Inspection on 19/03/09 for New Park House Nursing & Residential Home

This inspection was carried out on 19th March 2009.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

New Park House Nursing &... 29/09/09

New Park House Nursing &... 30/06/08

New Park House Nursing &... 26/02/07

New Park House Nursing &... 19/10/05

New Park House Nursing &... 29/06/05

New Park House Nursing &... 26/02/05

New Park House Nursing &... 29/06/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

CARE HOMES FOR OLDER PEOPLE New Park House Nursing & Residential Home New Park, Chivelstone Grove Trentham Stoke on Trent Staffordshire ST4 8HN Lead Inspector Yvonne Allen Unannounced Inspection 09:30 19 March 2009 th 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 New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service New Park House Nursing & Residential Home Address New Park, Chivelstone Grove Trentham Stoke on Trent Staffordshire ST4 8HN 01782 657664 01782 644555 info@newparkhouse.co.uk 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) New Park House Ltd Nora Patricia Sandra Wilson Care Home 92 Category(ies) of Dementia (29), Old age, not falling within any registration, with number other category (92), Physical disability (92) of places New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of care Care Home only (Code PC) To service users of the following gender; Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 92 Physical Disability (PD) 92 Dementia (DE) 29 The maximum number of service users to be accommodated is 92. 2. Date of last inspection 30/06/08 Brief Description of the Service: New Park House is a registered care home currently providing nursing and personal care for up to 92 older people with varying levels of dependency. The home is a large detached property situated in its own spacious grounds in a residential area of Trentham, Stoke on Trent. The home has been extended over the years including a recent extension of a 29-bedded unit. The grounds are extensive and easily accessible and there is ample car parking facilities. Within the grounds of the home are 21 housing association supported bungalows for older people. An emergency care call system links each bungalow with the home and emergency support is provided by staff of the home. The home offers personal and nursing care for older people with varying physical limitations and needs. The home is also registered to care for people with dementia care needs, but is not registered to accept people with mental health needs requiring nursing care. The new extension - which was registered in January 2008 can accommodate up to 29 people. Currently some the people accommodated in this unit have personal care needs, some have dementia care needs and some people have come from the hospital whilst waiting to go home or to another placement. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 5 The fees charged by the home range from £363.00 to £680.00 per week. Additional charges are incurred for hairdressing, toiletries, newspapers, magazines and transport. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that the people who use this service experience POOR quality outcomes. The inspection process commenced several weeks prior to the visit and was not fully completed until 18th May 2009. This was because we were still receiving information about the home from people using the service, their relatives, and purchasers of care. All of the Key minimum standards were assessed and for each outcome a judgement has been made, based on the evidence gathered. These judgements tell us what it is like for the people who live in this home. Prior to the inspection visit the Providers had completed a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to under-take a self-assessment, which focuses on how well outcomes are met for people using the service. It gave detailed information about the services offered. The ways in which in we gathered evidence to make our judgements were as follows – We looked at any information we had received about the home since the last Key Inspection. This included any compliments, complaints and Safeguarding referrals we had received. We spoke with the people who live in the home. We spoke with the staff who work at the home. Discussions were held with the registered manager and responsible individual of the home. We spoke with professionals who are involved with purchasing care at the home. We examined relevant paperwork and documentation at the home. We walked around the home and we visited all the units. We looked at how staff interact with and care for the people who live at the home. We are trying to improve the way we engage with people who use services so we can gain a real understanding of their views and experiences of social care services. We are using a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 7 inspector to help them get a picture of what it is like to live in or use the service. During this inspection an expert by experience joined us from 10am to 1pm. She spoke to some of the people who live at the home and made observations about the care they received. She also looked around the home and spoke to some visiting relatives and some staff members. The expert by experience then wrote a short report for us and her comments have been included in the main body of this inspection report. At the end of the inspection visit we discussed our findings with the registered manager and responsible individual. What the service does well: The service provides spacious accommodation and a home which has character. There are large communal rooms and other pleasant sitting areas where people can sit in privacy if they wish to. The grounds are spacious and provide an accessible pleasant outdoor space where people can sit and enjoy sunny days. Bedrooms can be made homely and personalised and are adapted to meet the needs of people living in the home. People told us that this is what they think the home does well – “Staff are usually pleasant and helpful. People who live in the home look clean and well presented. The home generally looks and smells clean. There is usually some activity taking place in the main lounge in the afternoons”. “I think that the home is home from home”. “Everything – nursing, observations, calls as needed. My relative is able to go out when she likes and take part in activities when she likes. Pleasant staff who treat each person respectfully and with dignity. Good food and choices”. “They check to see if people are alright in their rooms. They keep their clothes changes every day and beds clean”. “My father is a very independent man and the home helps him to keep this position. Also I know that he feels safe and has a good fondness for the people who look after him. The staff are always very pleasant”. “The atmosphere in this home is lovely. The staff are pleasant and cheerful and you can always speak to someone if you have any concerns about your relative. Also my father is regularly seen by the doctor so any problems are always acted upon”. