Inspection on 28/09/05 for James Page House

This inspection was carried out on 28th September 2005.

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 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

James Page House 31/10/07

James Page House 16/08/06

James Page House 18/01/06

James Page House 19/10/04

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

CARE HOMES FOR OLDER PEOPLE James Page House Deyes Lane Maghull Liverpool Merseyside L31 6DJ Lead Inspector Ms Lorraine Farrar Unannounced Inspection 28th September 2005 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 James Page House DS0000017244.V251833.R01.S.doc Version 5.0 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. James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service James Page House Address Deyes Lane Maghull Liverpool Merseyside L31 6DJ 0151 526 4133 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) Parkhaven Trust Mrs Sheila Francis Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (3) of places James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service users to include up to 30 OP. Maximum no. registered - 33, of which up to a maximum of 30 (OP) (N) and up to a maximum of 3 (YA) (PD). The service has two (2) named service users under pensionable age. The service should, at all times, employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. That Mrs Francis receives training with regard to the specific needs of YA, PD, this should include person centred planning training, challenging behaviour training and the Learning Disabilities Award Framework (IDAF) training. 19/10/04 5. Date of last inspection Brief Description of the Service: James Page House is owned and run by Parkhaven Trust, an organisation that have a several care homes in the Maghull area of Liverpool. The home is on a large site on Deyes Lane in Maghull, there is another registered home sharing the site called the Kyffin Taylor. The grounds are large and there is plenty of room for residents to sit out and to go for a walk. Although in its own grounds the home is in the middle of a residential area and there is a public transport service nearby, car parking is provided and local shops and facilities are not far away. The building is single story and has been adapted to a high standard, there are 30 single bedrooms each of which has an en-suite with toilet and sink. The home has three “wings” and a main dining / sitting area. Each wing has bedrooms, sitting and dining areas and bathrooms. In addition there is a main laundry, kitchen, offices and a reception area. The home is registered to provide care with nursing for 30 people over retirement age. Registered Nurses and carers are available 24 hours a day and there are domestic and kitchen staff during the day. James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out by two Inspectors, Lorraine Farrar and Trish Thomas. It included reading some resident and staff files, records and safety certificates and discussion with some residents, visitors, staff and the acting manager, parts of the building were looked at and medication storage and systems were sampled. What the service does well: What has improved since the last inspection? What they could do better: The home needs to make sure that care plans are reviewed monthly and that resident’s or their representatives are consulted about these. They also need to make sure that they review, monitor and record information regarding pressure sores. The home needs to monitor how their medication system works to make sure residents receive medication that is prescribed for them and that this is recorded. James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 6 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. James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 7 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 James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 8 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): These standards were not looked at during this inspection EVIDENCE: James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 9 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 There are individual care plans in place for each resident, which provide information regarding the care they require. Some of these have not been updated as often as needed and there is insufficient information regarding pressure sores. There are appropriate storage facilities for medication however recording and use of medication dispensing systems is not always followed by staff resulting in some residents not getting the medication prescribed on occasion. EVIDENCE: All residents had a care plan and these were well organised and followed a standard format. A member of staff has recently been given the task of overseeing the content and quality of care plans. Seven care plans were looked at. These had brief personal information about the resident, their history, finances, family contact and medical conditions. There were copies of assessment’s carried out by staff, these included the person’s health and personal care needs, pressure care and nutritional assessments and weight charts. James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 10 There were action plans in place to address some of the persons needs identified, this included, their mobility needs, nutritional needs and continence needs and there was evidence on a care plan, of best practice regarding a resident’s personal choices. Not all plans had been reviewed in the past month, as residents needs can change quickly the home needs to make sure all plans are updated monthly to make sure any changes are recorded and appropriate support is given. The home must also make sure that residents or their representatives are given the opportunity to read and sign their care plan. On speaking with four residents whose care plans were read, there was evidence that assessments and action plans were meeting their needs at the time of inspection, with the exception of pressure care assessment and recording. There was evidence of a shortfall in one care plan, as the pressure risk assessment and reviews were out of date. The latest pressure risk assessment for one resident was dated 3/5/05 “all pressure areas intact.” It was recorded elsewhere in her notes that there had been superficial skin breaks to the base of spine, on 26/7/05. On speaking with the resident concerned, she confirmed that