09:00 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 Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 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. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Holly Park Address Clayton Lane Clayton Bradford BD14 6BB 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) 01274 883480 01274 816120 N/A Park Homes UK Ltd Ms Janet McDonald Care Home 43 Category(ies) of Dementia - over 65 years of age (43), Physical registration, with number disability over 65 years of age (43) of places Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd November 2005 Brief Description of the Service: Holly Park was converted from a former school property. It is located in the centre of Clayton village and conveniently placed for shops, library, church and local bus route. Accommodation is provided on the ground and first floor predominantly in single bedrooms. The rooms on the first floor and in the reception area have en suite facilities. There is no passenger lift although a stair lift provides access to the first floor. There are three separate communal rooms two lounges and a dining room. Forty-three service users can be accommodated and the home is registered for nursing. (Discussions are on going about the registration) Some of these have varying degrees of mental health needs as well as physical care needs. A mix of registered nurses and care staff provides the care in this home. The current weekly fees charged by the providers is £318-15p to £623. Additional charges are made for hairdressing, private chiropody and newspapers. This information was provided to the Commission for Social Care Inspection in April 2006. The contents of Inspection reports are discussed at staff, relative and residents meetings. A copy of the report was displayed in the entrance hall. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection by two inspectors took place over one day, starting at 9.00am and finishing at 6.10pm. The registered manager for Holly Park was on annual leave. The person in charge of the home was Ms.B Hogan, the Quality Manager for Park Homes Ltd. She assisted with the inspection throughout the day. The organisation’s Operational Director, Mr J Sykes, and Ms Hogan were given feedback on the findings of the inspection at the end of the visit by the inspectors. The inspectors would like to thank everyone who took the time to talk to us and express their views. This report reflects the preference of people living at Holly Park to be collectively referred to as residents, rather than service users. Before the inspection, the inspectors asked for information which would help with the inspection. The home did not provide this information. Decisions about which residents would be case tracked was made on arrival at the home. During the visit to Holly Park the inspectors case tracked a number of residents. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. Where appropriate, issues relating to the cultural and diverse needs of residents and staff were considered. Using this method the inspectors assessed all twenty-two key standards from the Care Homes for Older People National Minimum Standards, plus other standards relevant to the visit. The inspectors looked at documentation that included care-plans, number of reported accidents, complaints and compliments from service users and relatives. Social activities, staff recruitment and training, and ways in which the home evaluates the quality of services were also reviewed. Areas of the building were looked at. The inspectors spoke with identified residents and relevant members of the staff team who provide support to the residents. Documentation relating to these residents was looked at. Where possible, contact was made with relatives and other external professionals to obtain their opinions about the quality of services provided at the home. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 6 Two residents completed the CSCI survey forms during the inspection. They identified they were satisfied with the services they received. More surveys and comment cards for residents and relatives were left at the home. These cards provide people with an opportunity to share their views of the service with the CSCI. Comments received in this way are shared with the provider without revealing the identity of those completing them. The inspectors shared with the providers their concerns that standards at Holly Park are below minimum standards regarding environmental and care practice standards. Details of the findings are included in the text of this report. What the service does well: What has improved since the last inspection? What they could do better: The providers have not undertaken an agreed review of the numbers of residents with dementia. It is two years since the Commission requested this information, to resolve the registration categories and numbers of residents with dementia living at a home that does not meet their environmental needs. Environmental standards are poor, and unsuitable for the large number of residents with dementia. