Inspection on 10/11/05 for King`s Park Nursing Home

This inspection was carried out on 10th November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

King`s Park Nursing Home 14/09/07

King`s Park Nursing Home 06/10/06

King`s Park Nursing Home 17/05/05

King`s Park Nursing Home 04/12/04

King`s Park Nursing Home 26/05/04

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

CARE HOMES FOR OLDER PEOPLE King`s Park Nursing Home King`s Road Ashton-under-Lyne Tameside OL6 8EZ Lead Inspector Mrs Fiona Bryan Unannounced Inspection 10th November 2005 10:30 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 King`s Park Nursing Home DS0000025439.V265535.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. King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service King`s Park Nursing Home Address King`s Road Ashton-under-Lyne Tameside OL6 8EZ 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) 0161 343 4733 0161 343 4943 Southern Cross Healthcare Services Limited Care Home 44 Category(ies) of Dementia (44), Dementia - over 65 years of age registration, with number (44) of places King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Person in Charge shall be supernumerary to the stated staffing levels and shall be a first level registered mental nurse. Over 24 hours - 2 Registered nurses No service user under the age of 55 years to be admitted to the establishment. 17th May 2005 Date of last inspection Brief Description of the Service: Kings Park is a Care Home with Nursing that provides specialist dementia care for up to 44 service users. Kings Park is owned by Southern Cross Healthcare, which is a private limited company. Registered nurses with both mental health and general nurse qualifications are on duty throughout the 24 hours and a manager who is also a registered nurse manages the home on a day-to-day basis. The home is a purpose built, two-storey building. Accommodation is provided in 36 single rooms, four of which have en-suite facilities. Four double rooms are provided for service users who wish to share. There are several lounge and dining areas on each floor. Hallways are wide ensuring that service users have plenty of room to mobilise. A keypad system ensures that potentially hazardous areas to service users are restricted. The home is situated in the Hurst Cross area of Ashton under Lyne. King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the second inspection of the year. At the last inspection in May 2005 the home was performing satisfactorily in many areas so the purpose of this inspection was to review progress in the small number of areas that were identified as needing improvement. This was mainly related to how the social care needs of residents were planned and met. Staff training was also needed in dementia care and other topics to be certain that staff had the skills and knowledge to care for the residents properly. A pharmacy inspection took place on 6th July 2005 and requirements made at that time were reviewed. Five other key standards, which have to be assessed at least once year were not examined at the last inspection, and were therefore considered at this inspection. These standards included how the home dealt with staff recruitment, and how they ensured that residents and their families were able to give their views about how the home was run. The qualifications of the care staff were also looked at. Since the last inspection the CSCI has received one telephone call from a member of staff who had concerns about the staffing levels in the home and therefore an assessment was made as to whether the home had enough staff on duty to meet the needs of the residents at all times. Standards which were not assessed at this inspection, were considered to be satisfactory at the last inspection. For further information about how the home met these standards please refer to the report of the inspection on 17th May 2005. Time was spent talking with staff. As the majority of service users were unable to offer in depth responses, staff interaction with them and the overall ambience of the home was noted and the effect that it had on the service users. A selection of documents was examined including residents’ care files, medicine administration records and staff personnel files. Comments cards for residents and visitors were left at the home but none had been returned at the time of writing this report. The manager was on holiday on the day of the inspection. The inspector was assisted by the administrator and the deputy manager during the inspection and subsequently telephoned the manager to offer verbal feedback of the findings of the inspection. King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Staff continue to require formal training in certain topics such as the care of people with dementia, dealing with challenging behaviour and the prevention of abuse, although during the inspection staff were seen to have patience, skills and knowledge in how best to manage and care for the residents. Thought must be given as to whether the staffing levels are good enough to enable staff to look after the residents properly. Many of the residents are highly dependent and a small number are quite resistant to receiving care, and need time and space to encourage them to cooperate. These issues should be considered when deciding how many staff are needed to work. Whilst recruitment procedures were generally satisfactory care must be taken to verify that references are valid. King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 7 The home is purpose built and suitable for the residents but many areas look tired and worn, as no major redecorating or refurbishment has taken place for several years. 