she had a pressure sore on returning to the home, having been discharged from hospital, but this had now healed. Another care plan recorded 29/5/05 pressure sore – Right buttock, 13/8/05 – pressure sore – Right Buttock. There was no limited evidence to show how this had been dealt with or whether the area was getting better. The home must put into place a system for monitoring pressure sores on a regular basis. The care plan did not record any equipment or instructions for staff to prevent further skin break down or help the sore heal. The home has a room for storing medication in and each wing has a medication trolley for the people living there. They use a blister pack system for most medicines, which is provided by a local Pharmacist. The home had given the task of overseeing medication ordering, storing and returns to 2 Registered Nurses one of whom was spoken with during the inspection, she explained that there have been some difficulties with medication but this was being addressed and they had arranged for the Pharmacist to visit the following day to give advice. Storage of medication and controlled drugs was checked and was appropriate, there are locked cupboards and a fridge provided which is kept at the right temperature. Parts of the stock, returns and controlled drug books were checked and were in order. One resident had been given paracetomol on a number of occasions; this was because her prescribed painkillers were not available. Two of the Nurses said this was because the ordering system did not work correctly at the time. Blister packs were checked and there were some difficulties with these. Staff are not using the blister pack system in order of the days listed. This makes it difficult to check at a glance and make sure people have had all of the medication they need. James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 11 One resident had had medication signed for but when checked there were too many tablets in the pack, this indicates that on one or more occasions’ tablets are not given but are signed for. It is not possible to check when this happened due to the current system of tablets being taken from anywhere in the pack. Another resident had 8 tablets signed for but the pack indicated she had taken 10. The home must put an internal audit system into place for their medication, they must also provide written advice to all registered nurses on how to use the blister pack system. Residents’ records were seen to be secured in the offices to ensure confidentiality. Bedroom and bathroom and toilet doors were closed throughout the inspection and staff were seen knocking on doors before entering private rooms. All bedrooms are single and have en- suite facilities. A resident commented on privacy, She said she prefers to stay in her bedroom and appreciates having en-suite shower facilities. She said that meals and drinks are brought to her room and staff call in for a chat, but there is no undue intrusion into her privacy. She said that staff speak to her respectfully and she had no complaints about their conduct towards her. She said she has a call bell to summon staff if she needs anything. This lady said she is always left in private with her visitors. Two visitors to another resident confirmed this, saying that they are always left undisturbed when visiting their friend. They said that staff are always polite and respectful and they had no concerns regarding staff conduct. All residents have a key-worker who spends time with them and helps with their room, shopping etc. James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 12 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): 12,13,15 The home offers a quiet pleasant environment in which residents can spend time in private or socialising as they chose. There are some arranged activities as well as those found in most domestic homes such as music and TV. Visitors are welcomed and able to meet with the resident in private if they chose. The home provides varied meals with staff support at meal times where needed. EVIDENCE: One of the most positive things about this home was the relaxed atmosphere. Residents appeared to be content and were either in their bedrooms or in small lounges, watching T.V. reading, or entertaining visitors. One lady says she stays in contact with the voluntary agencies and committees, which were of interest to her before she moved into the home. She said she has retained friendships and contact with her family who live out of the area and that her relatives and friends who live locally are regular visitors and are always made welcome by staff. One lady said, when weather permits, she likes to sit out in the garden, where seating and shade is provided. Another lady who used to enjoy art, has become very frail, and said she was not up to colouring that day. A gentleman was involving himself in craftwork. James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 13 No communal/arranged activities were observed during this inspection. There is an in-house activities co-ordinator, who visits the home three times a week. Visitors were calling at the home throughout the inspection. The menu was varied and is rotated over three weekly periods. In discussion with the chef, it was confirmed that residents are consulted daily as to their meals, and choices and alternatives are offered. Meals are served from heated trolleys and residents have a choice as to where to take their meals (in the dining room or their bedrooms). Staff serve meals from the trolleys directly to the tables, or they are taken to bedrooms on trays. The food stores were well stocked with basic provisions and choices of breakfast cereals, hot and cold drinks, and fresh vegetables were observed. Three residents who commented on food said they were satisfied with their meals. Jugs containing cold drinks were seen in residents’ bedrooms and hot drinks were served during the afternoon. The home caters for special diets and nutritional assessments were seen on care plans. Dining areas are nicely decorated and furnished and provide pleasant areas to sit in. James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 14 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): These standards not looked at during this inspection EVIDENCE: James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 15 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): 19,20,21,22,23,24,25,26 The home is