Inspection on 16/06/05 for Palace House Nursing Home

This inspection was carried out on 16th June 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

Palace House Nursing Home 06/03/07

Palace House Nursing Home 19/12/05

Palace House Nursing Home 19/01/05

Palace House Nursing Home 13/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Palace House 460 Padiham Road Burnley Lancs BB12 6TD Lead Inspector Marie Matthews Announced 16th June 2005 9.30 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. Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Palace House Address 460 Padiham Road Burnley Lancs BB12 6TD 01282 428635 01282 416165 palace.house@fshc.co.uk Alliance Care (Dale Homes) Ltd 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) Mrs Patricia Bibby Care Home 33 25 33 33 Category(ies) of OP registration, with number PD(E) of places PD Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the overall registration of 33, a maximum of 25 service users requiring personal care who falls into the category OP 2. Within the overall registration of 33, a maximum of 33 service users requiring nursing care who fall into the category PD or PD(E) 3. Staffing for service users requiring nursing care will be in accordance with the Notice issued dated 22 October 1999 4. The service must at all times, employ a suitably qualified manager who is registered with the Commission for Social Care Inspection Date of last inspection 19th January 2005 Brief Description of the Service: Palace House is a care home that provides personal and nursing care for up to thirty-three people and is situated within extensive grounds on the main road between Burnley and Padiham. The home is converted from a Georgian building and still has some of the features of the original house. There has been an extension built to provide extra accommodation. There is a lift to access the first floor. The attractive gardens are visible from many of the bedrooms and the lounge and dining room. There is a level path through the garden and it is possible to push a wheelchair around this. A raised patio area, which overlooks the gardens, is easily accessible from the dining area. The home is near to local amenities including shops, bus stops and pubs and the town centre of Burnley is accessible by a bus ride. At the time of the inspection all rooms except one were used as single occupancy rooms. Some of the rooms are particularly spacious. Six of the single rooms and one of the double rooms have en-suite facilities all others have hand wash basins. Many of the people who live in the home have personalised their room with their own belongings and this enhances the comfortable appearance of the home. The communal areas of the home are homely and nicely decorated. Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection was conducted at Palace House on 16th June 2005. The inspection involved looking at records, talking to management, five staff, ten residents and two visitors, a tour of the home and generally looking at what was happening in the home. Information was also taken from comment cards filled in by three visitors. This inspection looked at things that should have been done since the last visit and a number of areas that affect resident’s lives. At the time of the visit the registered manager was still on long-term sickness leave and the deputy manager was in charge. There were twenty-nine people living in the home on the day of the visit. Residents and visitors were content with the care provided. Residents commented that staff ‘did a good job’ were ‘wonderful’ and ‘very patient’. Building work to extend the home had been planned but a date to begin the work had still not been set. However this did not currently affect the lives of the people who lived at the home. What the service does well: Residents said they were offered a choice in many aspects of their care. They said they were given a choice of menu and how and where they spent their day. Visitors and residents were treated with respect and visitors were made to feel welcome. One visitor said their relative was ‘getting the best care possible’. There was a clear complaints system and people knew who to talk to if they were unhappy. Residents were confident their concerns would be listened to and taken seriously. The home was well maintained, safe and comfortable. Residents and their visitors made positive comments about the cleanliness and tidiness of the home; one visitor said ‘the home was spotless’. Residents had brought in personal items and this added to the homely feel of the home. A number of bedrooms had been pleasantly redecorated and refurbished since the last visit. The gardens were attractive and tidy. Residents were able to walk and sit in the grounds of the home. Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 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 Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 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 and 4. The home did not provide current or prospective residents and their representatives with enough information to enable them to make an informed choice about admission to the home. The home obtained detailed information about prospective residents to ensure the home was able to fully meet their needs. EVIDENCE: The statement of purpose and service user guide had been reviewed. The service user guide was available in resident’s rooms and was given, with a brochure, to prospective residents or their relatives before admission. Some minor alteration needed to be done to make sure the service user guide included enough information. The contract for residents with the home was still under review. Three resident’s care plans were looked at and all had had their care needs assessed before admission to the home to determine whether their needs could be met. The assessments were detailed. Residents said they or their relatives had visited the home before deciding to move in. Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 9 The home had confirmed, in writing, that they were able to meet prospective resident’s needs. Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 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 and 10. The standard of care planning had improved but still needed to include all information to ensure staff had a good understanding of how to meet the resident’s health needs. The systems for the management of medication had improved to ensure that resident’s medication needs were safely met. Staff treated residents with respect and care was offered in such a way to maintain the residents rights to privacy and dignity. EVIDENCE: Three residents care plans were looked at. All residents had a well organised, detailed care plan developed from the assessment that generally set out action to be taken by staff to ensure resident’s needs were met. Risk assessments were included in the plans and these had been reviewed. There was evidence to support that resident’s had been involved in the development of their care plans and reviews had taken place every month and the care plan reflected any changing needs. Two residents said they had been consulted about their care. Three visitors said they had been consulted about Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 11 their relatives care as needed. One visitor said their relative was ‘getting the best care possible’. Generally resident’s health needs were met. However whilst assessments had been completed to identify whether residents were at risk of developing pressure sores, appropriate interventions had not been recorded. Short-term health problems that had required specific intervention from staff had also not been recorded in two of the residents care plans. Residents said they were able to see their GP and that they were ‘always looked after really well ‘ when they felt unwell. The deputy manager would be completing regular audits of all care plans. The system of medication had been changed since the last visit. Records were clearly maintained and issues raised at the last visit had been addressed. Policies and procedures needed minor review to reflect current practice within the home. All of the residents spoken to said staff respected their right to privacy. Staff were seen knocking on doors and talking to residents and visitors in a friendly but respectful manner. Visitors said they were able to see their relative in private. Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 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 and 15. The home did not provide a suitable and varied programme of activities to meet the social needs and interest of the residents. Residents were able to make choices and decisions about their life in the home and visitors were made to feel welcome. The meals in this home were good with a menu offering choice and variety. EVIDENCE: Residents said they were offered a choice in relation to many aspects of their care. All residents had a detailed social assessment on their care plan and also an activity record sheet that indicated what they had participated in. On the day of the visit a number of residents were enjoying watching ‘ladies day’ at Ascot on TV. They said someone visited each week to play the organ or piano and were able to sing along but that otherwise there was very little to do in the afternoons. Residents said they had not been ‘on an outing for a long time’ but had enjoyed the trip to Blackpool Illuminations last year. The deputy manager and staff said that entertainments had been booked and a summer fete was planned. Some residents said they were able to go out with relatives but this was not the case for all residents. One resident was able to stroll in Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 13 the attractive gardens in the fine weather. The home did not have an activities co-ordinator in post and residents were unable to chat with staff as they were ‘always very, very busy’. Staffing levels did not allow for staff to become involved in organising and participating in activities for residents. This situation needed to be reviewed to ensure the social needs, preferences and expectations of residents were met. Visitors said they were welcomed into the home and staff were seen talking to them in a friendly and helpful manner. The menu had been reviewed since the last visit and a choice of meal was now available. Residents made positive comments about this and the quality of the food. One resident said the food was ‘interesting and not always the same’ and that the cook ‘tried different things’. Assistance was given to those residents who needed it and one resident, who needed help, said staff were ‘very patient’ with her. Residents confirmed they were able to dine in their rooms. The meals served looked nutritious and appealing. Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 14 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. The home had a clear complaints system and residents were confident that their concerns would be taken seriously. EVIDENCE: From looking at records and talking to people it was clear that residents knew who to talk to if they were unhappy with their care. Three relatives said they were aware of the complaints procedure. A number of residents said they would feel confident that staff would listen to and respond to their concerns. Clear records had been kept and complaints had been dealt with appropriately. Information about who to complain to was available for residents in the service user guide and on the notice board. Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 15 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, 24 and 26. The standard of the environment, both inside and outside, was good and provided residents with an attractive, comfortable, safe, well maintained and homely place to live in. EVIDENCE: From a tour of the building it was clear that the home was accessible, safe and well maintained. The gardens were tidy and accessible to residents. There was an ongoing programme of repairs, renewal and refurbishment and evidence of this was seen around the home. Residents and staff had commented positively about the standard of decoration in the lounge and dining areas but were looking forward to replacement of the carpets to complete the work. A number of bedrooms had been pleasantly redecorated and refurbished since the last visit. Plans to re-site the laundry and kitchens and to extend the home had yet to be confirmed with the Commission although residents were aware of the changes planned. Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 16 Residents were happy with their rooms and had personalised them to add to the homely atmosphere of the home. One said she was pleased with her room and that it ‘was like a bed-sit’. It was again recommended that where rooms do not provide minimum furnishings this, and the resident’s choice,should be recorded in the care plan. The deputy manager stated that quotes to supply a sluicing disinfector had been forwarded to head office. At the time of the inspection the home was unable to meet this standard. Concerns regarding the laundry are brought forward from the last inspections. The home was clean, tidy and all rooms odour free. Residents and their visitors commented on how clean and tidy the home was. One visitor commented that ‘the home is spotless’. Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 17 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 and 30. The standard of recruitment practices had declined with appropriate checks not being carried out and potentially leaving residents at risk. New staff had not consistently received appropriate training to ensure they had the skills to meet the needs of residents in their care. Residents were confident that staff worked very hard to ensure their needs were met. EVIDENCE: Staffing numbers were in accordance with the agreed minimum levels. However comments from staff and residents indicated that staff had very little time to spend with residents. One resident said ‘staff are always working hard and are always very, very busy’ another said ‘we are looked after very well but sometimes have to wait until staff are free’. Residents and staff said that the busy periods were mornings and evenings when resident’s wanted to get up or go to bed. The home did not have an activities co-ordinator (see standard 12) who would have spent time chatting with residents. It was required that the staffing levels and dependency levels of residents were kept under review to ensure all resident’s needs were met. Three staff files were looked at. These included two new staff and one who had worked at the home for some time. Criminal Records Bureau and Protection of Vulnerable Adults checks had not been requested prior to employment. Two of the files contained only one reference. Contracts and Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 18 start dates were included. One other staff file did not include any employment information as the documents could not be found. Four other files for existing staff did not include Criminal Records Bureau or Protection of Vulnerable Adults checks. Staff photographs, as a means of identification, were not included. The two new staff had not completed a basic induction nor registered to commence induction or foundation training. One member of staff said when she had started she had been given a basic induction. The deputy manager said that almost half of care staff had obtained an NVQ in care and others were due to complete this. Staff said they had attended recent update training. Some certificates were seen. Other training was advertised on the staff notice board. Residents commented that staff ‘did a good job’, were ‘ wonderful’ and ‘very patient’. Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 19 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) 32, 36 and 37. Staff had not consistently received formal supervision sessions to ensure they were supported and able to meet resident’s needs. Residents were not formally consulted about the way the home was run. EVIDENCE: The registered manager had been on sickness leave for some time and the deputy manager, Sheila Knight, was in charge. Mrs Knight is a qualified nurse with management experience and has worked at the home for many years. Staff and residents spoke very positively about the deputy manager. Staff said the recent meetings had been held to discuss various issues about the home. They said they were able to raise any concerns and felt they would be listened to. Minutes from staff meetings were not available. Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 20 Residents said they had not attended resident’s meetings but that staff would ‘keep us up to date’. Not all staff had received appropriate formal supervision. Only one of the three staff files checked included supervision records. The deputy manager was aware that supervision sessions had ‘fallen behind’ but this was being addressed. Regular visits under Regulation 26 had been completed. Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 21 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 2 1 3 3 x N/A 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 3 x x x x 2 x 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x 2 x x x 2 3 x Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 22 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 1 Regulation 5 Requirement The registered person must review the service user guide and make any amendments or additions required to fully meet the regulation and standards. Timescale of 7/03/05 not met. The registered person must have a contract available for residents who wish to be or are accommodated in the home. Timescale of 16/07/04 not met. The registered person must ensure the residents plan of care sets out in detail the action to be taken by staff to ensure all aspects of health needs are met. Timescale of 7/02/05 not met. The registered person must ensure once a risk is identified appropriate interventions to reduce the risk are documented in the care plan. The registered person must ensure that policies and procedures are reviewed to reflect current practice within the home. The registered person must ensure residents are given opportunities for stimulation through activities in and outside F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Timescale for action By 15/8/05 2. 2 5 By 15/8/05 3. 7 15 By 15/8/05 4. 8 13 By 15/8/05 5. 9 13 By 15/8/05 6. 12 16 By 15/8/05 Palace House Version 1.30 Page 23 7. 26 13 8. 27 18 9. 29 19 10. 30 12 11. 36 18 the home which suit their needs, preferences and capacities. The registered person must review the laundry size and layout to ensure there is no risk of contamination of clean linen by fouled linen. Timescale of 1/12/04 not met. The registered person must ensure that staffing numbers are appropriate to the assessed needs of the residents and the size and layout of the building and that additional staff are on duty at peak times of activity. The registered person must operate a thorough recruitment procedure that ensures the protection of residents. The registered person must ensure staff receive induction (within 6 weeks) and foundation (within 6 months) training to NTO specification. The registered person must ensure that care staff receive formal supervision at least six times per year. By 15/8/05 By 30/6/05 By 30/6/05 By 30/6/05 By 15/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 12 24 Good Practice Recommendations The registered person should consider employing an activities co-ordinator The registered person should ensure that any agreement to change from the minimum standards for room furnishings be documented and signed as part of the care plan. The registered person should ensure that adjustable beds are available for those residents receiving nursing care. The registered person should review the provision of sluicing facilities in the home in order to meet the F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 24 3. 4. 24 26 Palace House 5. 6. 7. 27 28 32 requirements of this standard as regards nursing homes. The registered person should include a clear means of identification (photograph) on staff recruitment files. The registered person should ensure that 50 care staff are qualified to NVQ level 2 in care (or equivalent). The registered person should ensure that regular meetings with residents, relatives and staff are held and minutes are recorded. Palace House F57 F07 S22466 Palace Hs V222120 140605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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