CARE HOMES FOR OLDER PEOPLE
Palace House Nursing Home 460 Padiham Road Burnley Lancashire BB12 6TD Lead Inspector
Mrs Marie Matthews Unannounced Inspection 19th December 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 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. Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Palace House Nursing Home Address 460 Padiham Road Burnley Lancashire BB12 6TD 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) 01282 428635 01282 428635 Alliance Care (Dales Homes) Limited Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability (33), Physical disability of places over 65 years of age (33) Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Within the overall registration of 33, a maximum of 25 service users requiring personal care who fall into the category OP Within the overall registration of 33, a maximum of 33 service users requiring nursing care who fall into the category PD or PD(E) Staffing for service users requiring nursing care will be in accordance with the Notice issued dated 22 October 1999 The service must, at all times, employ a suitably qualified manager who is registered with the National Care Standards Commission. 16th June 2005 Date of last inspection 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 washbasins. 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 Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was conducted at Palace House on the 19th December 2005. The inspection involved looking at records, talking to management, staff, ten residents and one visitor, a tour of the home and generally looking at what was happening in the home. This inspection looked at things that should have been done since the last visit and a number of areas that affect resident’s lives. There were twenty-eight people living in the home on the day of the visit. Residents made positive comments about staff. One said ‘they work ever so hard’ another said ‘they are great’. The manager had recently started employment at the home and was due to register with the Commission for Social Care Inspection. The home was assessed against the National Minimum Standards for Older People. This report should be read with the inspection report of 16th June 2005 for the reader to get a complete overview of the home. What the service does well:
The gardens were tidy and accessible to residents. Rooms were bright, clean and pleasantly decorated. The home was clean, tidy and all rooms odour free. Residents said the home was ‘always clean’. People were provided with a safe and comfortable place to live. The home provided sufficient numbers of staff. Residents said there were enough staff to meet their needs. The home kept clear and detailed records of any money held on behalf of residents. Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
The information about the home, given to new and prospective residents, still needed minor alteration to ensure that people had enough information to make informed choices. The care plans were clear, organised and generally set out action to be taken by staff to ensure resident’s needs were met. However individual care plans still needed to include all information to ensure staff had a good understanding of how to meet the resident’s needs. Residents needed to be involved more with the development of the care plan and reviews needed to be done on a monthly basis. The home needed to improve the way it consulted with people about the way the home was run and whether their needs were being met. Staff had not consistently received formal supervision sessions to ensure they were supported and competent to care for people. Some moving and handling update training was needed for existing staff to ensure they had the skills to safely care for the residents. Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 Page 7 The home needed to improve the way it managed systems that protect people’s health, safety and welfare. Records showed that some service certificates were out of date. 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 Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 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 Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 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 and 2. Standard 6 was not applicable. The home needed to up date the information about services offered by the home to enable current and future residents to make an informed choice about admission to the home. EVIDENCE: Information about the home 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. A contract of admission had been given to all residents or their relatives so that they were clear as to their rights within the home. Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 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 the following standard(s): 7, 8 and 9. Individual care plans still needed to include all information to ensure staff had a good understanding of how to meet the resident’s health needs. The policies and procedures for the management of medication had improved and ensured that resident’s medication needs were safely met. EVIDENCE: Two care plans were looked at. The care plans were clear, organised and generally set out action to be taken by staff to ensure resident’s needs were met. Detailed risk assessments were included in the plans. However staff needed to make sure that once a risk had been identified there should be a plan to detail preventative action. Use of bed rails needed to be agreed with the resident or representative and documented in the care plan. There was evidence of involvement of the resident on one of the plans. Reviews had been completed but not on a monthly basis. Medication policies and procedures had been reviewed and guided staff to provide safe systems in all aspects of medication.
Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 Page 11 Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 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 the following standard(s): 12. The home had improved the activities to meet the social needs, expectations and interests of the residents. EVIDENCE: An activities co-ordinator was due to start employment in the New Year. Residents said they were looking forward to the Christmas party and three others said suitable activities and entertainments had been provided for them. Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 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 the following standard(s): 18. Residents were protected by the home’s policies and procedures and staff awareness of adult abuse. EVIDENCE: The policies and procedures relating to adult abuse were clear and detailed. Staff were aware of action to be taken. A number of staff had received adult abuse training. Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 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 the following standard(s): 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: The home was accessible, safe and well maintained. The gardens were tidy and accessible to residents. Repairs, renewals and refurbishments were ongoing and evidence of this was seen around the home. Rooms were bright, clean and pleasantly decorated. Some rooms would benefit from replacement of furnishings but the manager said this was underway as part of the replacement programme. It was again recommended that where rooms do not provide minimum furnishings this and the resident’s wishes should be recorded in the care plan. Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 Page 15 The home was clean, tidy and all rooms odour free. Three residents said the home was ‘always clean’. Plans to re-site the laundry and kitchens and to extend the home had yet to be confirmed. Residents were aware of the changes planned and had been told at a recent meeting that the plans ‘were on hold’. The manager stated that requests 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. Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The staffing numbers were sufficient to meet the needs of the residents. The home had improved the way it recruited new staff and this protected the people who lived in the home. The home had improved the provision of induction training for new staff but some update training was needed for existing staff to ensure they had the skills to meet the needs of residents in their care. EVIDENCE: Staffing numbers were in accordance with the agreed minimum levels and residents said there were enough staff to meet their needs. New staff had received appropriate training. A number of staff were due to complete NVQ training. The record of staff training had not been completed since July 2005. Some staff needed update training. (See standard 38). Two staff files were looked at. Both files contained the required checks and a safe procedure had been followed. Staff passport photographs, as a means of identification, were not clear. Residents made positive comments about staff. One said ‘they work ever so hard’ another said ‘they are great’. Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 Page 17 Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 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 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 and 38. Staff had not consistently received formal supervision sessions to ensure they were supported and able to meet resident’s needs. The home needed to improve the way it consulted with people about the way the home was run. The home needed to improve the way it managed systems that protect people’s health, safety and welfare. EVIDENCE: Mrs Julie Johnson had recently been employed as manager and an application to register with the Commission for Social Care Inspection was to be completed. Mrs Johnson is a qualified nurse with many years experience of caring for people. Regular staff meetings had been held and minutes were available. Resident’s meetings had not been held although a recent general meeting had taken
Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 Page 19 place to introduce the new manager. The home had the Investors In people award. The home needed to consult with people who used their services to ensure the home was being run in the best interest of the residents. The last service user survey had been done in July 2004 and the results of this were unavailable. Not all staff had received appropriate formal supervision. The manager was aware of this. Records of any money held on behalf of residents were maintained. The records were clear and detailed. Records to show that people’s health, safety and welfare was protected were checked. Certificates for the electrical installation test and servicing of the boilers and central heating system needed to be renewed. Records showed that staff needed training update for safe moving and handling; two staff were observed using an unsafe handling method and this was discussed with the manager. Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X 2 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 Page 21 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 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 ensure the resident’s plan of care sets out in detail the action to be taken by staff to ensure all aspects of health needs are met. The plan must be reviewed at least once a month and involve the resident in the development and review. The registered person must ensure once a risk is identified appropriate interventions to reduce the risk are documented in the care plan. Timescale of 15/08/05 not met. The registered person must ensure a record of staff training and development is maintained. The registered provider must forward an application to register a manager with the Commission for Social Care Inspection. The views of residents, their
DS0000022466.V273881.R01.S.doc Timescale for action 13/02/06 2. OP7 15 13/02/06 3. OP8 13 13/02/06 4. 5. OP30 OP31 18 9 13/02/06 13/02/06 6. OP33 24 13/02/06
Page 22 Palace House Nursing Home Version 5.1 7. OP36 18 8. OP38 13 9. OP38 13 representatives and stakeholders in the community about the services offered must be sought. The results of the survey must be published and made available to interested parties. The registered person must ensure that care staff receive formal supervision at least six times per year. Timescale of 15/08/05 not met. The registered person must ensure the electrical installation test certificate and records to evidence regular servicing of the boilers and central heating systems are up to date. The registered person must ensure all staff receive moving and handling training on a regular basis. 13/02/06 16/01/06 13/02/06 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 OP24 Good Practice Recommendations 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 review the provision of sluicing facilities in the home in order to meet the requirements of this standard as regards nursing homes. The registered person should ensure that 50 care staff are qualified to NVQ level 2 in care (or equivalent). The registered person should include a clear means of identification (photograph) on staff recruitment files. 2. 3. 4. OP26 OP28 OP29 Palace House Nursing Home DS0000022466.V273881.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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