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Inspection on 19/10/05 for New Park House Nursing & Residential Home

Also see our care home review for New Park House Nursing & Residential Home for more information

This inspection was carried out on 19th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

A well presented environment which resembles a large country house. Warm, close, professional working relationships with relatives. 1.5. full time Activities workers providing an excellent range of stimulating activities enhancing quality of life. A large nursing home providing adequate staffing levels with specific allocation of staff to various parts of the home reflecting dependency levels. Chosen lifestyles are accommodated and central to care provision. Adequate and flexible staffing levels to provide care and a wide range of support staff ensure the smooth running of the home.

What has improved since the last inspection?

Greater accuracy in recording on MAR sheets, but other areas of medication administration requiring attention. Alginate bags have been introduced to handle soiled laundry, thereby improving infection control. Automatic Doorguards have been fitted to some bedroom doors to avoid them being propped open, which is a dangerous practice. All bedrooms doors have name of resident. The complaints procedure has been amended as required and is readily available in the home. Food provision has been reviewed to take account of previous comments. The clinical room has been cleared of unnecessary items and is kept clean. There has been re-carpeting of some bedrooms and redecoration of others.

What the care home could do better:

Recording of the progress of tissue viability issues should be improved. Residents should be checked at 1 hourly intervals not 2 as at this time. The call system should be regularly checked for any faults. COSHH cupboards should be kept closed when not in use. All required documents relating to staff should be provided. Consider options for greater and easier use of the payphone system in the home. Only medication in current use and with clear prescription details should be kept in the medication trolley.

CARE HOMES FOR OLDER PEOPLE New Park House Nursing & Residential Home New Park, Chivelstone Grove Trentham Stoke-on-trent Staffordshire ST4 8HN Lead Inspector Mr Peter Dawson Unannounced Inspection 19th October 2005 09:30 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 New Park House Nursing & Residential Home DS0000026956.V259977.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. New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 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 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) N U Groom Ltd Nora Patricia Sandra Wilson Care Home 63 Category(ies) of Old age, not falling within any other category registration, with number (63), Physical disability over 65 years of age of places (63) New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Physical Disability (PD) aged 55 years on admission for three persons Date of last inspection 29th June 2005 Brief Description of the Service: New Park House is a registered care home currently providing nursing and personal care for up to 63 older people with varying levels of dependency. The home is situated in its own spacious grounds in a residential area of Trentham, Stoke on Trent. The home is a large detached property that has been extended over the years. The grounds are extensive and easily accessible and there is ample car parking facilities. Accommodation is provided between two floors and a passenger lift provides access between the two. The home has 58 bedrooms and 26 of these have en-suite facilities. Five of the bedrooms can be used as companion rooms if required. The home offers a choice of five lounges and three dining rooms, there are assisted bathing and toilet facilities to both floors, meals are prepared in a central kitchen and there is a central laundry. 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. New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. At the time of this unannounced inspection there were 59 people in residence, 38 having been assessed as requiring nursing care. There are 21 bungalows in the grounds with call systems connected directly to the home, all are contacted daily by staff by telephone but very infrequent demands made upon staff time for input. The home presents well in a peaceful setting and with good facilities. The reception area is welcoming with comfortable seating and gives a good first impression of the home. There were 12 staff on duty including 2 registered nurses, all were busy during the morning of the inspection attending to the early morning needs of the residents but the atmosphere was calm, appeared unhurried and staff engagement with residents was relaxed and caring. The home was purchased by the present proprietor 3 years ago who has a directly almost daily input into the home and keen to maintain standards. The Registered Manager stated she was fully supported by the proprietor and matters of provision including staffing numbers were not questioned. Most bedrooms are large and have good facilities and good views of the delightful garden areas surrounding the building. All were well personalised and residents were seen to access their rooms throughout the day as they wished. Approximately 12 residents were spoken to by the inspector and all commented very positively about the facilities at New Park and the high standards of care provided by the staff. Two visitors were also spoken to at length and confirmed the comments made by residents. One visitor in particular had high expectations of standards of care for her mother and said she had no complaints, adding that if she wished to discuss any matter should has and would speak directly to the Manager with whom she clearly had a good dialogue. There are a proportion of highly dependent people in the nursing category and their needs clearly documented and known to staff. 