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 8 “I feel that the staff always do their best. The people are always well cared for. The staff are always pleasant and will try to answer your questions”. “The care home is very very clean”. What has improved since the last inspection? What they could do better: Care plan reviews should be kept up to date and reflect any changes. This will help to ensure that peoples’ specific individual care needs are met. Care is very often delivered in a task orientated approach due to time restrictions. The provision of staff needs to be reviewed and improved. Also staff need further training and development in meeting dementia care needs. This will help to promote a person centred care approach. People told us “Many of the care staff are kept very busy after the evening meal but I have noticed that there are periods when a lounge full of people are left unattended”. “Need more staff cover”. “The staff do listen but there is not enough of them especially in the evenings”. “The staffing ratio needs improving”. In order to meet the individual social and therapeutic needs of people, activities should be based around the person’s previous occupation and interests. Also some people are alienated by being unable to participate in activities. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 9 People told us – “Mrs X doesn’t take part in any of the activities as she is hard of hearing and her sight isn’t much good. But she had new glasses so she seems better. They don’t put her in front of the TV so she can see it. She just sits around bored and some days confused.” I would like to help people but you don’t get much chance”. “There are some books around, but I couldn’t tell you where”. Regarding the management of concerns and complaints some improvements have been made in this area. However, it cannot always be guaranteed that peoples’ concerns will be listened to and acted upon. The expert by experience spoke to a set of relatives who had not had a satisfactory response to their concerns. Also the log of concerns kept by the manager did not contain outcomes to a number of complaints. These were added by the management during the inspection visit. The home provides spacious accommodation but the fabric of the main building is dated and, in areas, showing signs of wear and tear. Also, it cannot always be guaranteed that infection control guidelines are adhered to. We found uncovered food and limited access to hand washing for staff. Overall management is satisfactory but the registered manager and managing director need to work together more effectively to help ensure that the home is run in the best interests of the people who live there A number of relatives feel that the laundry system could be improved. “Clothes are well laundered but there is no efficient system for returning clothes to the appropriate people. Items are frequently missing even when marked”. “They have ruined so many good clothes. We have even received clothes back from the laundry and they are still soiled and we have had to return them”. There are health and safety issues with the use of wheelchairs. We found that some of the wheelchairs are being used without footrests in place. This poses a risk of injury to the people using the chair. Also a concerned relative told us, “Many of the wheelchairs appear in need of maintenance and are hazardous to both people and staff”. We also identified that, where a need for the use of the Kirton type of chair has been identified for safety reasons, then a risk assessment must be completed, the decision must include the multidisciplinary team and the person’s representative or advocate. Also, as this type of chair can be viewed as a New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 10 method of restraint, the service must refer to the Deprivation Of Liberty Safeguarding policy. We found the following in relation to the administration of medication. The person who administers the prescribed cream must be the same person who signs that it has been applied. Also the “medications received” book needs a staff signature as does the “medication disposal” book. Also instructions on Medication Administration Records (MAR) charts should be printed by the pharmacist to help avoid errors in drug administration. No staff should be offered employment until a satisfactory POVA check has been received in order to help ensure that people who live in the home are protected from harm or abuse. The registered manager and managing director need to work together more effectively to help ensure that the home is run in the best interests of the people who live there. Overall we have found that people have a mix of conflicting opinions about the service provided in this home. Some people are very happy that they, or their relative are being well cared for. Others are not happy with the service provided. Some people feel able to complain and are satisfied that their concerns would be addressed and others are not. The issues identified during this inspection are the responsibility of the management and indicate a lack of managerial monitoring and communication. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 11 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 New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. People undergo an assessment prior to admission to ensure that the home can meet their needs. EVIDENCE: In their AQAA the Providers tell us that, “An enquiry form is completed and prospective residents are invited to look around the home and come and stay with us for a visit”. They tell us that, “A member of the management team will come and do a full assessment of a person’s needs prior to admission”. Our inspection confirmed that this information is correct. Also, “Admission documents are completed taking into account preferences and choices. Care plans are then compiled and reviewed monthly. A good relationship is built up with the person and the staff”. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 13 On the surveys we received the following comments, “I received this information by using the Commission for Social Care website and going on a visit to look around the home and stayed for a few hours. No information on this home came from anywhere else.” “Admitted originally as emergency but told by social workers that it was rated well. Very large establishment which seems to be getting even bigger with more beds in new wing added recently.” “The staff are meeting mum’s needs better now as they have got to know her and as a family we are very vocal and will address any issues we have.” “It was the home Mum liked the best due to the closure of her last home by our local Council.” We looked at the process of pre-admission assessment. Each person who wants to come into this home undergoes an assessment of their needs before they are offered a place here. We discussed this with the manager of the home and she explained the process of assessment. We saw that pre-admission assessments are contained in individual care plans. The manager informed us that the contract with the local authority to take admissions of “step down beds” was due to end on 31/3/09. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to have their personal, nursing and health care needs met at the home but it cannot be guaranteed that care will be delivered with a person centred approach. EVIDENCE: In their AQAA the Providers tell us that, “People are informed of any changes and a comprehensive plan of care is compiled with the input of individual people, which is reviewed monthly”. We were able to confirm some of this information, although the standard and quality of care planning and records varied and some lacked vital detail. We found that not all care plans had been reviewed. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 15 The AQAA also said that, “People are assessed for free nursing care and people and significant others are involved in decision-making”. The Providers also talk of, “Involvement with appropriate disciplinary agencies”. They explain that “Risk assessments are developed and health and safety issues are considered”. We found that not all risks had been assessed, but that the home involves external health agencies, as required. The AQAA says, “Medicines are handled safely and GPs review medication regularly”. Generally, we were able to confirm this and medication practices have improved. They say that, “Equipment is provided and inspected to meet peoples’ needs”. We found that vital equipment is available, although we questioned whether people had been individually assessed or risk assessed to use it. We received the following comments on the surveys we sent out – “My father is very poorly. In regards to medication details and Care I can find no fault.” “Staff need to be reminded of Mum’s needs (lack of training).” “Tablets are left untaken on the tables and sometimes on the floor.” “Individual patients would benefit from having their own cohort of carers who might then be able to give a more personal service.” “The home is getting much better at letting relatives know about hospital appointments etc.” “We are really pleased with the care my mum has received so far with plenty of interaction, care and good food and lots of understanding of my mother’s needs.” “When we ask about information we only get told when we go to visit. They never ring any of the contact numbers if there is a problem with her care.” We looked at a number of personal care plans and spoke to people about their care. The standard of care planning is not always consistent with some gaps noted in documentation in relation to care practices. For example nothing documented for mouth and hair care or the wearing of spectacles for one person and for another person we found that there was a lack of documentation about personal cleansing saying that this person had received a shower on February 10th and on February 24th but nothing documented in between or since. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 16 Also the way in which documentation is recorded in care plans in relation to assessment tools, does not make clear the action to be taken to address the problem. Examples of this are some nutritional assessments plus a Barthel Score. There is also a lack of documentation about what people like or prefer to do. For instance what time they prefer to go to bed, or get up or have a bath or a shower. Adding in personal preferences would help make the care plans more person centred. We did speak to a person who used to get up early with his job when he was younger and he told us that he still does now through his own choice. He also said that the “staff are good” at the home. We did see evidence of visits by other health care professionals such as the Tissue Viability Specialist Nurse, the Optician, the District Nurse, the Doctors and the Chiropodist. The Doctors visit weekly or whenever a visit is required. We also noted that investigations are ordered and carried out in relation to the health care needs of individual people. These investigations include various observations, blood tests, x-rays and attendance at Clinics. Nutrition is monitored and we saw that people had been referred to the doctor following weight loss and nutritional supplements had been prescribed and administered. It was identified that individual health care is assessed and monitored appropriately. The Community Matron was present on both days of the inspection visit and we spoke with her. She told us that she offers support and advice to the staff and was currently helping them with the care of an elderly person who needs had suddenly changed. This person needed palliative care and not all staff had the necessary knowledge and skills to meet his needs. The person was waiting to transfer to a hospice at the time of the inspection visit. When we looked at this person’s care plan, however, the change in care needs to palliative nursing care was not reflected. There had been no review of this person’s needs to reflect the changes in his condition. It is a requirement that care plan reviews are kept up to date and that reviews reflect any changes. This will help to ensure that peoples’ specific individual care needs are met. We walked around the home and observed care practices over the two inspection days. We noted that there was a group of frail elderly ladies sitting together in the small lounge area opposite room 25. One of these ladies was very distressed and shouting on both days, with little evidence of staff interaction. We discussed this with the manager who informed us that a visit by the doctor had been requested. However, we also noted that most of these ladies were sitting in recliner (Kirton-type) chairs. When we looked at the care plans for these ladies there was no related risk assessments, reasons or decisions New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 17 documented in respect of the use of these chairs. We discussed this with the manager and it is a requirement that, where a need for this type of chair has been identified then a risk assessment must be completed, the decision must include the multidisciplinary team and the person’s representative or advocate. Also, as this type of chair can be viewed as a method of restraint, the service must refer to the Deprivation Of Liberty Safeguarding policy. In individual care plans people are assessed as to their mobility including the need for help with moving and handling. Where hoists are required then these are documented including the type of hoist and sling to be used. Whilst we were sitting in the large lounge on the nursing unit we noted that every person was moved using the same Stand aid-type hoist. It is unlikely that each person sat in the lounge should need the same hoist and sling for moving and handling and we highlighted this to the manager at the time of the visit. We looked at the process for the receipt, storage, administration and disposal of medication. We identified that some creams and lotions are being administered by care workers and signed for by nurses. This practice must cease and the person who administers the prescribed cream must be the same person who signs the MAR chart. The service has provided two new controlled drugs cabinets since the last Key Inspection. Also the drugs fridge has been repaired and moved to another secure room. A room thermometer is needed where the medication is stored as this room felt warm and liquid medication must be stored at no more than 25 degrees centigrade. The expert by experience visited the new smaller unit and spoke to people who live there, visitors and staff. She found that staff did not seem particularly aware of the needs and preferences of individual people and she did not see much evidence of spontaneous interaction between staff and people they were looking after. The approach of the care staff generally appeared to be taskorientated rather than person-centred. She observed two members of staff hoist two people from their chairs into wheelchairs carefully but in a rather mechanical way, with little interaction with the person concerned. Members of staff were somewhat vague in their responses when asked about the nature and extent of the needs of the people living in the unit. This did not inspire confidence that the needs of individuals on this unit were being catered for. Their view of the expert by experience was that people are kept clean, fed and given some entertainment but ‘that was as far as it went’. The other relatives she spoke with echoed this view. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 18 The expert by experience did not witness anyone having to wait long for attention, and there appeared to by sufficient staff on hand, although they seemed to be mostly carrying out tasks. The expert by experience noted that several of the people living in the home had sight and/or hearing disabilities but she was unable to discover any specific personalised adaptations or measures in place in the home to address these. She identified that the home lacks evidence of a person-centred approach, and whilst people appear well cared for physically, attention and a responsive approach to individual and emotional needs is less evident. Over the two inspection days, discussions with care staff and the registered manager of the home identified that only nurses receive a “handover” or “report” at the beginning of each shift change. Care staff are then updated as the shift progresses. It was also noted that care staff have little or no input into the care plans of people they are looking after. We discussed the implications of this with the manager at the time of the inspection report. Following this inspection visit we received a Safeguarding referral from StokeOn-Trent Social Services regarding a person who lived at the home. One of the allegations was that care staff had very little knowledge about the care needs and condition of the person living at the home when questioned by paramedics who had arrived to take the lady to hospital. This confirms our own findings at the inspection. It is a recommendation of this report that all staff delivering care to people who live in the home are given sufficient information at each shift change in order for them to be able to identify, understand and meet peoples’ needs safely. The same Safeguarding referral also identified that there had been a delay in contacting the family of the lady. It is recommended that lines of communication between the staff looking after people and peoples’ representatives are improved so as to ensure that representatives are kept fully informed of any changes. The Safeguarding referral also identified that a doctor was not called out to this lady until the third day of her illness. Discussions with the manager of the home and examination of relevant records of care identified that the lady was “off colour” with a cold for the first two days and then her condition deteriorated quite rapidly. She was seen by the doctor who prescribed antibiotics and later that same day the staff sent for the paramedics as the lady’s condition worsened. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 19 When we looked at records of care these appeared satisfactory and identified that the required observations and checks had been carried out by staff and documented accordingly. Also the lady’s general vital signs including pulse, blood pressure and temperature stayed within normal limits until the day when the doctor was called. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 20 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lifestyles in this home are reasonably flexible and varied but do not always take into account the individual social and therapeutic needs of people. Some people are alienated by being unable to participate in activities. EVIDENCE: In their AQAA the Providers tell us that they, “Encourage daily routines for each person’s requirements”. They say that, “Special diets are catered for”. Also, “Advocates can be arranged”. They tell us that “Likes and dislikes are noted in the care plan” and also, “Peoples’ choices are upheld at all times”. We found that people’s preferences are not always recorded on care plans and felt that the home need to adopt a more person centered approach. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 21 The AQAA says that there are, “No restrictions on visiting” and that, “Local Community groups are encouraged to visit the home”. They also tell us that “Designated hours are given to Activities” and that there is a “Minibus and hairdresser”. We felt that the quality of activities varied and that people did not always receive the stimulation or interaction they needed. The Providers say that the service has “Strong links with the local Church”. They also tell us that, “People are encouraged to manage their own finances for as long as possible”. We received the following comments from the surveys we sent out – “Mrs X doesn’t take part in any of the activities as she is hard of hearing and her sight isn’t much good. But she had new glasses so she seems better. They don’t put her in front of the TV so she can see it. She just sits around bored and some days confused.” “I know she likes her porridge and don’t think that they give her meat because she has no bottom teeth.” “You are allowed to visit at any time and join in on entertainment and activities – excellent!” “My mother likes her food and nothing is too much trouble. They are willing to deviate from the day’s menu if there is something she isn’t fond of and they are great.” The expert by experience looked at the lifestyle for the people who live in the home and found the following – She observed the activity taking place in the lounge of the new unit which was bingo, with an electronic display. The activity was ‘delivered’ rather in the same way as all other tasks appeared to be tackled in the home – something to be done to people rather than with them. People were ticking off the numbers from cards. It was evident that not all of the people could join in this, but there was no attempt at including those who could not. Some were seated in chairs where it was obvious they would not be able to see or hear the numbers being called out. There was not much scope for interaction during this game, which was rather a passive and mechanical activity, being delivered rather than being participated in. The expert by experience felt that this activity lacked inspiration, creativity or evidence of thoughtful planning and not particularly appropriate for people with visual, hearing impediments or for those who suffered from dementia. Some of the staff told us, “I would like to help people but you don’t get much chance”. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 22 “There are some books around, but I couldn’t tell you where”. Several of the people whom we spoke with had worked in the pottery industry as enamellers, casters or fettlers. These were occupations involving dextrous manual working. We were not able to find out whether any attempt had been made to offer the chance of participating in activities related to peoples’ previous lives. For example, painting or any craft-related activity, or reminiscences relating to their life history and whether reference to their previous occupations was included in their personal care plan. The expert by experience was shown an activity room, with boxes of resource materials and was informed that sometimes activities take place in this room. In this case few people would be able to participate, as it is a quite small room with not many tables. The expert by experience was informed that people do get taken on trips and that today there had been a trip to Amerton Farm. She was unable to find out how people access these trips or how people are selected to participate. She asked whether people get to sit outside on sunny days or to walk around the grounds and was told that they do and was shown a gardening area and small patio with some plastic chairs and a wooden seat. Whilst she was there, staff took two people outside for a walk. The activities co-ordinator started a course