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 7 There was no evidence that the providers had undertaken the remedial work identified in the fire officers report. Since the inspection the poviders have sent written evidence that the gas safety certificate and the electrical hard wiring certificates are valid. They also indicated that some remedial fire safety work had been undertaken. The portable appliance testing were all out of date. This increases the health and safety risks to residents and staff in the home. Some fire doors were ill fitting. The inspector was very concerned to notice live electrical wires protruding from the wall in a communal toilet. Immediate action was taken by the handyman to make this wiring safe. No one in the home was aware of this serious health and safety hazard. The downstairs corridor carpet presents a serious trip hazard and must be made safe immediately. The bathrooms were stark and institutionalised, with no privacy curtains. One bath had no hot water. The absence of a passenger lift means that only mobile residents can live on the first floor. However, a stair lift can present moving and handling risks for people with dementia. The home had no appropriate aids or adaptations to weigh or move residents who are diagnosed as morbidly obese. The home must address this shortfall as it could put residents and staff at risk. The laundry has to be taken from the home to a room under the home. The room has no light or ventilation. It is cluttered with no shelves for clean laundry, so clean and dirty laundry are placed on the laundry floor. This increases the risk of cross infection. The management of infection control by staff was poor, putting residents at risk from cross infection. Emergency call bells for those residents cared for in their own rooms were out of reach of the resident, leaving them unable to summon help. The practice used by the registered nurse administering medication to residents during the inspection was dangerous, and could result in the wrong medication being given to residents. Documentation in residents’ care plans was incomplete, resulting in staff being unaware of the needs of residents. This was especially noticeable for a recently admitted resident with specific health needs. Care plan reviews were lacking in information to assess any changing needs of residents. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 8 Staff said the quality of information given to them by senior staff about residents was poor, and left them unsure of their responsibilities during their shift. Staff focus on tasks rather than individual residents’ needs; for example, the practice of assisting all residents to the toilet at specific times is poor practice. There was no evidence of person centred care for residents with dementia. Social activities for residents are minimal, and not suitable for everyone. Staff said they have little time to meet the social needs of residents. The specific plans of care identifying residents’ social care needs were blank. The providers must recruit staff to undertake social activities to promote the well being of residents at the home. The providers must, as a matter of urgency, review the senior nursing structure within the home. The clinical nurse manager post is vacant. A bank nurse, who had not worked in the home for a month, taking charge of the home on the day of the inspection. It was evident she did not have the confidence or competence to take on this responsibility. This puts residents and staff at risk. The inspectors were reassured that Ms Hogan was overseeing the home whilst the manager was on leave. The recording and response to resident or relative complaints must be improved. Copies of documentation relevant to the maintenance and repair of the building, and documentation relevant to residents and staff of Holly Park must be held at the home and available for inspection. 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. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 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 Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, People who use the service are able to access clear information to help them decide whether or not they wish to live in the home. Effective systems are in place to assess service user needs before admission. The practice of encouraging relatives and prospective residents to visit Holly Park before making a decision to move in enables all parties to assess the suitability of the service to meet those needs. The home does not meet the needs of some residents with dementia. Written contracts of the terms and conditions of occupancy outline the service to be provided. EVIDENCE: The home has written information about services provided at Holly Park. This document is on display in the entrance hall. It was looked at, and found to contain comprehensive information about services provided by the home, to assist people make a decision about moving to the home. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 11 Since the last inspection all residents or their representatives have been issued with written contracts. This document states the terms and conditions of occupancy and the weekly charges made by the providers. Three signed contracts were seen, which relatives on behalf of the resident had signed. A senior manager and a care assistant visit all prospective residents before they move to the home. This allows them the opportunity to assess the needs of the individual, and decide if those needs could be met within the home. Four pre admission assessments were seen. Two had basic relevant information about the individual’s needs, whilst the others were backed up by additional Social Services core assessments. This information forms the basis of an initial plan of care when the resident moves to the home. A relative said she had visited the home before deciding to bring her husband to live at Holly Park. She said the manager had been friendly and helpful when she came to look around. The home does not meet the needs of residents with dementia. The Commission for Social Care Inspection has requested the providers review the number of people with dementia admitted to the home. This remains unresolved two years on. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. The home does not fully meet residents’ health and social care needs. Care planning for some individuals was totally inadequate, resulting in staff not knowing how to deliver the care they need. Residents may be at risk of receiving the wrong medication due to poor administration practices observed. Residents are generally treated with respect and dignity. EVIDENCE: Four care plans were looked at. Each contained incomplete information that made it difficult to identify how staff should provide effective care to residents. There was an example of good recording relating to a specific incident. But, generally the information did not give a good overview of the needs of the residents. One set of records was poor in the quality of information. The pre-admission assessment identified a specific issue that would need a referral to a specialist community nurse to follow up the treatment plan and provide advice for staff. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 13 It was not clear whether this had been done when the resident was admitted. There was no wound care plan in place and staff were unaware of any specific treatment needed. The care staff told the inspector that they were aware of possible crossinfection issues, but had not utilised the protective equipment in place in the resident’s bedroom, provided to prevent cross-infection. There were appropriate risk management plans in place for residents who smoke, with a designated area set aside for smokers to use. None of the care plans examined had been signed by the resident and there was no evidence to show that the care plans had been drawn up in conjunction with the individual or their representative. One resident capable of being involved and signing agreement to the plans of care, was not aware of her care plan and had never seen it. A resident said,” I am content here.” Other comments were “The place is nice enough to come for a rest”, “I’m quite settled here” and “the staff are nice and very helpful to me”. Two staff were observed using the mobile hoist to transfer a resident from wheelchair to easy chair; their practice was good and they paid good attention to maintaining the resident’s dignity and modesty. However, later in the day another two staff were observed doing the same task and, whilst their technique was safe and correct, there was no attention given to dignity issues. On two occasions, staff were also observed or heard going into residents’ bedrooms without knocking. The written information on the monthly reviews gave no indication of the changing needs of the residents. Two of the care plans examined showed that residents had had significant weight losses over the past 3 months; however, their nutritional risk assessments had not reflected this, nor had their care plans changed in response. The weights of all residents should be taken and recorded on a regular basis. This includes residents whose weight is of clinical concern. There was evidence that the specific health needs of some residents were met by visits from external health professionals. A district nurse visiting said she had been to the home a number of times, and staff were available to take the resident to their room, so that treatment could be given in privacy. One of the residents who was case-tracked also confirmed that the Doctor and the Optician had been to see her at the home and she could see them in private. The care plans had a facility to record the social background and interests of each resident. All of those seen were blank. There was scant reference to any Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 14 type of social activity in the daily notes, other than the occasional reference to visitors. The home has a comprehensive medication procedure. This document identifies how nurses who administer medication, must do so in a safe way, to protect residents from receiving the wrong medication. Therefore, it was of concern to the inspector, to observe a nurse not following the procedure, and administering medication in such a way that residents were at risk from receiving the wrong medication. In discussion with the nurse, she was aware she was not following the correct procedure, but said she did not know all the residents, as it was some time since she had worked at the home. She said she was trying to save time by administering medication in the way observed. She was informed this practice must stop as it was putting residents at risk. The Medicines Administration Record sheets are used to record if medication has been given to residents. It was identified that for three residents recently admitted, medication administration was recorded inappropriately as the correct documentation was not in the home. The instrument used by nurses to check the blood sugar levels of residents who are diabetics was not working because there was no battery. This lack of information could have a negative health effect on residents with diabetes, because the information about blood sugar levels indicates the correct dose of insulin to be given. Medicines when not in use are stored appropriately within a locked area of the home. The inspector was not able to check the management of controlled drugs held in the home, as the nurse was not able to find the correct key to open the controlled drugs cabinet. The recording of the medicine fridge temperatures was not up to date and not recorded in a hard backed book for easy reference. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Generally, residents were not satisfied with the standard of social activities offered in the home. Relatives are welcomed, but residents have little opportunities to participate in local community events. Residents have some degree of control about how they spend their days. Meal provision meets the needs of most of the residents, although the arrangements for providing drinks during the day need urgently reviewing. EVIDENCE: The home has no social activities coordinator. As a result, there was very little social interaction noted. Staff said they are busy most of the shift, but did try to fit in some time to chat to residents. There was evidence of a good rapport between staff and residents. One member of staff was reading the newspaper to residents in one of the lounges, but this was considered to be the role of an activities coordinator, and there was verbal evidence that care staff did not generally see