47 people require wheelchairs for movements within the home and there are excellent facilities for this purpose. Hoists, handrails, ramps and other disability provision is evident also in the home. The proprietor, managers and staff all provided open and helpful information during the inspection. New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 6 The impression gained is of a home with a good standard environment and high standards of care. The home does not have category to admit people needing dementia care (DE) or with mental health needs (MD). This is unusual for a home of this size. At least one person is presently referred for psychiatric assessment because of indications of mental health needs. It is suggested that the home consider additional registration categories to allow for changes in mental health status of existing residents. At this time the home cannot admit people in the DE or MD category and this must be stated in the Statement of Purpose. What the service does well: What has improved since the last inspection? Greater accuracy in recording on MAR sheets, but other areas of medication administration requiring attention. Alginate bags have been introduced to handle soiled laundry, thereby improving infection control. Automatic Doorguards have been fitted to some bedroom doors to avoid them being propped open, which is a dangerous practice. All bedrooms doors have name of resident. The complaints procedure has been amended as required and is readily available in the home. Food provision has been reviewed to take account of previous comments. New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 7 The clinical room has been cleared of unnecessary items and is kept clean. There has been re-carpeting of some bedrooms and redecoration of others. What they could do better: 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. New Park House Nursing & Residential Home DS0000026956.V259977.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 New Park House Nursing & Residential Home DS0000026956.V259977.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): 1-5 Standards relating to Choice of Home were found to be met. EVIDENCE: The Statement of Purpose/Service Users Guide has been updated since the last inspection to include the necessary changed information relating to the home and staffing etc. In relation to recently admitted residents care plans evidenced pre-admission assessments by the home and Care Management personnel where involved (not usually self-funding residents). The Homes Manager always carries out her own assessment of the person in their current environment. All residents sign and retain copies of contracts with sponsoring local authorities or the home and are clear and satisfactory. Where possible residents are invited to spend time at the home prior to admission. In circumstances where this may not be possible (in hospital) New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 10 relatives always visit the home and are involved in all discussions and arrangements. The statement of purpose defines the broad needs which can be met in the home. The home does not at this time have category to admit people requiring dementia care or those with mental health needs, and this needs to be stated in the statement of purpose. There is a good programme of staff training in place to ensure staff have the required skills to deliver services which the home offers. New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 11 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 - 10 Care plans provided required information to provide care. Health care needs were known and seen to be met. The recording of pressure area management was inadequate to allow treatment to be assessed and this should be provided in accordance with required professional standards. There has been some improvement in recording of medication administration, although some further areas still do require attention. The principles of privacy and dignity were seen to be applied in all situations observed. EVIDENCE: Several care plans were sampled and provided the comprehensive information required to provide care. They were based upon pre admission assessments and reviewed on a regular basis as required. Risk assessments were in place relating all aspects of resident activity and also reviewed on a regular basis. Daily entries were made on all residents by the nurse in charge of the shift. New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 12 Care staff complete contact sheets which relate to provision of personal care e.g. turning residents, fluid intake etc, these are vital notes and are left in the bedrooms of residents for easy access. The area not documented as required relates to wound care management. There are currently 3 residents with pressure area sores and although there was information in daily notes it was not possible to assess the progress or otherwise of treatment regimes Incidents of pressure sores, their treatment and outcomes must be recorded in required professional form to monitor progress of treatment, this includes Sterling grades, body charts, mapping etc. Waterlow assessments were seen to be in place assessing risk. Records indicated that all residents were weighed on a regular monthly basis or more frequently where there were concerns about weight loss. New sit-on scales