CARE HOMES FOR OLDER PEOPLE
Palm Court Nursing Home 7 Marine Parade Dawlish Devon EX7 9DJ Lead Inspector
Clare Medlock Unannounced Inspection 16th November 2005 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 Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 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. Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Palm Court Nursing Home Address 7 Marine Parade Dawlish Devon EX7 9DJ 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) 01626 866142 01626 888580 Mrs Lorraine Jacqueline Greenaway Mr Graham James Greenaway Vacancy Care Home 36 Category(ies) of Dementia - over 65 years of age (3), Learning registration, with number disability (3), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (3), Old age, not falling within any other category (3), Physical disability over 65 years of age (36) Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. As a condition of registration minimum staffing levels for full occupation will be as stated in the signed letter of agreement dated 16th September 2003. Registered for maximum of 3 OP Registered for maximum of 3 LD Registered for maximum of 36 PD(E) Service Users aged 65 years and over Registered for maximum of 3 DE(E) Service Users 65 years and over Registered for maximum of 3 MD(E) Service Users 65 years and over 2. 3. 4. 5. 6. Date of last inspection 6th July 2005 Brief Description of the Service: Palm Court Nursing Home is a purpose built establishment located on the sea front of the holiday town of Dawlish. It is within approximately 100 yards of the town’s park, train station and main street, all of which are on the level to the home. The home is built on three levels with a car parking area at the front of the building. There are some seating areas outside and to the front of the home and a Gazebo is erected during suitable weather conditions for the Service Users. The home has a large lounge on the second floor that has uninterrupted views over the sea. There are thirty-six single bedrooms, one of which has ensuite facilities. The bathrooms and toilets are all of good size, equipped with modern facilities for the disabled and are all within a short distance of the bedrooms and communal areas. There is a shaft lift near the main entrance that provides access to each floor in addition to two staircases. A large dining room can be found at the rear of the building on the ground floor. The home is registered to provide personal and nursing care. Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on Wednesday 16th November 2005, between the hours of 10.00am and 15.30pm. It consisted of speaking with staff, residents, and relatives, touring the home and looking at records and Care Plans. There have been no questionnaires, complaints or letters received by the Commission for Social Care Inspection regarding this home since the last inspection. This inspection was unannounced and did not look at all standards. All standards were looked at during the last inspection in July 2005, it is therefore recommended that the reader obtains this report to have a full picture of events within the home. What the service does well: What has improved since the last inspection?
The Presence of a new manager within Palm Court has had a beneficial impact on residents, staff and the home generally. The Manager has provided a point of contact for all residents, relatives and staff alike.
Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 Page 6 The leadership has improved within the home and has resulted in an improvement in the way care is planned and recorded. The Manager has written a new Statement of Purpose and Service User Guide for the home to ensure residents and their families have all the information required to know whether Palm Court is the right place for them to be. The Manager has also introduced meetings and questionnaires to gain the feedback from residents, their families and staff. This will provide direction for improvements and changes within the home. The Provider has purchased eight new nursing beds which provide equipment where residents will be able to operate the bed independently. Some areas of the home have been decorated which has improved the environment for residents. New staff have been recruited who have experience in working in Care Homes this will benefit the care staff within the home and provide valuable support for the Manager. What they could do better:
The life for Residents within the home must be further improved by listening to the feedback from residents and families. This includes ensuring the activities programme is re started and practices changed within the home to make sure the wishes and requests of residents comes before the routines of the home. Safety can also be improved within the home by completing the adult protection training and other mandatory training. This will include health and safety training, manual handling, first aid and food hygiene training. This will ensure residents are cared for in a safe and appropriate way. Residents can also be further protected by changing the way staff are recruited to ensure staff have had all the relevant checks performed and showing the home meet equal opportunities to demonstrate staff are employed in a fair and consistent way. Although the standard of the food is praised by residents, the management of the kitchen must be improved to show that food is stored in a clean environment and equipment is well maintained and appropriately cleaned. Small changes to the way resident finances is managed will protect both resident and Provider, showing the process is appropriate and well managed. The contracts should also be changed to protect the residents and Provider, thus improving communication. Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 Page 7 The overall management of the home has improved but needs to continue. Staff supervision and induction was not inspected on this occasion, but the Manager should ensure previous shortfalls are met by the next inspection. The improvements to the care planning system must also be continued ensuring all plans are up to date and completed by the next inspection. The actions taken in response to these findings can be discussed with the Manager (Mr Nigel Morris) at the home. 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. Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 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 Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 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 The newly introduced Statement of Purpose and Service User Guide ensure residents and their families have all the information they require to decide whether Palm Court is the right place for them to live. EVIDENCE: The New Manager has introduced a Statement of Purpose and Service User Guide. Both documents include all information required and are displayed within the entrance hall. Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 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): 7,8,10 and 11. The general and specific care needs of the residents are well met by a dedicated established team of staff who promote the privacy and dignity of residents. The improved system for recording residents needs and reporting how they have been met reflects the level of care that is given. EVIDENCE: Residents spoken to on the day of inspection said they felt well cared for. All residents seen on the day of inspection appeared well cared for, with the finer details of care attended to. This included clean shoes, new hairstyles and nail care. Residents who were being cared for in bed appeared warm, comfortable and pain free. The homes diary confirmed that staff within the home access a full range of health care services depending on the need of each resident. These included General Practitioner, out patient appointment and other health care professionals.
Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 Page 11 Care Plans have greatly improved since the last inspection and are in a period of being upgraded. Some Care Plans seen were up to date and complete but others have yet to be improved. It was decided that the outstanding requirements and recommendations would remain until all care plans have been up dated. This will be reviewed at the next inspection. Observation confirmed that staff within the home access the services of General Practitioners. A thank you card seen in the office read: ‘We can not repay you enough for the care and love you showed ‘our relative’ during her time with you.’ Direct and Indirect observation confirmed that staff are kind, sensitive and respectful. Observation confirmed that staff knock on Residents doors prior to entering and prevent entry when care was being given to protect their privacy. However, one practice was noted by the inspector which demonstrated that the routines at the home were being put before residents needs and preferences. Observation confirmed that Residents are able to receive visitors in private, receive their post unopened and use the telephone in private. Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 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 and 15 The reduced amount of social activities at the home means Residents do not have sufficient stimulation within the home. Residents enjoy the meals that are provided. EVIDENCE: Residents and staff confirmed that usually forthcoming activities are displayed on a notice board and by care staff on a daily basis, but that this has been affected by the lack of an activities co coordinator. Discussion at the last inspection confirmed that the post of activities coordinator was being advertised. At this inspection this was still the case. This has the impact that residents do not receive sufficient stimulation and often find the days are long. Residents stated that the activities have included: entertainers, singers, visiting pets, pantomime artists at Christmas and church services. Discussion with the Provider confirmed that the Christmas pantomime of Cinderella has been arranged. Residents stated that they also provide their own entertainment in the form of trips out into the local town. Discussion confirmed that residents are able to ‘go out’ for walks with relatives.
Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 Page 13 A tour of the building confirmed a photograph board which demonstrated activities. Photographs and trophies confirmed that staff from the home won first place at the local carnival. One resident had officially opened the carnival and stated that the carnival is a highlight within Dawlish and that the home benefit from views of the red arrow display. Observation confirmed that residents are able to wear their own clothes. Residents stated that they are pleased with the laundry service that is provided within the home. All relative questionnaires and discussion with relatives confirmed that staff welcome visitors to the home. The visitors book confirmed that relatives are welcomed at the home at all times. Observation and discussion with the Manager confirmed the home have introduced a new menu plan. Residents and staff stated that since the arrival of the new chef the quality of the food has improved. A tour of the kitchen confirmed that the management of the kitchen was poor. There were no fridge or freezer temperatures, food was uncovered and unlabelled in the fridge and areas of the kitchen were unclean. Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 The complaints process within the home is adequately managed and ensures Resident’s views are listened to and acted upon. The incomplete adult protection training continues to place Residents at high risk. EVIDENCE: The Home have received no complaints since the last inspection. The Commission for Social Care Inspection have also not received any complaints. The Manager has introduced a complaints register to use if and when the home receive complaints. Records and discussion confirmed that the Manager has introduced some adult protection training but this was not complete. A new timescale was agreed to achieve this by. Therefore this requirement remains. Observation confirmed that the use of bed rails continues within the home. A check of all equipment has occurred and new beds with integrated bed rails has been introduced to prevent entrapment. Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 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 the following standard(s): 19 and 26 Palm Court Nursing Home is a purpose built and provides a safe comfortable home in which Residents are able to stay as independent as possible. The home has a good standard of décor, furnishings and fittings which provide a comfortable pleasing environment for residents to live in. EVIDENCE: Palm Court is a purpose built care home. There is a large dining room on the ground floor which residents appeared to enjoy at lunch time. There is also a large lounge on the second floor with uninterrupted sea views. These rooms are furnished in a domestic yet homely way. There are sufficient levels of natural lighting and ventilation in the building. All rooms are of a similar size and are for single occupancy. Only one of the rooms have ensuite facilities. There are toilets on each floor which allow wheel chair access, and enable Service Users to receive assistance should they need it. There are 14 toilets strategically placed around the home. The bathing
Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 Page 16 facilities consist of wheel in showers, high specification disabled bathing facilities and domestic style bathing facilities. The ground floor wheel in shower is often used by the Service Users. There are disinfecting sluices provided on each floor of the home. The home also has its own hairdressing salon. Observation confirmed the home was very clean and free from offensive odours. Residents said the cleaning staff were very good and that all areas of the home were spotless. Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 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 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 and 29 There is a dedicated stable staff group at the home who meet the needs of the residents well. The staff files and recruitment procedures are inadequate in places and have the potential to place residents at risk. EVIDENCE: Discussion with staff confirmed that the sickness rate and staff turnover has been low within Palm Court. Staff spoken to said staff rally round and fill in gaps so that agency use is kept to a minimum. Staff stated that morale is generally good. Off duty confirmed that staff levels are stable. On the day of inspection there appeared to be sufficient numbers of staff to meet the needs of the residents. All staff seen on the day of inspection were extremely polite, professional and cooperative. All staff were in a uniform and were wearing the newly introduced name badges. Three newly appointed staff files were inspected, Not all files contained the correct information. No file contained evidence that an interview had occurred which will demonstrated the home recruit staff in line with equal opportunities, one staff file did not contain evidence that a verbal reference had been recorded or followed up and one file did not contain evidence that a POVA (Protection of Vulnerable adults) check had been performed. These shortfalls must be actioned to ensure residents are cared for by staff who have had all the necessary checks performed.
Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 Page 18 New staff stated that they are supported well. Staff spoken to who were under 18 were aware that they were not able to perform personal care and were to be supervised at all times. Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 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 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): 31,32,35 and 38. The improvements in the management within the home is beginning to improve the quality of service provided for the residents, and the leadership for the staff. EVIDENCE: There is a new Manager at the home who is a Registered Nurse and has experience managing care homes. The Manager has commenced the Registered Managers award. Residents spoken to said that it was good to have a manager and that he was calm and effective. One resident said he is getting things done. Staff said the new manager was calm and gave a clear sense of direction. Another member of staff said the Manager was approachable and that it was good that he worked with staff. Feedback regarding communication was mixed at the inspection. Residents spoken to said they had enough information and were told when things were being changed. One relative said communication was still poor and that often
Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 Page 20 massages were not passed on and that it was unclear as to who the key nurse was. Staff said communication was improving within the home. One member for staff said that sometimes specific information was not ‘handed over’ which affected the way care was given. Discussion with the senior carer confirmed that meetings had been planned to discuss how communication could be improved. This will be reviewed at the next inspection. Records confirmed that resident, relative, staff and senior staff meetings have been held to improve communication. Changes have been made to care plans to help with communication. Discussion with the Manager confirmed questionnaires have been sent to residents and their families. Generally the feedback has been that the care has been good, the food is good, but more activities have been requested. The Management of three residents accounts was discussed at this inspection. The Provider confirmed that how to manage these accounts has been discussed and that the home will access advocacy services to ensure the home is managing these funds appropriately. Records and discussion with the Manager confirmed that some but not all staff have received all mandatory training. A new timescale was issued for the achievement of this. Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 1 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 X X X X X x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 2 X X 1 Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 Page 22 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 OP7 Regulation 15(2c) Requirement Carried forward: The Manager must ensure: 1. consult with residents and/or relatives regarding the care plan 2. Ensure records are kept which reflect and demonstrate that care has been delivered The Manager must ensure staff ensure residents needs and preferences are put before the routines of the home. Carried forward: The wishes and feelings regarding terminal illness and death must be recorded in care plans The Manager must ensure the kitchen is clean and well managed. Carried forward: The Manager must: 1. Ensure all staff recieve training in adult protection issues. The Provider must ensure staff are not employed unless two written references are obtained and staff have a POVA check. Carried forward:The Manager
DS0000050094.V251604.R01.S.doc Timescale for action 31/03/06 1 2 OP7 OP10 15(2c) 12(3) 31/03/06 01/12/05 3 OP11 12 (2&3) 31/03/06 4 5 OP15 OP18 13(3) 13(4c) 13(6) 13(8) 19 Schedule 2 18(1c) 31/03/06 31/03/06 6 OP29 31/03/06 7 OP30 31/03/06
Page 23 Palm Court Nursing Home Version 5.0 8 OP35 13 9 OP36 18(2) 10 OP38 18(c) 10 OP38 18(c ) must ensure that the induction process is formalised Carried Forward:The Provider must ensure any accounts held for residents are separate and not pooled. Carried Forward:The Manager must ensure staff are supervised at the home including clinical supervision for staff Carried Forward: The Manager must ensure evidence is provided to show all staff have received mandatory training in respect of: moving and handling, Infection control, food hygiene, first aid, fire safety and adult protection 31/03/06 31/03/06 31/03/06 31/03/06 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 2 3 4 5 6 Refer to Standard OP2 OP28 OP24 OP29 OP32 OP37 Good Practice Recommendations The Provider should include the room to be occupied on admission to the home on the contract. The Manager should ensure staff complete NVQ training to meet the standard Doors to Service Users accommodation should be fitted with locks suited to Service Users capabilities and accessible to staff in emergencies to fulfil this standard. The Provider should ensure all staff are interviewed with notes taken to demonstrate the home recruit staff in line with equal opportunities. The Manager should continue to improve the way staff communicate with each other and improve the way the home communicates with families. The Manager should ensure that all policies and procedures are relevant to the home and up dated on at least an annual basis Palm Court Nursing Home DS0000050094.V251604.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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