it as their responsibility to fill the gap the activities co-ordinator had left. The two communal televisions were on all day. Only one resident had made a positive decision to watch it. A television is not a substitute for personal Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 16 interaction. For residents with dementia it is often a noisy intrusive substitute and does not help to promote a feeling of well-being. It was of concern that two residents who were being cared for in their own room had no access to the emergency call bells, leaving them unable to summon help. One said, “I just shout until someone hears me”. There was evidence that staff communicate with a resident from an ethnic minority background, who had little understanding of English, using pictures and phrases written by a family member. This is good practice and should be developed to include another resident whose first language is not English. Examples of how residents chose to spend their day were seen. One resident said, “They let me stay in my room with my television. I like that. They help me when I need it.” Another resident known to enjoy television had a prime seat in front of one of the two communal televisions. One resident said that she liked to do “bits” in her own room, despite having a visual impairment, “I make my own bed and try to help myself a bit. It passes the time on.” She enjoyed listening to talking books, which she receives by post every week. She said that one of the residents who likes to go out posts them back for her when they are finished. She had lived at the home for 4 years and had made friends with a few of the other residents. Staff were observed ignoring the distress of a resident with dementia. When asked, they said, the resident is always like this. They made no effort to identify the cause of the distress. This was an indication that staff lack training and understanding of the differing needs of residents with dementia. Relatives are made welcome and staff were observed talking to them and putting them at ease. However, one incident was noted where the request of a relative for help for a resident was ignored. This was included in the feedback to senior managers. A number of relatives were approached for their views on standards in the home. The response including one by telephone after the inspection was mixed. Generally, most were satisfied. All said staff were kind, and friendly. One relative had negative views about the home and incidents relating to the care of her relative. She was encouraged to use the complaints procedure to assist in a resolution to the problems identified. One inspector looked at the standards relating to nutrition and food provision, examining nutritional care plans, menus, observing the lunchtime meal and speaking to the chef. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 17 There are many people who require assistance with eating and take a soft diet. These residents are assisted first at lunchtime. The lunchtime meal looked appetising and well presented and residents had had a choice, some opting for an omelette. The dining room was managed quite well, in a calm atmosphere. The chef discussed the new menus, which have been introduced as standard across all of the company’s homes. He felt there was insufficient variation on the four-week menu cycle, and there had been teething problems with the new produce suppliers. The chef said that visiting families were encouraged to try a meal now and again, to monitor quality. Residents confirmed that the meals were of a good enough standard, although one said that they lack variety. Two of the residents who were case-tracked had lost significant amounts of weight, but their nutritional risk assessments had not reflected this. One person had a nutritional care plan stating what assistance staff were to give (this was observed as taking place during the meal) and that a high calorie diet was to be provided. The chef did not know about this. The records for another resident showed a weight loss of 10 kg in the three months since admission. It was not clear if this was intentional or not and there had been no nutritional plan implemented. It was observed by one of the inspectors that no residents had been offered a mid-morning drink. The care staff said that this had been one of the tasks done by the social activities co-ordinator, but they had now left. It was apparent that no arrangements had been made for any other staff to take over this task, so it was not done at all. The inspector was told that a drink would be made if anyone asked for one, or that jugs and glasses were freely available for cold drinks. The inspectors had concerns about the ability of a large number of residents with dementia and communication difficulties to voluntarily ask for cups of tea. It was also noted that visitors were not offered drinks when they arrived. Staff are able to communicate with a service user whose first language is not English, by way of flash cards translating the words of various items of food and drink. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Systems are in place to protect residents from abuse, and encourage them or their relatives to make complaints. However, the recording of complaints was not evidenced. EVIDENCE: The home has a comprehensive complaints procedure. It was displayed in the entrance hall. A review of the number of complaints since the last inspection identified that one complaint sent by the CSCI to the providers for investigation had not been logged. There was no recording of complaints in the complaints log. Yet, there was verbal evidence from a relative about an unresolved complaint. All complaints must be recorded, with evidence of investigation, outcome and the complainant’s response to the outcome. Staff had a good understanding of adult abuse awareness. They had received training and said they were confident to report to senior managers if they saw, or were told, anything of this nature. This was seen to have been put into practice recently, when a resident claimed to have been hit by another resident. The inspector saw written evidence of good practice involving all relevant external agencies during the investigation into the allegation. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,25,26. The environmental standards at Holly Park are poor, and generally fail to meet minimum standards. The building is not designed for those residents with dementia, nor has it been adapted sufficiently. The location of the laundry makes it difficult for staff to provide an effective laundry service. There was little evidence to judge the home is safe and well maintained. The home does not have the correct aids and adaptations to meet the needs of all residents. There were a number of health and safety hazards observed that could put residents and staff at risk of injury. The home was generally clean and tidy and free from odour. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 20 EVIDENCE: Previous reports have identified concerns about the building, in particular the lack of suitability for those with dementia and mobility needs. The operations director advised that the providers have plans in hand to address these issues. To date the plans have not been sent to the CSCI for consideration. In the mean time ongoing problems with the poor environmental standards remain. There is no passenger lift, with the result that only mobile residents are able live on the first floor. The stair lift may present moving and handling risks for residents with dementia. The home does not have appropriate aids or adaptations to weigh or move some residents. The home must address this shortfall as it could put residents and staff at risk. There was no evidence at the inspection that the providers had undertaken the remedial work identified in the fire officers report. However, the providers at a later meeting to discuss the report, stated some remedial work had been done. There was no evidence at the inspection, of up to date certificates for gas safety, five year electrical hard wiring and portable appliance testing. This documentation was sent to the inspector following the inspection. Some fire doors were ill fitting, some had been wedged open increase the risks should a fire occur in the home. It was noted during the inspection that the fire door in the lounge opposite the kitchen was partially blocked by a large easy chair and a mobile screen. In the event of a fire, this exit would not be easily accessible. The inspector advised senior managers that a request would be made to the fire safety officer to revisit the home. This would provide further guidance for the providers on remedial work necessary to ensure maximum safety for people in the building should a fire occur. There was evidence that fire alarms testing had recommenced but there were no up to date records of checking emergency lighting. The inspector was very concerned to notice live electrical wires protruding from the wall in a communal toilet. Immediate action was taken by the handyman to make this wiring safe. No one in the home was aware of this serious health and safety hazard. The downstairs corridor carpet presents a serious trip hazard and must be made safe immediately with a risk assessment and remedial action. The carpet Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 21 was stained and had been refitted so many times that replacement should be considered the most appropriate action. The threshold wood between the corridor and the lounge is too high, causing problems in trying to move the medicines trolley in and out. This constitutes a health and safety hazard. The bathrooms were institutionalised with no privacy curtains at the windows. One bath had no hot water. The management of infection control by staff was poor, putting residents at risk from cross infection. Staff were aware they should wear protective clothing when providing personal care to a resident with an infection, but there was no evidence they were doing so. Emergency call bells for those residents cared for in their own rooms were out of reach of the resident, leaving them unable to summon help. A handyman had recently commenced work at Holly Park. He should be supported in producing priority lists of remedial work, rather than him deciding what tasks he should undertake. His competence to check the safety of bed rails should be assessed. One resident whose room was seen had an overlay mattress in place, to prevent pressure damage; there was also a chair cushion for use during the day. However, this was seen to have been left in the chair in the bedroom, whilst the resident was spending the day in the lounge, with no pressure relief in that chair. Residents’ bedrooms had the facility of a lockable drawer but no keys were in the residents room. The quality of bedding varied. In two rooms there was no soap or towels for the residents. There was hand washing facilities for staff with paper hand towels. Some residents had brought pictures and small items of furniture to personalise their room. Staff do not always put away residents clean laundry in their wardrobes in a tidy way. One relative was concerned that other peoples clothes were found in her relative’s wardrobe. Ms Hogan said the standards of cleanliness of laundry had improved in recent weeks; it could be seen that the laundry worker was producing a good standard of clean linen and clothing, in very difficult and cramped working conditions. The situation of the laundry remains unsuitable, as dirty and clean laundry has to be carried by staff outside the building to access the laundry. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 22 The home was generally clean and tidy. A cleaner had recently left and the building cleanliness was currently the responsibility of one domestic, supported by other staff for the specific deep cleaning of certain areas. The providers must ensure the environment at Holly Park is fit for purpose as a matter of priority. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The numbers and skill mix of staff needs to be reviewed in order to ensure residents’ needs are met. The current nursing numbers and irregular use of some nurses may put residents at risk. Information regarding the number of care staff with National Vocational Qualifications at level two was not available. Residents are protected by the home’s recruitment procedures. The home has made some improvements in the area of staff training, but there is still a lot to be done to ensure that the staff have the necessary skills and knowledge to meet residents’ needs. EVIDENCE: In discussion with care staff, they said there had been an increase in staff numbers. However, the care staff said that information given to them when arriving for work could be improved. They were not always sure what was happening to residents during the shift. Staff said they felt confident to undertake the roles and responsibilities required of care staff. The inspectors were concerned that the nurse in charge of the building on their arrival had not worked in the home for four weeks, and was not confident or competent to understand the unannounced inspection process. The Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 24 organisation’s quality manager arrived, and explained she was providing management cover whilst the registered manager was on leave. The home has a vacancy for a clinical nurse manager. None of the existing nursing staff have a relevant qualification in dementia care. The recruitment file of one nurse was looked at. It contained all relevant documentation to demonstrate the home has a robust recruitment procedure. There were interview notes, two references, and confirmation that the nurse was registered to practice from the Nursing and Midwifery Council. The providers were asked to check that a new Criminal Records Bureau check had been undertaken by the home as part of the recruitment process, as it was not clear from the documentation seen. There was evidence that the applicant had undergone a preliminary screening, to ensure she could work with older vulnerable adults. Staff said they had received more training recently, and a number were working towards NVQ qualifications. This number could not be identified during the inspection. The quality manager provided a training chart that identified what training every member of staff was to undertake in the coming year. In view of the number of residents with dementia and the staff team’s current understanding of the needs of residents with dementia, the inspectors suggested that this aspect of training be identified as a priority. A new member of the care team was undertaking her induction programme. The quality manager was seen demonstrating the home’s fire safety procedures and instructing the staff member not to undertake moving and handling of residents until she had completed a moving and handling training course, planned for the following day. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37,38. The home manager is experienced in providing care to residents. She is well liked by both residents and staff. Care staff do not receive one to one supervision that assesses their performance and future personal development. Systems are in place to include the views of residents, relatives and staff views on the quality of services at the home. However, on the day of inspection there was little evidence to show that the home was being run in the best interests of all the residents. The health and safety of residents and staff may be at risk because of the failure of the providers to ensure effective provision and maintenance of equipment and the building. The standard relating to the management of residents’ finances could not be inspected in full at this visit, therefore no judgement could be made about the level of protection afforded to those whose personal allowances are looked after. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 26 EVIDENCE: Ms J McDonald is a nurse with many years experience of caring for older people. She has recently been registered with the CSCI as manager of Holly Park. She was on annual leave at the time of the unannounced inspection. Staff said she was very approachable and supportive and they valued the development opportunities she had introduced for them. Residents and relatives said she was kind, and helpful. On the day of inspection it was clear that, in the manager’s absence, there had been no-one able to take on the role of spending time with the relatives of residents who had been newly admitted, explaining the care planning process, including them in information sharing and subsequently passing essential information on to staff. Staff said a staff meeting had been held about two months ago, but the minutes of that meeting could not be found. Staff confirmed they do not receive one to one supervision to provide them with opportunities to discuss their performance and personal development. Copies of a document were seen identifying staff had received training in caring for people with diabetes. This is not supervision as identified in the National Minimum Standards. The providers must identify appropriate training for a number of senior staff to understand the roles and responsibilities of supervision for care staff and produce an implementation plan as soon as possible. Residents meetings are held, but again the minutes of the last meeting seen was from May 2005. It is acknowledged that in Ms McDonald’s absence there was a dependency on a newly appointed administrator and the quality manager to provide documents for the inspectors. They were both very helpful and enthusiastic, but a lack of knowledge about where certain documents were stored provided them with challenges. However, the process