have been recently purchased for this purpose. The home has a range of specialist pressure-relieving mattresses and specialist beds which were widely in the home. Residents with pressure areas were nursed on this equipment and turned at 2 hourly intervals which were recorded. Health care needs are recorded in care plans with diagnoses and treatments required by external health professionals. Where there were changes in health care needs a new plan of care was established. Relatives spoken to said they were kept informed of all matters affecting the health and welfare of their relatives. The home has a retained GP, Dr Jones who visits the home each Monday and is available for consultation by residents/relatives also if they wish. There are regular reviews of health care needs during these visits and also reviews of medication. Staff report a good service from Dr Jones who will obviously visit at other times if there are pressing needs. Dental, optical and chiropody services were provided on a required regular basis to the home, on the day of inspection a resident had been taken to her own dentist in the community, escorted by a member of staff. District nurses provided any required nursing service to the 21 people not assessed as requiring nursing care and were visiting currently only in relation to catheter care for a resident. District Nursing Continence Advisors had assed and provided continence products as required for those residents. There has been staff training in relation to MRSA and infection control practices. Discussions with staff indicated they had a positive approach to health care issues and were aware of the importance of early identification and treatment. New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 13 The home operates the Nomad system of MDS (monitored dose system) for medication administration. Requirements were made in the last report relating to medication and these have been addressed: MAR sheets had been completed and signed as required. A list of signatures and initials for staff administering medication had been provided. Photographs of all residents have been place with MAR sheets and oxygen cylinders were found to be secured to the wall. There were other aspects of medication requiring attention at this time – Liquid medication had been separated from its box in the medication trolley, there was no label indicating the person prescribed or dose etc. Medication previously prescribed and not on MAR sheets was found. All unused medication must be removed and disposed of. Some eye-drops with a use-by date of 28 days had not been dated when opened. Nurses only medicate at this time and there are plans for possible training of Senior Carers in medication administration to allow them to administer medication to non-nursing residents. The Manager raised the question of disposal of medication from nursing homes in the light of the PCT directive that it should not be returned to the pharmacy. The inspector was unable to give a definitive answer at this time as the matter is being widely discussed and questioned – the basic principles must be to record and witness disposal of medication in good faith whatever route is taken. Staff talked about and were seen to treat residents with dignity and respect during the inspection, this was confirmed also in discussions with residents. New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 14 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 - 15 A wide range of activities both internally and externally are provided with a large number of hours provided by Activity Workers. The result is a wide and interesting range of activities to stimulate individual interests and needs and develop social interactions – This positively influences the quality of life of residents. Residents are helped to exercise choice and control over their lives. Residents meetings would further enhance this but Managers said that previous meetings had become less popular. Food provision in the home appears good, there were many positive comments from residents and visitors during this visit. EVIDENCE: There was evidence of chosen lifestyles being known and acted upon. Several residents were seen in their bedrooms, some have all meals provided there as part of their choice for privacy and preference. Residents being bathed confirmed that was their choice of day and time. Several had had breakfast served in their bedrooms. Residents and relatives said that their preferences were known in a variety of areas and were accommodated. New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 15 There is excellent provision of activities in this home. There are two Activities workers working 37.5 and 18 hours per week respectively covering mainly Monday to Friday. There is an activities programme on display which caters for the diverse needs of the resident group. During this unannounced inspection 15 – 20 people were seen to be involved in (and enjoying) a quiz in the large lounge area, this provoked discussions and comments as the quiz progressed. There are activities for smaller groups e.g. craft activity for which the home provides an activities rooms suitably equipped. The needs of the more dependent residents are also catered for with 1:1 contact/communication/stimulation. There are also organised social occasions and entertainment is arranged in the home on a regular basis. External activities are arranged on a regular basis a mini-bus purchased by the home for this purpose – 7 seats plus driver and wheelchair space. There have been trips to Regent Theatre, Trentham Gardens and several local areas of interest. On the day of inspection some residents were being taken to a Church