Inspection on 07/09/05 for Paisley Court

This inspection was carried out on 7th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Paisley Court 07/06/07

Paisley Court 11/05/06

Paisley Court 01/02/06

Paisley Court 25/02/05

Paisley Court 13/07/04

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

CARE HOMES FOR OLDER PEOPLE Paisley Court 36 Gemini Drive East Prescot Road Liverpool L14 9LT Lead Inspector Pat Kearney Julie King Unannounced 7 September 2005 th 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 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. Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Paisley Court Address 36 Gemini Drive East Prescot Road Liverpool L14 9LT 0151 230 0857 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Community Health Services Ltd Mrs Jayne Allison Kennie CRH Care Home 60 Category(ies) of DE(E) Dementia - over 65 registration, with number of places Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: n/a Date of last inspection 25.2.05 Brief Description of the Service: Paisley Court is situated in a middle of a residential development and is easily accessible by public transport and close to local shops. At the front of the building there is a large parking area and at the rear of the property there is an enclosed garden, which service users on the ground floor can access easily. Paisley Court is a care home providing nursing care for 60 older service users who are elderly mentally infirm. Accommodation is divided into four fifteen bedded units. All bedrooms are single and have en-suite toilet facilities. Each unit has its own dining and lounge areas. Qualified nursing staff is on duty at all times. In addition a full time activities co-ordinator is employed to provide activities for service users. All beds at Paisley Court are contracted to Liverpool Health Authority resulting in all referrals made to the home are through the team of consultants at the hospitals. Thus, service users benefit from ongoing assessment from their consultant. Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place over five hours. A full tour of the premises took place. A range of records such as care plans, staff personnel files, policies & procedures and medication charts were examined. A selection of staff on duty, and a number of service users were spoken to during the course of this inspection. What the service does well: What has improved since the last inspection? What they could do better: Provide documented evidence of service user specific risk assessments and regular checks by a competent person, regarding the use of bed rails by service users. The overall standard of the environment, including cleanliness needs upgrading. Some areas were nicely furnished and had obviously been redecorated and refurnished recently, whilst others were in urgent need of deep cleaning and refurbishment. The daily records completed by the qualified staff need more attention to detail, and certainly need to be cross-referenced Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 6 with accident / incident reports, including basic observations, as required. The overall standard of communal furnishings was poor, as were the shower rooms. 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. Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 8 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 standard(s) 1.2.3.4.5. The homes Statement of Purpose and Service User Guide are well written providing service users and /or their relative with details of the services the home provides enabling an informed decision about admission to the home. Service users have a holistic assessment prior to admission, from which a plan of care is developed. EVIDENCE: Paisley Court has developed a ‘Welcome Pack’ which gives prospective service users and / or their representatives the required information to make an informed choice. The welcome pack includes a description of accommodation, qualification of staff, number of places provided and a copy of the home’s complaints procedure and details of the local C.S.C.I office. The Service Users Guide is printed in large print increasing accessibility to service users. Relatives spoken to on the day of the inspection said “How helpful and informative the welcome pack had been when dad was admitted.” Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 9 Since the last inspection the pre assessment documentation has been revised and updated and provides for a holistic assessment to be completed prior to the prospective service user being admitted to the home. Care U.K. are currently reviewing the service user contract the Deputy Manager said that the review process was expected to be completed within the next month and that all service users would be given revised contract and that copies would be put into the service users file. Service users and/or their relatives are given the opportunity to visit the home prior to admission however the level of cognitive impairment experienced by some service users limits this opportunity. Relatives spoken to during the inspection confirmed that they had been invited to visit the home and had taken the opportunity to do so they said “they were made welcome and felt very reassured that their dad would be well cared for here.” Paisley court does not provide intermediate care. Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7.8.9.10.11. Resident’s individual health, personal and social care needs are not always clearly recorded, and so does not provides care staff the information they need to meet the residents care needs. EVIDENCE: The pre assessment documentation has been recently reviewed and updated and all service users are assessed by the management team prior to admission. The pre admission assessment forms the basis of the initial care plan. As part of the inspection a random samples of care plans were ‘case tracked’ All service users have a holistic plan of care which is based on the Roper, Logan & Tierney model of care. Some of the care plans showed that the assessed and ongoing needs of the service users were not always being met. Service users who should be having monthly weight checks, their care plans show that this has not been completed for several months some care plans give an explanation others record nothing at all. Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 11 Daily recording in the care plans is poor and needs to be improved to reflect the ongoing and changing needs of the service users. In some care plans a chart was completed saying that a consultant had been requested to visit there was no evidence in the daily report as to the outcome of that visit and any changes to the treatment or care of the service user. Since the last inspection the home has developed a social history portfolio which is called “ The Journey of My Life” the aim of the portfolio is to work in partnership with service users their relatives and friends to develop a comprehensive picture of the individual service user prior to them becoming ill. The portfolios contain sections on school days, employment history, family life as well as favourite things i.e., food radio or television programmes hobbies and interests. While the work is ongoing and not all the portfolios are completed there were some excellent examples which were comprehensive detailed and included allsorts of information particular to the individual. This information will assist staff to see and understand the person behind the illness and assist them to maintain their individuality. Paisley Court has developed a “Bereavement Pack” for service user relatives as well as having policies and procedures in place caring for the dying. Inspection of a sample of service user files and discussion with the deputy manager confirmed that where possible information is obtained about the wishes of the service and their family regarding terminal care and arrangements after death. The inspector saw large numbers of thank you cards and letters from relatives and friends of former service users in appreciation for the care comfort and concern offered to relatives whose relatives are terminally ill and following bereavement. As part of this unannounced inspection all the medicine rooms, stock and management of medications were also examined. The management of medications on the respite unit were found to be well kept, and in accordance with current good practice guidelines. However the other units evidenced transcriptions not double signed (or signed on a couple of occasions), labels on medication administration records (MARs), medication rooms too hot (over 25 degrees celcius), lack of knowledge from one qualified staff member regarding the importance of using correct supply and recording of drugs of potential abuse, and numerous gaps on MARs with the ‘key’ system not in use. The inadequate and poor medication management on these units constitutes a non-compliance from the previous inspection report. Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15. Residents have choice and flexibility how they spend their day in the home, and pursue leisure activities according to their choice and preferences. This allows independence and individuality for each resident. EVIDENCE: Residents in the home are asked on admission about their lifestyle, choice of foods, and choices and preferences of the social activities they would like to participate in. On admission to the home the resident with help from a family member completes “Getting to know you” questionnaire, which is a “Work life History” of the resident, and includes schooling, work, hobbies, food likes and dislikes etc. This information is used to facilitate organised activities for the resident, and is part of the pre-admission assessment and new social portfolio. The daily routines provided were flexible as far as possible, and service users are encouraged to exercise choice and control over their lives. Friends and family are actively encouraged to participate in the service user’s lives. A varied and nutritious diet was provided with specialist service user’s medical needs (such as diabetes) being catered for. Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16.17.18. The home has a detailed complaints procedure, with evidence that residents and or their relatives feel their views are being listened to and acted upon. The home’s policy and training programmes for POVA and Whistle blowing help ensure that the residents are protected from abuse. EVIDENCE: The home includes in the welcome pack a copy of the complaints procedure which includes the address and telephone number of the Commission for Social Care Inspection. Relatives said that they felt able to discuss any concerns they may have with the Management team and commented that “any issues raised would be addressed.” On the day of the inspection there was evidence that many of the staff in the home had undertaken training on POVA protocols and a training schedule showed that ongoing training on POVA was planned . The registered person is a member of Liverpool’s interagency Adult Protection Group. Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21 & 26 The standard of the furnishings and fittings has deteriorated and not conducive of a well kept, homely environment. EVIDENCE: All communal areas and bedrooms were examined, and some evidenced personalization, with these service users bringing in their own furniture, etc. Some service users rooms had a strong smell of urine, and many of the carpets in these rooms were dirty and stained. Some rooms had damage to the wallpaper, and chunks of wood out of the woodwork. A number of clinical and general waste bins had no lids, presenting an infection control and odour risk – this had been identified on previous inspection reports. Extractor fans in some of the sluices, and all of the shower rooms were still not working, again identified on the previous inspection; and combustibles were found on one of the internal fire escapes. Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 15 The bathrooms on most units had items such as mattresses and weighing scales in them. When questioned, the nurse in charge informed the inspector that there was no where to store these items, but each time the bathroom was used, these items were removed. This practice must cease as it constitutes an infection control and risk hazard. Some of the chairs in the lounges evidenced signs of wear and tear, one of the ‘bucket’ chairs must be discarded as it was ripped, exposing the inner foam of the seating area. Other items of furniture, including ordinary chairs also evidenced damage and must be replaced. Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27.28.29.30. The recruitment policies and practices of the home are robust, and the appropriate checks on staff are carried out. This ensures that residents are safeguarded from risk or harm. Records of staff training are kept and detail the training and development each member of staff have completed and evidence the competence of staff to do their jobs. EVIDENCE: The care home operates a robust and comprehensive recruitment policy to ensure that staff have the required skills to facilitate care for all service users. On the day of this unannounced inspection a selection of staff personal files reviewed contained up to date enhanced CRB/POVA certificate. The Personal Identification Numbers (PINS) of all the registered nurse in the home were documented on Nursing and Midwifery Council (NMC) stationary. The home has a comprehensive staff development and training strategy. All members of staff at the care home have access to mandatory and specialist training and records are kept of courses attended. On the day of this inspection some mandatory training was overdue, however a dated schedule has been drawn up to ensure that all mandatory training will be completed. Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 17 All staff in the care home receive documented supervision six times per year and an annual appraisal is completed. Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31.32.33.35.36.37.38. The management team has a good understanding of the areas in which the home needs to improve. Plans were being developed as to how these improvements were going to be resourced and managed. EVIDENCE: The care home benefits from the clear leadership of the management team comments received during the inspection from relatives, staff, visitors to the home and professionals who work with the home all confirm that the manager involves and informs them about all aspects of the management of the home. Relatives confirmed that they are kept informed of the “changing needs of the service users.” The homes certificates of insurance and worthiness for gas, electricity, fire equipments, lift, hoists and Employers Liability were in date and valid. Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 19 However the fire alarm test book showed that the fire alarm testing had not been completed for the past two weeks. On the day of the inspection the inspector saw that not all the assessment care planning and risk assessment documentation was up to date; this compromises the health, safety and welfare of the residents. Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x 2 x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x 3 3 3 2 Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 21 yes Are there any outstanding requirements from the last inspection? 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 2 Regulation 17 (2) Requirement The registered person must produce a contract / statement of terms and conditions to the service user and their representative in accordance with this regulation. The registered person must ensure that all service users care plans are valid and up to date at all times. The registered person must ensure that all service users who receive multidisciplinary healthcare team input have the progress notes adequately recorded. The registered person must ensure that all medications are kept in accordance with current good practice guidelines. The registered person must ensure the furnishings and floor coverings identified during this inspection are either deep cleaned or replaced. The registered person must ensure that the bathrooms and shower rooms identified to the person in charge are cleaned, repaired, and kept free of clutter at all times. Timescale for action 31 October 2005 2. 7 15 31 October 2005 31 October 2005 3. 8 12 4. 9 13 (2) 31 October 2005 31 October 2005 5. 19 16 & 23 6. 21 16 & 23 31 October 2005 Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 22 7. 8. 26 38 16 13 The registered person must ensure tha care home is kept clean and odour free at all times. The registered person must ensure that suitable and sufficient risk assessments are in place for all service users as needed. 31 October 2005 31 October 2005 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 38 Good Practice Recommendations It is strongly recommended that the registered person obtains training to a competant standard for the person responsible for checking and risk assessing bedrails. Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 3rd Floor, Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Paisley Court F52 F02 S25191 Paisley Court V242619 070905 Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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