at Cauldon College but was unable to complete this. She is now doing a course entitled “Activities in Age” with Age Concern in Stafford. Another assistant was working alongside her and she was doing craft, baking and reminiscence. There was a party for Saint Patrick’s Day and a shamrock cake was planned. There was an Easter bonnet parade and many other events are held in the home. Peoples’ birthdays are celebrated and everybody gets a birthday cake. Activities are documented. Church services are held on a regular basis. All denominations and spiritual needs are catered for. We spoke with the Cook and assistant Cook where we identified that special diets are catered for in the home. People are offered a choice to the main menu. We met a lady who told us, “The meals are ok but I don’t like fish so I am having an omelette”. We later observed this lady having the omelette as she had requested. Lunch time choices included Steamed fish, Scampi, Omelette and for tea Pork pie, Sandwiches and a soft diet for those needing it. We observed care staff feeding people who could not feed themselves. In care plans the nutritional needs of people are assessed and monitored. People are weighed at least monthly and more often when required. We saw that people who had lost weight had been referred to the doctor and some to New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 23 the dietician. Some people had been prescribed nutritional supplements by the doctor. People told us, “Lovely meals here, its fish today”. “I am very happy with everything, that’s the good thing about here, and you can choose, the meals are lovely”. “The girls hold my clothes in front of me and ask what I would like to wear so I choose”. We met a person who has lived in the home for many years. She told us that she is happy with everything but the food could be improved. People told us that, “Relatives’ and Residents meetings” are held at the home. We met with a person who lives in the home and whom we had spoken with at the last inspection visit. The last time we spoke with this person he had some concerns about the home. This time he told us, “I think its improved here, when I ask it is done more quickly now”. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 24 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there have been some improvements in this area it cannot always be guaranteed that peoples’ concerns will be listened to and acted upon. EVIDENCE: In their AQAA the Providers tell us that, “The Complaints procedure is displayed in the home” and that, “We record details of any complaints we receive”. We found that the home did not always record the action taken and outcomes of complaints and the management completed this information in time for the second day of our visit. They also tell us “We take on board any new legislation such as the Mental Capacity Act”. We found that the home was using Kirton type chairs without assessing the risks or considering the capacity of the people. They had not considered consent or the involvement of advocates. They tell us that, “Staff training ensures that staff are aware of complaints and protection” and that, “All people have their rights and choices protected”. We found staff that had commenced work at the home before receipt of vital checks. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 25 We received the following comments from surveys we sent out – “If things had not improved for my mum I would not hesitate in making a complaint.” “Anything he requests is actioned. He is always listened to and consulted.” “Not had to raise concerns as yet over care but feel they would listen if I spoke to them.” “And have done so! There is a healthy relationship with respect and plain speaking on both sides.” “We didn’t know how to make a complaint but we do now.” We, the commission, have received two complaints since the last inspection. Both of these complaints were referred to and addressed by the Providers. The number of complaints we have received about the home has reduced since the last Key Inspection. The expert by experience spoke with a set of relatives who informed her that they had raised several concerns to the manager. The first concern was in relation to finding their relative in a distressed state in her room, having apparently spent two days in her room ‘trapped’ in a chair with a table being placed in front of her to prevent her moving from this position. The relatives said that they had informed staff immediately to their concerns over this and had subsequently received an apology from the manager. Another concern from the same relatives was in relation to the cleanliness of their relative’s bathroom. They told the expert by experience that they their complaints had not been addressed and they have resorted to cleaning the toilet themselves. They also apparently wash their relative’s clothes at home and stated that this was because clothes had either gone missing or been ‘ruined’. We discussed this with the manager and director and could find no record of this complaint being received, recorded or investigated. Another concern from this family was that their relative was refusing to eat and/or to have her hair done. The incidents have been apparently raised with ‘the office’ and a promise made that a meeting would be held over it but nothing further has been heard to date. We spoke with the manager and director and they stated that they are unaware of the matter and there were no records of this. We looked at the log of concerns and complaints and noted that complaints had been referred to and taken by the manager but a number of these complaints did not have an outcome documented. This was discussed with the New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 26 manager and Director at the time of the visit and they explained that outcomes had been reached and complaints addressed but that these hadn’t always been documented. By the second day of the inspection visit the complaints book had been amended to demonstrate how complaints had been addressed by them. We found that two staff had commenced employment before the service had received a clear POVA. This was discussed this with the manager and we have made a requirement to ensure that no staff are offered employment until a satisfactory POVA check has been returned in order to help ensure that people who live in the home are protected from harm or abuse. People need to be confident that they are supported by appropriately checked personnel. Since this inspection we have received one Safeguarding referral from Stoke on Trent Social Services. We have highlighted this referral previously in this report under “Health and Personal Care”. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 27 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s spacious environment has been adapted to meet the needs of people who live there. Although there is pleasant outdoor space the fabric of the main building is dated and, in areas, showing signs of wear and tear. It cannot always be guaranteed that environmental health guidelines are adhered to. EVIDENCE: In their AQAA the Providers tell us that the, “Environment is well maintained and homely” and “Suitable for peoples’ needs”. They say that, “cross infection is managed” and, “Linen is washed as per infection control guidelines”. They also say that “Routine maintenance work is on going”. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 28 Generally we found that this was confirmed, although more work is needed to make staff hand washing more accessible and people have complained about the laundry system. The AQAA tells us that, “Toilet and bathing facilities meet peoples’ needs” and, “Adapted equipment is suitable for peoples’ needs”. There is a, “Call bell in each room” and, “The Fire alarm serviced and suitable for use”. They tell us that there is, “Pleasant outdoor space” for people to enjoy and that there are, “Policies and Procedures” in place. They tell us that, “Health and safety issues are identified and dealt with by an outside agency” and that, “Risk assessments are undertaken and reviewed”. Also “Audits are undertaken and evaluated” and “Water temperatures are recorded”. Generally we were able to confirm this during our visit, although there have been complaints about the cleanliness of toilets. The surveys we sent out contained the following comments – “When we go to visit we take Nan to her room to where there is a bathroom. The bathroom has not been cleaned when we leave at 12 noon. We have even taken it upon ourselves to clean it.” “The Care home is very clean” “Not enough toilets around the lounge area.” Previous to this inspection visit we received a letter from the Health protection Agency nurse. She had been out to do a visit to the service last year and had left some recommendations regarding infection control. The letter was informing us of these recommendations. We walked around the home and visited all the communal areas and a selection of bedrooms. The home is in need of some updating in areas, especially in the older parts which are more difficult to maintain. The general décor and fabric of the home is looking a little tired and dated. The dining room is quite sparse with plastic tablecloths and little décor. This is in need of updating to help provide an environment more conducive to pleasant dining. We noted that in some areas the home has been redecorated and new carpets fitted. The main lounge looks attractive after its make over. It is recommended that the programme of redecoration and refurbishment be stepped up to ensure that the remainder of the home is updated. We looked at the recommendations made by the Health Protection Agency Nurse and found that these had been addressed. The recommendation for hand washing facilities to be available in bedrooms for staff had been partially addressed. We saw that hand wash and paper towels were put into cupboards underneath people’s sinks. We were told that the home is currently in the process of putting these in dispensers on the walls in order to make them more New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 29 readily available. In the dining room we noted uncovered food which had been prepared for tea and left ready. Foodstuffs included a bowl of trifle. This practice should cease and food must be kept refrigerated and/or covered. We recommend that the above is addressed in order to avoid food contamination. Bedrooms are personalised and people are encouraged to bring in personal effects such as photographs, pictures and small items of furniture. Some of the bedrooms we saw were very domesticated and homely. People have aids and adaptations to help them to maintain as much of their independence as possible. The home is adapted to allow access to everyone including people who use wheelchairs. The service also assesses people for the type of mattress they need and provides specialist pressure relieving equipment when required. They have purchased a number of profiling beds since the last inspection and it is recommended that more of these beds be provided in order to help meet the needs of people with highly dependant nursing needs. The service employs a Housekeeper and a team of domestic staff to keep the home clean. This also includes dedicated laundry staff. A number of relatives feel that the laundry system could be improved. “Clothes are well laundered but there is no efficient system for returning clothes to the appropriate people. Items are frequently missing even when marked”. “They have ruined so many good clothes. We have even received clothes back from the laundry and they are still soiled and we have had to return them”. There are large accessible lawned areas around the home which provide pleasant outdoor space for people. This space is accessible to people who have mobility problems. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 30 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People can be assured that staff are caring and dedicated to meeting their needs. However, at times there are not enough staff to allow effective interaction and encourage person centred care and recruitment practices do not safe guard the people using the service. EVIDENCE: In their AQAA the Providers tell us that, “Senior staff are trained to National Vocational Qualification (NVQ) level 3 and there is ongoing NVQ training”. They say that, “Senior staff are trained to safe handling of medication”. They tell us that, “Mandatory training is on going” as is, “Induction training for all new staff”. They tell us that there is a, “Robust recruitment procedure” and that “Staff supervisions and appraisals” are regularly carried out. They also tell us that there is a “Staff rota” and “Team working and low turnover of staff”. We found that staff are undertaking regular training and feel supported, although more understanding is needed of challenging needs. The home has employed two members of staff without vital checks and staffing levels do not allow for person centred care of the people using the service. The surveys we sent out contained the following comments New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 31 “I feel that there is not enough staff for the number of residents in the annexe. This does not give the staff a chance to spend time with individuals on a 1:1 basis”. “I feel the staff do their best for the residents”. “The staff are always pleasant and will try to answer your questions”. “The staff are always pleasant my father knows them all by name and they treat him with fondness”. “The staff do listen but there is not enough of them to act on it especially at night”. “Such a large home entails a lot of work for senior staff who work hard but are often diverted into change management”. “I feel that there isn’t enough staff a lot of the time. You have to go looking for the right staff”. “Staff are usually pleasant and helpful”. At the time of the inspection visit we were told that there was a total of 69 people accommodated in the home. 42 of these people required nursing care and the remainder personal care. We discussed recruitment and staff training with the registered manager. She explained that she usually deals with staff recruitment but not always. This is sometimes done by the director of the home. The numbers of staff on duty at this home have been behind many of the concerns we have received in the past about this home. At the last inspection we identified that peoples’ needs were not being met appropriately due to insufficient staff numbers and left a requirement to improve this. This is a difficult home to staff due to the layout of the building itself. This combined with the higher dependency needs of people now coming into the home means that extra staff are needed in order to continue to meet the needs of people. The Providers have looked at this and adjusted staffing levels accordingly. However, we are still receiving some anonymous calls claiming that staffing is insufficient at the home. This inspection visit found that basic care needs are being met and people are safe, but that staff have no time to do anything else for people and the care people receive is not person centred. People know that staff “try their best” but that there, “isn’t enough of them”. The Providers will need to review and adjust staffing levels so that people receive a better quality of life in the home. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 32 We spoke to staff and looked at records of staff training and identified that NVQ training is on going at the home and staff are supported to do this training. There is a staff training and development programme and staff confirmed that they feel supported with their training needs. One of the nurses recently recruited told us, “It’s a nice home here” and “I had a good induction”. We spoke with several staff members. One of them is a, “moving and handling trainer” and has done NVQ level 3 in Care. She told us, “We are starting to update all the staff on Moving and Handling”. She also said, “There is a trainer on nights who updates the night staff”. Another staff member told us that she had done induction training and a medication course and has attended a fire drill. She also stated that she wants to do a dementia course so that she can better understand dementia care. Another care assistant who started recently told us that she had done her induction, Health and Safety, POVA, fire safety and a fire drill. We spoke with another care assistant who had recently started to work at the home. She already has NVQ level 2 training in Care. She told us that she, “likes working at the home” and feels that there is enough staff to meet the needs of people. She said that she did manual handling and fire safety training as soon as she arrived. She also did “refresher training” recently. She confirmed that she has had one supervision session and one appraisal since she started to work at the home. She also told us that she meets once a week with Sandra the manager to discuss any issues and that, “regular team meetings” are held. Discussions with other staff members and examination of training records identified that not all staff who care for people with dementia have received sufficient training in this area. There is also a need to develop staff knowledge about how to manage people with challenging behavioural needs. We observed that care staff who look after people with dementia needs do not interact effectively with them. This, together with some of the comments we received from staff would indicate that peoples’ needs are not fully understood and are not therefore, fully met. Further staff development and training in this area would help to promote a greater understanding of individual needs and would help develop a person centred care approach. We looked at staff files and spoke to staff about the recruitment process. Whilst this process is generally good, there were two staff members whose POVA checks had not been received back prior to them starting to work at the New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 33 home. We have highlighted this, together with the requirement for improvement, under the outcome “Complaints and Protection”. People need to be confident that they are supported by appropriately checked personnel. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 34 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not run in the best interests of all the people who live there. EVIDENCE: Prior to the inspection visit the Providers had completed a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to under-take a self-assessment, which focuses on how well outcomes are met for people using the service. It gave detailed information about the services provided. However our evidence conflicts with much of the information offered. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 35 In their AQAA the Providers tell us that the registered manager has completed the, “Registered Manager’s Award” and is, “confident in all aspects of management of the home.” They say that the manager, “seeks to deliver the service efficiently” and, “provides quality care” for people who live in the home. They also tell us that they, “encourage staff to create a skilled and trained for purpose staff team”. The manager has continued with her development training including, personnel issues, Health and Safety, Mental Capacity Act training and Mandatory training. The management structure in the home comprises of the Proprietor, Managing Director, Financial Director, Registered Manager and Deputy Manager. The Providers tell us that, “New Park provides an open door policy”. They say that they have a “Clear and accountable management structure” and that “Annual Quality Assurance Audits are taken”. On the surveys we sent out we received the following comment back about management of the home – “There seems to be some communication problems between managers in the home”. The Safe Guarding referral findings, as described in the Complaints and Protection outcome group, highlight and confirm the need for better communication at the service. We have received two anonymous concern letters since the last report. Both of these letters highlight concerns about the overall management of the home and highlight differences and conflicts between the managers. The letters also highlight that this is causing unrest and unhappiness amongst the staff team. One of these letters of concern ended with the words, “Please help us”. During our discussions we did confirm that these thoughts are reflected by some of the people who work in the home. We also witnessed some tension within the management team, with blame for any identified issues being attributed to the other party. It is recommended that the overall management of this home be improved. The registered manager should be allowed to fulfil her role as manager of the home and needs support in her role. This will help to ensure that the home is run in the best interests of the people who live there. The service does carry out some audits in various areas and we saw that there had been an audit of infection control, care plans, medication and health and safety. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 36 The effectiveness of some audits tools, especially relating to care plans, needs reviewing as we identified some areas in need of improvement which the audits had not picked up. The service should demonstrate how it takes into account the views of people living at the home and what their action has been to consider these views in making improvements to the service. We looked at the administration and maintenance of personal allowances for some of the people who live at the home. People are encouraged to manage their own finances wherever possible. The service provides a secure facility for the safekeeping of monies and valuables for people living at the home. Records are maintained of individual transactions and these are transparent and easily audited. Receipts and invoices are kept for individual people. We checked these against the balances for three people and are satisfied that these are maintained correctly. The home has a Health and Safety Policy Statement in place and as the AQAA states an outside company is employed to oversee Health and Safety at the home. We noted that equipment used at the home, including fire fighting equipment, has been regularly serviced by outside companies. There is a maintenance person responsible for the checking and testing of equipment. During our visit we did note that some people were being wheeled along in wheelchairs without the use of footrests. One gentleman