Inspection on 29/09/09 for New Park House Nursing & Residential Home

This inspection was carried out on 29th September 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC 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 &... 19/03/09

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

Key inspection report 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 2nd Inspector Peter Dawson Key Unannounced Inspection 29th September 2009 09:00 DS0000026956.V377782.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address New Park House Nursing & Residential Home DS0000026956.V377782.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 Care Home 92 Category(ies) of Dementia (92), Old age, not falling within any registration, with number other category (92), Physical disability (92) of places New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) 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) 92 The maximum number of service users to be accommodated is: 92 2. Date of last inspection 19th March 2009 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. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.2 Page 5 The fees charged by the home range from £378.00 to £605.00 per week for people requiring personal care needs and £496.00 to £710.00 per week for people requiring nursing care. Further information can be obtained from the manager of the home. Additional charges are incurred for hairdressing, toiletries, newspapers, magazines and transport. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 1 STAR. This means that the people using this service experience ADEQUATE quality outcomes. We, the commission, carried out this unannounced Key Inspection visit on 29th September 2009. This inspection visit was undertaken by two inspectors and took one day. The inspection process was commenced prior to the visit and included surveys completed by people who live in the home, relatives and staff. All of the Key minimum standards were assessed and for each outcome a judgment has been made, based on the evidence gathered. These judgments tell us what it is like for the people who live in the 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 was completed to a good standard and gave detailed information about the services offered. Information from the AQAA was used to plan the inspection visit and references to it have been included in this report. The ways in which we gathered evidence to make our judgments were as follows - We looked at any information we had received about the service since the last Key Inspection. We spoke with people who live in the home. We spoke with the staff who work at the home. We examined relevant records and documentation in the home. We walked around the home and visited all of the units. We observed staff interaction with people they care for. The Registered Manager had left the home several weeks prior to this inspection visit and the managing Director Ann Hill was off with illness at the time of the visit. We met with two members of the management consultancy currently overseeing the management of the home. The Provider has employed the management consultancy until the newly appointed acting registered manager takes up her position in the near future. At the end of the inspection visit we discussed our findings with the management consultants. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.2 Page 7 What the service does well: “The care is excellent as my relative is always clean and smartly dressed” “Her room is always clean and bed linen changed regularly” “Staff are always very helpful and considerate” “The food is good” “The home is good and clean” “The home does everything well except activities” Staff tell us that – “The needs of the residents always come first and the home is always clean and tidy” “There is training for all the staff and support and care for all the residents. The home is good at listening to relatives’ concerns and sorting them out as soon as possible” “The home cares for its residents well” “The home meets the training needs for our clientele” “Provides for all our residents and good care is always given. All our residents are lovely people and I know they think a lot of us” “All our residents are well cared for and happy” “The home always tries to make sure the residents’ needs come first and always deals with residents’ complaints straight away” New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? The service has now addressed all of the previous requirements including those which we issued under our enforcement process at the recent compliance visit. The service is in the process of introducing a new care plan system and although this needs to develop further, improvements have been noted. We saw some good practice and recording of personal and health care issues as we have outlined in the report. Care plan reviews take place more regularly, at least monthly. Overall management of the service has improved. This is what people tell us about what they think has improved at the home “Its so much better lately. They now listen to you and try to help” “I have got a code to the front door now so that I don’t have to wait at any time” Staff tell us - “Our new management team are getting us back on the right track (which is what our residents deserve) and staff are working hard to do this” “The home is improving on a daily basis” “The home is going through many changes at the moment so hopefully the changes are all to the good of the residents” “NewPark is now a nicer place to work with changes being made over the last few months. It has made very much improvement” “NewPark is improving every single day and it is now a pleasure to be part of” “The home was poor before but now there are a lot of changes which have made the home is now very good” “Now all the staff are happy working in a good environment” “Before management was not involving us in anything. Now I feel part and parcel of the home” “Communication between office staff, carers and nurses has improved greatly” “Things are now improving for the better. Staff are being trained on different courses. The staff have more idea of what their job role is” The staff recruitment procedure has improved, with all the legally required checks being carried out on staff before they are offered employment. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.2 Page 9 The recruitment procedure is therefore now robust and protects people who live in the home. The service now recognises the need to carry out full risk assessments in order to safeguard people against possible deprivation of their liberty. An example of this is where people are cared for in recliner type chairs, then a full risk assessment is carried out involving a multidisciplinary team. The decision is then based on ensuring the person’s best interests. The wheel chair policy is now adhered to with people being fully assessed for their use, including the use of footrests. This helps to ensure that people are safe whilst using wheelchairs. What they could do better: This is what people tell us needs to improve at the home – “The laundry leaves much to be desired with cardigans ruined and clothes lost” “Some of the younger members of staff do not appreciate patients’ conditions” “There are insufficient activities for residents to take part in” “Take us out more” “Hot water first thing in a morning” “At times my relative would like more variety of food and would also like to be taken back to her room after meals as she occasionally has to wait a while” “I would like more activities and to go out on trips more often” “More day trips needed” Staff tell us that the staff could “work as a team more and communicate to each other better. There are not enough meetings so that people can have their say about things” Three of the staff members told us that there needs to be “Better communication between staff.” “Make sure that we have the equipment to do our job efficiently (when hoists are out of order)”. Although the service has started to implement new care plans, and improvements have been made in this area, specific care plans and risk assessments must be established for people at risk of pressure damage. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.2 Page 10 Pressure relieving equipment identified must be in place at all times to ensure good skin integrity for people. The service had stared to address the recommendation in respect of the administration of prescribed creams. However, the current system is not working effectively and the service needs to review the system for storage, allocation and recording of prescribed creams. This is to help ensure that people receive their creams and lotions as prescribed. The social and therapeutic needs of people are only partly met. This outcome area would be improved by ensuring that activities are based on what people actually want to do and making activities more person centred. The service also needs to arrange more trips out for people as highlighted above. This will help to ensure that individual social needs are met. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 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.V377782.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are only offered a place at the home following an assessment of their needs. People are given sufficient information about the home to enable them to make an informed decision about moving in. EVIDENCE: In their AQAA the Providers tell us that – “We believe our residents and their families can be confident that the care home can support them, because we undertake an accurate assessment of their needs”. They also say that “Our pre admission process encourages prospective New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 13 residents to visit the home first, come for tea and then maybe stay overnight or for a weekend. During these visits our pre-admission assessments are undertaken. This gives existing residents the opportunity to meet prospective clients and make any comments”. The Providers also say that “Prospective residents and those people close to them are helped to decide whether the care home can meet their support and accommodation needs by our statement of purpose and service user guide, which tell them all about the home and what we have to offer”. “Each resident has an individualised pre-admission assessment to ascertain whether the home can meet their needs, if they feel they cannot then an explanation of why is given to the proposed resident”. The Providers tell us that “Residents are provided with comprehensive documentation pre-admission, which explains the way in which the home is run, for example, residents guide”. They say that “Each resident is given the opportunity to visit the home and spend some time within the home before a decision is made. If the resident is unable to do so the home will offer to send out an appropriate staff member out to see them and answer any questions they may have”. The Providers tell us, in their AQAA that the “home offers a six weeks settling in period and then both parties are able to reassess the placement” and that “the care home welcomes enquiries from any group in society, the preassessment process will identify whether we can meet their needs”. The Providers tell us that the “care home ensures an individualised holistic package of care is planned, implemented and evaluated from pre-admission throughout the service users stay”. During our visit to the service we spoke with a person, and her visiting relatives. She had recently come into the home and when we asked her about the admission process she explained that her family had visited the home first and then they had brought her for a look around. She confirmed that an assessment of her needs had been carried out before they had offered her a place. She also told us that she was settling in well to the home. When we looked at individual care plans we saw that pre admission assessments of people’s needs had been carried out. People entering the home through Care Management arrangements have assessments in place from Health and Social Services. Each person wanting to come into the home has an assessment of their needs carried out by a suitably trained member of staff from the home. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples’ personal, nursing and health care needs are monitored and met satisfactorily. Attention to detail in relation to pressure area care and the administration of prescribed creams will help to improve this outcome area. EVIDENCE: In their AQAA the Providers tell us that – “Residents are informed of any changes either to their care plan, environment or fee structure”. They also tell us that there is a “Plan of care with comprehensive assessments New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 15 compiled with the residents’ input reviewed monthly or to reflect changes as required”. The Providers tell us that the “home welcomes enquiries from any group in society. New Park House provides an holistic plan of care for all the residents”. Also “Residents and significant others are involved in the decision making process for best outcomes”. They also say that there is “involvement with appropriate disciplinary agencies as required”. “All nursing and senior care members of the team within the home are aware of the policies and procedures and have completed or are in the process of completing the safe handling of medication course”. They tell us that the home “liaises closely with the GP and the Pharmacy” and The “GP undertakes annual reviews of the residents medication to ensure that the residents requirements are met”. There is “Equipment provided and inspected to meet the residents’ needs”. They tell us that there is “Staff training” to meet peoples’ needs and that the service “Keeps up to date with legislation”. They say that “Any suggestions raised by the Environmental Health Department are acted on as soon as possible”. They also tell us that “A consultancy firm has now taken over the Health and Safety issues regarding the home”. We looked at the personal and health care needs of three people in detail but we spoke to others who live in the home. We found that service is in the process of introducing a new care planning system. Good comprehensive information is given in new plans. Those seen had been well written and transferred from old records with some minor exceptions. One person had a pressure ulcer two months ago which has now healed. This person’s tissue viability (Waterlow) assessment places the person at high risk of developing further pressure damage. The person was seen by the Tissue Viability Nurse Specialist in August 09 who had documented “There is a care plan to manage pressure areas” but this could not be found. This means that the person’s risk of developing pressure damage was not being monitored. The person does have a soft form mattress in place. She was observed sitting in the Conservatory area during the inspection day without a pressure relieving cushion in place. Although it was not possible to refer to the care plan for pressure relief as this was not in place it was agreed that, due to the person’s high risk that she should be sitting on a pressure relieving cushion. There are three people accommodated in the home with pressure damage. We examined the records relating to one of these people. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 16 A grade two pressure sore was recorded. There is a Body Map identifying areas and measurements of wound damage. There is a care plan in place regarding wound care and each intervention for wound care is recorded. This person is seen by the Community Matron on weekly visits. There is good assessment, care plan recording and management of wound care in place. A Deprivation of Liberties Safeguarding screening assessment form was seen for this person signed by the Deputy Manager the and by GP One person was seen nursed in a Kirton Chair. This is a type of chair which reclines back and prevents a person from sitting forward. Following the last Key Inspection we took action to ensure that this person undergoes a multidisciplinary team assessment, in order to ensure that the use of this type of chair is used in the best interests of the person. This has now been carried out and we saw that a risk assessment has been completed and signed by the GP, Nurse, Deputy Manager and Chairman. We were told that this person’s relative had sent consent by email as they do not live locally. This risk assessment is being reviewed monthly. Professional visits sheets recorded visits by General Practitioners, Chiropodists and other health care professionals. We saw risk assessments relating to managing the needs of other people who live in the home and these were completed to a good standard and contained relevant information. Care plans also reflected personal choices and preferred routines. Daily care charts were seen in peoples’ bedrooms. Positional change charts were seen completed well. Fluid intake charts were completed well and identified that drinks are offered to people throughout each 24 hour period. However we did not see jugs of drinks or other available fluids in peoples’ rooms. Also a number of people who have swallowing difficulties had been prescribed a thickener to add to their drinks. These were stored in the medication room and were not readily accessible for staff to use. Discussions with the management consultancy identified that these might be better stored in peoples’ rooms so that they are more accessible for staff to use. We looked at the medication procedure within the service. We saw that only one person keeps prescribed creams in his room. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 17 All other creams and lotions are locked away in a store room. We were shown a new file for staff to sign for the administration of creams and lotions. The signing of these creams is haphazard and it was impossible to identify whether people had received their creams and lotions as directed. There is a need to review the location of creams and the recording system in order to ensure that people are given creams as prescribed. Records must include times applied, where applied and signature as proof. Both records and the creams need to be readily available to staff. Footrests were seen on all wheelchair transports during the inspection visit. A suitably adapted wheelchair has been provided for the person identified in the last report. Staff comments were very positive. “Keith is listening and asking and things have improved”. “We feel that we are now listened to and more involved”. A visitor to the home told us that staff are “Excellent in the care they provide, always respectful and caring”. These are other comments we received about how people feel that the service is meeting their personal and health care needs. “The staff give a high standard of care” “They look after my mum very well” “They make me feel safe” “They should return quicker after I call my bell – when they promise to come back later” “The nursing care is excellent. The staff are always available and ready to help” “Dad is always nicely dressed and clean shaven and the girls regularly speak to him about what he likes to wear” Staff tell us that – “The needs of the residents always come first and the home is always clean and tidy” New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities of daily life in the home are somewhat flexible and varied but it cannot be guaranteed that individual social and therapeutic needs are met. EVIDENCE: In their AQAA the Providers tell us that – “We ensure that our residents are treated as individuals and we are responsive to their race, culture, religion, age, disability, gender and sexual orientation. We monitor this through our care plans. We recognise the importance of: Independence, Privacy, Dignity and Respect.” They also tell us that they “Encourage daily routines for each resident’s personal requirements within in any restraints”. They say that “Special diets are catered for” DS0000026956.V377782.R01.S.doc Version 5.3 Page 19 New Park House Nursing & Residential Home They also “Provide information for residents i.e. Advocacy and IMCAs” They “Take into account likes and dislikes and these are noted in the care plan” They tell us that individual “Choice is upheld at all times and there is no restrictions on visitors and refreshments are always offered” They say “The home is as flexible as possible to the residents’ needs” “Local groups within the community are encouraged to visit the home” There is a “Welcome Pack on admission” “Designated hours are given to Activities” There is a “Mini bus for residents’ outings and an In house hairdresser” The Providers tell us that the service has “Strong links with the local church, and communion is held on a monthly basis” “Domiciliary visits by both the dentist and optician are organised as requested” “Residents are encouraged to continue to manage their own financial affairs, outside agencies i.e. advocates may be required to support this activity”. The following are comments we received from people who live at the home “The food is good” “The home does everything well except activities” “There are insufficient activities for residents to take part in” “Take us out more” “At times my relative would like more variety of food and would also like to be taken back to her room after meals as she occasionally has to wait a while” “I would like more activities and to go out on trips more often” “More day trips needed” We looked at how the service meets the social and therapeutic needs of people who live in the home. There were group activities taking place in the main lounge and the lounge in the new unit. However there were people sitting around the home in other areas who were not receiving any form of stimulation. Whilst there are dedicated activity staff, the current programme of activities and entertainment does not guarantee that people’s individual needs will be met. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 20 Some people feel that there should be more trips out and improved activities as highlighted above. Discussions with the management identified that the meeting of social needs is currently being reviewed and that there are plans in place to help improve this outcome area. The religious and spiritual needs of people are identified on admission to the home and regular services are held at the home. Some people go out to their place of worship and others are visited in the home by the local clergy. One lady, who had recently come in to the home, was very keen to maintain her religious needs and when we asked the manager of the unit about this she was obviously aware and plans were underway to ensure that this lady attends church services. Visitors were observed coming and going at various times during the inspection visit. Relatives and friends were pleased that they no longer have to wait for the doorbell to be answered. “I have got a code to the front door now so that I don’t have to wait at any time.” The management consultants have been reviewing the arrangements for taking meals and have made some positive changes to the décor and presentation of the dining rooms. This has helped to improve the dining experience for people living in the home. Also attention and improvements to food hygiene practices has helped to ensure that food is stored safely in the dining room areas. People are generally happy with the standard of the meals served to them and told us that “The food is good” at the home. They also told us that they are given choices and we observed people being served alternatives to the main menu. Special diets are catered for including diabetic, vegetarian and soft diets. The nutritional needs of people are assessed and monitored and people are given dietary supplements and assistance with food and fluid intake where necessary. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can be assured that any concerns they have will be listened to and taken seriously. Action is taken by the service to improve areas where people have identified concerns. EVIDENCE: In their AQAA the Providers tell us that – The “Up to date Complaints procedure is on display in a prominent place in reception, families and significant others are made aware of this procedure” The Providers tell us that they keep a “Record of any complaints, concerns, compliments and incidents and details of any investigation” The “Concerns and compliments box is checked daily” “We try to ensure that we safeguard our residents from abuse and neglect, through, having policies and procedures in place, a robust recruitment process and we are committed to training and development” “We have good liaisons with the care agencies” and “We have effective care planning” New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 22 The Providers tell us that “We have our own safeguarding and whistle blowing policy and staff have attended training” “The home has a clear and accessible concerns / complaints procedure illustrating time scales and how complaints are dealt with” The providers say that “All residents are informed of the concerns and complaints procedure and would be fully supported by staff in making their complaint” They also tell us that “The home adopts the opinion that each resident has the capacity to make all their decisions unless proved otherwise” They take on board “new legislation such as the Mental Capacity Act, Advocacy and IMCA” They tell us that “Staff training as part of their induction procedure ensures that staff are aware of the policies and procedures regarding Complaints and Protection” “All residents have their rights and choices protected and upheld such as their right to vote, either in person or by postal vote” Staff tell us that “the home is good at listening to relatives’ concerns and sorting them out as soon as possible” and “There is training for all the staff and support and care for all the residents. A relative told us - “It’s so much better lately. They now listen to you and try to help.” We saw that the complaints procedure is displayed prominently within the home. We looked at the log of complaints which the management consultants have maintained. This demonstrates that complaints raised by people and their representatives are addressed and action taken where necessary. This has improved from the previous inspection when the service was unable to demonstrate clearly that complaints were being addressed within the timescale of the complaints procedure. People told us that they know who to speak to if they have any concerns. We, the commission have not received any more complaints about the service since the last inspection. The service has a policy on Safeguarding vulnerable adults, including a local referral procedure and Whistle blowing policy. Staff are made aware of this during their induction period, and are given training in the Protection Of Vulnerable Adults (POVA) as part of the staff training and development programme. Also staff are carefully selected to work in the home and undergo stringent checks before being offered employment. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 23 Discussions with the senior nurses who work in the home identified that they are aware of their roles and responsibilities in relation to the recognition and reporting of poor or abusive practice. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe, clean and comfortable environment which has been adapted to meet the needs of people who live there. EVIDENCE: In their AQAA the Providers tell us that – “We believe that our residents live in a safe and well-maintained home that is homely, clean, pleasant and hygienic” “We continue to maintain the standard of the home and we have an experienced head housekeeper who takes pride in maintaining the home to a good standard and she is supported by our domestic and laundry staff” New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 25 They tell us that “We offer spacious, comfortably furnished rooms, all with wash hand basin, call system and TV point. We have 3 twin bedded rooms and 88 for single occupancy, 53 have en suite facilities” “We offer assisted bathrooms or showers to make the bathing experience more enjoyable” The Providers say that the “Environment is suitable for residents needs, and assessed on a needs based audit” The service manages infection control and “liaises with the Hospital Trust Infection Control department” They tell us that “Routine maintenance work within the home is ongoing” They also say that “Adapted equipment is suitable for our residents needs. We always aim to give our residents the right specialist equipment that encourages and promotes their independence and we have aids and adaptations” They tell us that “Where possible we encourage our residents to arrange their room so that it feels like their own, it is comfortable and they feel safe when they use it. We encourage them to bring in their personal possessions and furniture, involve them in choosing the decoration for their room and ensure that there is appropriate light and heat” There is a “Call bell system in each room” “The home complies with the requirements of the local Fire Service and the fire alarm system is serviced and suitable for use” There is “Pleasant outdoor space suitable for our residents and easily accessed” “Health and Safety issues are identified and dealt with as soon as possible by an outside consultancy” and “Risk Assessments are undertaken and reviewed” “Audits are undertaken and evaluated as an ongoing process” “New Park House has a designated Smoking room to ensure residents have the right or choice to smoke” We walked around the home and visited all the communal areas and a selection of bedrooms. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 26 When a relative was referring to her mother she said - “Her room is always clean and the bed linen is changed regularly.” Another person said that “The home is good and clean.” Another relative, however, was concerned that “The laundry leaves much to be desired with cardigans ruined and clothes lost.” The service will need to look into this with a view to making improvements. A staff member commented that the home should “Make sure that we have the equipment to do our job efficiently (when hoists are out of order)”. We observed moving and handling equipment in use throughout the home at the time of the visit and no other staff members raised this as a concern. People have access to all of the areas throughout the home and we observed individuals sitting in either the large lounge or the quiet areas throughout. Some people prefer to stay in their bedroom and watch their television or just enjoy the privacy of their own space. Some people also like to entertain their visitors in the privacy of their own bedrooms and we observed this during the visit. The home was clean and well presented at the time and there are a team of eight domestic staff who work under the supervision of the housekeeper. The housekeeper explained how each room is cleaned daily but is also cleaned thoroughly once per fortnight. The service has a policy on infection control and some of the staff who work at the home have received training in this area. It is recommended that all staff who work at the home undergo training in infection control in order to help ensure that staff understand the basics of this and can work safely. The management consultants are continuing to make the suggested improvements to infection control, as per the Infection Control Audit recommendations. This includes installing hand wash facilities for staff to use in peoples’ bedrooms. These are being installed on walls over the sinks. The programme of redecoration and refurbishment is being stepped up. Three of the bedrooms currently empty are being totally redecorated and refurbished. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 27 New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 28 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are cared for by a skilled and caring staff team who are trained to meet their needs. EVIDENCE: In their AQAA the Providers tell us – “The home has more than enough staff on duty although up to recently they have not been deployed correctly losing this advantage” They also tell us that “Nurses working within the care home are suitably registered with the appropriate body” “As an organisation we recruit in a fair and open way ensuring we employ the right people” and “We now undertake a robust recruitment process and carry out various checks on possible employees, for example, CRB, references, employment history and as of now all POVA checks are carried out to the letter of the law” “All staff receive a job description, handbook and contract and “All staff receive induction training and regular updates” New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 29 “The care home has an appropriately qualified workforce with at least 45 of staff delivering personal care holding an NVQ level 2 or above” The Providers tell us that “Nurses and Senior Care staff are trained to deliver Safe Handling of Medication” Mandatory training includes “Moving and Handling and Fire Awareness” There is an “In house Induction course for all staff” “Infection control training starting in January 2009 with the Hospital Trust” The Providers tell us that they “Access training suitable for the staff and residents’ needs” On going support for staff includes – “Supervisions, Appraisals and Team Working” and there is a “Low Turnover of staff” at the home. Staff told us that the management “is listening and asking and things have improved”. They said that they “feel that we are now listened to and more involved”. Visitors we spoke with during the inspection visit were complimentary about the staff. One couple told us that staff are “excellent in the care they provide, always respectful and caring.” Another told us that “Staff are always very helpful and considerate.” Staff who work at the home told us – “The home meets the training needs for our clientele” “There is training for all the staff” Staff morale has improved at the home since the last inspection, with staff commenting positively about the home – “NewPark is now a nicer place to work with changes being made over the last few months. It has made very much improvement” “NewPark is improving every single day and it is now a pleasure to be part of” “Now all the staff are happy working in a good environment” “Communication between office staff, carers and nurses has improved greatly” The staff training and development programme is being implemented. We looked at four staff files and saw that records of training and development were in place and staff feel that – “Things are now improving for the better. Staff are being trained on different courses. The staff have more idea of what their job role is” New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 30 Another staff member told us that the staff could “work as a team more and communicate to each other better. There are not enough meetings so that people can have their say about things” Three of the staff members told us that there needs to be “Better communication between staff” Staff were observed interacting well with the people who live at the home. They were observed to be attentive, polite and respectful throughout the visit. The staff recruitment process was examined and this was found to have improved. We looked at a random sample of four staff files relating to staff who have been recruited since the last inspection. All the required information was present and the necessary CRB and POVA checks had been completed prior to their employment. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 31 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is currently well run and is managed in the best interests of the people who live there. This area will be improved further by the registration of a permanent manager. EVIDENCE: In their AQAA the Providers tell us that – New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 32 “All staff receive induction training, supervisions and appraisals to identify their training needs” They also tell us that “As of July 2009 a closer relationship has and is being formed with all members of staff by the management team” They say that “The staff will receive full support and supervision to help them adjust to the person centred care now being delivered where the dignity and rights of the resident is paramount” “All workers are supervised at least six times per year” “The home has a clear and accountable management structure appropriate for it’s size” “The care home has up to date policies and procedures” “The care home regularly analyses the quality of the service” “We provide a safe place for residents to keep valuables and money. A record of anything kept within this area is maintained” Since we carried out the last inspection the Registered Manager Sandra Wilson has left the home. The service has a management consultancy in place to oversee the management of the home in the interim until a new Registered Manager is in place. We were informed that a new manager had just been appointed and we met with her briefly during the inspection visit.We were told that she will be taking up her new position in October 2009. Throughout the course of the inspection we received many positive comments about the new management structure – “Our new management team are getting us back on the right track (which is what our residents deserve) and staff are working hard to do this” “Before, management was not involving us in anything. Now I feel part and parcel of the home” “The current management consultant is excellent” “Its so much better lately. They now listen to you and try to help” The management consultancy has taken on board the legal requirements and good practice recommendations of the last report, and these have now all been addressed satisfactorily. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 33 The service is developing a Quality Assurance system which involves auditing all of the services provided and taking action to improve areas which are poor. A staff member told us that the management consultant “comes around and listens to you and if you have any suggestions for improvement he will try them out. Then he comes back to make sure that this is working” Meetings are being held, communication is better and people are being informed of the changes taking place. We saw the minutes of meetings which had been held since the last inspection. We looked at how the service keeps peoples’ personal allowances safe. The administration of this is transparent, safe and effective. People who live in the home are able to access their personal allowances at any time by arrangement. The system allows for an audit trail to be carried out effectively. There is a system in place for formal staff supervision but this has not been maintained satisfactorily since the last inspection. However, discussions with the management consultant identified that this is now going to be developed so that all staff will receive regular formal supervision. Records relating to Health and Safety of the home have been maintained accordingly in order to ensure that the home is safe for staff to work in and for people to live in. These include records of staff mandatory training updates and individual and generic risk assessments. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 34 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 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 x 3 2 x 3 New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 35 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 OP8 Regulation 12(1)(a) Requirement Care plans and risk assessments must be established for people at risk of pressure damage, Pressure relieving equipment identified must be in place at all times to ensure good skin integrity for people. Timescale for action 28/10/09 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. Refer to Standard OP9 Good Practice Recommendations The service should review the system for storage, allocation and recording of prescribed creams. This is to help ensure that people receive their creams and lotions as prescribed. It is recommended that all staff who work at the home undergo training in infection control in order to help ensure that staff understand the basics of this and can work safely. It is recommended that the system for formal staff supervision is improved in order to ensure that staff continue to develop and maintain the skills needed to DS0000026956.V377782.R01.S.doc Version 5.3 Page 36 2. OP26 3. OP36 New Park House Nursing & Residential Home meet peoples’ needs. New Park House Nursing & Residential Home DS0000026956.V377782.R01.S.doc Version 5.3 Page 37 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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