Day Centre at Bucknall (previously attended by a recently admitted resident) the further objective being to explore the possibilities of a regular social group contact. There is contact with 3 local schools, Trentham High School, St Josephs College and local primary school. Visits are made to the home and school and there are work experience placements with the High School. Local Clergy visit the home regularly and there is a monthly Communion Service available to all in the home. A record is kept of activities undertaken and involvement of residents which are then included in individual care planning information. Some written comments concerning food provided were received from residents and visitors on the last inspection – the Manager and Cook were to pursue and act upon them accordingly. The Manager advised that this had been done. There had also been very positive comments about food also. Residents spoken to all stated they were happy with food type, quantity and provision. Catering staff seek input from individual residents when planning menus but menus are ultimately compiled by staff. There is a choice of main dish at all mealtimes, the authenticity of this was questioned by the inspector as there is a basic menu and later additions written onto menus, but it seemed that all had a choice of dish, choosing one day for the next. The cook was reminded that a record of all food provided for residents must be kept. Menus seen indicated a varied and interesting range of dishes. A cooked breakfast with toast, cereal etc. are provided each day for those wishing to avail themselves of this. There are 3 separate dining areas: one for more able residents where service is from catering staff. One for wheelchair users with New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 16 spacious access and another for more dependent residents who require staff assistance with eating. New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Only standards relating to Complaints were inspected and found to be satisfactory with an amended complaints procedure available to all. EVIDENCE: Some amendments have been made to the complaints procedure following a requirement of the last report. A copy of the procedure is prominently displayed in the reception area of the home and copy reported given to residents. A recent complaint to the Commission was investigated and found to be upheld, it related to an allegation when only 5 night staff had been employed, and there should have been 6. This related to a period of staff shortages due to holiday, sickness and staff leaving their employment. The home understands this should not happed and contended it happened in exceptional circumstances. The staffing rosters were examined the there are certainly 6 staff on duty throughout the night, in fact on some nights there are 7 staff. The Manager reports that the proprietor never questions additional staff both during the day and night time period if it is judged to be necessary in fact the proprietor actively encourages additional staff. No complaints have been received by the home since the last inspection. New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 18 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 - 26 There is a good standard environment which is well maintained and safe. There is good wheelchair access throughout the home and to the garden areas. Specialist equipments are provided as required to accommodate people in wheelchairs. There are good supplies of specialist beds and mattresses throughout the home to ensure tissue viability. Bedrooms are spacious, well furnished, comfortable and well personalised. Good infection control practices are evident. Attention is required to ensure that the call system operates effectively at all times and cupboards containing COSHH materials must be secure at all times. An alternative pay-phone point should be considered. New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 19 EVIDENCE: This is a large nursing home situated in a woodland setting in an exclusive residential area. The grounds are extensive and provide privacy and seclusion from the surrounding houses. The home presents well as a secluded country house. There have been extensions to the original building over the years providing a good standard of accommodation on two floors spreading over a large area – some areas are single storey and there is a shaft lift for access to the first floor. The grounds are well maintained and enjoyed by residents who spoke of watching squirrels, feeding birds etc. There are excellent views from the majority of the communal areas and bedrooms. There are 58 bedrooms (26 en-suite), 5 lounges and 3 dining areas. Furniture, fittings, equipment and décor are to a high standard and there is an ongoing maintenance programme. Since the last inspection 2 bedrooms have been redecorated/re-carpeted and several other bedrooms redecorated, usually as they become vacant they are redecorated. There are many large bedrooms, one double bedroom is in the process of being split into two single bedrooms, both with en-suite facilities. Many of the rooms are large enough to be used as bed-sitting areas where guests are entertained. There are only 3 double bedrooms remaining in the home and they are really currently used as singles. All bedrooms are over the required Minimum Standard size. There is a good choice of sitting areas in large or small lounge areas, one small area used on first floor for a very dependent group which can be easily monitored. There is a very pleasant and comfortable sun-lounge on the first floor, often used by visitors also, where there are extensive green views over the main garden area. A