bright, pleasant and generally well maintained with enough space for people to feel comfortable and be able to have some privacy. Décor and furnishings is of a high standard and there aids and adaptations suitable for residents needs. The majority of rooms in the home are clean and hygienically maintained apart from the kitchen area, which does not meet hygiene standards. EVIDENCE: The building and grounds were generally well maintained at the time of inspection. There is enough space within the home and the grounds for residents, staff and visitors to feel comfortable and spend time alone or socialising as they chose. The home has domestic staff who work shifts and are on duty throughout the week. Their work was evident in the good standards of cleanliness observed throughout the building, other than some areas of the kitchen (referred to in standard 38). James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 16 The building is single-storey and divided into three wings with ample office and storage space. There is a lounge / dining area on each wing, and a larger central lounge/ dining area. Outside there are large gardens and a small patio and seating area, which residents can use. Shared areas were well lit, nicely decorated and furnished with comfortable seating. The Bedrooms of four residents were seen and these were comfortable, warm, well lit and had been made personal to the resident with their own belongings. All rooms have a good view of the gardens. Shortfalls were noted with regards to some of the facilities in the kitchen, there was not enough cutlery and the steamer was not working. The manager must ensure that the steamer is replaced/repaired and that replacement/additional cutlery is provided. The home is on one level, with wide doorways and level access to outside. There are different aids to help with mobility, including grab rails, raised toilet seats, handrails, three hoists for use throughout the home, and an adapted Parker bath on each wing in addition to the en-suite facilities. The manager confirmed that she is in the process of obtaining new wheelchairs for a number of residents (three having been obtained) and a service contract for wheelchairs has been set up. There is a nurse call system throughout the home. Care plans contained moving and handling assessments for individual residents. The acting manager confirmed that the number of hoists in the home (three) was adequate to the needs of those in residence at that time. The home has a laundry room with a permanent member of staff who looks after the laundry and residents clothes. This room was clean and well organised with industrial machines and disposable equipment including aprons, gloves and soluble bags to help prevent the spread of infection. James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 17 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): 27,29 EVIDENCE: The home had an acting Manager in place who is a registered RGN who has worked in the home and for the organisation for some time. She is not counted in the numbers of staff on duty each day. In addition there is a part time administrator and back up support from the main organisation departments. There is at least 1 registered nurse on duty 24 hours a day with 2 in the morning; in addition there are a number of care and domestic staff. Staff were busy on the day of the inspection but did not appear unduly rushed and were able to meet residents needs in an appropriate manner. It is recorded elsewhere in this report that the kitchen area was not as clean as it should be, it is therefore recommended that the manager reviews the amount of hours there is a domestic working in this area. The organisation have a good policy in place for recruiting new staff and staff files have copies of their terms and conditions, job descriptions, references and Criminal Records Bureau checks. James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 18 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): 38 The home carries out regular safety checks on the building and equipment and offer training to staff in health and safety areas. Most areas of the home are clean and well maintained, however the home are not maintaining the kitchen area to a good standard of cleanliness. EVIDENCE: Records showed that the home had carried out a recent fire drill and checks, safety records and certificates for small appliances, electrics, gas and hoists were satisfactory. Staff records and discussion with staff show training is provided in 1st aid, fire, COSHH, manual handling and food hygiene. Shortfalls were noted in the standards of cleanliness in the kitchen, tiles over the sinks were soiled, food (saucepans and tins) were soiled and greasy, especially the outsides of these containers, this could lead to a spread of infection within the home. The manager must make sure that the kitchen environment and equipment is maintained to a high standard. James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 19 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 20 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 2 Standard OP7 OP7 Regulation 15(2)(b) 15(1) Requirement The Home must make sure all relevant sections of care plans are reviewed monthly. The home must offer residents or their representatives the opportunity to discuss and sign their care plan The home must put a system into place for regular assessment, monitoring and recording of pressure sore’s and the care required. The home must put a system into place for internally auditing their medication. The manager must ensure that the steamer is replaced/repaired and that replacement/additional cutlery is provided. The manager must ensure that the kitchen (environment and equipment) is maintained to a high standard of cleanliness. Timescale for action 23/12/05 20/01/06 3 OP8 15(1) 15(2)(b) 25/11/05 4 5 OP10 OP19 13(2) 23(2)(c) 25/11/05 25/11/05 6 OP38 13(3) 11/11/05 James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 21 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 OP27 Good Practice Recommendations The manager should review kitchen domestic hours to ensure that the kitchen (environment and equipment) is maintained to a high standard of cleanliness. James Page House DS0000017244.V251833.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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. 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