was made more difficult because a number of documents relating to the home and residents were held at the organisation’s headquarters. A copy of all documents relevant to the building, maintenance, and residents must be held at the home. The new administrator said that her knowledge of financial matters was limited at present. She was able to show the inspectors a receipting system for those residents’ relatives who pay their proportion of the fees directly to the home. She also had access to petty cash so that the handyman, for example, could purchase items needed straight away. She did not have access to records or Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 27 cash held on behalf of residents who cannot manage their own personal allowances. The organisation’s quality manager carries out monthly visits. Copies of the findings from the visits are sent to the inspector. They are informative and assist in the continuous evaluation of service standards at the home. The quality manager also praised the staff team for responding so well to a recent request for them to come in for extra hours, specifically to help with a deep cleansing of the home. Inspection survey material identified that most policies and procedures are due to be reviewed to see if they are still relevant. A document seen at the home indicated that the home does not comply with the safe use of chemicals hazardous to health. Staff receive regular up dated training for the safe moving and handling of residents. This was confirmed by observation during the inspection. A number of health and safety hazards have been identified in the environmental standards, and the summary. Most require the providers to deal with the shortfalls as a matter of urgency, to protect the health and safety of residents and staff. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 28 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 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 1 2 2 2 x 3 3 1 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 1 2 1 Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 29 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 OP4 Regulation 14 (1 ) Requirement The providers must ensure they meet the needs of individual service users, especially those with dementia. The providers must provide the CSCI with information to amend the current registration categories. Care plans must include up to date information. The health needs of a residents care plan must be identified and appropriate action taken. Medication for residents must be administered, recorded in a safe manner by nurses working at the home. Nurses must have access to equipment that enables them to carry out nursing tasks. The medication fridge temperatures must be recorded and retained. That bedroom keys are offered to residents assessed as able to use them. (previous timescale not met.) Emergency call bells must be accessible to residents when they are in their own rooms. The manager must ensure staff DS0000029171.V293846.R01.S.doc Timescale for action 30/07/06 2 3 4 OP7 OP7 OP9 15 15 13 (2) 30/07/06 30/07/06 30/06/06 5. OP10 12 30/08/06 6 7 Holly Park OP10 OP10 13 12 (4) 30/06/06 30/06/06 Page 30 Version 5.1 8 OP12 16 (2 ) (n) 17 (2) 23 (4 ) 9 10 OP16 OP19 11 OP19 23 12 13 OP19 OP20 13 19 avoid institutional practice such as toilet rounds. The providers must introduce a range of social activities appropriate to the needs of the residents. Complaints must be recorded with evidence of investigation and subsequent outcome. Fire doors must not be wedged open and fire exits must be kept clear. The provider must undertake remedial work identified in Schedule 1& 2 of the fire safety officers report. The overdue fiveyear electrical hard wiring, and portable appliance testing checks must be completed as a matter of priority. The provider must as a matter of urgency repair or replace the corridor carpet on the ground floor. The providers must ensure any electrical wiring is made safe. Improve the access to the garden and make safe. (Previous timescale not met) Bathrooms must be fit for purpose and provide dignity for those using them. Hot water to all bathrooms and handbasins must be available. Communal toilets must be free from hazards. The providers must ensure the home has appropriate aids and adaptations to meet the needs of residents. A hoist and scales for those residents who cannot be weighed on existing scales is a priority. An alternative to the stair lift must be found to ensure the safety and dignity of residents on the first floor. DS0000029171.V293846.R01.S.doc 30/07/06 30/07/06 30/07/06 30/06/06 17/05/06 30/07/06 14 OP21 32 30/07/06 15 OP22 23 30/07/06 Holly Park Version 5.1 Page 31 16 OP26 13 Resite laundry facilities. Staff must be trained in infection control and use universal precautions to minimise the risk of cross contamination. The providers must ensure that the numbers and competence of nurses in the home meets the needs of residents. The providers must ensure that 50 of care staff are trained in NVQ level 2 The providers must ensure relevant ongoing training for all staff. All care staff must receive supervision six times a year. (previous time scale not met.) The providers must ensure relevant documentation is held at the home. Ensure that all wheelchairs are serviced. (Previous timescale not met) .The fire safety, environmental health and safety are identified in regulations above. 30/08/06 17 OP27 18 30/07/06 18 19 20 OP28 OP30 OP36 18 12 18 30/08/06 30/07/06 30/08/06 21 22 OP37 OP38 17 13 30/07/06 30/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP32 Good Practice Recommendations The manager should consider changes to existing staff handovers to improve communication. Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Holly Park DS0000029171.V293846.R01.S.doc Version 5.1 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. 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