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. King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the standards in this section were assessed. EVIDENCE: King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 10 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 and 10 Care plans for residents’ health and personal care clearly identify individuals’ needs. Social care needs are not identified as clearly and require more development. Residents’ health care needs are fully met. The management of medicines is generally satisfactory but some minor areas need addressing. EVIDENCE: A selection of care files were examined, in which plans were available to address care needs that were identified during the assessment process. Care plans for all physical and mental health needs were generally detailed and person centred. Since the last inspection care plans have been developed for residents’ social care needs as well. However, these were not as detailed and tended to rely on phrases such as “Ask the activities organiser to arrange suitable activities”. No record was made of what activities the residents had participated in, other than watching television. King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 11 On the day of the inspection, residents appeared clean, tidy and well presented. Examination of a selection of medication administration records indicated that medicines had been signed for contemporaneously and accurately. Variable doses were recorded and the records for controlled medicines were satisfactory. Whilst some handwritten medication administration details had been countersigned by a second member of staff, others had not. A fan had been installed in the treatment room on the first floor ensuring that the temperature remained within optimum limits. The temperature of the drugs fridge and been monitored and recorded and was within satisfactory limits. Two residents were administered medicines covertly, in agreement with their GP and other representatives. Signed consent for this was included in the residents’ files. However the home needs to develop specific policies and procedures for staff to follow regarding covert administration. It was found that not all of the containers of eye drops or eye ointment had been labelled with the date of opening of the container. This practice ensures that the item can be discarded 28 days after this date to prevent bacterial contamination. Staff were observed to be extremely kind and patient with residents and were obviously skilled and well practised in dealing with residents who were not always amenable to care interventions. King`s Park Nursing Home DS0000025439.V265535.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 The home needs to continue to explore how residents’ social care needs can best be met. EVIDENCE: The activities organiser was due to attend training provided by the Alzheimer’s Society regarding activities for people with dementia. It was reported that the activities organiser spent much of her time with residents on a one-to-one basis. Various amenities such as videos, CD’s, large print books and arts and craft materials are available. An entertainer is invited in to the home to sing for the residents from time to time. Although efforts have been made to develop social care plans for residents since the last inspection, possible actions and interventions that could be used to meet residents’ needs in a more person centred way remained somewhat vague. The inspector did however recognise the challenges faced by staff in dealing with highly dependent residents and the limitations imposed by staffing levels and the capacity of some of the residents to participate. King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 13 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): 18 Some staff did not have the necessary training to protect residents from abuse. EVIDENCE: Staff said they were still waiting to receive training in dementia care, prevention of abuse and dealing with challenging behaviour. They were however aware of the procedures to follow in the case of suspected abuse. The timescale for these training requirements had not expired and has been extended at this inspection to enable the training to be accessed. King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 14 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 and 24 Whilst the home is safe for residents to live in, many areas need redecorating and refurbishing. EVIDENCE: The home has a secure keypad lock system on each floor to ensure that residents at risk of wandering out of the building are safe and are able to mobilise around each floor freely. Few improvements appeared to have been made to the environment. Although it was reported at the last inspection that there was a rolling programme of maintenance, all the communal rooms need redecorating and refurbishing, as they look tired and worn. In addition hallways need painting. In a number of rooms bed linen was thin and worn and curtains need replacing. A new carpet had been provided in the foyer and some extra storage space has been created. King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 15 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 and 30 Staffing levels are not always sufficient to meet the needs of the residents. Many of the permanent care staff hold relevant qualifications but the use of agency staff reduces the overall ratio of staff who are suitably qualified. Recruitment procedures are followed but more rigour is needed in checking the authenticity of references. Further training is required to ensure that residents receive care based on current best practice. EVIDENCE: Examination