sample of bedrooms showed that they were well appointed and comfortable and met minimum standards. All were well personalised reflecting the individuality of residents and there were many instances of items of furniture being brought from home. The call system is installed in all resident areas including bedrooms and test of 2 bedroom call points revealed they were not operating. The home must check all call points regularly to ensure the system is operating in all areas at all times. There is one payphone point in a room away from the main area of the home and this was being used by a resident from the first floor who had negotiated New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 20 the lift and corridor areas to phone her relative in Australia. This she does regularly. The home is asked to consider the provision of alternative payphone point perhaps at a central point on the first floor. Some residents have telephones installed in their bedrooms for which they meet the cost. There are adequate numbers of bathrooms (including shower-rooms) throughout the building. There are assisted bathing facilities in these areas. There are toilets appropriately situation throughout the building available close to bedroom and communal areas. Half the bedrooms have en-suite facility. Many bedrooms have commodes, some of which have toilet facilities also – but residents are given a choice. The sluice areas were seen and although old and require removal of some older equipment were suitable for their purpose. The laundry was not inspected on this visit but operates from 7.30 a.m. – 3 pm daily, usually with 2 laundry assistants. The home changed to alginate (red) bags for contaminated linen following a requirement of the last report. The Manager reports there is a “residue” of the bags after washing that has to be removed from the washer, this has not been previously known to the inspector. To cupboards containing COSHH items were found to be open, part of the lock on one had been removed. These cupboards must be kept locked at all times to ensure safety of residents. There were suitable aids and adaptations throughout the home. All bathrooms had assisted facility, toilets had appropriate grab-rails, raised seats, lever rails to accommodate people with disabilities. All corridor areas are wide and fitted with handrails throughout. There is a change in the level of the ground floor area where suitable ramps are fitted. There are actually 47 people who use wheelchairs for transport within the home and the facilities for wheelchairs are excellent. There is good wheelchair access to all parts of the home. The standards of hygiene throughout the home were high and there were no mal-odours. Infection control practices were good with good handwashing/drying facilities in all toilet/bathroom areas with soap dispensers and paper towels. There were strategic supplies of glove/aprons near relevant areas to ensure good infection control practice. New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 21 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 – 30 There were adequate staffing levels to meet the perceived needs of the current resident group. Staff training is good and all staff expected to achieve NVQ status. Statutory training has been carried out as required. Recruitment procedures are generally good, additional copies of documents required as stated below. Staff appeared competent and well trained. Good sensitive engagement was observed between residents and staff. EVIDENCE: At the time of this inspection there were 59 people in residence, 38 of those having been assessed as requiring nursing care. Staffing levels of the home are: 8am – 2pm 2 x RGN’s and up to 12 Care Staff 2pm – 8pm 1 x (sometimes 2) RGN and up to 10 Care staff. NIGHTS: 8pm – 8 am. 1 x RGN and 5 Care Staff. New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 22 Rosters seen indicated that often there were 7 staff on duty at night, not 6. The daytime staffing is boosted by 2 Carers working 7am – 11. am to ensure cover during the peak times. There are similar staff to cover the evening peak times. Two Activities Workers are employed total of 56 hours per week. There are adequate numbers of ancillary staff including several catering staff, laundry, domestic and handypersons/gardeners. There are 2.5 full time administrators who also cover the Company’s sister home nearby. Agency staff have not been used recently in the home, existing staff, including Manager tending to cover shifts wherever possible. There are 27 bungalows in the grounds of the home run by the Teachers Retirement Society, all have a call system connected to the home that will respond if called by contacting relatives, GP etc. Staff telephone each person in the bungalows daily. Rarely have staff had to physically respond to such calls. Staff were seen to be very busy during the morning of this unannounced inspection but there were adequate numbers of staff to deal with the needs and demands of residents seen. The call system was responded to swiftly and residents said they did not have long waiting times for toileting etc. A recent change has been to allocate staff specifically to the various parts of the home (the home covers a large spacious area with several wings), this seems to work well and “spread the work” but staff have to remain flexible to assist in all areas where there may be need. This allocates staff proportionately to areas of the home where there is high dependency. There are 46 Care Staff employed. Apart from recent appointments all have either completed NVQ training or involved currently in training. The exceptions are 3 new people working nights and 7 working days who are