in particular had his feet dragging along the floor underneath the front of the wheelchair. We brought this to the immediate attention of the manager at the time who told us that she would address this. Occasionally, for some people, the use of footrests is inappropriate and this is highlighted in the person’s care plan. We looked at this person’s care plan and could not find any documentation relating to the footrests. It is a requirement of this report that the proper use of wheelchairs is enforced in the home in order to keep people safe. Since the inspection visit we have also received an anonymous concern highlighting that staff do not receive appropriate training in moving and handling. The caller told us that updates in training consist of watching a video and do not include training and assessment of staff practically using hoists and other equipment. We discussed this with the manager over the telephone following receipt of this call and she assured us that staff do undergo the practical training as well as watching the video. Inappropriate moving and handling techniques were highlighted at the home during the last Key Inspection. The Providers included this in their Improvement Plan to us and have been working toward all staff receiving appropriate training updates. We found, as previously raised, that staff New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 37 appeared to be using the same hoist and sling to move all of the people who were sat in the lounge. Overall we have found that people have a mix of conflicting opinions about the service provided in this home. Some people are very happy that they, or their relative are being well cared for. Others are not happy with the service provided. Some people feel able to complain and are satisfied that their concerns would be addressed and others are not. The expert by experience felt that although people’s physical needs are catered for, their emotional needs are not and we agreed that there is a lack of person centred care especially for people with dementia care needs. People are cared for in a task orientated way, with little opportunity for meaningful communication and this would seem to be indicative of too few staff. We found that care staff are not provided with the information they need to support people properly and this was confirmed by visiting paramedics. We are also concerned that two new staff worked in the home without the required POVA checks being received. This is not only a legal requirement but is vital to ensure that people using the service are supported safely by suitable personnel. The issues identified during this inspection are the responsibility of the management and indicate a lack of managerial monitoring and communication. Although the home has addressed the requirements made at the last inspection, we have made a further five as a result of this inspection. This does not suggest a service providing good outcomes and we will be closely monitoring its progress. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 38 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 3 x x x 2 3 3 3 3 3 3 2 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 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 x 3 x x 2 New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 39 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(b,c) Timescale for action It is a requirement that care plan 20/06/09 reviews are kept up to date and that reviews reflect any changes. This will help to ensure that peoples’ specific individual care needs are met. It is a requirement that, where a 20/06/09 need for the use of the Kirton or recliner type of chair has been identified, then a risk assessment must be completed, the decision must include the multidisciplinary team and the person’s representative or advocate. Also, as this type of chair can be viewed as a method of restraint, the service must refer to the Deprivation Of Liberty Safeguarding policy. It is a requirement that the 20/06/09 person who administers prescribed creams must be the same person who signs for these. There is a requirement to ensure 20/06/09 that staff are not offered employment until a satisfactory POVA check has been returned in order to help ensure that people DS0000026956.V373945.R01.S.doc Version 5.2 Page 40 Requirement 2. OP8 13(7) 3. OP9 13(2) 4. OP18 19(1) New Park House Nursing & Residential Home 5. OP38 13(4)(c) who live in the home are protected from harm or abuse. It is a requirement that the wheelchair policy is enforced throughout the home and that, unless a risk assessment suggests otherwise, footrests are not removed from wheelchairs. This is so that people are kept safe whist using wheelchairs. Where people are unable to use normal footrests then the person should be referred for an OT assessment for a more suitably adapted wheelchair 20/06/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP7 OP8 Good Practice Recommendations Care plans should be made more consistent with documentation completed effectively. This will help to ensure that peoples’ needs are identified and met. People’s preferences and choices should be included in care plans to help make them more person centred. All staff delivering care to people who live in the home should be given sufficient information at each shift change in order for them to be able to identify, understand and meet peoples’ needs safely. It is recommended that lines of communication between the staff looking after people and peoples’ representatives are improved so as to ensure that representatives are kept fully informed of any changes. Planned activities should take into account previous lifestyles and preferences in order to help meet the individual social and therapeutic needs of people. The service should be able to demonstrate, by keeping records, that peoples’ concerns about the home have been listened to, taken seriously and acted upon. It is recommended that the programme of redecoration and refurbishment be stepped up to ensure that the DS0000026956.V373945.R01.S.doc Version 5.2 Page 41 4 OP8 5 6 7 OP12 OP16 OP19 New Park House Nursing & Residential Home 8 9 10 OP26 OP27 OP30 11 OP33 13 14 OP26 OP32 remainder of the home is updated. Foodstuffs should be kept covered whilst standing in the dining room in order to help prevent contamination. The Providers should review and adjust staffing levels so that people receive a better quality of life in the home and allow for person centred care. Further staff development and training in the care of people with dementia care needs would help to promote a greater understanding of individual needs and would help develop a person centred care approach. The effectiveness of some audits tools, especially relating to care plans, should be reviewed, as we identified some areas in need of improvement which the audits had not picked up. Also the service needs to demonstrate how it takes into account the views of people living at the home and what their action has been to consider these views in making improvements to the service. The laundry system should be reviewed and improved to help deliver a more effective service. The overall management of this home should be improved. This will help to ensure that the home is run in the best interests of the people who live there. New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI New Park House Nursing & Residential Home DS0000026956.V373945.R01.S.doc Version 5.2 Page 43 - 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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