of staff duty rotas indicated that there had been shortages of both nurses and carers at times. On a number of occasions the manager had worked in the absence of a nurse although the conditions of the home’s registration state that she must be supernumerary. Staff said that staffing levels were low at times. Two relatives who had responded to the home’s satisfaction survey in October 2005 had stated that on occasions staffing levels were low or staff did not have time to spend with individual residents. Three to four staff are sometimes needed to manage some of the residents who can be uncooperative and resistant to care interventions. An example of King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 16 this was observed during the inspection and staff were seen to be patient and understanding even though the episode was time consuming and reduced time they could spend supervising other residents. A significant number of the home’s permanent care staff hold a National Vocational Qualification in care. However as there are several care staff vacancies at present and agency staff have been used to cover a significant number of shifts, the inspector could not evidence that the overall target ratio of 50 of care staff to have achieved NVQ level 2 or above had been met, as the qualifications of agency staff must be included and it was not possible to verify what percentage of these staff had achieved the qualification. Examination of staff personnel files indicated that staff were being recruited following the obtainment of CRB and POVA checks. Files contained proof of identification and references. However the references for one employee were not satisfactory and should have been further investigated. Well-maintained records indicate that staff have received training in mandatory health and safety topics such as fire safety, moving and handling and food hygiene. Three staff had attended training as appointed first aiders and two staff had undertaken training in wound care. However, staff continue to require training in dementia care, dealing with challenging behaviour and prevention of abuse. King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 17 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): 33 Residents and their representatives have opportunities to offer their opinion about how the home is run. EVIDENCE: Care staff stated that there had not been any staff meetings for some time, but there were minutes available of qualified staff meetings held in June and August 2005. Relatives’ meetings are held monthly. Nine satisfaction surveys had been sent to relatives in October 2005 and four had responded. The majority of comments had been very positive. King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 18 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X X X 2 X X STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X X King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 19 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 OP9 Regulation 13, 14 Requirement The registered person must ensure that a policy is developed for the covert administration of medicines, which reflects the current guidance issued by the Nursing and Midwifery Council and the Royal Pharmaceutical Society. (Timescale of 8/9/05 not met). The registered person must ensure that staff receive training in dealing with challenging behaviour, protection of vulnerable adults and the care of people with dementia. The registered person must ensure that the communal rooms are redecorated and refurbished and the hallways are repainted. The registered person must ensure that bed linen and curtains are replaced. The registered person must ensure that there are sufficient staff on duty at all times to meet the needs of the residents. The registered person must ensure that the manager’s hours are supernumerary to any DS0000025439.V265535.R01.S.doc Timescale for action 31/12/05 2 OP18OP30 13, 18 31/03/06 3 OP19 23 31/03/06 4. 5 OP24 OP27 16 18 31/03/06 31/12/05 6 OP27 18 31/12/05 King`s Park Nursing Home Version 5.0 Page 20 7 OP29 19 staffing levels calculated as being required for the provision of care to residents. The registered person must 31/12/05 ensure that the authenticity of references is established and must investigate the authenticity of the references provided by the staff member identified during the inspection. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP9 Good Practice Recommendations The registered person should ensure that social care plans for residents are person centred and offer specific information about residents preferences and capabilities. The registered person should ensure that handwritten medication details on the medication administration records are signed and dated and the details are validated by an additional member of staff. The registered person should ensure that all eye drops and eye ointments are labelled with the date of opening of the container, and discarded 28 days after this date. If the service user is being treated for an open eye infection and both eyes require treatment, the home should ensure that a separate bottle of eye drops is obtained for each eye. The registered person should ensure that staff continue to explore ways in which the social care needs of residents can be met. The registered person should continue to recruit permanent care staff with NVQ’s or train existing staff to ensure that the target ratio is achieved. 3 OP9 4 5 OP12 OP28 King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 King`s Park Nursing Home DS0000025439.V265535.R01.S.doc Version 5.0 Page 22 - 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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