due to commence NVQ training in January 2006. The 2 Activity Workers are presently studying NVQ in relation to activities. There is a good programme of statutory training and all requirements in relation to this have been met previously. Staff files were sampled in relation to recent employees. All references, police checks etc had been obtained, POVA First checks obtained initially pending CRB returns. Items required under Schedule 2 for all staff were checked and the home are required to have a recent photograph of staff and copy of birth certificate, this must become part of the recruitment procedures in the future New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31-32 and 37 -38 The home is well run and managed. The Registered Manager takes a positive lead. The proprietor has virtual daily input into the home. Staff morale seemed high and there was a relaxed atmosphere with an air of professional competence. Safe working practices were generally in place and practised. Two matters require action: COSHH cupboards must be locked at all times and residents should be checked 2 hourly not 1 hourly throughout the night. EVIDENCE: The Registered Manager is a registered nurse and has considerable experience in the care of older people in the Health Service for many years and various appointments in nursing homes for the elderly. She is also a qualified practice nurse and been involved in nurse training. New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 24 She is currently studying for the Registered Managers Award and due to complete the course late 2005. She will therefore have the required experience and care as stipulated in Standard 31 by 2005. The Registered Manager demonstrates a clear lead in the home and has positive views about standards of care which she expects of other staff. Her relationships with staff were seen to positive, relaxed and professional. The process of managing the home and achieving objectives and standards appears to be open. The Manager is keen to provide staff with support and training to achieve required goals. Regular weekly staff meetings are held and there is weekly discussion about care issues e.g. health issues. Staff have the opportunity to raise matters in these meetings (minutes not seen). The proprietor has appointed a General Manager to oversee the running of New Park House and also Haversham House a non-nursing home in the same ownership nearby. The inspector had some discussions with the Proprietor, General Manager and Registered Manager on the day of inspection and there appeared an open and positive working relationship between them. Resident’s finances and the finances of the home were not inspected on this visit. Records inspected for the purposes of the visit indicated a good level of recording to comply with requirements of records kept in the home. Resident’s records are secure in the office area of the home. In relation to safe working practices the following matters were noted: Moving and handling is provided for all staff by one of the homes 2 approved trainers, new staff swiftly complete training prior to handling residents. Fire records indicated checks of the system and fire fighting equipment. The fire alarm system was checked during the inspection. All staff had received appropriate fire drills and training. The home purchased several Doorguards Following a requirement of the last report that doors must not be wedged open. Those residents now wishing to have their bedroom doors open during the day or night can do so. It was noted that in a wing on the first floor bedrooms were not fitted with automatic closure, this will be checked with the Fire Officer. All other bedroom doors have self closing arms or doorguards. There has been staff training in food hygiene and infection control in the past. Two COSHH cupboards were not locked and it is a requirement of this report that these are kept locked at all times to ensure safety of residents. New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 25 Risk assessments in relation to activity were seen in care plans and reviewed regularly. Discussion revealed that the 6 night staff check residents at 2 hourly intervals throughout the night. This should be increased to one-hourly checks to ensure the health, welfare and safety of residents. Accidents and reportable incidents were not inspected on this visit. Hot water temperatures were randomly tested in resident areas and comply with required temperatures, all outlets are fitted with fail-safe valves. It was reported that regular manual checks of hot water were carried out and recorded (records not seen). New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X 3 2 New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP38 OP8 Regulation 12(1) 12(1) Sched.3 (n) 23(2)(c) 23(4) 13(2) 19(1)(b) & Sched 2 Requirement Residents must be checked at hourly intervals throughout the night. Incidents of pressure sores, their treatment and outcomes must be recorded to required professional standards. Nurse call system to be operative at all times COSHH cupboards must be kept locked when not in use. Medication must bed administered and stored in line with NMC requirements. Provide recent photograph and birth certificate for all staff. Timescale for action 19/10/05 19/10/05 3. 4. 5. 6. OP22 OP38 OP9 OP29 19/10/05 19/10/05 19/10/05 19/10/05 New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 22 Good Practice Recommendations Review availability of payphone facility in the home New Park House Nursing & Residential Home DS0000026956.V259977.R01.S.doc Version 5.0 Page 29 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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