CARE HOMES FOR OLDER PEOPLE
Offington Park Care Home 145 Offington Drive Worthing West Sussex BN14 9PU Lead Inspector
Mrs J Farrell Unannounced Inspection 27th June 2006 10:00 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 Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Offington Park Care Home Address 145 Offington Drive Worthing West Sussex BN14 9PU 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) 01903 260202 offingtonpark@btinternet.com Claremont Care Service Limited Jacqueline McCurdy Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Five service users age sixty years and over may be accommodated. Service Users are in the category old age however one named person in the home age 62 years - 65 years, may be accommodated. 2nd February 2006 Date of last inspection Brief Description of the Service: The property is a detached three-storey building situated in a residential road on the outskirts of Worthing, a West Sussex seaside town with shops, train stations and other amenities. Accommodation is provided in twenty-two single and one double room. However the double room is used for single occupancy unless there is a specific request for it as a double. The rooms are arranged on ground and first floors only and thirteen have en-suite facilities. There is a passenger lift. Communal rooms including a large conservatory are on the ground floor. The home has pleasant gardens with a decking area to the rear of the home, all of which are accessible to residents. Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the first key inspection of this year. This unannounced inspection took place on the twenty seventh of June 2006 and lasted six hours. There were 17 residents living at the home at the time of inspection. During this inspection the inspector had lunch residents in the dining area. The overall impression of this home is that there is now a clear strong leadership, which is consistently looking to improve the quality of care already received by the residents at Offington park. The inspector feel this home has made significant improvements since the last inspection. The home is currently undergoing a programme of refurbishment and redecoration and residents said that they were pleased with the improvements to the environment. Offington Park provides comfortable, attractive accommodation for residents and it was the opinion of the inspector that a good quality of care is currently being provided. However documentation still needs to be improved to assist the management to evidence the improvements the inspector observed. A tour of the premises took place, rotas and care records were inspected. Ten residents and four staff members were spoken with. The residents have different levels of communication ability and therefore it was difficult to ascertain all their views on how their needs are met. However all comments by residents who were able to contribute were very positive. Comments such as ‘it is wonderful here’ ‘the staff will do anything for you’ ‘staff are always very happy’ ‘ the food is fantastic’. A General Practitioner and Nurse Practitioner were both highly complimentary In respect of the level of care and standard of service provided. The Inspectors would like to thank the management, staff and service users for their hospitality and cooperation throughout the inspection. The company is now caring out Regulation 26 visits. What the service does well:
At the time of this inspection the home was being efficiently managed. Systems are in place to ensure residents are safeguarded and their health and social care needs are being met. The home has an experienced team of staff who enjoy their work and have a good understanding of the needs of the people living at the home. Relatives spoke highly of the support their relatives receive from staff and positive relationships were observed between staff and residents. The environment is relaxed and friendly and residents have use of a range of communal areas in addition to their individual rooms. Residents are supported with their personal routines and this support was seen to be offered and carried out with dignity and respect. All records and files were found to be neat and easily assessable, though not always complete.
Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
The home needs to improve the Statement of Purpose and the Service Users Guide so that prospective residence obtained a fuller picture of what the home can provide. The way care plans are developed still needs to be improved. The Inspector noted that though there was a clear indication by residents saying they have been involved in their care planning and signing to say that the care plan had been reviewed, not all evidence was up to date. As identified, the level of care provided at the home is good, but the paperwork in place does not reflect the work staff undertake. The danger of not maintaining accurate records is always that people may not provide safe and consistent care and that changes in needs cannot be tracked. Some health and safety policies still need to be developed, this and other environmental issues were fed back to the manager at the time of inspection. Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 7 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. Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 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 Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 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, 3, 4 The outcome for the residents in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home is working towards producing a Statement of Purpose and Service Users Guide which can provide sufficient information, so that prospective service users are clear about the services the home provides, and can make an informed choice about where they live. Arrangements are in place to ensure that the health care needs of most residents are identified and met. However supporting documentation must be available. Staff have sufficient knowledge and abilities to meet the needs of new residents admitted to the home EVIDENCE: The current Statement of Purpose and Service Users Guide does not included all the services the home offers, these need to include all items identified in schedule one of the Care Standards Act 2000. Fees £400-£625. At an extra cost are toiletries, papers and magazines. Physiotherapy, dentistry, chiropody and travel costs.
Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 10 The care records of three residents were looked at and there was evidence in most records to confirm that the manager had carried out an assessment on each resident’s care needs. This information was comprehensive and provided a good overall picture of the individual needs of each resident. However in one case the evidence could not be provided. There was documented evidence that demonstrated the manager had consulted with the resident, or their relative, with regard to how the care home proposed to meet their identified needs. Two of the three assessments or care plans seen had been signed by the resident, relative or advocate concerned. Staff confirmed that they had received training to meet the needs of the current residents. All three residents who were case tracked and spoken with were able to provide significant information about their care needs, these had all been recorded and staff were aware how to meet the needs. This home does not provide intermediate care. Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 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): 7,8,9,10 The outcome for the residents in this area is good. This judgement has been made from evidence gathered during the visit to this service. Progress has been made on improving arrangements to ensure that health care needs of the residents are identified and met, this will limit the risks to the residents. Residents’ health have been promoted and maintained. Access to health care services have been provided to ensure assessed needs have been met. Medication handling has improved the outcomes for residents. Arrangements are made to meet residents’ health and personal care ensure their privacy and dignity have been upheld. EVIDENCE: The care needs of residents are set out in their individual files. The inspector examined three files at random including two new residents. This sample of care plans showed a significant improvement has been made in this area. Residents said they were aware that information is recorded about them and that staff members refer to it in order to meet their varying needs. Individual files contained most relevant information, including risk assessments for moving and handling but as yet do not hold a nutritional assessment and
Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 12 some other necessary risk assessments. From discussion with the residents they gave a clear and concise pen picture of the person, however the files need to contain photos of the residents. Staff had access to new policies and procedures and were getting used to the new recording for ordering and receiving medicines. Medicine administration records were clear. The inspector observed staff members entering resident’s bedrooms. They knocked the door and waited for permission to enter. Staff members said that there was strict guidance about respecting resident’s privacy. The manager advised that there is a very good working relationship with the residents GPs, the district nurse service and specialist nurses. Two visiting professionals confirmed this. The residents can choose which GP they wish to register with, in the locality. Residents spoken with discussed how they are assisted to attend all hospital outpatients, dentist, eye, and hearing appointments. Though not all staff interviewed had attended training on how to look after people who are dying, they did however show considerable compassion and understanding of the dying process. Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The outcome for the residents in this area is good. This judgement has been made from evidence gathered during the visit to this service. Opportunities are offered for residents regardless of their frailty to be involved in activities and for all residents to have contact with family, friends and the local community. The service is partly enabling resident to make choices about personal issues important to themselves. Residents are offered a choice of food and refreshment throughout the day. EVIDENCE: It was clear from observation that Offington Park provides flexible care to its residents, wherever possible, particularly in relation to meal times and the provision of personal care. The inspection took place on a Tuesday and during this time service users were observed watching television or listening to music. Staffing levels were adequate for the number of service users. The environment is relaxed and friendly and residents have use of a range of communal areas in addition to their individual rooms. There is a passenger shaft lift to aide residents going to the upper floor. Some residents did say they would like to have a more robust programme of activities. The manager stated that there was a programme of activities however this was not always followed. Staff stated that during the summer
Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 14 residents like to go into the garden, which was seen to be well kept, with an attractive decking area and new garden furniture. Staff also stated that no activities take place at the weekends because they are so many visitors. The inspector joined the residents for lunch. Residents interviewed said the food was good and they could choose a different main meal if they wanted to. The cook confirmed she talks to the resident and has written feedback from them confirming what they liked and would prefer to have changed on the menu. A recent audit highlighted that residents liked the fish dishes however they like one type better than another so the menu changed. Homemade cake is offered at teatime. The Inspector observed staff assisting residents to eat. There was some very good communication noted and this was fed back to the manager. Good practice was noted with regard to a resident who weight needed to increase and the support staff gave to this resident. A drink is served to residents in the evening. Feedback from residents indicated that an evening snack could be provided if asked for. It is recommended that as part of the quality assurance the manager audits what residents would like in the way of activities and if there is enough choice. This information also needs to be recorded in the care plans. Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 15 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): 16,18 The outcomes for residents in this area is good. This judgement has been made from evidence gathered during the visit to this service. Service users and relatives are able to express their opinions, which they know will be listened to. Adequate systems are in place to protect service users from abuse. EVIDENCE: The Regulation 37 incident reports were examined during this inspection, the Inspectors were pleased to note that since January to June 2006 the numbers had been decreasing. The inspectors viewed the complaint records and these were reviewed and action plans seen to be appropriate. Two new staff records seen and all have had appropriate CRB checks. Policies are clear and robust. There is a copy of The West Sussex guidelines. Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 16 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 The outcome for the residents in this area is good. The environment is subject to on going improvement, which is needed to maintain and raise the standard of accommodation. The home is clean and hygienic. EVIDENCE: At the time of the inspection, all communal areas and the ten bedrooms seen by the Inspector were found to be clean, tidy and well maintained. All residents and relatives spoken with confirmed that the home was always clean and free from odour. In communal areas the carpet was noted to be tired looking. The staff interviewed stated that they take pride in maintaining a very clean environment and all were very clear regarding the issues of infection control. Bedroom’s seen were homely and residents said they liked their rooms and were happy Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 17 Since the last inspection the home has continued with the redecoration and refurbishment programme, in particular the garden, which now has decking around the patio area and is fully accessible to the residents. The inspector noted that a great deal of care had been made to unsure that resident could help with the gardening by developing raised beds. Residents spoken with confirmed that they helped with the potting up and planting of bedding plants. New garden furniture has been acquired including large umbrellas which residents spoken with said means they can enjoy lunch in the garden when the weather is fine. The home was regularly maintained and the grounds were attractive, well kept and secure. Reports from the Environmental Health Officer and the Fire Service were available and the manager confirmed that the home has met their requirements. Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 18 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): The outcome for the residents in this area is good. This judgement has been made from evidence gathered during the visit to this service. The deployment, time management and skills of staff is sufficient to meet the needs of the residents. The procedures for the recruitment of staff ensure that residents are protected. Resident’s benefit from an effective team of staff to support them. EVIDENCE: The Inspector found that there was sufficient staff on duty to meet the residents basic care needs as detailed in the care plans. Staff spoken with confirmed that staffing levels were adequate at this time. The residents, who provided comments about the home staff, said they were happy with the number of staff at the home and found them to be kind and knowledgeable. Residents spoken with confirmed that they were happy with the number of staff and that they felt well cared for. The home has achieved more than the standard requiring fifty percent of staff to hold an NVQ level two in Care. The manager is ensuring that staff continue to develop their skills and Knowledge by continuing to support care staff through their NVQ level three. Staff files checked at random showed that the home had undertaken all the necessary checks to ensure protection of residents. Staff members spoken with said that they had been asked to complete an application form and obtain a Criminal Records Bureau checks before starting work in the home. However they are still a few staff files that need to provide further information to meet
Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 19 the regulation. The Inspector would like to say that the files have improved greatly since the last inspection. During the inspection staff were seen to go about their duties in an unhurried manner. Induction of new staff is now being facilitated by the use of the Skills for Care induction tool. The manager confirmed that staff are now receiving at least three days paid training per year. Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 20 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): 31,33,35,36,38 The outcome for the residents in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. From observation the care received by the residents is good however documentation needs to provide an audit trail to ensure that the home can prove residents receive a service, which meets its purpose and aims and objectives. There needs to be a thorough system for reviewing the quality of care delivered to residents in the home. The resident’s financial interests are safeguarded. Improvements are being made to the way staff are supervised to ensure that residents have their needs met. Some practices, environmental issues and lack of documentation do not protect the health, safety and welfare of the residents. Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 21 EVIDENCE: The manager is now registered with the Commission. She holds The Registered managers award and NVQ level 4 in care will be looking to complete the last six units in her NVQ level 4 in management so she can hold the whole 3 awards. Staff, residents and outside professionals made very positive comments about the environment and the manager. Staff talked about one to one and group meetings they had with the manager, which they felt benefited the resident. Residents and staff stated that they found the manager very approachable. A resident spoken with said that staff were far more relaxed since Ms McCurdy had been working at Offington Park. The manager is aware of current developments both nationally and by CSCI and is making plans for the service accordingly. There is clear reference to a Quality Assurance process in the Statement of Purpose and Service Users Guide however the manager stated as yet she has not undertaken a full audit of residents/relatives and outside professional who have input into the home. It was reiterated that this review of quality of care needs to be formatted into a report and made available to the Commission. The safe keeping of resident’s money. The home Records were seen and all met the standard. Staff could not confirm that formal supervision is taking place six times a year. Some supervision files were seen. Staff also spoken with were unable to confirm that they had received all mandatory training this included prevention of abuse, first aid and fire and that they were supervised while working with residents. A maintenance person is employed to undertake a variety of checks and audits and to keep the home in a good state of repair. The establishment have some health and safety policies however these need to be reviewed to ensure that all are included such as a legionalla policy and that they are all in keeping with current good practice. These policies also need to be reviewed at least annually to unsure they continue to be relevant and meet the variety of different regulations. Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 22 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 2 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 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 3 x 2 x 3 2 x 2 Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(13)1&5(12) Requirement That all the requirements of Standard 1 and Schedule 1 be included in the Statement of Purpose. That the Service Users Guide be amended to include all the requirements of Standard 1.2. These documents need to be forwarded to the Commission as soon as completed. Comprehensive risk assessments are carried out in respect of all areas of resident’s lives and the controls in place evaluated. That the home’s care planning system to effectively monitor resident’s health and welfare needs. This should include a nutritional assessment and what to do at the end stage of life The Registered Person consults with residents and relatives about a fulfilling programme of activities. That all staff receives induction, supervision and training relevant
DS0000043533.V301799.R01.S.doc Timescale for action 01/10/06 2. OP7 13(4) 01/10/06 3. OP8 15(2) 01/10/06 4. OP33 16(2)(m& n) 01/10/06 5 OP36 18(2) 01/10/06 Offington Park Care Home Version 5.2 Page 24 5. OP38 13(4)(c) to their roles and responsibilities. The registered person shall 01/10/06 ensure that a Legionella. Policy is produced. That all Health and safety policy’s are reviewed annually Environmental risk assessments must be carried out. The registered person shall ensure that all staff have suitable training in all mandatory issues this include, 1st Aid. 01/10/06 01/10/06 6. 7 OP38 OP38 13(4) 18(a-c) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Offington Park Care Home DS0000043533.V301799.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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